For too long, the dialogue around immigrant mental health and alcohol use has undervalued the role that structural factors play. Past research focused on individual or cultural reasons for why certain groups relied on drinking alcohol to cope with mental health issues, which often led to ineffective interventions for Latinx immigrants.

However, new studies are broadening the approach to immigrant alcohol treatment to provide more successful interventions. As part of that research, Prof. Christina Lee has investigated the connection between stigma, racism, mental health, and alcohol misuse for the past two decades. Her most recently led study, “Structural Racism & Reflections from Latinx Heavy Drinkers,” shows why structural racism is a crucial factor in Latinx immigrants’ mental health and alcohol use. Lee’s co-authors include Bridget M. O’Connor; Mariana E. Nicholls, PhD; Northeastern University Prof. Irina Todorova; and Brown University Prof. Suzanne M. Colby.

Structural racism impacts mental health, which can lead to increased alcohol use.

Structural racism–or dividing access to opportunities and resources along race and ethnic lines–can deteriorate a person’s mental health. For Latinx immigrants, exclusionary policies discriminate and make people feel like they are not deserving of help, leading to low self-esteem. “When the exposure to stressors becomes overwhelming, the increased negative emotions begin to undermine healthy coping responses, leaving people prone to adopting risky health behaviors, like heavy drinking, to cope,” say the authors.

In order to discover better ways to engage Latinx immigrants in alcohol use interventions, the study interviewed those with patterns of heavy drinking and who were not in alcohol treatment. The survey included questions about their experiences as immigrants. Participant answers revealed several ways structural racism affected their mental health and alcohol use, such as:

  • A lack of belonging, or being “othered” by society, social circles, school, and work
  • A loss of status, or being placed lower on the social hierarchy than white European immigrants
  • Treatment by immigration policies as being undeserving of citizenship due to race or language
  • Limited access to quality education, well-paying employment, or reliable transportation due to race or immigration status

“Participants’ experiences of exclusion prompted symptoms of depression and anxiety and they used drinking to minimize those feelings.” the authors explain. “We did not ask participants to confirm any associations between heavy drinking and psychological distress, yet most participants reported using alcohol as a way of coping with negative feelings.”

Addressing mental health first can lead to more successful alcohol use interventions.

Most of the participants recognized that the path to stopping their alcohol misuse lay in addressing their mental health needs. For example, by centering an intervention on their experience as immigrants and its effect on their mental health, many participants noted a decrease in the anxiety and depression that led to them drinking. “The intervention may have offered an unexpected opportunity to relieve participants of psychological distress,” the authors suspect. “The intervention allowed participants to discuss their experiences of being discriminated against. Perhaps simply being invited to explore such experiences conferred psychological benefits.”

In addition, interventions can pave the way to more stable mental health by valuing Latinx immigrants’ resiliency: “In listening to session recordings, we noted that participants placed great value on their family and community connections, on their ethnic identity, ability to care for family members, and took pride in doing one’s best to improve despite difficult circumstances,” say the authors. “Highlighting personal resources and strengths during interventions may counter the ‘self-blame’ that immigrants may assume for their hardships.”

Future Research

This study began with 70 participants in a northeast US city. However, they were unable to reach over half of their participants: “Our participation rates suggest that we may have missed the most vulnerable people who face greater structural barriers to attend the interviews (e.g., farther away from the study site, no childcare, unstable housing).” Therefore, the authors urge future researchers to proactively retain participants.

In addition, the authors suggest that the timing of their study may also have contributed to the drop in participants. “We conducted our study in 2017–2018, when anti-immigrant political discourse and enforcement of harsh policies had created a hostile climate for immigrants,” the authors explain. “With local and federal governments applying deportations and other anti-immigrant policies, the hostile climate may have discouraged participants from staying in contact.” It is possible that should future research be conducted in a less tumultuous environment, participants may be easier to contact.

In spite of these limitations, this study can help health providers in offering more successful alcohol use interventions for Latinx immigrant patients. By incorporating the effects of structural racism, their unique experiences as immigrants, and their overall mental health into interventions, Latinx immigrants will be more likely to find healthier ways to cope with stressors throughout their lives.

Read more here.