Sangre Mala, Sangre Buena/Good Blood, Bad Blood: The Role of Familismo As Risk and Protective Factor in Heroin-Injecting Mexican American

Background: Cultural values such as Familismo (familism) have been found to influence initiation of substance use, treatment initiation, and cessation of substance abuse and more specifically, injection drug use. Numerous health and psychosocial consequences are associated with injection drug use (IDU) including increased rates of HIV and Hepatitis B/C. Between 2007 and 2009, 4.8 million adults 50 years and older report using illicit drugs over the last year. Rates of substance abuse treatment among the elderly have increased significantly since 2000. Moreover, researchers predict elderly substance use disorders will double by 2020 partly due to the retirement of the baby-boomers who have increased rates of drug use. Public health implications for aging Hispanics are of particular concern given projected Hispanic population growth. Morbidity and mortality of IDU is disproportionately associated within minority communities and heroin is most commonly used among Mexican-American Hispanics who represent the largest number of IDUs. Culture has been found to influence perceptions of substance abuse, treatment initiation, personal responsibility, and enabling behaviors. Initiation and recovery from substance abuse may be impacted by certain Hispanic cultural values such as familismo. For instance, substance abuse may be considered a private family matter, thus, professional help is not considered. Familismo has been found to function as both a risk and a protective factor with regards to drug use. Prevalence rates for health-risk behaviors are significantly higher in more acculturated Hispanics, suggesting that more traditional cultural values may protect the less acculturated. This paper examines the role of familismo in initiation, treatment, and cessation of IDU in aging Mexican-American heroin users.

Methods: A cross-sectional research design and field-intensive outreach methodology were utilized. Trained outreach specialists recruited 227 Mexican-American men with at least a 3-year history of IDU, were current injectors, former injectors, or on methadone. Ethnographic interviews utilizing an open-ended, semi-structured interview guide were administered collecting data on drug use trajectories, demographics, health histories. Exploratory qualitative research design using content analysis was utilized to identify thematic categories via iterative review. Frameworks of assumptions and concepts were identified from an initial analysis and a more focused successive approximation methodology was implemented to extract thicker, richer data.

Results: Familismo was found to influence both initiation and cessation of heroin use and played a significant role in the ability to abstain from heroin over longer periods of time. Moreover, familismo functioned in a dichotomous role for initiation and cessation. A majority of participants reported being initiated into IDU by a male family member (brother, uncle, close family friend). Additionally, a vast majority of these participants reported cessation of IDU influenced by a female family member (mother, sister, or wife). One individual reported, “I stopped [heroin use] because I didn’t want my mother to die seeing me this way.”

Conclusions: This study provides an alternative viewpoint for informing unique and novel approaches to drug abuse treatment. Our findings demonstrate the importance of cultural values on substance abuse initiation and cessation and can aid in the development of future interventions.