Rx Summit Spotlight | Socio-Economic Factors Drive Stimulant Use in Black Communities

Stimulant use—particularly cocaine and crystal meth—is on the rise in African American communities, and lingering sentiment stemming from the war on drugs a generation ago and a variety of conditions today are creating an especially difficult challenge for practitioners.

At the upcoming Rx Drug Abuse & Heroin Summit, Lucy Cannon, EdD, LCSW, LICSW, CCDP-D, MATS, who is the CEO and owner of LEJ Behavioral Health Services in Atlanta, will discuss trends in stimulant use in African American communities, as well as treatment strategies and resources that are needed to address the challenge. Ahead of the Rx Summit, Cannon spoke with Addiction Professional about socio-economic factors fueling stimulant use and keys for treatment providers to keep in mind when working with African American patients.

Editor’s note: This interview has been edited for length and clarity.

What factors are driving the trends you’re seeing with regards to stimulant use in African American communities?

I don’t think we’ve ever fixed the problem. We’ve put some Band-Aids on it. When we look at African American communities, there is high poverty. There are socio-economic conditions—the unemployment rate, housing. There are single-parent homes. The whole notion of the availability of treatment. Those are some of the driving factors, and the pandemic certainly has not helped. … High school dropout rates, we see a great deal in African American communities. In rural communities, we see a great deal more cocaine use. We see a little bit of amphetamine use, which is a legal drug that can be used legally to treat narcolepsy, ADHD and obesity. But it’s also used illegally, with Adderall and Ritalin use we see a little bit of on college campuses in the 18-25 age group. It allows students to stay up longer. It incites the central nervous system. The danger with that is that people get addicted. We’re also seeing an increase in opioid use in African American communities, as well as meth.

There are two components here: prevention and treatment. On the treatment side of the equation, are there things practitioners are missing? What do we need to focus on?

What we know about African American families is there is a huge support of the church and spirituality. It has a large impact on whether they get treatment or not. They depend on their spiritual leaders and, of course, resources connected with the church, like AA meetings. What seems to work a lot for this community is making sure whatever the treatment—cognitive behavioral therapy, motivational interviewing, contingency-based interventions to reward behaviors when you’re not using drugs—ultimately, it gets into a trust factor. When you look back on the war on drugs and the high rates of imprisonment, a lot of times, African Americans have been afraid to disclose use because they have been afraid of being incarcerated. It’s imperative counselors look at 12-Step programs because African Americans really gravitate toward the spirituality side of it, and the whole notion of making sure that spirituality is incorporated.

Also, making the setting more user-friendly. When patients come to our centers, whether it’s a mental health, residential or outpatient program, they can see some evidence of their culture. … While they might be suspicious of traditional settings, they’re not against traditional treatments we might provide in Caucasian or Hispanic communities.

Therapists have to spend a lot of time building relationships. Some of the things that are important for therapists, regardless of race, are being able to develop trust. That takes time. … Another thing is being sensitive to barriers—racism, inequalities in the system. The goal is to empower patients, get them to talk about it, and teach them how to work through it. The reality is we deal with inequality a lot in the treatment setting, and the therapist has to be cognizant of the plight of African Americans, especially African American men who look at employment and pay raises and see salaries that are less than those of Caucasian men and women. Be sensitive to those realities and not assuming they’re not important. Also, when we work with patients, it’s important to not assume they’re coming to us with one issue. A lot of times, it’s a lifetime of poverty, unemployment and high dropout rates. Then there are health disparities and not having access to insurance. They don’t stay in treatment as long sometimes because of a lack of transportation or childcare or work-related reasons. It’s imperative we are sensitive to that and help them with community resources as much as possible.
 

And it seems like a lot of those barriers you’re describing can exacerbate each other.

Exactly. That’s what makes these disparities so difficult. A lot of patients want treatment but don’t have the insurance to afford it. Clearly, we have to get the income level up. We have to get the education level up, as well as housing and poverty. Those are all things that have an impact on why this population uses cocaine.

We have to pay attention to stimulant use disorders as well as look at mental health issues in this community. There’s a lot of dual diagnosis—a lot of depression. We see a lot of spikes in women 18-25 with chronic depression. … Many of these women are dealing with depression, and there comes the suicide impact. Those numbers are increasing among that 18-25 group. So, we’ve got lots to do.