Substance Use Disorders Among Immigrants in the United States: Multigenerational Evidence of an Immigrant Paradox
An emerging body of evidence suggests that immigrants to the United States, relative to native-born Americans, are less likely to initiate and develop substance use disorders. Notably, however, the overwhelming majority of studies on this topic have been conducted exclusively with adolescent and young adult populations, or with immigrants from particular nations. Moreover, prior studies have typically not examined any potential differences that might emerge between first and second-generation immigrants or among immigrants from various regions of the world. In all, despite the advances made in recent years, there remains a pressing need for a comprehensive examination of the multi-generational and global links between immigration and substance use disorders among adults in the United States.
Method:
Study findings are based on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC is a nationally representative sample of non-institutionalized U.S. residents aged 18 years and older. Psychiatric interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM-IV version (AUDADIS-IV), which provides diagnoses for an array of mental and substance use disorders. Statistical analyses were carried out in multiple steps: First, logistic regression analyses were conducted that compared non-immigrants with first and second-generation immigrants in terms of lifetime substance use disorders (i.e. alcohol, cannabis, cocaine, stimulant, sedative, tranquilizer, opioid abuse/dependence). Next, multinomial regression analyses were conducted that compared non-immigrants with second-generation immigrants, childhood immigrants (e.g., immigrated before age 13), adolescent immigrants (i.e., immigrated between age 13-17), and adult immigrants (i.e., immigrated after age 18). All analyses were conducted with adults between the ages 18 and 49 (N = 19,073).
Results:
Controlling for sociodemographic factors (age, gender, race/ethnicity, household income, education level, marital status, region of the United States, urbanicity) as well as parental antisocial influence, parental substance use, and lifetime diagnoses of clinical and personality disorders, first-generation immigrants were between roughly 3 and 5 times less likely than second-generation immigrants to have met criteria for all substance use disorders examined in this study. Controlling for the same list of confounds, second-generation immigrants were significantly less likely than non-immigrants to have met criteria for alcohol (AOR = 0.65, 95% CI = 0.62-0.68), cannabis (AOR = 0.82, 95% CI = 0.76-0.87), sedative (AOR = 0.74, 95% CI = 0.58-0.94), and opioid (AOR = 0.81, 95% CI = 0.68-0.96) use disorders; however, no differences were observed in terms of cocaine, stimulant, or tranquilizer use disorders. Effects were largest among individuals who immigrated during adolescence and adulthood.
Conclusions and Implications:
Results provide robust evidence in support of a multigenerational immigrant paradox in which first-generation immigrants and, to a lesser extent, second-generation immigrants are less likely than native-born Americans to meet criteria for a host of substance use disorders. Moreover, the findings suggest that the older immigrants are at the time of immigration, the more robust the relationship between immigration and substance use disorders. These findings were consistent when examined among immigrants from major regions of the world including Latin America, Asia, Africa, and Europe.