Although the term African American is generally applied to individuals in the United States who can trace their ancestry to Africa, the term is often used to encompass a broad range of people of color, including individuals from Brazil or the Caribbean. Africa itself is an enormous continent, and its immigrants represent numerous nations. Yet the major government-sponsored studies of substance abuse and mental illness in African American communities do not differentiate between these recent immigrants from countries like Ethiopia or Somalia versus African Americans whose ancestors were brought to the US as slaves many generations ago.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), African Americans represent approximately 14.2 percent of the population. The majority of these individuals are descended from Africans who were brought to the US as slaves, and the repercussions of slavery, sharecropping, and racial segregation continue to exert a negative influence on their socioeconomic and political status. However, when looking at a portrait of substance abuse and mental illness among African Americans, it is important to remember that this group includes many ethnic subgroups, with varying traditions, beliefs, and practices.

Furthermore, many individuals do not identify with a single racial category, but with two or more groups. A black American might identify as Hispanic as well as African American, for instance. Providing effective substance abuse treatment and mental health care requires cultural awareness and sensitivity to the individual’s unique origins.

Substance abuse in minority populations may be considered the result of acculturation, or the assimilation into a new culture. This is certainly the case for American Indians and Alaskan Natives who experience a violent expulsion from their land and way of life. The pressure to assimilate has been forced upon them in the most brutal and oppressive way. Stress related to the division between their native culture and American culture may increase the potential for substance abuse and dependency, Psychiatric Times publishes. Native American elders, for example, believe troubles with substance abuse occur when individuals lose connection to their culture and heritage. Individuals who are closely connected to both sets of cultural values have fewer difficulties with alcohol or drug concerns they are finding.

In 2010, Native Americans, according to SAMHSA, had the highest rate of drug-induced death of any other race or ethnic group at 17.1 percent. American Indians and Alaska Natives also have high rates of mental illness, with rates of co-occurring substance abuse or dependence and mental illness of 8.8 percent in the past year (based on 2014 data by SAMHSA). This is much higher than the national average of 3.3 percent. This racial minority group also had higher rates of young adult (those 15-24) suicide at levels 2.5 times those of the general population.

A general mistrust of outside healthcare providers and cultural differences may prevent American Indians and Alaskan Natives from seeking mental health and/or substance abuse treatment. This group tends to be less likely to enter into treatment programs and may instead focus on traditional healing methods, the National Alliance on Mental Illness (NAMI) reports. More than a quarter of this ethnic population group lives in poverty as well, which is double the national average, according to NAMI.

Asian Americans appear to have the lowest rates of substance abuse but this might be due to their unwillingness to seek treatment outside the family. Perhaps because of the strong cultural view that drug or alcohol abused is seen as aberrant and shameful. Culture constraints may dictate that substance abuse and addiction is something to be handled within the family. Family dysfunction may be considered a private affair and not up for discussion publicly or even within the family, creating a potential social stigma that may act as a barrier to treatment. This stigmatization of substance-abusing individuals may be why Asian Americans do not seek treatment for addiction and therefore do not appear as much in the data. (SAMHSA’s Treatment Improvement Protocol (TIP)).

Hispanics have a strong sense of family that may differ from the traditional American nuclear family. The Hispanic view of family is likely to include a large extended family and potentially even close family friends with the mentality that problems stay within that unit and may not be acknowledged publicly.

Native Hawaiian and Other Pacific Islanders tend to abuse substances at rates much higher than the national average and higher than other minority groups. This may be due to the fact that many live on islands that may have limited care available and depressed economics. In addition, easy and regular access to drugs and alcohol at a young age may be common, and therefore they may be less likely to seek healthcare than other population groups. According to the journal Public Health Reports, Asians and Pacific Islanders may abuse stimulant drugs more often than other ethnic groups, as these drugs are common in their cultures. These drugs may be affordable and easy to obtain.