摘要：Objectives. We examined the relationship between everyday and major discrimination and alcohol and drug use disorders in a nationally representative sample of African Americans and Black Caribbeans. Methods. With data from the National Survey of American Life Study, we employed multivariable logistic regression analyses—while controlling for potential confounders—to examine the relationship between everyday and major discrimination and substance use disorders on the basis of Diagnostic and Statistical Manual of Mental Disorders criteria. Results. Every 1 unit increase in the everyday discrimination scale positively predicted alcohol (odds ratio [OR] = 1.02; P < .01) and drug use (OR = 1.02; P < .05) disorders. Similarly, each additional major discrimination event positively predicted alcohol (OR = 1.10; P < .05) and drug use (OR = 1.15; P < .01) disorders. Conclusions. To our knowledge, this study is the first to examine problematic usage patterns rather than infrequent use of alcohol and drugs in a national sample of African American and Black Caribbean adults and the first to examine this particular relationship in a national sample of Black Caribbeans. Alcohol and drug abuse and dependence are risky health behaviors not only to the individuals who engage in these behaviors and their loved ones but also to society. Estimates from the 2000 National Survey on Drug Use and Health suggest that of persons aged 18 years or older, approximately 12.7 million (6.3%) were either dependent on or abused both alcohol and illicit drugs, 3.3 million (1.6%) were dependent on or abused illicit drugs but not alcohol, and 10.9 million (5.5%) were dependent on or abused alcohol but not illicit drugs. 1 It is estimated that the overall economic cost of substance abuse in 1992 was $246 billion 2 and in 2001 $414 billion. 3 Psychoanalytically informed hypotheses, like the self-medication hypothesis, suggest that substance use and abuse are self-soothing behaviors among some individuals who are psychologically distressed. Individuals may use or abuse substances such as alcohol, cigarettes, and illicit and licit drugs to manage emotional pain and anxiety to achieve emotional stability. 4–8 On the basis of these stress-coping frameworks, a small number of studies suggests that perceived experiences of interpersonal discrimination, a psychosocial stressor, are associated with various risky health behaviors. 9,10 Specifically, previous studies posit that in response to perceived experiences of interpersonal discrimination (“discrimination”), some individuals may engage in risky coping behaviors such as alcohol, 11–13 tobacco, 13–18 and prescribed 19 and illicit drug use. 13,19 Yen et al., 11,12 for example, showed that Whites who experienced racial/ethnic discrimination (e.g., at school, getting a job) in 5 or more domains consumed more alcoholic drinks than did peers who had not experienced discrimination. Using the CAGE questionnaire, 20 Martin et al. 21 showed that African American adults who experienced racial/ethnic discrimination were twice as likely to have a problematic drinking behavior as were African Americans who reported no discrimination. Similarly, using a standardized survey for mental illness diagnosis derived from the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R ) criteria, Gee et al. 19 reported that Filipino Americans who experienced chronic discrimination were more likely to be dependent on alcohol. With regard to tobacco use, similar to other studies, 16,17 Landrine and Klonoff 14 reported that African Americans who experienced racial/ethnic discrimination and appraised their experiences as more stressful were more likely to smoke cigarettes than were African Americans who did not report discrimination. Beyond alcohol and tobacco use, recent investigations have reported positive associations between discrimination and licit (e.g., medically prescribed medication) and illicit (e.g., marijuana) drug abuse. 13,19 Specifically, Borrell et al. 13 reported that racial discrimination was associated with increased lifetime use of marijuana and cocaine among African Americans but not among Whites. Gee et al. 19 reported that discrimination was positively associated with the usage of illicit drugs among Filipino American adults. Although these studies are not directly comparable, taken together they suggest a relationship between experiences of discrimination and substance use. Despite a growing literature base in this area, our understanding of the relationship between discrimination and clinically diagnosed alcohol and drug use disorders is limited. Although most will agree that alcohol use and illicit drug use (regardless of frequency and quantity) are potential health risk behaviors, infrequent usage patterns, such as those currently studied in most of the published literature, may not indicate the damaging behavior patterns that are associated with a clinical diagnosis of abusing or being dependent on alcohol or drugs, such as recurrently driving an automobile when impaired or continued drinking despite knowledge of a serious physical or psychological problem. 22 Using the 2001 National Study of American Life (NSAL), we aimed to extend previous research in 2 important ways. The first concerns the generalizability of the current findings in this area. We are aware of only 1 study that has examined problematic usage patterns of alcohol use and none examining problematic drug usage among African Americans. 19,21 In a sample of employed African Americans, Martin et al. 18 showed that discrimination was positively associated with problematic drinking behavior; however, the sample was not representative of the general population of African Americans in the United States. To date, we are unaware of any studies that have examined the relationship between discrimination and substance use disorders among Black Caribbeans, the second largest subgroup of Blacks living in the United States. To fill these gaps, we examined the relationship between discrimination and alcohol and illicit drug use disorders in a nationally representative sample of African Americans and Black Caribbeans, 2 groups that traditionally report relatively high levels of discrimination. 23–25 We subsequently examined whether interpersonal discrimination was related to the co-occurrence of alcohol and drug use disorders, given that alcohol and drug use disorders often co-occur. 26–29
