Cultural Complexities: Examining the Roles of Discrimination, Acculturation, and Spirituality in Alcohol Use Among Minority Young Adults

Background and Purpose: Young adults (YA) from racial and ethnic minority groups in the United States face significant disparities in alcohol use disorders (AUD), worsened by factors such as discrimination, acculturation stress, and spirituality conflicts. Despite these disparities, treatment engagement rates remain low among these groups. The present study examines the intersections of discrimination, acculturation, and spirituality in relation to alcohol use, through the lens of beliefs and lived experiences of Asian, Black/African American, and Latine YA with AUD.

Methods: This qualitative study employed purposive sampling methods to recruit participants who (1) were aged 18 to 29, (2) self-identified as Asian, Latine, or Black YA, and (3) had moderate to severe AUD. Semi-structured individual interviews were conducted virtually via Zoom. Concepts were explored surrounding participants' experiences with discrimination, acculturation-related stressors, spirituality, substance use behaviors, and treatment perceptions. Interview transcripts were stored and analyzed in Dedoose. A team of four researchers co-coded interview transcripts and built consensus around emerging themes and subthemes. A codebook was developed, and themes were produced and analyzed.

Results: The sample comprised 34 participants (60% female; average age 24.1 years). Analysis revealed five overarching themes with multiple subthemes: 1) multidimensional experiences of discrimination (sub-themes: racial microaggressions, systemic barriers, intra-community biases), 2) acculturation stress and substance use behaviors (sub-themes: identity conflicts, cultural isolation, coping through alcohol), 3) spirituality as protective and risk factor (sub-themes: spiritual coping mechanisms, religious stigmatization of AUD, spiritual identity conflict), 4) familial and community influences on drinking behaviors, and 5) perceptions and accessibility of AUD treatment (sub-themes: cultural mismatch in treatment approaches, stigma-related barriers, recommendations for culturally adapted interventions).

Conclusions and Implications: Findings underscore the complexity of AUD among diverse minority YA and highlight the significant impacts of discrimination, acculturation stressors, and spirituality on alcohol use patterns and treatment engagement. Spirituality emerged in dual roles, both buffering against and contributing to alcohol-related challenges, depending on its alignment with participants' sociocultural values. These results advocate for culturally nuanced substance use interventions that take into account intersectional identities, experiences of discrimination, and spiritual considerations. Future research should further examine these dynamics to inform comprehensive policy and clinical practice tailored to YA of color facing AUD.