RESUMO
BACKGROUND: Heroin use is a public health concern in the United States. Despite the unique etiology and patterns of heroin use among U.S. Latinos, long-term heroin trajectories and health consequences among Latinos are not well understood. This study aims to document the distinct heroin use trajectories for a group of street-recruited (non-treatment), young adult Mexican American men living in a disadvantaged community who were affiliated with gangs during their youth. METHODS: One-time interviews conducted between 2009-2012 in San Antonio, TX collected retrospective data from a sample of 212 Mexican American young adult men who reported using heroin at least once. Group-based trajectory modeling was applied to determine discrete developmental trajectories of heroin use. ANOVA, Chi square tests, and multinomial logistic regression examined current (past year) social and health indicators among each trajectory group. RESULTS: Five discrete heroin trajectories groups were identified: low use (nâ¯=â¯65); late accelerating (nâ¯=â¯31); early decelerating (nâ¯=â¯26); late decelerating (nâ¯=â¯38); and stably high (nâ¯=â¯52). Varying social and health consequences were found among the trajectory groups. CONCLUSION: This study describes the unique heroin use trajectories and social and health outcomes among a high-risk subgroup of Mexican American men. The findings suggest that early intervention and intervention available in easy to access non-treatment spaces may be especially useful for groups of people who use relatively less heroin.
Assuntos
Dependência de Heroína/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Grupo Associado , Adolescente , Adulto , Dependência de Heroína/etnologia , Dependência de Heroína/psicologia , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Americanos Mexicanos/psicologia , Estudos Retrospectivos , Texas/epidemiologia , Adulto JovemRESUMO
Understanding the effect of cultural values on depression and how social networks influence these relationships may be important in the treatment of substance-using, Mexican American populations. Latino cultural values, familismo, personalismo, fatalismo, and machismo, may be associated with depression among Latinos. The current study identified the association of traditional Latino values on depressive symptomatology among a sample of Mexican American heroin injectors. A cross-sectional research design and field-intensive outreach methodology were utilized to recruit 227 Mexican American men. Participants were categorized into depressed and nondepressed groups. Relations among cultural values and depression were examined using logistic regression. Findings indicate that drug-using men with higher familismo and fatalismo scores are protected against depressive symptomatology. Relations between familismo and depression seem to be moderated by having a drug use network. In addition, findings reveal that age is inversely related to depressive symptomatology. Young Mexican American heroin users who do not ascribe to traditional Latino values may be highly associated with depression and therefore more vulnerable to riskier drug use behaviors. Moreover, drug-using social networks may affect the protective nature of certain cultural values. Further research is needed to identify whether culturally tailored treatments can cultivate these values while simultaneously undermining the effect of substance-using social networks in order to reduce depression symptoms among this group of high-risk substance users.
Assuntos
Depressão/epidemiologia , Usuários de Drogas/psicologia , Dependência de Heroína/epidemiologia , Americanos Mexicanos/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Estudos Transversais , Características Culturais , Depressão/etnologia , Dependência de Heroína/etnologia , Dependência de Heroína/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Proteção , Fatores de Risco , Rede Social , Abuso de Substâncias por Via Intravenosa/etnologia , Abuso de Substâncias por Via Intravenosa/psicologiaRESUMO
OBJECTIVE: To examine the applicability of the "maturing out" theory to a sample of aging Mexican American men who are long-term heroin injectors. METHOD: Ethnographic data were collected as part of a cross-sectional study of aging Mexican American heroin users in Houston with 20 current heroin users. RESULTS: Findings indicate that dysfunctions that emerge in the heroin lifestyle lead not to cessation but rather to "maturing in," a specific process of social readjustment that returns the heroin user to a stable maintenance pattern of use instead of a recovery phase. This process of paradoxical maturing out can be attributed to the unconditional social support provided to the heroin user by family, peers, and the tecato subculture embedded in Mexican American communities. DISCUSSION: Results highlight the implications for the intersection of heroin-related conditions, natural age-related impairments, and cognitive functioning that make this population increasingly susceptible to adverse health consequences.
Assuntos
Envelhecimento/etnologia , Dependência de Heroína/etnologia , Americanos Mexicanos/psicologia , Teoria Psicológica , Abuso de Substâncias por Via Intravenosa/etnologia , Idoso , Estudos Transversais , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
Clinical and cultural characteristics of Hispanic adolescent heroin users are not well described. The current exploratory study was conducted to describe a sample of in-treatment Hispanic adolescents with opioid dependence, specifically, cheese heroin. Mexican and Mexican American adolescents with heroin dependence (N = 72) in three treatment programs were interviewed and completed self-report measures. Participants reported, on average, first using cheese heroin at age 13.5 years and daily use at age 14.2 years. The majority (74%) reported a previous overdose. Adolescents being raised by caregivers other than both biological parents, who used drugs with relatives, and whose immediate family members have documentation to be in the United States fared worse on several indicators of drug use severity and other risky behaviors. The self-reported brief time period from first use to daily use strongly suggests the need for early prevention efforts. Additional research is needed to add to these preliminary results and inform prevention efforts.
Assuntos
Overdose de Drogas/epidemiologia , Dependência de Heroína/reabilitação , Americanos Mexicanos/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias , Adolescente , Estudos Transversais , Overdose de Drogas/etnologia , Família , Feminino , Dependência de Heroína/etnologia , Humanos , Masculino , México/etnologia , Estados UnidosRESUMO
Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users' adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.
Assuntos
Cultura , Dependência de Heroína/etnologia , Americanos Mexicanos/psicologia , Abuso de Substâncias por Via Intravenosa/etnologia , Síndrome de Abstinência a Substâncias/etnologia , Idoso , Idoso de 80 Anos ou mais , Dependência de Heroína/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/reabilitação , Síndrome de Abstinência a Substâncias/prevenção & controle , Inquéritos e Questionários , TexasRESUMO
We used an intersectional minority stress perspective to examine the association between family/cultural stress and mental health among substance-using Mexican-Americans. Employing a unique longitudinal sample of 239 socioeconomically disadvantaged, non-injecting heroin-using Mexican-Americans from San Antonio, Texas, we examined how culturally relevant stressors are related to depression and suicidal ideation. First, we identified depression and suicidal ideation prevalence rates for this disadvantaged sample. Second, we determined how cultural stress is experienced over time using stress trajectories. Third, we evaluated how family/cultural stressors and stress trajectories are related to depression and suicidal ideation outcomes. Results showed high rates of baseline depression (24 %) and suicidal ideation (30 %). We used latent class growth analysis to identify three primary stress trajectories (stable, high but decreasing, and increasing) over three time points during 1 year. We found that the increasing stressors trajectory was associated with higher rates of depression and suicidal ideation, and that stress trajectories had unique relationships with mental illness. We also showed that baseline stressors, sum stressors, and high but decreasing stressors maintained positive associations with mental illness after controlling for baseline depression. Our results highlight the importance of focusing on within-group, culturally specific stressors and addressing both operant and cumulative stressors in the study of mental health for marginalized populations and suggest the importance of early intervention in minimizing stressors.
Assuntos
Características Culturais , Transtorno Depressivo/psicologia , Família , Dependência de Heroína/psicologia , Americanos Mexicanos/psicologia , Estresse Psicológico/psicologia , Ideação Suicida , Aculturação , Adolescente , Adulto , Estudos de Coortes , Transtorno Depressivo/etnologia , Progressão da Doença , Feminino , Dependência de Heroína/etnologia , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Modelos Estatísticos , Prevalência , Estresse Psicológico/etnologia , Texas/epidemiologia , Adulto JovemRESUMO
This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.
Assuntos
Dependência de Heroína/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Apoio Social , Abuso de Substâncias por Via Intravenosa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dependência de Heroína/etnologia , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/etnologiaRESUMO
Using a sample of 280 Puerto Rican drug users with a history of incarceration residing in Massachusetts, we explore whether a significant association exists between social and economic factors (maintaining social network contacts, receiving public assistance) and lifetime incarceration. Analysis of survey data using regression methods shows that respondents who live in their own home, receive public assistance, and have recent familial contact are significantly less likely to have been incarcerated in the past 6 months. Among study participants, men and those who initiated heroin use at younger ages are more likely to have greater lifetime incarceration totals. Practice implications are discussed.
Assuntos
Dependência de Heroína/epidemiologia , Prisioneiros/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idade de Início , Relações Familiares , Feminino , Dependência de Heroína/etnologia , Habitação/estatística & dados numéricos , Humanos , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Assistência Pública/estatística & dados numéricos , Porto Rico/etnologia , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/etnologia , Adulto JovemRESUMO
INTRODUCTION: Existing research has documented high comorbid rates for injecting drug use (IDU) and social and health consequences including HIV infection, a condition that disproportionately affects U.S. Hispanic populations. Few studies have examined the specific associations between injecting transition risk among non-injecting heroin using (NIU) populations and mental health conditions. This study hypothesizes that injecting transition risk will be strongly associated with depression symptomatology controlling for age and gender among Mexican American NIUs. METHODS: Street-recruited NIUs (n=300) were administered structured interviews. The Mexican American sample was predominantly male (66%), unemployed (75%) with more than half experiencing incarceration in their lifetimes (58%). Depression was measured using the CES-D scale. Univariate and multivariate logistic regression analysis were employed to determine the associations between the dependent variable of heroin injecting transition risk and the key independent variables of depression symptomatology and other independent variables. RESULTS: Depression symptomatology was the strongest independent correlate of injecting transition risk. Those NIUs with high levels of depression symptomatology had more than three times the heroin injecting transition risk than those NIUs with low levels. Heroin use network influence was also found to be a strong correlate. Acculturation level was significantly associated with injecting transition risk. CONCLUSION: The comorbid condition of depression symptomatology and heroin use places Mexican American NIUs at elevated risk of contracting blood-borne pathogens such as HIV. Development of prevention and treatment strategies that target Hispanic non-injecting heroin users in socially disadvantaged communities should consider depression symptoms and develop interventions that build new social networks.
Assuntos
Depressão/etnologia , Dependência de Heroína/etnologia , Americanos Mexicanos/etnologia , Abuso de Substâncias por Via Intravenosa/etnologia , Estudos de Coortes , Depressão/complicações , Depressão/psicologia , Feminino , Seguimentos , Infecções por HIV/etnologia , Infecções por HIV/etiologia , Infecções por HIV/psicologia , Dependência de Heroína/psicologia , Humanos , Masculino , Americanos Mexicanos/psicologia , Estudos Prospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/etiologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto JovemRESUMO
We examined correlates of ever injecting drugs in Mexico among residents of San Diego, California. From 2007 to 2010, injecting drug users (IDUs) in San Diego underwent an interviewer-administered survey. Logistic regression identified correlates of injection drug use in Mexico. Of 302 IDUs, 38% were Hispanic, 72% male and median age was 37; 27% ever injected in Mexico; 43% reported distributive syringe sharing there. Factors independently associated with ever injecting drugs in Mexico included being younger at first injection, injecting heroin, distributive syringe sharing at least half of the time, and transporting drugs over the last 6 months. One-quarter of IDUs reported ever injecting drugs in Mexico, among whom syringe sharing was common, suggesting possible mixing between IDUs in the Mexico-US border region. Prospective studies should monitor trends in cross-border drug use in light of recent Mexican drug policy reforms partially decriminalizing drug possession.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Dependência de Heroína/etnologia , Abuso de Substâncias por Via Intravenosa/etnologia , Viagem/estatística & dados numéricos , Adulto , Fatores Etários , California/epidemiologia , Feminino , Humanos , Masculino , México , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Assunção de Riscos , Fatores SocioeconômicosRESUMO
OBJECTIVES: Research on the health consequences of long-term injection drug use (IDU) is limited. This article examines these consequences among aging, male Mexican American injecting heroin users. Concern for this group is crucial, given its health disparities and the association of IDU with disease transmission. METHOD: Aging, male Mexican American IDUs (N = 227) were recruited through intensive outreach. Participants self-reported health status, medical and substance use history, and completed behavioral and psychometric health scales. RESULTS: Results: Participants had significantly poorer self-rated health and negative health conditions. Selected medical conditions not associated with the heroin-use lifestyle (i.e., hypertension, diabetes, arthritis) were lower relative to the comparison samples. DISCUSSION: This population has a complex profile of health consequences linked to a heroin-using lifestyle. The study concludes that routine screening of infectious diseases and medical and behavioral conditions among aging substance using populations may contribute to reducing Hispanic health disparities.
Assuntos
Envelhecimento/etnologia , Disparidades nos Níveis de Saúde , Dependência de Heroína/etnologia , Americanos Mexicanos/psicologia , Abuso de Substâncias por Via Intravenosa/etnologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Infecções por HIV/etnologia , Infecções por HIV/etiologia , Dependência de Heroína/complicações , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/complicações , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To assess the incidence and rate of transition to injecting among Mexican American noninjecting heroin users. METHODS: In a prospective cohort study of street-recruited MA-NIU in San Antonio, Texas, 2002-2005, participants were administered structured interviews and tested for Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). The analysis sample comprised former injection drug users (last injected >6 months ago, n=47) and those who had never injected drugs and tested HCV negative (n=219). A transition to injecting was defined as the first injection of illicit drugs since baseline interview. Transition rates were based on person-years at-risk (PYAR). Proportional hazards regression was used to estimate crude and adjusted (for significant differences between former and never injectors) hazard ratios and 95% confidence intervals of injecting history on transitioning to injecting. RESULTS: Sixty-three (24%) participants transitioned to injecting at a rate of 22.3/100 PYAR (95% CI: 17.2-28.2). Former-injectors were significantly more likely to transition than never injectors (43% or 20/47 vs. 20% or 43/219; p<0.001), and did so at a faster rate (40.4/100 PYAR, 95% CI: 24.6-60.0 vs. 18.5/100 PYAR, 95% CI: 13.4-24.4), with the crude HR=1.931 (95% CI: 1.116, 3.341) and adjusted HR=2.263 (95% CI: 1.192-4.294). CONCLUSIONS: The rate of transitioning to injecting was high and greater among former injectors. Of particular concern is the high rate of injecting initiation among never injectors. Future analyses will examine factors associated with injecting initiation, including individual susceptibility and behaviors, social networks, and the cultural and drug market context.
Assuntos
Dependência de Heroína/etnologia , Dependência de Heroína/psicologia , Americanos Mexicanos/etnologia , Americanos Mexicanos/psicologia , Abuso de Substâncias por Via Intravenosa/etnologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adolescente , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de Risco , Texas/etnologia , Adulto JovemRESUMO
This paper provides a brief review of the addictions field in Latin America. Epidemiology, legal aspects, dual pathology, treatment, prevention and future directions are discussed. This increasing disease is one of the major contributors for mental health problems in the region. Efforts have been made in treatment and prevention but results and budgets are scarce. Dual pathology, new modalities such as injected heroin in countries such as Colombia, low coverage of programmes, training resources, research and publications are important challenges. The tendency to liberalize legal terms of use would require more effort for prevention and education. Based on relevant literature and a long and current experience in the area, the authors summarize this important theme.
Assuntos
Psiquiatria/tendências , Transtornos Relacionados ao Uso de Substâncias/etnologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Colômbia/epidemiologia , Comparação Transcultural , Características Culturais , Dependência de Heroína/etnologia , Dependência de Heroína/prevenção & controle , Humanos , América Latina/epidemiologia , Psiquiatria/legislação & jurisprudência , Meio Social , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
This study examines potential risk factors for resuming and transitioning to injecting among a prospective cohort of 300 Mexican American non-injecting heroin users (NIUs) with distinct injecting histories (i.e., never vs. former injectors). Overall, findings revealed NIUs with an injecting history are more likely to be at greater risk for resuming injecting practices. Of interest, scoring high on acculturation decreased the risk of being a former injector. The present analysis supports previous research, and more importantly further identifies potential risk factors for injecting that are unique to the cultural and social context of the Mexican American community.
Assuntos
Aculturação , Dependência de Heroína/psicologia , Americanos Mexicanos/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Adolescente , Adulto , Patógenos Transmitidos pelo Sangue , Estudos de Coortes , Coleta de Dados , Feminino , Seguimentos , Dependência de Heroína/etnologia , Humanos , Incidência , Masculino , Prevalência , Estudos Prospectivos , Fatores de Risco , Doenças Virais Sexualmente Transmissíveis/etnologia , Abuso de Substâncias por Via Intravenosa/etnologia , Texas/etnologiaRESUMO
AIMS: To describe and assess the changing trends in socio-demographic, risk, clinical and immunological parameters in male intravenous drug users (IDU) with AIDS. DESIGN, SETTING AND PARTICIPANTS: Baseline description by year of entry of 610 male IDU with AIDS who entered into a cohort study in Bayamón, Puerto Rico, from 1992 to 2000. Study participants were evaluated at in-patient health-care facilities in the University Hospital Ramón Ruiz Arnau or in the ambulatory immunology clinic facilities. FINDINGS: The median age at which subjects entered the study and the proportion of patients with an educational level lower than a high school degree increased from 1992 to 2000. Upward trends were also observed in the practice of injecting non-prescription drugs during the last 12-month period, the practice of needle sharing and the use of a combination of heroin and cocaine ('speedballs'). Higher proportions of subjects were also diagnosed with wasting syndrome and bacterial pneumonia. The median CD4 count recorded at entry decreased over the course of the study. CONCLUSIONS: Puerto Rican male IDU diagnosed with AIDS are arriving at health-care facilities in the latest stages of the disease. Better and early interventions with different health care approaches need to be developed.
Assuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/etnologia , Adulto , Distribuição por Idade , Contagem de Linfócito CD4 , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/etnologia , Estudos de Coortes , Escolaridade , Dependência de Heroína/complicações , Dependência de Heroína/epidemiologia , Dependência de Heroína/etnologia , Humanos , Masculino , Uso Comum de Agulhas e Seringas , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/etnologia , Prevalência , Porto Rico/epidemiologia , Porto Rico/etnologia , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/etnologia , Síndrome de Emaciação/complicações , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/etnologiaRESUMO
Between September 1993 and December 1995, 528 foreign individuals at risk of HIV infection attended the drug treatment centre located in the Santo Spirito Hospital in Rome, undergoing medical examination, HIV testing and counselling. The geographic distribution showed that the majority of the participants were from South America (40.0%), most of whom were transsexual sex workers (from Brazil or Columbia), and from North Africa (37.5%); all the individuals coming from Western and Eastern Europe and the USA were heroin users. The overall HIV prevalence was high (21.6%), though it varied by nationality, ranging from 5.1% among North Africans to 68.3% among Brazilian transsexuals. During the study period, 170 of the individuals returned for at least one follow-up visit. Three seroconversions occurred among the 118 initially HIV-negative immigrants who were retested, all three among the 26 HIV-negative Columbian transsexuals; the seroconversion rate within this group was 10.1 per 100 persons/years. During follow-up, there was no reduction observed in drug-related practices associated with HIV infection, yet a general increase in regular condom use was reported. The increasing number of foreign persons contacting our programme emphasizes the need for easy access to care and treatment for marginalized populations possibly engaging in behaviour at risk for HIV infection. Counselling strategies seem to be relatively effective in promoting safer sex among these population groups.
Assuntos
Infecções por HIV/prevenção & controle , Adulto , África/etnologia , Assistência Ambulatorial/estatística & dados numéricos , Estudos Transversais , Europa Oriental/etnologia , Feminino , Infecções por HIV/etnologia , Soroprevalência de HIV , Dependência de Heroína/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Assunção de Riscos , Cidade de Roma/epidemiologia , Trabalho Sexual , América do Sul/etnologia , Transexualidade , Estados Unidos/etnologiaAssuntos
Grupos Minoritários/psicologia , Refugiados/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Alcoolismo/etnologia , Alcoolismo/psicologia , Camboja/etnologia , Cocaína , Cuba/etnologia , Etiópia/etnologia , Feminino , Dependência de Heroína/etnologia , Dependência de Heroína/psicologia , Humanos , Laos/etnologia , Masculino , Fumar Maconha/etnologia , Fumar Maconha/psicologia , Oriente Médio/etnologia , Ópio , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos , Vietnã/etnologiaRESUMO
Part I of this series compared characteristics of 546 Chicanos and Anglo men and women methadone maintenance (MM) clients. In Part II, specific differences between Chicanos and Anglos are analyzed, by sex, for each of five stages in the addiction career: preexperimentation, experimentation addiction, initial MM treatment, and posttreatment. The analysis examines narcotic and other drug use, arrest, incarceration and legal supervision histories, criminal involvement, employment, interpersonal relationships, and treatment history. Whereas preaddiction differences between addicts parallel ethnic differences found in the general population, after addiction occurs the similarities are greater than the dissimilarities between ethnic groups, except for Chicanas. Chicanos appear to continue to function as part of their community after addiction, but Chicanas appear to risk becoming marginal. Treatment outcomes for Chicanos were, in general, less successful than for Anglos.