ALCOHOL USE AMONG BLACK AMERICANS Sarah Pedersen, Ph.D. University of Pittsburgh School of Medicine © AMSP 20151

ALCOHOL USE AMONG BLACK AMERICANS

Sarah Pedersen, Ph.D.

University of Pittsburgh

School of Medicine

© AMSP 2015 1

Alcohol Use is Common

• Past 30 day use:

–52% any use

–23% > 5 drinks/occasion

–6% 5+ drinks on 5+ days© AMSP 2015 2

Alcohol Use is Costly

• 44,000 acute alc. deaths in past year

• $235 billion estimated cost/year in USA

• $30 billion in health care costs© AMSP 2015 3

Alcohol Use Disorder (AUD)• DSM-5 criteria (2+ in 12 months)

– Larger/longer– Unable to cut down/control use – Large amount of time spent– Cravings or urges to use– Failure to live up to obligations– Continued despite social problems– Activities given up– Use in hazardous situations– Continued despite health problems– Tolerance– Withdrawal

© AMSP 2015 4

AUD Rates

• 7% age 18+ had AUD past year

• Heaviest drinking: ages 18-25

• Men more likely than women

• Racial/ethnic group differences

© AMSP 2015 5

• Rates of use and disorder

• Consequences of use

• More problems among drinkers

• Historical context

• Current reasons for use

• Treatment implications

© AMSP 2015 6

Lecture: Black American Alcohol Use

Case 1: Mr. B• 32 year old Black man • Employed at local university• Religious• Lives in Black neighborhood• Drinks (~3 drinks) with friends• Referred for treatment after DUI• No prior criminal hx

© AMSP 2015 7

Case 2: Mr. H

• 34 year old White man

• Unemployed past 8 months

• Lives in White suburb

• Drinks (~6 drinks) at bar

• Referred for depression

• No criminal hx

© AMSP 2015 8







© AMSP 2015 9


Alcohol Use in Black Americans

• Black Americans use less alcohol than Whites

– Current use: 44% Blacks vs. 58% Whites

• Lower rates of heavy episodic drinking

– 20% Blacks vs. 24% Whites© AMSP 2015 10

Differences into Young Adulthood

• Adolescence: Ages 12-17

– 10% Blacks vs. 18% Whites (past 30 days)

• Young adulthood: Ages 18-25

– 50% Blacks vs. 68% Whites (past 30 days)

• College

– 33% Blacks vs. 60% Whites intox.

© AMSP 2015 11

Differences in AUD with Age• 12 month AUD dependence prevalence

– Age 18-29

• 6% Blacks vs. 11% Whites

– Age 30-44

• 3% Blacks vs. 4% Whites

– Age 45-64

• 3% Blacks vs. 2% Whites© AMSP 2015 12







© AMSP 2015 13


Black Drinkers Alc. Problems

• Social consequences– 3X higher for Blacks vs. Whites

• Liver cirrhosis– 1.3X higher for Blacks vs. Whites

• AUD mortality: 10% higher for Blacks– Alcohol-related cancers

– Illness and injury

© AMSP 2015 14

Racial Differences Summary

• Blacks are less likely to drink

– Overall lower levels of use

– Varies across age

• Among drinkers

– Blacks have more problems

• Integrating historical context needed

© AMSP 2015 15







© AMSP 2015 16


Important Historical Dates

© AMSP 2013 17

1640’s-1865Slavery in U.S.A.

1861-1865Civil War

1830’s-1930’sTemperance Movement

1919: 18th amendmentProhibition

1933: 21st amendment end of Prohibition

Drinking in Africa (pre-slavery)

• Limited alcohol use in Africa

–Ceremonial

–Small amounts

–Intoxication unacceptable

–Drunkenness = weakness

© AMSP 2015 18

Slavery and Alcohol Use

• Slaves limited alcohol use

–Owners prohibited use

–Slaves stayed sober for protection

–Abstinence the norm

© AMSP 2015 19

Temperance Movement Era

• Abstinence linked with freedom

• Leaders against slavery and drinking

• Black churches grew

– Pushed abstinence

© AMSP 2015 20

Post-Prohibition Period

• Restricted use continued

Blacks died from alcohol than Whites

• Conservative norms

© AMSP 2015 21

History Present Day

• Sets stage:

Drunkenness in Black communities

Abstinence

• May inform clinical practice

• Allows perspective on current factors

© AMSP 2015 22







© AMSP 2015 23


Protective Factors

© AMSP 2013 24

Black American Drinking Norms• More conservative drinking norms

• Alcohol not in social events– 80% Whites vs. 46% Blacks drink at restaurant

• Avoid intoxication criticism for drinking 4+

disapproval from parents monitoring

alcohol in Black homes

© AMSP 2015 25

Religiosity religiosity = alcohol use

religiosity Blacks vs. Whites

– 92% of Blacks identify as Christian

– Denominations with conservative alc. view

• Black churches active in community

– Preserves historical views

– Provides monitoring

– One reason for lower use in Black teens

© AMSP 2015 26

Genetics• ADH/ALDH genes = alc. metabolism

– Variants alter rate of metabolism

– Produce stronger response to alcohol

• African heritage: 30% have ADH variant

– Metabolize alcohol differently

family history

pulse rate after drinking

AUD

© AMSP 2015 27

Risk Factors

© AMSP 2013 28

Discrimination

• 98% report racist event/past year

discrimination =

stress

drinking and drinking to cope

well-being

• Drinking to cope = more alc. problems

© AMSP 2015 29

Neighborhood factors

• 8X # liquor stores in Black neighborhoods

convenient store space for alcohol

• Blacks drinking in public space

– Encounter police

© AMSP 2015 30

Alcohol Preference

• Black drinkers more likely to drink liquor

– Increased alcohol content

– Mixed drinks hard to estimate amount

– Men may underestimate alc. by 31%

• White drinkers more likely to drink beer

• Differences early in adolescence

© AMSP 2015 31

Alcohol Sensitivity

• People respond to alcohol differently

sensitivity to rewarding effects

or

sensitivity to negative effects

• = INCREASED RISK

© AMSP 2015 32

Blacks Alcohol Sensitivity

• At same alcohol level:

– Blacks “up, talkative” vs. Whites

• Feel more intoxicated, experience more reward

• Indicates risk for alcohol problems

– Black women sedation: “sluggish”

• Protective against alcohol problems

© AMSP 2015 33

Within the Black Community

• Important to move beyond racial groups

• What subgroups are at risk?

• Protective factors:

– Positive parental influence

– Strong ethnic identity

– Strong africentric world view

© AMSP 2015 34

Within Race Risk Factors

• Low income

• Male

• Exposure to violence in home

• Most at risk = low income men

access to housing, work

– Heavy drinking cannot cost access

© AMSP 2015 35

Mr. B and Mr. H

• Who is most at risk for AUD? Alc. prob?

© AMSP 2015 36

Protective Risk

Mr. B • Religious• Employed

• Male• Drinks in public place• Black neighborhood

Mr. H • White neighborhood • Male• HED• Unemployed• Depressed• No sober support







© AMSP 2015 37


Overrepresented in Treatment

• 14% of U.S. population

• 21% of treatment population

• Feel stigmatized– Racial profiling

– Did this occur for Mr. B?

– Resist treatment dropout© AMSP 2015 38

Healthcare Access

Healthcare utilization

• Mistrust of medical professionals

• Integrate religious/community

• Educate on alcohol effects

• UD treatment as an alternative to jail

© AMSP 2015 39

Case Studies

© AMSP 2015 40

Mr. B Mr. H

Resistant to psychotherapyPrefer pastor

Diagnosed with AUD

Treatment plan ultimately included pastor

Treatment focused on decreasing alcohol use

Education about being a Black drinker

Treated comorbid depression

Conclusions

• Complex drinking differences

alcohol use

– Among drinkers: problems

– Overrepresented in treatment

© AMSP 2015 41

Conclusions

• Historical factors

– A long history shows less drinking

– Cultural views on intoxication

• Current factors

– Risk exists among Black drinkers

– Particularly low income men

– Sensitivity to alcohol

© AMSP 2015 42

Conclusions

• Understanding differences informs tx

– Integrate with community/church

– Understand resistance

– Moderate drinking may cause problems

– Modify standard psychoeducation

© AMSP 2015 43

Conclusions

• More work is needed

• Treatment access

• Screening for alcohol problems

• Cultural sensitivity

• Integration with community

© AMSP 2015 44

Acknowledgements

• Marc Schuckit, M.D.

• Benjamin Nordstrom, M.D.

• Marcy Gregg

• Alcohol Medical Scholars Program

© AMSP 2015 45

Documents

ALCOHOL USE AMONG BLACK AMERICANS Sarah Pedersen, Ph.D. University of Pittsburgh School of Medicine © AMSP 20151