Community Influences On Heroin Injecting Older Mexican Americans

Background and Purpose. Latino older adults currently account for 7% of the older adult U.S. population.  By 2050, approximately 20% of older adults will be Latinos, constituting the largest minority older adult group. In 2009, a nationally representative study found drug abuse among individuals aged 50 and 59 increased to 6.2 from 2.7 percent a decade earlier.  The older adult Latino population will increase six fold in the next forty years, presenting epidemiological concerns about heroin injecting drug user (IDU). The term tecatos refers to long-term or intermittent, late or new starters, or returning heroin users, relapsing after sustained periods of cessation. Current literature on addictive behaviors provides limited information on older heroin users’ relapse behaviors. Using a qualitative approach, study explores determinants of heroin relapse among tecatos and implications for relapse prevention and culturally responsive interventions. 

Methods. Intensive Life History Interviews of tecatos (N=18) were conducted with former heroin users, current heroin users, or users in methadone treatment. Interviews were randomly selected from a subsample of 61 ethnographies, and were transcribed in English and Spanish by bilingual/bicultural translators. This paper uses an exploratory qualitative research design via content analyses with open, axial, and selective coding to develop categories, concepts, and themes that addressed the research questions. These analyses allowed researchers to explore behavioral patterns, practices, significant events, relationships, and lifestyles or subcultures and exemplars utilizing thick descriptions.  The Successive Approximation model enabled researchers to navigate between abstract, vague ideas to more explicit, concrete detail that led to comprehensive analysis with generalizations.

Results. Five major themes emerged related to community influences on relapse. The first theme was economic stressors and included the interrelated factors of poverty, homelessness and unemployment. Combined, these three stressors prevented respondents from extricating themselves from a vicious cycle of despair and hopelessness, ultimately resorting to a negative coping strategy of heroin IDU. The second theme was peer-based social networks of friends and neighbors which were highly instrumental in relapse and continuation of heroin drug use. The third theme was a return to environment as a community factor that led IDU’s to resume their heroin injecting use after periods of cessation. Neighborhood saturated with drug dealers and users were an environmental proximal factor resulting in a contextual-based cue reactivity triggering a resumption of IDU. The fourth theme was the ready availability of heroin, and not limited to the barrios. Heroin availability was reported during military service, in work settings, family networks, and peer social networks. The fifth theme was the influence of intimate partners and familial influences concentrated among in-generation family-based social networks.

Conclusions and implications. Older Mexican American IDUs face multiple contextual barriers that hinder their ability to remain drug free and trigger relapse. These barriers must be addressed in a culturally-grounded and context-relevant manner to give these individuals and their communities a true chance at a drug-free life.