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Immigrants, Refugees Immigrants, Refugees and Alcoholand Alcohol

NIAAA Social Work EducationNIAAA Social Work Education

Module 10FModule 10F

Appreciation is expressed to the NIAAA Appreciation is expressed to the NIAAA for support of this research (1 U24 AA11899-04)for support of this research (1 U24 AA11899-04)

(revised 3/04)

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OutlineOutline

BackgroundBackground Psychosocial IssuesPsychosocial Issues Alcohol Use ModelsAlcohol Use Models Empirical StudiesEmpirical Studies Social Work PracticeSocial Work Practice SummarySummary

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BackgroundBackground1981-1996 Immigration1981-1996 Immigration

MexicoMexico 3,304,6823,304,682

Philippines Philippines 843,741843,741 Vietnam Vietnam 719,239719,239 ChinaChina 539,267539,267 Dominican Republic Dominican Republic 509,902509,902 IndiaIndia 498,309498,309 KoreaKorea 453,018453,018 El SalvadorEl Salvador 362,225362,225 JamaicaJamaica 323,625323,625 CubaCuba 254,193254,193

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Background Background (continued)(continued)

1981-1996 Refugees1981-1996 Refugees VietnamVietnam 420,178420,178 Soviet UnionSoviet Union 413,862413,862 LaosLaos 147,530147,530 CambodiaCambodia 109,914109,914 IranIran 41,27641,276 RomaniaRomania 38,56738,567 PolandPoland 37,99637,996 Bosnia-Herzegovina 35,172Bosnia-Herzegovina 35,172 EthiopiaEthiopia 34,13834,138 AfghanistanAfghanistan 30,95230,952

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Background Background (continued)(continued)

1996 Estimated Undocumented 1996 Estimated Undocumented ResidentsResidents

MexicoMexico 2,700,0002,700,000 El SalvadorEl Salvador 335,000335,000 GuatemalaGuatemala 165,000 165,000 CanadaCanada 120,000120,000 HaitiHaiti 105,000105,000 PhilippinesPhilippines 95,00095,000 HondurasHonduras 90,00090,000 PolandPoland 70,00070,000 NicaraguaNicaragua 70,00070,000 BahamasBahamas 70,00070,000 OtherOther 1,180,0001,180,000 TotalTotal 5,000,0005,000,000

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Background Background (continued)(continued)

Foreign born Foreign born residents: residents:

– 26.4 million 26.4 million persons persons

– 9.7% of the U.S. 9.7% of the U.S. populationpopulation

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Background Background (continued)(continued)

Legal Permanent and Legal Permanent and Undocumented Residents Undocumented Residents

by Top Seven Statesby Top Seven StatesUndocUndoc LPLP

California California 35.3% 35.3% 40%40%New YorkNew York 14.2% 14.2% 11%11%TexasTexas 7.8% 7.8% 14%14%FloridaFlorida 7.5% 7.5% 7%7%New JerseyNew Jersey 4.4% 4.4% 3%3%IllinoisIllinois 4.3% 4.3% 6%6%MassachusettsMassachusetts 2.9% 2.9% 2%2%

©2002 Microsoft Corporation.

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Psychosocial IssuesPsychosocial Issues

Family process, even for Family process, even for individualsindividuals

Three phases of migration:Three phases of migration:1.1. Pre-migration/departurePre-migration/departure

2.2. TransitTransit

3.3. ResettlementResettlement

Source: Drachman and Halburstadt, 1992Source: Drachman and Halburstadt, 1992

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Psychosocial Issues Psychosocial Issues (continued)(continued)

Separation from social Separation from social networksnetworks

Separation from Separation from familiar environmentsfamiliar environments

Concerns about family Concerns about family members left behindmembers left behind

Depression, grief due Depression, grief due to multipleto multiple losseslosses

Pre-migration/Departure PhasePre-migration/Departure Phase

©2002 Microsoft Corporation.

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Psychosocial Issues Psychosocial Issues (continued)(continued)

May involve May involve uncomplicated uncomplicated traveltravel

May involve May involve dangerous, dangerous, hazardous journeyshazardous journeys

May involve illegal May involve illegal border crossingsborder crossings

May be exploitedMay be exploited

©2002 Microsoft Corporation.

Transit PhaseTransit Phase

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Psychosocial Issues Psychosocial Issues (continued)(continued)

Cultural dissonanceCultural dissonance DepressionDepression Parent/child conflictParent/child conflict Racism/discriminationRacism/discrimination Language barriersLanguage barriers Loss of valued social Loss of valued social

rolesroles Alcohol and drug abuseAlcohol and drug abuse

Resettlement PhaseResettlement Phase

©2002 Microsoft Corporation.

©2002 Microsoft Corporation.

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Psychosocial Issues Psychosocial Issues (continued)(continued)

Refugee experience may Refugee experience may include:include: Persecution (religious, Persecution (religious,

political, or other)political, or other) Hardship and/or tortureHardship and/or torture Lack of choices, Lack of choices,

planning opportunities in planning opportunities in leaving country of originleaving country of origin

Post traumatic stress Post traumatic stress disorderdisorder

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Psychosocial Issues Psychosocial Issues (continued)(continued)

Undocumented Immigrants/ Undocumented Immigrants/ Refugees experience:Refugees experience:– Lack of legal documentation Lack of legal documentation

(and protections)(and protections)– Risk of deportation, detentionRisk of deportation, detention– Vulnerability to exploitation Vulnerability to exploitation

(unjust labor practices, low (unjust labor practices, low pay)pay)

– Ineligible for many programsIneligible for many programs

©2002 Microsoft Corporation.

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Psychosocial Issues Psychosocial Issues (continued)(continued)

Heterogeneity in degree of Heterogeneity in degree of social network supportsocial network support

Variability in economic self-Variability in economic self-sufficiencysufficiency

Differences in degree to Differences in degree to which experience is positive; which experience is positive; grants opportunitiesgrants opportunities

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Alcohol Use ModelsAlcohol Use Models

1.1. Acculturative stress modelAcculturative stress model2.2. Assimilation/acculturation Assimilation/acculturation

modelmodel3.3. Continued original patternsContinued original patterns4.4. Intracultural diversity modelIntracultural diversity model

Source: Johnson, 1996; Gutmann, 1999Source: Johnson, 1996; Gutmann, 1999

©2002 Microsoft Corporation.

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Alcohol Use Models Alcohol Use Models (continued)(continued)

1. Acculturative Stress Model:1. Acculturative Stress Model: Use of alcohol is a result Use of alcohol is a result

of reaction to the stresses of reaction to the stresses associated with the associated with the immigration experienceimmigration experience

Lack of social and Lack of social and economic resources for economic resources for copingcoping

AlcoholUse

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Alcohol Use Models Alcohol Use Models (continued)(continued)

2. 2. Assimilation/AcculturatioAssimilation/Acculturation Model:n Model:As migrants adopt As migrants adopt

customs of host customs of host country, patterns of country, patterns of alcohol use reflect those alcohol use reflect those of the new location of the new location

©2002 Microsoft Corporation.

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Alcohol Use Models Alcohol Use Models (continued)(continued)

3. Intracultural Diversity 3. Intracultural Diversity Model:Model:It is important to recognize It is important to recognize

the diversity of alcohol and the diversity of alcohol and other substance use patterns other substance use patterns that may exist WITHIN an that may exist WITHIN an immigrant or refugee groupimmigrant or refugee group

Source: Gutmann, 1999Source: Gutmann, 1999

©2002 Microsoft Corporation.

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Empirical StudiesEmpirical Studies

Empirical knowledge of Empirical knowledge of immigrant alcohol use is limited:immigrant alcohol use is limited:Little research is availableLittle research is availableExisting research usually Existing research usually

addresses groups with a longer addresses groups with a longer history in the U.S. (e.g., Mexican, history in the U.S. (e.g., Mexican, Chinese, Japanese, Korean)Chinese, Japanese, Korean)

Dearth of research on WITHIN Dearth of research on WITHIN group differencesgroup differences

©2002 Microsoft Corporation

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Studies: Studies: Intra-National Intra-National DifferencesDifferences

Mexican Indian Immigrants compared to non-Mexican Indian Immigrants compared to non-Mexican IndiansMexican Indians Fresno, CA (n=3,012)Fresno, CA (n=3,012) Lifetime alcohol abuse or dependence at Lifetime alcohol abuse or dependence at

higher rates among Mexican Indian than non-higher rates among Mexican Indian than non-Mexican Indian groupsMexican Indian groups

No significant differences after adjusting for No significant differences after adjusting for socioeconomic statussocioeconomic status

Source: Alderete et al, 2000Source: Alderete et al, 2000

Within Group Differences

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Studies: Studies: Differences Between Differences Between GroupsGroups

Comparing 391 immigrants from Mexico Comparing 391 immigrants from Mexico with 531 from Central America (mostly with 531 from Central America (mostly El Salvador and Nicaragua):El Salvador and Nicaragua): Abstention from alcohol in previous 30 Abstention from alcohol in previous 30

days was 64% for Central Americans, days was 64% for Central Americans, 57% for Mexicans57% for Mexicans

Average drinks in previous 30 days was Average drinks in previous 30 days was 6 for Central Americans, 96 for Central Americans, 9 for Mexicans for Mexicans

Source: Marin and Posner, 1995Source: Marin and Posner, 1995

National Differences

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Studies: Studies: Differences Differences Between Groups Between Groups (continued)(continued)

Comparing Dominican and Guatemalan Comparing Dominican and Guatemalan immigrants living in New Jersey on immigrants living in New Jersey on choices for alcohol treatment:choices for alcohol treatment: Dominican immigrants opt for church-Dominican immigrants opt for church-

based programsbased programs Guatemalan immigrants opt for Spanish-Guatemalan immigrants opt for Spanish-

language AA groupslanguage AA groups

Source: Rebhun, 1998Source: Rebhun, 1998

National Differences

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Among Asian groups in California:Among Asian groups in California: Vietnamese and Chinese-Vietnamese Vietnamese and Chinese-Vietnamese

individuals have higher alcohol individuals have higher alcohol consumption levels than Japanese, consumption levels than Japanese, Chinese, Korean, or Filipino individualsChinese, Korean, or Filipino individuals

Source: Caetano, Clark and Tam, 1998Source: Caetano, Clark and Tam, 1998

Studies: Studies: Differences Differences Between Groups Between Groups (continued)(continued)

National Differences

24Studies: Studies: U.S.-Born/Immigrant U.S.-Born/Immigrant DifferencesDifferences

U.S.-born Mexican Americans (n=188) U.S.-born Mexican Americans (n=188) compared to immigrants from Mexico, compared to immigrants from Mexico, Central America (n=264):Central America (n=264): U.S.-born men and women more likely to be U.S.-born men and women more likely to be

heavy drinkers than immigrantsheavy drinkers than immigrants U.S.-born women more likely than U.S.-born women more likely than

immigrant women to describe alcohol as immigrant women to describe alcohol as mood elevator, tension reducer, and social mood elevator, tension reducer, and social disinhibiter disinhibiter

Source: Cervantes et al, 1990-91Source: Cervantes et al, 1990-91

Between Group Differences

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Among Vietnamese men living in California:Among Vietnamese men living in California: Percentage of drinkers was the same Percentage of drinkers was the same

compared to men in the general U.S. compared to men in the general U.S. populationpopulation

Binge drinking was twice as common Binge drinking was twice as common among Vietnamese menamong Vietnamese men

Source: Makimoto, 1998Source: Makimoto, 1998

Studies: Studies: U.S.-Born/Immigrant U.S.-Born/Immigrant DifferencesDifferences

Between Group Differences

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Studies: Studies: Acculturation Acculturation DifferencesDifferences Greater acculturation associated with Greater acculturation associated with

lower alcohol abstention among lower alcohol abstention among Mexicans and Central AmericansMexicans and Central Americans

More acculturated Mexicans drank More acculturated Mexicans drank greater than twice the number of greater than twice the number of drinks than less acculturated (no drinks than less acculturated (no significant difference for Central significant difference for Central Americans)Americans)

Source: Marin and Posner, 1995Source: Marin and Posner, 1995

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Studies: Studies: Gender Gender DifferencesDifferences

Among Mexicans and Central Among Mexicans and Central Americans:Americans: Women are more likely to abstain than Women are more likely to abstain than

menmen Men consume more than womenMen consume more than women Men drink more often than womenMen drink more often than women

Source: Marin and Posner, 1995Source: Marin and Posner, 1995

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Studies: Studies: Gender Differences Gender Differences (continued)(continued)

Among Vietnamese in California:Among Vietnamese in California: Women are more likely to abstain than Women are more likely to abstain than

men (51% vs. 6%)men (51% vs. 6%) Men are more likely to be moderate to Men are more likely to be moderate to

heavy drinkers than women (39% vs. 6%)heavy drinkers than women (39% vs. 6%)

Source: Padilla, Sung and Nam, 1993Source: Padilla, Sung and Nam, 1993

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Studies: Studies: Reasons for Reasons for DrinkingDrinking

Refugee women from Cambodia:Refugee women from Cambodia: Nervousness, stress, insomnia, pain Nervousness, stress, insomnia, pain

(emotional or physical)(emotional or physical) Hmong:Hmong:

Self-treating insomnia, pain, stressSelf-treating insomnia, pain, stress Southeast Asian refugees:Southeast Asian refugees:

StressStress Southeast Asian youth:Southeast Asian youth:

Forget their pastForget their past

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Social Work PracticeSocial Work Practice

Special Training Needs:Special Training Needs:Knowledge of Knowledge of

immigrant/refugee immigrant/refugee • HistoriesHistories• Former livesFormer lives• Immigration experiencesImmigration experiences

Knowledge of PTSD workKnowledge of PTSD workKnowledge of immigrant Knowledge of immigrant

subgroup differencessubgroup differences

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Social Work Practice Social Work Practice (continued)(continued)

Networking with community, Networking with community, existing ethnic associationsexisting ethnic associations

Involvement of indigenous persons, Involvement of indigenous persons, paraprofessionalsparaprofessionals

Involvement of Involvement of immigrant’s, refugee’s immigrant’s, refugee’s family family

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Social Work Practice Social Work Practice (continued)(continued)

Issues of Social Work values and ethics:Issues of Social Work values and ethics: NASW Code of EthicsNASW Code of Ethics Awareness of own personal valuesAwareness of own personal values Understanding immigrant’s/refugee’s Understanding immigrant’s/refugee’s

personal valuespersonal values Awareness of own stereotypes Awareness of own stereotypes

• Particularly with regard to group’s drinking Particularly with regard to group’s drinking (e.g., machismo)(e.g., machismo)

• Challenge stereotypesChallenge stereotypes

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SummarySummary

Vital role for social work to assist Vital role for social work to assist immigrants and refugees to:immigrants and refugees to:Decrease alcohol abuse and Decrease alcohol abuse and

dependencedependenceDecrease alcohol-related problemsDecrease alcohol-related problemsFind better strategies to cope with the Find better strategies to cope with the

stress of migration and acculturationstress of migration and acculturation