Consommations d’alcool et de drogues, et migrations en Amérique du Nord : revue critique de la littérature

Abstract

Quite a lot of research has been conducted in North America to study the relationship between alcohol and drug use (alcohol and drug consumption and/or substance related disorders) and migration. A review of the epidemiological studies is proposed with the example of research on Mexican Americans in the United States. Two models were used initially: acculturation and cultural identification. Acculturation refers to the processes of change in artifacts, customs and beliefs that result from the contact of societies with different cultural traditions or the results of such changes. A large number of acculturation scales have been created, but the use of objective variables (e.g., place of birth, age at arrival and years residing in host country, primary language use including a measure of the proficiency of the second language) is now recommended by a majority of the authors. Culture simply cannot be reduced to a measurable variable. The main limits of the studies reviewed are linked: 1) to the validity problems of ethnic or cultural groups studied; 2) to the cross-cultural applicability of diagnosis and assessment of substance use disorders, as the attitudes of societies to alcohol and drug use affects the use of criteria and the elaboration of diagnoses; and 3) to the frequent confusion between cultural factors and socio-economic, environmental or discrimination and racism factors. Even though these studies are not transposable to other contexts, they tend to show that substance use and substance related disorders prevalence are higher in non-migrants than in migrants and that this difference is correlated with time of residence. Exposure to mainstream American society often leads to patterns of alcohol and drug use among long term immigrants that approximate that of the native born population. These findings should not overshadow the migrants’ vulnerability and the importance of addressing cultural issues in the designing of treatment, in improving their accessibility to mental health care and to a better global quality of life.