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

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  • ALCOHOL USE AMONG BLACK AMERICANSSarah Pedersen, Ph.D.University of Pittsburgh School of Medicine AMSP 2015 *

    AMSP 2015

  • Alcohol Use is CommonPast 30 day use:52% any use 23% > 5 drinks/occasion6% 5+ drinks on 5+ days AMSP 2015 *

    AMSP 2015

  • Alcohol Use is Costly44,000 acute alc. deaths in past year$235 billion estimated cost/year in USA$30 billion in health care costs AMSP 2015 *

    AMSP 2015

  • Alcohol Use Disorder (AUD)DSM-5 criteria (2+ in 12 months)Larger/longerUnable to cut down/control use Large amount of time spentCravings or urges to useFailure to live up to obligationsContinued despite social problemsActivities given upUse in hazardous situationsContinued despite health problemsToleranceWithdrawal

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  • AUD Rates7% age 18+ had AUD past yearHeaviest drinking: ages 18-25Men more likely than womenRacial/ethnic group differences AMSP 2015 *

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  • Rates of use and disorderConsequences of useMore problems among drinkersHistorical contextCurrent reasons for useTreatment implications AMSP 2015 *Lecture: Black American Alcohol Use

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  • Case 1: Mr. B32 year old Black man Employed at local universityReligiousLives in Black neighborhoodDrinks (~3 drinks) with friendsReferred for treatment after DUINo prior criminal hx

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  • Case 2: Mr. H34 year old White man Unemployed past 8 monthsLives in White suburbDrinks (~6 drinks) at barReferred for depression No criminal hx

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  • Rates of use and disorderConsequences of useMore problems among drinkersHistorical contextCurrent reasons for useTreatment implications AMSP 2015 *Lecture: Black American Alcohol Use

    AMSP 2015

  • Alcohol Use in Black AmericansBlack Americans use less alcohol than WhitesCurrent use: 44% Blacks vs. 58% WhitesLower rates of heavy episodic drinking20% Blacks vs. 24% Whites AMSP 2015 *

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  • Differences into Young AdulthoodAdolescence: Ages 12-17 10% Blacks vs. 18% Whites (past 30 days)Young adulthood: Ages 18-2550% Blacks vs. 68% Whites (past 30 days)College33% Blacks vs. 60% Whites intox. AMSP 2015 *

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  • Differences in AUD with Age12 month AUD dependence prevalenceAge 18-296% Blacks vs. 11% WhitesAge 30-443% Blacks vs. 4% WhitesAge 45-643% Blacks vs. 2% Whites

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  • Rates of use and disorderConsequences of useMore problems among drinkersHistorical contextCurrent reasons for useTreatment implications AMSP 2015 *Lecture: Black American Alcohol Use

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  • Black Drinkers Alc. ProblemsSocial consequences3X higher for Blacks vs. WhitesLiver cirrhosis1.3X higher for Blacks vs. WhitesAUD mortality: 10% higher for BlacksAlcohol-related cancersIllness and injury AMSP 2015 *

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  • Racial Differences SummaryBlacks are less likely to drinkOverall lower levels of useVaries across ageAmong drinkers Blacks have more problemsIntegrating historical context needed AMSP 2015 *

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  • Rates of use and disorderConsequences of useMore problems among drinkersHistorical contextCurrent reasons for useTreatment implications AMSP 2015 *Lecture: Black American Alcohol Use

    AMSP 2015

  • Important Historical Dates AMSP 2013 *1640s-1865Slavery in U.S.A.1861-1865Civil War1830s-1930sTemperance Movement1919: 18th amendmentProhibition1933: 21st amendment end of Prohibition

    AMSP 2013

  • Drinking in Africa (pre-slavery)Limited alcohol use in AfricaCeremonialSmall amounts Intoxication unacceptableDrunkenness = weakness

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  • Slavery and Alcohol UseSlaves limited alcohol useOwners prohibited useSlaves stayed sober for protectionAbstinence the norm

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  • Temperance Movement EraAbstinence linked with freedomLeaders against slavery and drinkingBlack churches grewPushed abstinence

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  • Post-Prohibition PeriodRestricted use continuedBlacks died from alcohol than WhitesConservative norms

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  • History Present DaySets stage: Drunkenness in Black communities AbstinenceMay inform clinical practiceAllows perspective on current factors

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  • Rates of use and disorderConsequences of useMore problems among drinkersHistorical contextCurrent reasons for useTreatment implications AMSP 2015 *Lecture: Black American Alcohol Use

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  • Protective Factors AMSP 2013 *

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  • Black American Drinking NormsMore conservative drinking normsAlcohol not in social events80% Whites vs. 46% Blacks drink at restaurantAvoid intoxication criticism for drinking 4+ disapproval from parents monitoring alcohol in Black homes

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  • Religiosity religiosity = alcohol use religiosity Blacks vs. Whites92% of Blacks identify as ChristianDenominations with conservative alc. viewBlack churches active in communityPreserves historical viewsProvides monitoringOne reason for lower use in Black teens

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  • GeneticsADH/ALDH genes = alc. metabolismVariants alter rate of metabolismProduce stronger response to alcoholAfrican heritage: 30% have ADH variantMetabolize alcohol differently family history pulse rate after drinking AUD

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  • Risk Factors AMSP 2013 *

    AMSP 2013

  • Discrimination98% report racist event/past year discrimination = stress drinking and drinking to cope well-beingDrinking to cope = more alc. problems AMSP 2015 *

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  • Neighborhood factors8X # liquor stores in Black neighborhoods convenient store space for alcoholBlacks drinking in public spaceEncounter police

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  • Alcohol PreferenceBlack drinkers more likely to drink liquorIncreased alcohol contentMixed drinks hard to estimate amountMen may underestimate alc. by 31%White drinkers more likely to drink beerDifferences early in adolescence

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  • Alcohol SensitivityPeople respond to alcohol differently sensitivity to rewarding effects or sensitivity to negative effects= INCREASED RISK

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  • Blacks Alcohol SensitivityAt same alcohol level:Blacks up, talkative vs. WhitesFeel more intoxicated, experience more rewardIndicates risk for alcohol problemsBlack women sedation: sluggishProtective against alcohol problems

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  • Within the Black CommunityImportant to move beyond racial groupsWhat subgroups are at risk?Protective factors:Positive parental influenceStrong ethnic identityStrong africentric world view

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  • Within Race Risk FactorsLow incomeMaleExposure to violence in homeMost at risk = low income men access to housing, workHeavy drinking cannot cost access

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  • Mr. B and Mr. HWho is most at risk for AUD? Alc. prob? AMSP 2015 *

    ProtectiveRiskMr. BReligiousEmployed MaleDrinks in public placeBlack neighborhoodMr. HWhite neighborhoodMaleHEDUnemployedDepressedNo sober support

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  • Rates of use and disorderConsequences of useMore problems among drinkersHistorical contextCurrent reasons for useTreatment implications AMSP 2015 *Lecture: Black American Alcohol Use

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  • Overrepresented in Treatment14% of U.S. population 21% of treatment populationFeel stigmatized Racial profiling Did this occur for Mr. B? Resist treatment dropout AMSP 2015 *

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  • Healthcare Access Healthcare utilizationMistrust of medical professionalsIntegrate religious/communityEducate on alcohol effectsUD treatment as an alternative to jail AMSP 2015 *

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  • Case Studies AMSP 2015 *

    Mr. BMr. HResistant to psychotherapyPrefer pastorDiagnosed with AUDTreatment plan ultimately included pastorTreatment focused on decreasing alcohol useEducation about being a Black drinkerTreated comorbid depression

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  • ConclusionsComplex drinking differences

    alcohol use

    Among drinkers: problems

    Overrepresented in treatment

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  • ConclusionsHistorical factorsA long history shows less drinkingCultural views on intoxicationCurrent factorsRisk exists among Black drinkersParticularly low income menSensitivity to alcohol

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  • ConclusionsUnderstanding differences informs txIntegrate with community/churchUnderstand resistanceModerate drinking may cause problemsModify standard psychoeducation

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  • ConclusionsMore work is neededTreatment accessScreening for alcohol problemsCultural sensitivityIntegration with community

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  • AcknowledgementsMarc Schuckit, M.D.Benjamin Nordstrom, M.D.Marcy GreggAlcohol Medical Scholars Program AMSP 2015 *

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