Latinas in Recovery: Understanding the Evidence to Bridge Gaps in Service Disparities

August 23, 2016

Darice Orobitg, PhD
Training and TA Coordinator
National Hispanic and Latino ATTC

The National Hispanic and Latino ATTC symposium, Latinas in Recovery: Understanding the Evidence to Bridge Gaps in Service Disparities (September 14, 2016, Miami) will offer behavioral health professionals an opportunity to learn from experts while sharing their experiences in working with Latinas with substance use disorders.

The symposium will include presentations by researchers, clinicians, and Latinas in recovery. Their presentations will address the particular issues that may affect Latinas’ recovery processes. Presenters will also offer recommendations for professionals in the field. 

Conference objectives include: 

• Understanding disparities in behavioral health access and treatment and its relationship to gender.
• Identifying the complexities in understanding and treating Latinas in recovery who belong to other underserved populations.
• Promoting the formulation and implementation of behavioral health care services that address Latinas’ needs.

Following is an overview of some of the key issues that they symposium will cover.

Underlying factors for Latinas' substance use

Gender has been identified as a determinant of health, with women experiencing differences in rates of substance use and mental health issues. Gender risks may be acquired, multiple, and interconnected. Given that women experience higher levels of poverty, discrimination, and gender-based violence, it is critical to recognize and address issues that are particular to women in providing services and developing programs and models. For Latinas, it is important to consider not only gender related-factors, but also how minority status and culture-related issues may further contribute to increased rates of substance use and also hinder access to and use of behavioral health services. 

Gender-based violence

As the largest minority in the US, Hispanics and Latinos comprise 17% of the total US population, with 49.35% being women. In terms of substance use:

• In 2007, 32.3% of the approximately 1.8 million admissions to substance use treatment in the U.S. were female.
• Among women, Latinas have been found to report higher rates of lifetime use of alcohol and illicit drugs.
• Higher severity rates at intake have also been found among Latinas when compared to their male counterparts, along with lower levels of help-seeking for Latinas with substance dependence. (Guerrero, 2013; Grella and Stein, 2013).
• Data indicates that more Latinas are uninsured when compared to other women.

Gender-based violence is a reality that must be addressed when working with all women, including Latinas. According to the National Crime Victimization Survey, 1 in 6 females ages 13 or older experience rape, attempted rape, or sexual assault (OVC, 2016). Campesinos or female farm workers are 10 times more vulnerable than others to sexual assault and harassment at work (Lopez-Treviño, 1995.) Among all the burdens Latinas bear, these are often the heaviest. Immigrant Latina domestic workers are especially vulnerable to sexual exploitation because they depend financially on their employers, live in constant fear of being deported, suffer social isolation, and may be vulnerable to their employer's demands. 

Based on the US Census Bureau projections, by the year 2050 the number of Latinas who have had violent experiences may reach 10.8 million. However, in the National Violence Against Women Survey, Latinas were less likely to report rape than other groups (OVC, 2016). In another report, 77% of Latinas surveyed indicated that sexual harassment was a major issue in their workplace (Southern Poverty Law Center, 2009). Research indicates that women survivors of sexual abuse in all its manifestations are more vulnerable to substance use than those without histories of sexual abuse. Authors have suggested that substance use may be a way of coping with symptoms related to Post Traumatic Stress Disorder (PTSD) and depressive symptomatology associated with experiences of trauma and violence.

Intimate partner violence

In terms of Intimate Partner Violence (IPV), national statistics report that approximately 1 in 3 Latinas have experienced physical violence by an intimate partner, and 1 in 12 report such events in the previous 12 months (Klevens, 2014).  Reported rates of IPV were lower for Mexican immigrants (13.4%) than for persons of Mexican descent born in the U.S.  Data also indicates that immigrant women (including Latinas) who are married are more likely to experience IPV than unmarried women. A study that included 2,000 Latinas found 63.1% of women identified being victimized in their lifetime. 

The intersection between IPV and substance use 

The intersection between IPV and substance use among Latinas has been recognized as a significant factor for treatment and recovery.  Studies have suggested that substance use among women survivors of IPV may be encouraged or forced to use substance by an abusive partner as a control mechanism, which may prevent women from accurately assessing the level of danger posed by their perpetrators. Substance use and withdrawal symptoms may make it difficult for women who use substances and are in a violent relationship to access services such as shelter, advocacy, or other forms of help. 

Co-occurring substance use and PTSD

Research on substance use has documented high rates of co-occurring substance use and PTSD. For women, these rates range from 30-59%; two to three times higher than for men (Najavits, 2007).  These studies report higher rates of PTSD than for the general population of women; providing further evidence on the intersection between the two. Furthermore, when studies of women who use substances consider a lifetime history of trauma (vs. a diagnosis of PTSD), rates of victimization range from 55-99%. These studies have found that women report more experiences of victimization, by multiple perpetrators, and for longer periods of time. This in turn, may result in a complex manifestation of symptoms that will require attention to co-occurring disorders. 

Culture, substance use treatment, and recovery for Latinas

Latina survivors experience specific, culture-related barriers to services that need to be taken into consideration while developing programs and interventions. There remains still a lack of bilingual, integrated services that facilitate engagement for substance use and violence/trauma. 

Also, programs and clinicians should consider the cultural values of Latina survivors. For example, traditional gender role expectations known as machismo and marianismo play a role in the way IPV is understood and faced by many. Also, familism, which encompasses a family-centered approach to life, may play a role in a Latina's decision to stay in an abusive relationship. Spirituality may also play a role in a person’s understanding of IPV.  All of these elements are important to consider in the recovery process for a Latina as well as in developing programs and interventions. 

Immigration status, lack of health insurance, and lack of gender-specific support groups

Other barriers Latinas face in terms of services include immigration status, lack of health insurance, and lack of women-oriented support groups for recovery. Some programs do not provide services for individuals without citizenship documentation. Cultural and physical isolation may prevent a Latina survivor from accessing services. There also exists a lack of trust in a system that has been oppressive towards immigrants. Treatment centers or shelters that exclude women who use substances may also serve as a barrier to services due to the highly documented intersection of these two issues.

The workforce working with Latinas needs to understand how these factors affect their clients with--or at risk of developing-substance use disorders. Please join us in Miami on September 14 as we explore ways to support Latinas in their recovery process and help them achieve health and wellness.  

Click here to register for the symposium.

Related Resources from the National Hispanic and Latino ATTC Network:

Bilingual Fact Sheets: 

Gender-responsive treatment: Recognizing women's realities when addressing substance use disorders 

Intimate partner violence in Hispanic and Latino populations 

Webinars

January 2016, Part 1: Substance Use, Domestic Violence, and Latinas: Examining the Intersections

March 2016, Part 2: Substance Use, Domestic Violence, and Latinas: Examining the Intersections

References

Bureau of Justice Statistics. (2004). National Crime Victimization Survey. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.

Encuentro Latino.  (May, 2015).  The Facts on Latinos and Domestic Violence [Fact sheet].  Retrieved from: http://www.latinodv.org/handouts.php

Grella, CE and Stein, JA. (2013).  Remission from substance dependence: differences between individuals in a general population longitudinal survey who do and do not seek help.  Drug and  Alcohol Dependence.  Nov 1;133(1):146-53. doi: 10.1016/j.drugalcdep.2013.05.019. Epub 2013 Jun 21.

Klevens, J. (2007). An overview of intimate partner violence among Latinos. Violence Against Women, 13 (2), 111-22

Lopez-Treviño, Maria Elena. 1994. "The Needs and Problems Confronting Mexican American and Latin Women Farmworkers: A Socioeconomic and Human's Right Issue." (Unpublished on file with author.) Cited by Maria Ontiveros. 2003. "Lessons from the Fields: Female Farmworkers and the Law," Maine Law Review 55:157, 168.

Office of Victims of Crime.  (2016).  Existe Ayuda: Help Exists [fact sheet].  Retrieved from:  http://www.ovc.gov/pubs/existeayuda/tools/factsheets.html

Navajits, L., Weiss, R.D. & Shaw, S.R.  (1997). The link between substance abuse and posttraumatic stress disorder in women: A research review.  The American Journal of Addictions, 4(4) 273-283.

Najavits, L.M. (2007). Seeking Safety: An evidence-based model for substance abuse and trauma/PTSD. In K.A. Witkiewitz & G.A. Marlatt (Eds.). Therapist's guide to evidence based relapse prevention: Practical resources for the mental health professional (pp. 141-167). San Diego: Elsevier Press.  

Southern Poverty Law Center. (2009). “Sexual Abuse/Discrimination.” Under Siege: Life for Low-Income Latinos in the South. Montgomery, AL: Southern Poverty Law Center. Available at: www.splcenter.org/publications/undersiege-life-low-income-latinos-south/4-sexual-abuse-discrimination.

Ulibarri, M.D., Ulloa, E.C., and Salazar, M. (2015). Mental health and substance use implications for  sexual abuse experiences among Latinas. Journal of Child Sexual Abuse, 24(1), 35-54.

United States Census Bureau / American Fact Finder. “Hispanics by place of origin.” 2011-2013    American Community Survey. U.S. Census Bureau’s American Community Survey Office, 2013. Web. 1 December, 2014 <http://factfinder2.census.gov>.

World Health Organization (2016). Gender Disparities in Mental Health. Retrieved from:  http://www.who.int/mental_health/media/en/242.pdf?ua=1

Darice Orobitg, PhD, is the Training and Technical Assistance Coordinator for the National Hispanic and Latino ATTC. s. Originally from San Juan, PR., Dr. Orobitg received her BA in psychology at Washington University in St. Louis. She obtained her Ph.D. in Clinical Psychology from the Carlos Albizu University in San Juan, PR. As a research assistant, her focus was on child assessment and intervention and she later coordinated an NICHD sponsored study for Innovaciones Psicoeducativas (ISIED, Inc.) on early identification of learning and developmental disabilities. As a clinician, she has experience working in the Puerto Rico Rape Crisis Center as therapist, educator, and services coordinator. She has been in private practice since 2005.