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ATTC Messenger Feature Article February Featured Article

Addressing Alcohol Use Disorder in African American Youth

Addiction comes in many forms and does not discriminate. However, it’s important to understand its impact on specific populations to develop more targeted and effective strategies aimed at improving health equity. In honor of Black History Month, we will explore alcohol use disorder (AUD) and its impact on African American (AA) youth. We will also discuss the role of research in achieving more equitable health outcomes.
Across the U.S., underage drinking is a serious public health concern. Alcohol remains the most, and often, first substance used among youth. In 2021, nearly 6 million people aged 12 to 20 reported drinking alcohol. Among those, more than half (3.2 million) reported binge alcohol use (SAMHSA, 2023). An estimated 29.5 million people aged 12 and older were diagnosed with an AUD in 2021 including 900,000 youth aged 12-17 (SAMHSA, 2021). Nearly 5% of those youth identified as Black or AA and 3% identified as two or more races (SAMHSA, 2021).
Understanding the development of alcohol behaviors is important to understanding why some adolescents drink. First, alcohol-related cognitions, known as alcohol expectancies (AE), develop as early as age 4 (Smit, et al, 2018). AE significantly influences drinking behaviors. A positive AE is the belief that alcohol leads to more pleasurable outcomes (e.g., being more social) and is associated with increased drinking. In contrast, a negative AE is the belief that alcohol leads to undesirable outcomes (e.g., feeling ill) and is associated with less drinking (Smit, et al, 2018). 
Longitudinal examination of AE and alcohol use outcomes show that AA youth aged 7-10 reported higher positive AE compared to White youth (Banks, et al, 2020). Despite higher positive AE in AA youth, White youth were more likely to use alcohol, suggesting positive AE posed lower drinking risk for AA youth (Banks, et al, 2020). However, even though AAs report later alcohol initiation and lower rates of use, they still have more significant alcohol-related problems compared to Whites. Unfortunately, the lack of diversity in most studies makes it difficult to understand why the relationship between AE, alcohol use, and its consequences differ among racial and ethnic groups. 
We must better understand the specific factors associated with alcohol initiation and escalation in AA communities, which can be attributed to the complex interaction of systemic discrimination, environmental conditions (e.g., density of liquor stores),  and socioeconomic and barriers (e.g., financial instability, limited access to healthcare) (Zapolski, 2014). Developing large, diverse cohort studies that measure multiple determinants of health and their impact on health outcomes is a vital role for researchers to help inform strategies. 

An example of this type of study is the Adolescent Brain Cognitive Development SM (ABCD) study, the largest long-term study of brain development and child health in the U.S. The ABCD study® prospectively examines how childhood experiences (including substance use) interact with each other and with a child’s changing biology to affect brain development and social, behavioral, academic, health, and other outcomes. 
Measures within the ABCD study capture a more comprehensive look at factors impacting health like perceived discrimination, housing stability, neighborhood safety, and school characteristics. There is also active community engagement at each of the 21 sites participating in the study. This type of study is critical to identify the specific risk and protective factors that contribute to alcohol use and its consequences in AA communities.
Effective prevention and early intervention programs targeting AA youth require a better understanding of those specific factors. It is imperative that we go beyond a “one-size-fits-all” universal approach for prevention and early intervention programs if we want to achieve equitable health outcomes for AA youth, their families, and their communities. From parents to educators, clinicians to researchers – we all have a responsibility to create a better future for our youth. As we celebrate Black History Month, let us commit to protecting and celebrating Black Futures.

About the Authors

Faith Adams is a third-year PhD candidate at the Icahn School of Medicine at Mount Sinai. Her research aims to better understand psychosocial and neurobiological factors that may confer a substantial vulnerability for substance use disorders in youth, especially those from minority communities.

Dr. Traci M. Murray is a Scientific Advisor for Justice, Equity, Diversity, and Inclusion for the Adolescent Brain Cognitive Development (ABCD) and HEALthy Brain and Child Development (HBCD) studies at the National Institute on Drug Abuse (NIDA). Dr. Murray has been a registered nurse for over 10 years with experience in clinical research, epidemiology, and nursing education.

Banks, D. E., Faidley, M. T., Smith, G. T., & Zapolski, T. C. B. (2020). Racial/ethnic differences in the time-varying association between alcohol expectancies and drinking during the transition from childhood to adolescence. Journal of Ethnicity in Substance Abuse, 19(3), 371–387.

SAMHSA. (2021). NSDUH, table 5.1A, Substance Use Disorder for Specific Substances in Past Year. 

SAMHSA. (2021). NSDUH, table 5.6A, Alcohol Use Disorder in Past Year.

SAMHSA. (2023). Alcohol, tobacco, and other drugs.

Smit, K., Voogt, C., Hiemstra, M., Kleinjan, M., Otten, R., Kuntsche, E. (2018). Development of alcohol expectancies and early alcohol use in children and adolescents: a systematic review. Clinical Psychology Review. 60, 136–143.

Zapolski, T. C., Pedersen, S. L., McCarthy, D. M., & Smith, G. T. (2014). Less drinking, yet more problems: understanding African American drinking and related problems. Psychological bulletin, 140(1), 188–223.