Racial/ethnic disparities among adolescents with substance-related disorders

Substance use is widespread among adolescents in the United States, particularly among those of Native American, white, Hispanic and multiple race/ethnicity, and these groups are also disproportionally affected by substance-related disorders, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

"Adolescence marks the period of life with the highest risk for initiating substance use; thus, adolescents constitute a high-risk group requiring research to guide prevention efforts and health policy making," the authors write as background information in the article. "While eliminating racial/ethnic disparities in health problems and their treatment is a mission of the National Institutes of Health, few data about substance-related disorders exist for young groups of nonwhite race/ethnicity."

Because children and adolescents of nonwhite race/ethnicity are the fastest growing population in the United States, Li-Tzy Wu, Sc.D., of Duke University Medical Center, Durham, N.C., and colleagues, examined racial and ethnic variations among adolescents with past-year substance use or substance-related disorders. Using data collected during the 2005 to 2008 National Survey on Drug Use and Health, the authors examined questionnaires submitted from 72,561 adolescents ages 12 to 17 years. The authors used the DSM-IV to measure substance-related disorders.

Of the 72,561 adolescents surveyed, 27,705 (37 percent) reported past-year alcohol or dug use; 32 percent reported any alcohol, 19 percent any illicit or nonmedical drugs, and 15 percent reported using alcohol and drugs. Of this same group of adolescents, 7.9 percent met criteria for a substance-related disorder, with Native Americans having the highest prevalence of use (47.5 percent) and disorder (15 percent).

Marijuana use (13 percent of all adolescents) was the most prevalent of all drug classes, and analgesic opioids (7 percent) was more prevalent than other drug use (range 0.1 percent to 4 percent). Native Americans (20.5 percent), multiple race/ethnicity (18.1 percent) and white race/ethnicity (16.2 percent) had a higher prevalence of using both alcohol and drugs than other groups.

Among the 27,705 past-year alcohol or drug users, Native Americans (31.5 percent), multiple race/ethnicity (25.2 percent), white race/ethnicity (22.9 percent) and Hispanics (21 percent) had the highest rates of substance-related disorders. Additionally, adolescents of multiple race/ethnicity (19.4 percent), Hispanics (16.2 percent) and white race/ethnicity (14.3 percent) had higher conditional rates of comorbid alcohol and drug use disorders than African Americans (8.3 percent).

After controlling for other factors, adjusted analyses of adolescent substance users indicated elevated odds of substance-related disorders among Native Americans, adolescents of multiple race/ethnicity, adolescents of white race/ethnicity, and Hispanics compared with African Americans. The authors also found that African Americans did not differ from Asians or Pacific Islanders.

"Substance use is widespread among adolescents of Native American, white, Hispanic, and multiple race/ethnicity," the authors conclude. "Taken together, these findings call for efforts to identify and expand prevention measures that are culturally effective and address the quality and acceptability of treatment for adolescents with substance use problems."