529

Methodological and Conceptual

Issues in Understanding Female

Hispanic Drug Users 1

Margarita Alegría, Ph.D.; Mildred Vera, Ph.D.; Gisela Negrón,

Ph.D.; Margarita Burgos, Ph.Dc.; Carmen Albizu, M.D.; and

Glorisa Canino, Ph.D.

INTRODUCTION

This chapter has two main objectives. First, it briefly describes

the methodological limitations evidenced in the research on female

Hispanic drug users. Second, it proposes a conceptual framework that

stimulates the discussion of constructs needed to understand drug use

behavior and its consequences among Latinas. An attempt is made

to examine multivariate influences on drug use and related problem

behaviors for Latinas based on the work of our colleagues. The emphasis

is on including constructs that focus on gender and minority status and

capture the diverse levels of interrelationships (e.g., familial, friends and

peers, neighborhood, institutional) that may help in understanding

Latinas’ drug behavior and its negative consequences.

METHODOLOGICAL ISSUES

In 1986 the Anti-Drug Abuse Act emphasized the need to examine

drug abuse in minority groups, including Hispanics. Although interest

in studying minorities increased, many of these studies on drug abuse

and its sequelae included only a small proportion of Hispanics in their

samples, making it impossible to estimate with reasonable confidence

substance use prevalence among Hispanic females and males (Caetano

1990). Furthermore, the uncertainty of what the categorization of

Hispanic or Latino really stood for created difficulties in the interpretation of data (Booth et al. 1990). Ethnic group membership could have

been formulated on a variety of attributes, such as country of origin,

language preference, self-identified ethnic status, and others. Using the

Hispanic categorization to represent one or more sampled populations

may have diffused significant aspects of culture and muddled distinct
530

patterns of drug use for particular ethnic subgroups. The use of broad

ethnic descriptors in drug use research could have introduced external

validity problems and hindered replication of results (Trimble 1991).

Results for the Hispanic Health and Nutrition Examination Survey

(Amaro et al. 1990) support the argument that use of illicit drugs varies

widely among and within the three major Hispanic groups: MexicanAmericans, Puerto Ricans, and Cubans. Mainland Puerto Ricans have

the highest rates of drug use in comparison with other ethnic or Hispanic groups (Amaro et al. 1990). In addition, the correlates of drug

use appear to vary significantly by ethnicity (Kleinman and Lukoff 1978;

Vega et al. 1993). Other studies suggest an apparent heterogeneity in

the choice of drugs among different Hispanic groups. For example,

Puerto Ricans and Chicanos are overrepresented in the heroin-using

population (Newman et al. 1974) compared with Cubans. The absence

of population-based probability samples representative of the broad

spectrum of drug users also precludes the opportunity to understand

whether ethnic differences in drug behavior observed in clinic samples

could be explained by cultural or situational contextual factors.

Unfortunately, studies of substance use and abuse in Hispanic

populations have typically omitted gender differences as a focus of

interest. National data on substance abuse from the National Institute

on Drug Abuse (1989) start to examine gender differences by providing

descriptive information on Hispanic women’s drug use. Findings

depicted in table 1 suggest that Hispanic women are as likely as Anglo

women to have used any form of cocaine and as likely as AfricanAmerican women to have used crack or alcohol. Hispanic women

are less likely than African-Americans and Anglos to have ever used

cigarettes or marijuana. However, these data aggregate heterogeneous

Hispanic groups under one umbrella category. Different formulas for

combining factors may be needed not only to explain drug use among

women in contrast to men but also to explain drug use among MexicanAmerican women in comparison with women from other Hispanic

groups. As a result, the field lacks an indepth examination of the

characteristics, strengths, and problems that are shared by and that

differentiate various Hispanic women with drug problems.

Added to these methodological limitations to understanding drug

use among Hispanic women is the fact that women with increased

risk for drug use are excluded from the sampling frames, including sex
531

TABLE 1. Women’s drug use by ethnic status (percent)

Ever Used Anglo African-American Hispanic

Cigarettes 72.8 62.9 51.8

Alcohol 83.3 71.7 72.1

Marijuana 31.2 26.5 21.7

Cocaine 8.9 5.9 8.1

Crack 0.9 1.5 1.3

Stimulants 7.5 3.3 4.8

SOURCE: National Institute on Drug Abuse 1989

workers (women who exchange sexual relations for money, drugs, or

other material items as part of their livelihood) and incarcerated

women. There is also the possbile underreporting of substance use

by Hispanic women because of the fear of losing custodial rights of

their children and because of the use of self-administered questionnaires

among women with low literacy levels. An additional methodological

pitfall is the use of instruments that have not been developed for or

validated with Hispanic women.

Furthermore, use of cross-sectional designs has also been posited

as a limitation to understanding the changing trajectories of drug-using

Hispanic women. Most studies examining drug use behavior among

Latinas (Anglin et al. 1987a, 1987b; Moore and Devitt 1989; Moore

and Mata 1981) have been developed and examined with cross-sectional

data. They cannot offer much information about the process leading

to the entry, experimental use, or continuation of drug use by Latino

women. The absence of studies with a longitudinal design limits the

ability to examine the developmental course of drug use, the helpseeking process to deal with drug problems, the consequences of drug

use, and the impact of treatment. The lack of longitudinal data also

limits the possibility of discriminating the antecedents from the consequences of drug use.

In addition to methodological limitations, there is a lack of conceptual models with which to understand the drug use behaviors of

Latino women and the relevant correlates that may help explain such

behaviors. Basic decisions with regard to policy, intervention programs,

and strategies aimed toward women have been reached based on conceptual models that respond to men’s needs and lifestyles.
532

The need for conceptual models explaining Hispanic female drug

use is imperative, given that the pathways and factors associated with

drug use appear to vary by gender. Women have been found to be

more likely than men to be exposed to drugs by their sexual partners

(Rosenbaum 1981; Stenbacka et al. 1992; Bresnahan et al. 1992).

Women’s use of drugs has been explained as a coping strategy to deal

with stress (Sutker 1987, pp. 25-51; Rhoads 1983), sexual abuse

(Rohsenow et al. 1988; Inciardi et al. 1993), or treatment for an illness

(Marsh and Miller 1993).

The research literature also fails to bring attention to the differential

consequences of drug use in women in contrast to men. There is an

expectation that drug abuse will have more serious consequences among

women than among men because of women’s social roles (Rosenbaum

1981; Gomberg 1982). These findings explain the urgency of building

conceptual models dealing with Hispanic women’s drug use.

To be successful in model-building for Latino women, there is a

need to go beyond constructs that focus on the individual (e.g., biological/genetic, personality, life events) to interpersonal, neighborhood,

and institutional constructs. Although individuals are expected to

change behaviors such as illicit drug use, risky sexual practices, and

delinquency, these changes are often minuscule and unsustained because

interpersonal, neighborhood, and institutional variables have not been

altered to reinforce personal changes.

New paradigms are needed that go beyond understanding substance

abuse as a compendium of behaviors generated by an individual under

a rationally focused perspective. Particularly inadequate are the deficit

models. Deficit models, pervasive in treatment interventions, emphasize

the individual’s loss of control, maladaptive habits, and weak affect

management as the culprits for drug use. An explanatory framework

of drug use necessitates evaluating the external attachments of Latino

women. These external attachments are assumed to give meaning and

mold women’s lives and actions. They include the interpersonal relationships to family, lovers, and friends; the neighborhood context,

with its norms, constraints, and opportunities; and the interaction with

institutional systems that serve Latino women and their families. It is

only through the analysis of these components that drug use by Latinas

and the consequences of such behavior can be fully understood.
533

CONCEPTUAL FRAMEWORK

Several problems have impinged on the ability to generate conceptual models that explain drug use and problem behaviors among Latinas.

Most conceptual models used to guide research efforts on drug abuse

and other problem behaviors have been largely developed for men

(Copeland et al. 1993). These models assume that the same constructs

explain both male and female behaviors. However, research efforts with

females have demonstrated many differences between male and female

problem behaviors. In addition, there is consensus among researchers

that drug use and other problem behaviors (e.g., criminal activity) cannot

be understood solely on the basis of a single theory (Kaplan et al. 1986).

The proposed conceptual framework (table 2) combines elements

from several theoretical perspectives: the stress-vulnerability model

(Pearlin et al. 1981), the family interactional model (Brook et al. 1988,

1990), and the social learning theory (Akers et al. 1979). These models

complement one another by incorporating several possible factors that

explain drug use and problem behaviors. The stress-vulnerability model

posits a clear relationship among stress exposure and increased likelihood

of drug use and problem behaviors. There is considerable evidence

suggesting that differences in stress exposure and lack of resources (e.g.,

institutional and social supports) contribute to place women at risk of

drug use. The presence of vulnerabilities, such as childhood victimization (Miller 1993, pp. 315-323) and psychological distress (Deykin et al.

1987), is conceptualized as an important factor that, together with life

and role strains, is associated with drug use. For the proposed model,

stress is defined broadly to include circumstances such as life stresses (e.g.,

divorce, death of spouse) as well as role strains (e.g., burdens in parental,

occupational, and housekeeping responsibilities). Levels of stress exposure are also expected to vary across sociodemographic characteristics.

Interpersonal, neighborhood, and institutional factors are seen as particularly significant to the stress-vulnerability relationship (Aneshensel 1992;

Pearlin 1989).

Individual Domain

The conceptual framework presented in the box on the following

page includes the individual/personal, interpersonal, neighborhood, and

institutional domains as those influencing drug use and related negative
534
535

consequences. The sociodemographic characteristics of age, education,

employment status, and marital status that define the women’s background and developmental stage in the life cycle are encompassed under

the individual/personal domain. Income and, more specifically, purchasing power (Staats and Poole 1979) are seen as personal resources that

orient behavior. Family composition characterizes the structural constraints and attachments of the women’s actual situations.

Biologic and genetic constructs related to the risk of drug use and

relapse (e.g., craving) are also considered part of the individual/personal

domain. Parting from the dominant approach of treatment programs,

the authors hypothesize an underlying genetic predisposition (Crabbe et

al. 1985, pp. 13-64) that may increase the risk of developing physical

dependency or drug-addictive behaviors. Craving is assumed to be a

subjective state that is believed to have a biological as well as an environmental basis and is associated with drug dependence (Pickens and

Johanson 1992). Because of its possible usefulness in understanding

relapse and treatment experience, this construct was incorporated into

the model. Physical illness has also been identified as a major reason

for nonuse by abstainers of drugs (Winfree et al. 1981).

The psychoemotional component of the individual/personal domain

represents the attitudinal, motivational, mood, and distress dimensions

expected to influence drug use behaviors. The psychoemotional profile

of the person has been strongly implicated in the risk for drug use

(Lavouvine and McGee 1986; Anthony and Helzer 1991, pp. 116-154).

Feelings of powerlessness/hopelessness (Brooks-Gunn and Furstenberg

1989; Lavouvine and McGee 1986; Nyamathi and Vásquez 1988) have

been posited as precursors to drug use by women. Furthermore, the drug

research literature has consistently shown that attitudes toward deviance

(Jessor et al. 1973; Kandel 1985; Brook et al. 1983) can help distinguish

between drug users and drug nonusers. Depressive mood and depression

also are related to the use of illicit drugs other than marijuana

(Zuckerman et al. 1989; Kandel et al. 1978).

The experiential component of the individual/personal domain

addresses the negative life circumstances, stressors, and traumas that

may increase the likelihood of drug use or associated problem behaviors.

Childhood sexual abuse has been linked to the development of women’s

substance abuse problems (Miller 1993, pp. 315-323; Toray et al. 1991;

Rohsenow et al. 1988). The theoretical links between childhood sexual
536

abuse and the development of women’s substance abuse problems may

be indirectly generated as a consequence of the sexual abuse.

The conceptual framework also includes cultural characteristics,

such as ethnic identification and acculturative status, necessary to

untangle the role of culture from other situational or environmental

factors influencing drug use. The proposed conceptual approach aims to

be sensitive to the potential relevance of cultural factors unique to the

situation of Hispanic women. The experiences of discrimination and

acculturative stress may be hypothesized as the reasons for mainland

Puerto Rican women’s higher cocaine use compared with that of Anglos

and African-Americans (Booth et al. 1990).

Interpersonal Domain

The second domain of interest is the interpersonal domain. Interpersonal factors are the qualitative and structural dimensions of the

person’s interaction with family, friends, and significant others. People

act collectively, and in their interactions with significant others they

receive modeling, reinforcement, and rejection of their behavior and

attitudes. The importance of family relationships in the development

of drug use has been consistently documented (Brook et al. 1988, 1990).

Support from the family of origin and positive family interaction are

seen as protective factors that can mitigate the risks for drug use according to the family interactional model (Brook et al. 1992).

This model gains particular relevance for the study population

because Puerto Rican women sustain a high level of interaction with

their family of origin, even after adolescence. It is hypothesized that

significant others also play a major role in Hispanic women’s drug use

and problem behaviors, as suggested by social learning theory. According to this orientation, women engage in drug use and other problem

behaviors, such as criminal activity, because they are consistent with the

values of their significant others. Moreover, women learn these problem

behaviors through the same mechanisms of social influence through

which they learn conventional behaviors. For example, the influence

of a spouse’s or lover’s drug use is hypothesized as a powerful risk factor

for Hispanic women’s drug use and problem behaviors.

According to the reviewed literature, behaviors brought on by

drug abuse among women have been more closely associated with
537

interpersonal issues than have these behaviors among men. In a study

conducted with clients discharged from a detoxification program,

Rhoads (1983) found that female drug users are vulnerable to life

stressors and lack the support systems that are available to male addicts.

There is evidence to indicate that female drug abusers are characterized

by a lack of support among family and friends (Nyamathi and Vásquez

1988). Drug-using women who perceived the availability of social

support showed a reduction in negative feelings and an increase in

coping behaviors (Stephens 1987). Nonetheless, there are inconsistent

findings regarding the role of social support in female drug use. Degen

and colleagues (1993) reported strong similarities in social support

systems of drug-using and non-drug-using pregnant women in lower

class and working-class samples.

Moreover, drug-using women appear to be more socially isolated and

demonstrate greater difficulty with parenting, interpersonal relations,

and managing money than women who do not use drugs (Weissman

et al. 1972; Chasnoff 1988). Use of drugs could be a strategy for women

to actively deal with excessive demands in the family environment

(Reed 1985). Significant others, especially family members and sexual

partners, have an apparently strong influence on the lives of female

addicts. Stenbacka (1990) reported that one-third of the women in a

study group had been introduced to injecting drugs by a sexual partner.

Evidence from Bresnahan and colleagues’ (1992) study points to a nearly

fivefold increase in other drug use and heavy alcohol use by women

whose partners were also other drug or alcohol users. In another study

(Gerstein et al. 1979), women who reported having first used drugs in

the company of intimate others—lovers and relatives—rather than with

friends or alone displayed higher consumption and more prolonged use

of drugs. Furthermore, several studies have offered support for the

consistent relationship between respondents’ substance use and their

perceptions of friends’ drug use (Apsler and Blackman 1979; Nuttall and

Nuttall 1979). Similar associations between drug use by parents and

their adult offspring (Tennant 1976) have been reported in the literature. There is converging evidence that familial factors are associated

with the transition from substance use to abuse (Yamaguchi and Kandel

1984; Brook et al. 1988).

Puerto Ricans consider family membership preeminent to any other

intimate personal relationships (Obeso and Bordatto 1974). Traditional
538

Hispanic affiliative values have been characterized by a protective

position toward women (Booth et al. 1990). Hispanic women are raised

with traditional family values that are continually reinforced by women’s

strong family affiliation. The family is a central institution in which

close ties and obligations are fostered (Canino et al. 1980). For Latinas,

the primary role of the family and friends has been to buffer adversity

(both internal and external) and to maximize/minimize the impact

of exposure to positive/negative rewards promoted by interpersonal

interactions. The authors hypothesize that diminished protective effects

of interpersonal factors for women, such as family support and integration, might lead them to an increased likelihood of drug use.

Neighborhood Domain

The third dimension encompassed under our conceptual framework

is the neighborhood domain. The neighborhood is seen as the essential

point of departure in terms of the options, norms, values, and trends to

which a woman must respond. According to this conceptual framework,

neighborhood norms and trends may be tolerant or intolerant of crime,

drug use, and violence. They may provide opportunities for involvement in criminal activities or conventional activities, or they may

promote or penalize high-risk sexual activity. The predisposition to use

drugs appears to be influenced by the context of a women’s environment. Binion (1982) found that the neighborhood had an enormous

impact on women’s drug-using behavior, particularly when it denied

equal access to social mobility or when deviant activities were seen as

more attractive.

Strong disapproval and rejection of drug use behavior in the

neighborhood (as perceived by the respondent) is also hypothesized

to influence drug use behavior. Traditional neighborhood norms severely sanction women’s drug use (Anglin et al. 1988) and, as such, may

deter women from drug use. Block and colleagues (1988) found that

unconventional norms, an unpredictable environment, and lack of

pressure to achieve were related to subsequent drug use in females, but

not in males. Neighborhood norms and trends that promote conventional behavior, such as school achievement and job placement, are

expected to protect against drug use. Neighborhoods perceived as being

models of deviant/delinquent behavior, characterized by violence, are

expected to increase the likelihood of drug use.
539

Institutional Domain

The fourth dimension contemplates the transactions with institutional systems. There is growing awareness of the need to better serve

Hispanic drug-using women; however, there is limited research on their

treatment needs. It has been assumed that the dynamics of addiction

and treatment needs are substantially the same for women as for men.

Yet, findings have shown that (1) drug-using women have more difficulty identifying themselves as requiring treatment because they see

their difficulties as a consequence of their social or psychological problems (Thom 1986); (2) programs may not be appropriate for a large

segment of the drug-using female population; (3) women may have

special needs that are seldom met (Reed 1981); and (4) there are barriers

faced by women for entry into and retention in drug treatment programs,

such as the potential for discrimination and sexual harassment by male

staff members and clients (Nichols 1985), the absence of child-care

services (Reckman et al. 1984), and the failure to provide therapeutic

women-only groups (Sokolow et al. 1980). The failure to address these

crucial treatment concerns for women may in turn explain the ongoing

failure of these services to attract women (Copeland et al. 1993).

Failure to attract women into drug treatment may also be a consequence of not paying much attention to the appropriate treatment

strategies for women (Beschner and Thompson 1981). Yet, women’s

participation in treatment has been associated with a reduction in

heroin use and significant improvements in reported health and depression (Copeland et al. 1993). In a study conducted by Faupel and Hanke

(1993), the researchers examined whether women who had participated

in some form of treatment program over their drug-using careers significantly differed from women who had never been in treatment. Earlier

initiation into drug-using careers, having children, and older age were

positively associated with entering treatment. Contrary to what has

been suggested in the literature—that women with children are barred

from treatment programs—these researchers found that women with

children were more likely to have participated in treatment. However,

this appears to be a function of longevity, whereby older women were

more likely to have participated in treatment and had children. Hence,

it is important to understand whether the presence of children is a

barrier to treatment entry or if it actually prohibits effective completion

of treatment.
540

The focus of drug treatment has also been on whether it decreases

the level of drug use, criminal activities, and other problem behaviors.

Treatment, such as methadone maintenance, may relieve the drug user

from the constant pressure to obtain drugs and, as such, reduce the level

of criminal activity (Hunt et al. 1984). According to Senay’s (1985)

review of the effectiveness of methadone treatment, criminal involvement decreases after treatment and health status improves. Reno

and Aiken (1993) found that clients who left treatment within the

first 2 months differed from those who remained longer in treatment

by having more drug and criminal involvement and poorer health

status. Puerto Ricans have been less likely than other minority groups

to remain drug-free and show a tendency to continue criminal behavior

after treatment (Anglin et al. 1988). The reasons for such behavior

remain unexplained.

Few studies have explored ethnic differences in drug users’ attitudes

toward treatment for drug use (Longshore et al. 1993). The confrontational techniques used in many therapeutic communities have been

criticized for being unsuited to Hispanic clients (Tucker et al. 1988,

pp. 383-421). Attitudes toward these treatment modalities might make

Hispanics more reluctant to enter treatment. In Puerto Rico, there is

a paucity of research concerning the rate and correlates of participation

in drug programs. Even less research exists with regard to Puerto Rican

women. What is well known is that women are underrepresented

among the drug treatment population, accounting for only about

10 percent of those in treatment. This gender gap in admissions becomes greater in methadone programs, where only 2 percent of those in

treatment are women (Colón 1987).

The importance of establishing ethnic variations in the utilization

of treatment services has been well documented by Longshore and

colleagues (1993). In comparing drug treatment patterns among

African-American, Hispanic, and Anglo drug-using arrestees in Los

Angeles, they found, after controlling for nonethnic demographic

factors, that African-American and Hispanic drug users were less likely

to report having been in drug abuse treatment. Hispanics were more

likely than Anglos to say that they had not sought treatment because

they did not need it. The authors hypothesize that participation in

health and social services programs might be a resource that can help

women deal with everyday difficulties. Participation in drug treatment
541

services is also seen as a mediating factor that reduces a woman’s probability of engaging in problem behaviors. On the other hand, the

experience of incarceration might influence a woman’s prospective

criminal behavior, sexual activity, and physical health outcomes.

Outcomes

The framework presented above (see boxed chart) provides an

approach to understanding women’s drug use as well as the problem

behaviors that unfold as a result of drug use. Drug addiction has been

associated with interpersonal violence (Miller 1990, pp. 177-207;

Gomberg 1982). Several studies (e.g., Wallace 1991) have shown a high

prevalence of victimization among female substance abusers (Miller et

al. 1993). Amaro and colleagues (1990) examined violence during

pregnancy and found that victims of violent attacks were more likely

than nonvictims to be alcohol or other drug users. In a retrospective

study, Wallace (1991) studied 245 adults in treatment and found that

female respondents reported loss of custody of children (53 percent) and/

or violence (17 percent) after becoming addicted to crack. Partner

violence, such as spouse battering, has been strongly associated with the

use of alcohol and other drugs in both men and women (Downs et al.

1987; Miller 1990, pp. 177-207; Gorney 1989; Robbins 1989). Data

from the Epidemiologic Catchment Area Study showed that individuals

who met the criteria for having alcohol or other drug disorders, both

men (21.08 percent) and women (21.70 percent), had the highest

reported rates for engaging in some form of violence compared with the

rest of the population (Swanson et al. 1990). High levels of stress, as

well as poverty, unemployment, lack of social and family support, and

single parenthood, have been strongly associated with both wife-battering and child abuse (Cazenave and Straus 1990, pp. 321-340; Straus

1990, pp. 29-45), all conditions prevalent in female substance users.

When drug-using women engage in criminal activities, they are more

prone to participate in a climate of violence (Lex 1993, pp. 162-190).

Thus, the authors expect that female crack/cocaine and injection drug

users will engage in and experience higher levels of violence, such as

partner-battering, compared with similar women who are not substance

users.

According to Oppenheimer (1991), female drug users must confront

the financial problems of obtaining resources to pay for daily drugs.
542

Many of them engage in criminal behaviors to finance their habit.

Anglin and Speckart (1986) have shown that criminal activity increases

as a function of increased narcotic use. Some authors indicate that illegal

drug use may be a stronger predictor of crime for women than for men,

particularly among Mexican-Americans (Anglin et al. 1987a). Drug

dealing (Kleinman and Lukoff 1978; Anglin et al. 1987b; File et al. 1974),

theft (Nyamathi and Vásquez 1988; Rosenbaum 1979) and prostitution

(Inciardi 1989; Rolfs et al. 1990; Goldstein et al. 1992) have been reported as being strongly related to illegal drug use. However, given the

lack of panel data, few studies have been able to look at the interrelationships between drug use and criminal acts over time. Therefore, the causal

connection linking women’s drug use and crime has not been clarified.

Several investigators (Mott and Haurin 1988; Newcomb and Bentler

1986) have proposed that the use of illicit drugs increases risky sexual

behavior. In a study of African-American and Latino women from

methadone clinics, Schilling and colleagues (1991) found that frequent

drug injectors admitted to having more sexual partners and to having sex

more frequently than women who used injection drugs less often. Kandel

(1985) found a strong correlation between cocaine use and early sexual

experimentation and also found that although this finding was observed

independent of ethnic status, it was particularly striking for Hispanic

women.

The risk for sexually transmitted diseases (STDs) is also high

among drug users. Drug use has been associated with syphilis (Rolfs

et al. 1990) and HIV (human immunodeficiency virus) infection

(Des Jarlais et al. 1989; Chaisson et al. 1989) among females, particularly

among those trading sexual relations for drugs. Injection drug use

and unsafe sexual practices account for the disproportionate occurrence

of AIDS (acquired immunodeficiency syndrome) in the Hispanic

population.

It is expected that different domains of the framework will have

a stronger influence on drug use and related negative outcomes. For

example, the authors hypothesize that self-perceived job opportunities

play a more relevant role regarding criminal behavior, whereas the

presence of a drug-using partner may have a more prominent position

in a woman’s risk for partner violence or STD infection.
543

SUMMARY

The authors have benefited from the many contributions of researchers in the field. Based on their findings, a preliminary conceptual

framework of Hispanic women’s drug use and its consequences has been

proposed. The authors expect to empirically test the usefulness of this

framework among urban Puerto Rican women. Nonetheless, an attempt

was made to integrate elements from basic models as building blocks for

understanding Latino women’s drug use, their help-seeking behavior

leading to treatment, and the consequences tied to drug use. This

framework, as any initial attempt, is likely to evolve and to be modified

in the presence of additional research findings. It serves to open the

discussion on possible conceptual frameworks for Latinas.

The proposed conceptual framework has been formulated on the

basis of three theoretical approaches: the stress-vulnerability model,

the family interactional model, and the social learning model. The

focus of the proposed conceptual framework exhibited in the chart

above is not on juxtaposing these explanatory propositions. Rather, an

examination was made as to how they jointly or distinctively affect

different drug use behaviors and problem behaviors. Therefore, the

conceptual model includes individual/personal, interpersonal, neighborhood, and institutional factors as relevant in explaining drug use and its

consequences. It is expected that the mechanisms or domains of influence vary for the different problem behaviors. Key latent constructs

consonant with what has been substantiated by other researchers are

used in building this complex model.

NOTE

1. The terms “Hispanic” and “Latino” are used interchangeably; the

term “Latinas” refers to female Latinos or Hispanics.

REFERENCES

Akers, R.L.; Krohn, M.D.; Lanza-Kaduce, L.; and Radosevich, M. Social

learning and deviant behavior: A specific test of a general theory. Am Sociol

Rev 44:639-655, 1979.

Amaro, H.; Fried, L.; Cabral, H.; and Zuckerman, B. Violence during pregnancy

and substance use. Am J Public Health 80(5):575-579, 1990.
544

Aneshensel, C.S. Social stress: Theory and research. Annu Rev Sociol 18:15-38,

1992.

Anglin, D.; Hser, Y.; and Booth, M. Sex difference in addict careers. 4. Treatment. Am J Drug Alcohol Abuse 13:253-280, 1987a.

Anglin, D.; Hser, Y.; and McGlothlin, W. Sex differences in addict careers.

2. Becoming addicted. Am J Drug Alcohol Abuse 13(1-2):59-71, 1987b.

Anglin, M.D.; Ryan, T.M.; Booth, M.W.; and Hser, Y. Ethnic differences in

narcotics addiction: Part I. Characteristics of Chicano and Anglo

methadone maintenance clients. Int J Addict 23:125-149, 1988.

Anglin, M.D., and Speckart, G. Narcotics use, property crime, and dealing:

Structural dynamics across the addiction career. J Quant Criminol 2(4):355-

375, 1986.

Anthony, J., and Helzer, J. Syndromes of drug abuse and dependence. In:

Robins, L., and Regier, D., eds. Psychiatric Disorders in America. New York:

The Free Press, 1991.

Apsler, R., and Blackman, C. Adults’ drug use: Relationship to perceived drug

use of parents, friends while growing up, and present friends. Am J Drug

Alcohol Abuse 6(3):291-300, 1979.

Beschner, G., and Thompson, P. Women and Drug Abuse: Needs and Services.

Services Research Monograph Series. DHHS Pub. No. (ADM)81-1057.

Rockville, MD: National Institute on Drug Abuse, 1981.

Binion, V. Sex differences in socialization and family dynamics of female and

male heroin users. J Soc Issues 38(2):43-57, 1982.

Block, J.; Block, J.; and Keyes, A. Longitudinally foretelling drug usage in

adolescence: Early childhood personality and environmental precursors.

Child Dev 59:336-355, 1988.

Booth, M.; Castro, F.; and Anglin, D. What Do We Know About Hispanic

Substance Abuse? A Review of the Literature. New Brunswick, NJ: Rutgers

University Press, 1990.

Bresnahan, K.; Zuckerman, B.; and Cabral, H. Psychosocial correlates of drug

and heavy alcohol use among pregnant women at risk for drug use. Obstet

Gynecol 80(6):976-980, 1992.

Brook, J.; Whiteman, M.; Balka, E.B.; and Hamburg, B.A. African-American

and Puerto Rican drug use: Personality, familial, and other environmental

risk factors. Genet Soc Gen Psychol Monogr 118(4):417-438, 1992.

Brook, J.; Whiteman, M.; and Gordon, A.S. Stage of drug use in adolescence:

Personality, peer, and family correlates. Dev Psychol 19(2):269-277, 1983.

Brook, J.S.; Brook, D.W.; Gordon, A.S.; Whiteman, M.; and Cohen, P. The

psychosocial etiology of adolescent drug use: A family interactional

approach. Genet Soc Gen Psychol Monogr 116(2):111-267, 1990.
545

Brook, J.S.; Whiteman, M.; Nomura, C.; Gordon, A.S., et al. Personality, family,

and ecological influences on adolescent drug use: A developmental analysis. J

Chem Depend Treat 1(2):123-161, 1988.

Brooks-Gunn, J., and Furstenberg, F.F., Jr. Adolescent sexual behavior.

Am Psychol 44(2):249-257, 1989.

Caetano, R. Hispanic drinking in the U.S.: Thinking in new directions. Br J

Addict 85:1231-1236, 1990.

Canino, I.A.; Earley, B.F.; and Rogler, L.H. The Puerto Rican Child in New York

City: Stress and Mental Health. Monograph 4. New York: Fordham University,

Hispanic Research Center, 1980.

Cazenave, N., and Straus, M. Race, class, network embeddedness, and family

violence: A search for potent support systems. In: Straus, M.A., and Gelles,

R.J., eds. Physical Violence in American Families: Risk Factors and Adaptations to

Violence in 8,145 Families. New Brunswick, NJ: Transaction Publishers, 1990.

Chaisson, R.E.; Bacchetti, P.; Osmond, D.; Prodie, B.; Sande, M.A.; and Moss,

A.R. Cocaine use and HIV infection in intravenous drug users in San

Francisco. JAMA 261(4):561-565, 1989.

Chasnoff, I. Drug use in pregnancy: Parameters of risk. Pediatr Clin North Am

35:1403-1412, 1988.

Colón, H. “Second Report. Data Bank of Population on Drug Treatment.”

Santurce, PR: Department of Anti-Addiction Services, 1987. 26 pp.

Copeland, J.; Hall, W.; Didcott, P.; and Biggs, U. A comparison of a specialist

women’s alcohol and other drug treatment service with two traditional mixedsex services; client characteristics and treatment outcome. Drug Alcohol

Depend 32(1):81-92, 1993.

Crabbe, J.C.; McSwigan, J.D.; and Belknap, J.K. The role of genetics in substance

abuse. In: Galizo, M., and Maesto, S., eds. Determinants of Substance Abuse

Treatment: Biological, Psychological, and Environmental Factors. New York:

Plenum, 1985.

Degen, H.M.; Myers, B.J.; Williams-Petersen, M.G.; Kaisely, J.S.; and Schnoll, S.S.

Social support and anxiety in pregnant drug abusers and nonusers:

Unexpected findings of few differences. Drug Alcohol Depend 32(1):37-44,

1993.

Des Jarlais, D.C.; Casriel, C.; Friedman, S.R.; Rosenblum, A.; Frank, B.; and

Khouri, E. “The Prevention Message: AIDS and Initiation Into Drug

Injection.” Paper presented at the Fifth International Conference on AIDS,

Montreal, Quebec, Canada, June 4-9, 1989.

Deykin, E.Y.; Levy, J.C.; and Wells, V. Adolescent depression, alcohol and drug

abuse. Am J Public Health 77(2):178-182, 1987.

Downs, W.R.; Miller, B.A.; and Gondoli, D.M. Childhood experiences of parental

physical violence for alcoholic women compared with a randomly selected

household sample. Violence Vict 2(4):81-96, 1987.
546

Faupel, C., and Hanke, P. A comparative analysis of drug-using women with

and without treatment histories in New York City. Int J Addict 28:233-248,

1993.

File, K.N.; McCahill, T.W.; and Savitz, L.D. Narcotics involvement and female

criminality. Addict Dis 1(2):177-188, 1974.

Gerstein, D.; Judd, L.; and Rouner, S. Career dynamics of female heroin addicts.

Am J Drug Alcohol Abuse 6:1-23, 1979.

Goldstein, P.J.; Ouellet, L.J.; and Fendrich, M. From bag brides to skeezers: A

historical perspective on sex-for-drugs behavior. J Psychoactive Drugs 24(4):

349-361, 1992.

Gomberg, E. The young male alcoholic: A pilot study. J Stud Alcohol 43:683-

700, 1982.

Gorney, B. Domestic violence and chemical dependency: Dual problems, dual

interventions. J Psychoactive Drugs 21(2):229-238, 1989.

Hunt, D.; Lipton, D.; and Spot, B. Patterns of criminal activity among

methadone clients and current narcotics users not in treatment. J Drug

Issues 14:687-702, 1984.

Inciardi, J. Trading sex for crack among juvenile drug users: A research note.

Contemp Drug Probl 16:689-700, 1989.

Inciardi, J.; Lockwood, D.; and Pottieger, A. Women and Crack-Cocaine. New

York: Macmillan, 1993.

Jessor, R.; Jessor, S.; and Finney, J. A social psychology of marijuana use:

Longitudinal studies of high school and college youth. J Pers Soc Psychol

26:1-5, 1973.

Kandel, D. On process of peer influences in adolescent drug use: A

developmental perspective. Adv Alcohol Subst Abuse 4:3-4, 1985.

Kandel, D.; Kessler, R.; and Marguelies, R. Antecedents of adolescent initiation

into stages of drug use: A developmental analysis. In: Kandel, D.B., ed.

Longitudinal Research in Drug Use. New York: Halsted Press, 1978.

Kaplan, H.B.; Johnson, R.J.; and Bailey, C.A. Self-rejection and the explanation of deviance: Refinement and elaboration of a latent structure.

Soc Psychol Q 49:110-128, 1986.

Kleinman, P.H., and Lukoff, I.F. Ethnic differences in factors related to drug use.

J Health Soc Behav 19(2):190-199, 1978.

Lavouvine, E., and McGee, C. Relation of personality to alcohol and drug use

in adolescence. J Consult Clin Psychol 54:289-293, 1986.

Lex, B.W. Women and illicit drugs: Marijuana, heroin, and cocaine. In:

Lisansky Gomberg, E.S., and Nirenberg, T.D., eds. Women and Substance

Abuse. Norwood, NJ: Ablex Publishing, 1993.

Longshore, D.; Hsieh, S.; and Anglin, M. Ethnic and gender differences in drug

users’ perceived need for treatment. Int J Addict 28(6):539-558, 1993.
547

Marsh, J., and Miller, N. Female choice in substance abuse treatment. Int J

Addict 20:995-1019, 1993.

Miller, B.A. The interrelationships between alcohol and drugs and family

violence. In: De La Rosa, M.; Lambert, E.Y.; and Gropper, B., eds. Drugs

and Violence: Causes, Correlates, and Consequences. National Institute on

Drug Abuse Research Monograph 103. DHHS Pub. No. (ADM)91-1721.

Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1990.

Miller, B.A. Investigating links between childhood victimization and alcohol

problems. In: Martin, S.E., ed. Alcohol and Interpersonal Violence: Fostering

Multidisciplinary Perspectives. National Institute on Alcohol Abuse and

Alcoholism Research Monograph 24. NIH Pub. No. 93-3496. Rockville,

MD: U.S. Department of Health and Human Services, Public Health

Service, National Institutes of Health, 1993.

Miller, B.A.; Downs, W.R.; and Testa, M. Interrelationships between

victimization experiences and women’s alcohol/drug use. J Stud Alcohol

Suppl 11:109-117, 1993.

Moore, J.W., and Devitt, M. Addicted Mexican-American mothers. Gender Soc

3:53-78, 1989.

Moore, J.W., and Mata, A. “Women and Heroin in Chicano Communities.”

Unpublished manuscript, Chicano Pinto Research Project, Los Angeles,

1981.

Mott, F.L., and Haurin, R.J. Linkages between sexual activity and alcohol and

drug use among American adolescents. Fam Plann Perspect 20(3):128-136,

1988.

National Institute on Drug Abuse. National Household Survey on Drug Abuse:

Population Estimates 1988. DHHS Pub. No. (ADM)89-1636. Washington,

DC: Supt. of Docs., U.S. Govt. Print. Off., 1989.

Newcomb, M.D., and Bentler, P.M. Cocaine use among adolescents: Longitudinal associations with social context, psychopathology, and use of other

substances. Addict Behav 11(3):263-273, 1986.

Newman, R.G.; Cates, M.; Tytun, A.; and Werbell, B. Narcotic addiction in

New York City: Trends from 1968 to mid-1973. Am J Drug Alcohol Abuse

1(1):53-66, 1974.

Nichols, M. Theoretical concerns in the clinical treatment of substance-abusing

women: A feminist analysis. Alcohol Treat Q 2(1):79-90, 1985.

Nuttall, E., and Nuttall, R. Parental correlates of drug use among young Puerto

Rican adults. Am J Drug Alcohol Abuse 6(2):173-188, 1979.

Nyamathi, A., and Vásquez, R. Impact of poverty, homelessness, and drugs. Hisp

J Behav Sci 11(4):299-314, 1988.

Obeso, P., and Bordatto, O. Cultural implications in treating Puerto Ricans.

J Am Acad Psychoanal 2(2):129-137, 1974.
548

Oppenheimer, E. Alcohol and drug misuse among women: An overview. Br J

Psychiatry 158(Suppl 10):36-44, 1991.

Pearlin, L.I. The sociological study of stress. J Health Soc Behav 30(3):241-256,

1989.

Pearlin, L.I.; Menaghan, E.G.; Lieberman, M.A.; and Mullan, J.T. The stress

process. J Health Soc Behav 22:331-356, 1981.

Pickens, R.W., and Johanson, C.E. Craving: Consensus of status and agenda for

future research. Drug Alcohol Depend 30:127-131, 1992.

Reckman, L.W.; Babcock, P.; and O’Bryan, T. Meeting the child care needs of

the female alcoholic. Child Welfare 63(6):541-546, 1984.

Reed, B. Intervention strategies for drug-dependent women: An introduction.

In: Beschner, G.M.; Reed, B.G.; and Mondanaro, J., eds. Treatment Services

for Drug Dependent Women. Treatment Research Monograph Series. DHHS

Pub. No. (ADM)81-1177. Rockville, MD: National Institute on Drug

Abuse, 1981.

Reed, B. Drug misuse and dependency in women: The meaning and implications of being considered a special population or minority group. Int J

Addict 20:13-62, 1985.

Reno, R.R., and Aiken, L.S. Life activities and life quality of heroin addicts in

and out of methadone treatment. Int J Addict 28(3):211-232, 1993.

Rhoads, D.L. A longitudinal study of life stress and social support among drug

abusers. Int J Addict 18(2):195-222, 1983.

Robbins, C. Sex differences in psychosocial consequences of alcohol and drug

abuse. J Health Soc Behav 30:117-130, 1989.

Rohsenow, D.J.; Corbett, R.; and Devine, D. Molested as children: A hidden

contribution to substance abuse? J Subst Abuse Treat 5(Suppl. 1):13-18,

1988.

Rolfs, R.T.; Goldberg, M.; and Sharrar, R.G. Risk factors for syphilis: Cocaine

use and prostitution. Am J Public Health 80(7):853-857, 1990.

Rosenbaum, M. Becoming addicted: The women addicted: The woman addict.

Contemp Drug Probl 8:141-167, 1979.

Rosenbaum, M. Sex roles among deviants: The woman addict. Int J Addict

16:859-877, 1981.

Schilling, R.F.; El-Bassel, N.; Gilbert, L.; and Schinke, S.P. Correlates of drug

use, sexual behavior, and attitudes toward safer sex among AfricanAmerican and Hispanic women in methadone maintenance. J Drug Issues

21(4):685-698, 1991.

Senay, E. Methadone maintenance treatment. Int J Addict 20:803-821, 1985.

Sokolow, L.; Wetle, J.; Hynes, G.; et al. Treatment-related differences between

female and male alcoholics. J Addict Health 1:42-56, 1980.
549

Staats, G.R., and Poole, E.D. Changing orientations among cocaine users:

Consequences of involvement in community distribution networks.

Am J Drug Alcohol Abuse 6(3):283-290, 1979.

Stenbacka, M. Initiation into intravenous drug abuse. Acta Psychiatr Scand

81:459-462, 1990.

Stenbacka, M.; Allebeck, P.; and Romelsjo, A. Do cannabis drug abusers differ

from intravenous drug abusers? The role of social and behavioral risk

factors. Br J Addict 87(2):259-266, 1992.

Stephens, R. The truthfulness of addict respondents in research projects. Int J

Addict 7:549-558, 1987.

Straus, M. Measuring intrafamily conflict tactics scales. In: Straus, M.A., and

Gelles, R.J., eds. Physical Violence in American Families: Risk Factors and

Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction

Publishers, 1990.

Sutker, P. Drug dependent women: An overview of the literature. In: Beschner,

G.M.; Reed, B.G.; and Mondanaro, J., eds. Treatment Services for Drug

Dependent Women. Treatment Research Monograph Series. DHHS Pub.

No. (ADM)87-1219. Rockville, MD: National Institute on Drug Abuse,

1987.

Swanson, J.; Hozer, C.; and Ganju, V. Violence and psychiatric disorder in the

community: Evidence from the epidemiologic catchment area surveys. Hosp

Community Psychiatry 41:761-770, 1990.

Tennant, F. Dependency traits among parents of drug abusers. J Drug Educ 1:83-

88, 1976.

Thom, B. Sex differences in help-seeking for alcohol problems. 1. The barriers

to help-seeking. Br J Addict 81:777-788, 1986.

Toray, T.; Coughlin, C.; Vuchinich, S.; and Patricelli, P. Gender differences

associated with adolescent substance abuse: Comparisons and implications

for treatment. Family Relations 40:338-344, 1991.

Trimble, J. Ethnic specification, validation prospects, and the future of drug use

research. Int J Addict 25(2A):149-170, 1991.

Tucker, J.; Vuchihich, R.; and Harris, C. Determinants in substance abuse

relapse. In: Galizio, M., and Maisto, S.A., eds. Determinants of Substance

Abuse: Biological, Psychological, and Environmental Factors. New York:

Plenum Press, 1988.

Vega, W.A.; Gil, A.; Warheit, G.; Apospori, E.; and Zimmerman, R. The

relationship of drug use to suicide ideation and attempts among African

American, Hispanic, and white non-Hispanic male adolescents. Suicide Life

Threat Behav 23(2):110-119, 1993.

Wallace, B. Crack Cocaine: A Practical Treatment Approach for the Chemically

Dependent. New York: Brunner/Mazel, 1991.
550

Weissman, M.; Paykel, E.; and Klerman, G. The depressed woman as a mother.

Soc Psychiatry 7:99-108, 1972.

Winfree, T.; Beasley, R.; and Cary, K. The initiation and avoidance of drugs by

adolescents in the Southwest. J Drug Educ 11:327-341, 1981.

Yamaguchi, K., and Kandel, D.B. Patterns of drug use from adolescence to

young adulthood: II. Sequences of progression. Am J Public Health

74(7):668-672, 1984.

Zuckerman, B.; Amaro, H.; Bauchner, H.; and Cabral, H. Depressive symptoms

during pregnancy: Relationship to poor health behaviors. Am J Obstet

Gynecol 160:1107-1111, 1989.

ACKNOWLEDGMENT

This chapter was supported by National Institute on Drug Abuse

grant R01DA-09438 and National Institutes of Health through the

Research Center for Minority Institutions grant G13-RR-03051.

AUTHORS

Margarita Alegría, Ph.D.

Associate Professor

m_alegria@rcmaca.upr.clu.edu (E-mail)

Mildred Vera, Ph.D.

Associate Professor

m_vera@rcmaca.upr.clu.edu (E-mail)

Gisela Negrón, Ph.D.

Researcher

g_negron@rcmaca.upr.clu.edu (E-mail)

Margarita Burgos, Ph.Dc.

Research Assistant

m_burgos@rcmaca.upr.clu.edu (E-mail)

Carmen Albizu, M.D.

Associate Professor

c_albizu@rcmaca.upr.clu.edu (E-mail)
551

Center for Sociomedical Research and Evaluation

Graduate School of Public Health

Medical Sciences Campus

University of Puerto Rico

P.O. Box 365067

San Juan, PR 00936-5067

(787) 758-3189 (Tel)

(787) 759-6719 (Fax)

Glorisa Canino, Ph.D.

Professor

Behavioral Sciences Research Institute

Office of the Dean for Academic Affairs

Medical Sciences Campus

University of Puerto Rico

P.O. Box 365067

San Juan, PR 00936-5067

(787) 754-8624 (Tel)

(787) 767-5959 (Fax)

g_canino@rcmaca.upr.clu.edu (E-mail)