Alcohol Abuse & Treatment among First-Generation Immigrants

Immigrating to a new country can be a stressful experience. People who choose the United States as their new home may have exciting educational or career prospects, but integrating into a new culture while maintaining one’s identity can take a toll. The first generation to immigrate to the United States from another country typically makes less money than native-born Americans; graduates college at lower rates; experiences racism and other cultural barriers; and typically experiences higher levels of poverty. First-generation immigrants often have more hazardous jobs with lower pay while also navigating an unfamiliar language and cultural climate. They are at higher risk for abuse from strangers and employers compared to native-born Americans.

In spite of this, first-generation immigrants have been found in recent epidemiological studies to be healthier overall compared to native-born Americans. The first generation typically reports lower levels of substance abuse, mental health conditions, and mortality. These statistics can vary based on nationality and age of entry into the US.
For those who do struggle with alcohol and drugs, accessing treatment can be much more difficult, so it is important to understand the struggles of specific populations and how clinicians are working to improve access to healthcare for alcohol abuse, drug addiction, and mental illness for immigrant groups. The US is expected to see a surge in immigration over the next several decades, hitting a record high by 2065, so developing cultural competency and improved access to treatment is key.

Rates of Alcohol Abuse among Specific First-Generation Populations

The Migration Policy Institute (MPI) reported that, among the 43.3 million immigrants in the country in 2015 who arrived since 2010, they reported their races as:

• White: 47 percent
• Hispanic or Latino origin: 45 percent
• Asian: 27 percent
• Black: 9 percent
• Other: 15 percent
• Mixed race: 2 percent

A 2014 study on the “immigration paradox,” involving worsening health and increased risk of mental and behavioral disorders, reported that alcohol abuse, in particular, rose across generations.

• 43 percent of first-generation immigrants struggled with alcohol abuse
• 86 percent of second-generation immigrants reported alcohol abuse
• 49 percent of native-born Americans reported abusing alcohol

The study reported that specific populations had different rates of substance use disorders. Alcohol abuse rates were reported as follows:

• 57 percent of European immigrants
• 81 percent of Latin American immigrants
• 98 percent of Asian immigrants
• 73 percent of African immigrants

While the reported percentage of first-generation immigrants struggling with alcohol abuse is lower than second-generation immigrants, getting access to treatment is more difficult for this group. Additionally, the risk of developing an alcohol use disorder increases depending on the age the person was when they entered the US. The number of years the individual lived in the country, beginning in childhood, increases the risk of AUD or other forms of problem drinking. If the person entered the US as an adult, however, they were less likely to struggle with AUD.

Some of this increased risk among child immigrants could be due to peer pressure, aggression, and bullying. A study on Asian and South-East Asian immigrants to the US found that 50 percent of children from those regions reported ethnic and racial tension, and aggression from peers due to these differences.

Stresses on First-Generation Immigrants That May Lead to Alcohol Abuse

First-generation immigrants to the United States report better health than native-born Americans or second-generation immigrants. One survey found that the average life expectancy among first-generation immigrants was 80 years, which was 3.4 years older than native-born Americans’ life expectancy. Factors like age of immigration and country of origin influence the specific number of years.

Other influences include immigration status. Those who enter the US as refugees typically have higher rates of substance abuse and poorer health than other immigrant populations. Noncitizen immigrants report poorer health outcomes compared to their naturalized peers. Naturalized immigrants have better access to key factors that improve quality of life, including higher education, jobs with better pay, and safer neighborhoods. The health of undocumented immigrants is difficult to assess.

The longer a first-generation immigrant lives in the US, the more likely they are to struggle with chronic health issues, like hypertension, smoking, diabetes, heavy alcohol abuse, and other chronic illnesses. One factor in developing these conditions is perceived discrimination from healthcare providers, a form of stress that can wear at the emotional and mental wellbeing of any population. Perceived discrimination has been associated with poor health outcomes, including higher rates of smoking, alcohol abuse, obesity, hypertension, breast cancer, depression, anxiety, psychological distress, abuse of other substances, and poor self-rated health.

With more people immigrating to the US, it is important that clinicians address potential barriers to treatment so first-generation immigrants can get help for substance abuse and mental health.

Developing Better Treatment for First-Generation Immigrants

The American Psychological Association (APA) created a list of barriers to mental health services, which can apply to alcohol and drug abuse treatment as well. These barriers include:

• Social-cultural barriers: How symptoms are expressed, and views about potential causes, vary widely by culture. For example, some cultures may not view psychotherapy as valuable, and will be less likely to seek treatment from a therapist when struggling with chronic depression. Another immigrant group may be more likely to seek help from religious leaders for mental anguish or substance abuse compared to native-born Americans.
• Contextual-structural barriers: Lack of access to culturally sensitive and appropriate services can lead to fewer immigrants seeking treatment. For example, a lack of interpreters at an addiction rehabilitation facility will prevent specific immigrant populations from seeking treatment there.
• Clinical-procedural barriers: Clinician bias, communication problems, lack of cultural sensitivity in services, and failure to understand nuances in cultural expression can prevent a first-generation individual from getting the treatment they need. For example, an immigrant’s culture may focus on individual autonomy, so the individual downplays important symptoms, leading to a misdiagnosis or a failure to diagnose.

Although many first-generation immigrants report better health and less substance abuse, including alcohol abuse, compared to native-born Americans, this group has a range of outcomes based on age of entry, country of origin, and perceived discrimination. For example, while African immigrants consume less alcohol than native-born Americans, immigrants from Russia, Italy, and Germany are likely to report higher rates of alcohol abuse, but are still less likely to seek treatment from addiction specialists.

It’s important that anyone struggling with alcohol abuse has access to the treatment they need to heal. This means that treatment programs should address issues that are specific to first-generation immigrants, helping them to acquire the tools they need to embrace a future in recovery.