>> GOOD AFTERNOON EVERYONE, I'M 
CHRIS GAINS, THE PROGRAM MANAGER
FOR THE OFFICE LOAF SEARCH 
SERVICES, NIH, WELLNESS PROGRAM.
I'D LIKE TO WELCOME YOU TO OUR 
FOCUS ON YOU WELLNESS LECTURE 
SERIES.
TODAY'S TOPIC WILL BE DRUG USE 
IN RACIAL AND ETHNIC MINORITY 
POPULATIONS: AVOIDING RISKS AND 
SEEKING CARE PRESENTED BY 
DR. LULA BEATTY.
SHE'S THE DIRECTOR OF THE 
SPECIAL POPULATIONS OFFICEALITY 
THE NATIONAL INSTITUTE OF DRUG 
ABUSE, NIH.
THE SPECIAL POPULATION OFFICE IS
RESPONSIBLE FOR LEADING AND 
MONITORING NIDA'S MINORITY 
HEALTH AND HEALTH DISPARITIES.
PROGRAMS IN DEVELOPING 
INITIATIVES TO ENCOURAGE 
INCREASED PARTICIPATION OF 
UNDERREPRESENTED SCHOLARS IN 
DRUG ABUSE AND ADDICTION 
RESEARCH.
AND AT THIS TIME, LOOIKTD LIKE 
TO WELCOME DR. LULA BEATTY.
>> THANK YOU FOR INVITING ME E 
TO THIS FORUM.
I'M REALLY PLEASED TO BE HERE 
TODAY AND TO BE ABLE TO TALK 
WITH YOU ABOUT DRUG USE IN 
MINORITY POPULATIONS.
I ALSO WANTED TO ACKNOWLEDGE 
YOUR RECOGNITION OF NATIONAL 
MINORITY HEALTH MONTH, AND ALL 
THE WORK THAT'S GOING ON TO TRY 
E TO IMPROVE THE HEALTH OF 
MINORITIES.
I WANT TO THANK MY NIH 
COLLEAGUES AT OTHER ICs FOR THE 
WORK THEY'RE DOING AND HAVE BEEN
DOING FOR QUITE A WHILE.
IT'S VERY COMPLEX AND 
COMPLICATED WORK, AND I THANK 
THEM FOR THEIR EFFORTS.
I'VE LISTED SOME PEOPLE UP HERE 
AND SOME PLACES UP HERE JUST FOR
YOU TO KNOW WHO'S DOING WORK 
HERE AND WHETHER THERE ARE 
FORUMS TO GET MORE INFORMATION 
ABOUT THESE ISSUES.
THE FIRST IS A SPECIAL 
POPULATION FORUM WHICH IS MADE 
UP OF A A LOT OF PEOPLE WHO HAVE
INTEREST IN MINORITY HEALTH AND 
THE CHAIR OF THAT IS CARL HILL 
AT NICHD.
AND OF COURSE THE  -- I WANT TO 
ACKNOWLEDGE MY COLLEAGUES AT NI 
TRIPPED A, NCI AND NIMH AND I 
WANT TO THANK MY COLLEAGUES AT 
NIDA AND THEN THE SPECIAL 
POPULATIONS OFFICE.
I WANT TO BRIEFLY DESCRIBE THE 
NEED TO FOCUS ON MINORITY HEALTH
ON DESCRIBED DRUG USE AND 
MINORITY EAT NICK POPULATIONS 
AND DESCRIBE AND IDENTIFY SOME 
INFORMATION FOR YOU AND 
TREATMENT RESOURCES.
NOW, MINORITY HEALTH NEEDS, UM, 
STARTED -- THERE WAS WORK THAT 
STARTED QUITE A WHILE AGO WHEN 
THERE WAS A RECOGNITION THAT 
GOOD HEALTH AND BETTER HEALTH 
OUTCOMES WERE NOT EQUALLY 
EXPERIENCED BY ALL U.S. 
POPULATION GROUPS, AND THAT 
THERE ARE PRER SIS TENT HISTORIC
GAPS IN RACIAL AND ETHNIC 
MINORITIES IN THE U.S. COMPARE 
TO THE WHITE COUNTER PARTS.
MUCH OF THE EARLIER WORK 
FOCUSSED ON BLACKS BECAUSE 
THAT'S WHERE A LOT OF THE DATA 
HAD BEEN KEPT.
THERE WAS A NEED TO IMPROVE THE 
HEALTH OF RACIAL ETHNIC MINORITY
POPULATIONS THAT WAS RECOGNIZED 
AT THE FEDERAL LEVEL AND IT'S 
LED THROUGH NUMBER OF 
INITIATIVES IN VARIOUS MINORITY 
AND HEALTH DISPARITIES EFFORTS 
AND ONE OUTSTANDING ONE WAS THE 
1985 REPORT ON THE BLACK 
MINORITY HEALTH WHICH WAS DONE 
UNDER THE LEADERSHIP OF THE NIH 
DEPUTY DIRECTOR AT TIME.
NIH HAS BEEN INVOLVED IN THIS 
FOR A WHILE.
THEY DEVELOPED THE CONCEPT OF 
THE EXCESS DEATH WHICH LOOKS AT 
THE DIFFERENT DISA PARTIES IN 
THE DIP GROUPS.
THERE WERE DIFFERENT AREAS OF 
INTEREST.
THERE WAS CONGRESSIONAL CONCERN 
IN THE 1990s, AND THEY REQUESTED
THAT THE INSTITUTE OF MEDICINE 
DO A STUDY TO ASSESS THE EXTENT 
OF RACIAL AND ETHNIC DIFFERENCES
IN HEALTH CARE THAT WAS NOT 
ATTRIBUTABLE TO KNOWN FACTORS 
SUCH AS ACCESS TO CARE.
THEY WERE ASKED TO PROVIDE 
RECOMMENDATIONS REGARDING 
INTERVENTIONS TO ELIMINATE THESE
HEALTH CARE DISPARITIES.
THAT RESULTED IN THIS VERY 
WELL-KNOWN AND WELL-CITED 
DOCUMENT NOW ON EQUAL TREATMENT 
CONFRONTING RACIAL AND ETHNIC 
DISPARITIES IN HEALTH CARE.
THEY CONFIRMED THE DISPARITIES 
THAT EXISTED, AND THEY TALKED 
ABOUT WHAT SOME OF THOSE 
CONTRIBUTORS WERE TO THOSE 
DISPARITIES.
THEY INCLUDED THINGS LIKE HEALTH
PROVIDERS' BIAS, STEREO 
CARE 
TYPING PREJUDICE, UNCERTAINTY, 
AND PATIENTS THEMSELVES.
SO IN 2000, CONGRESS CAME UP 
WITH THIS THAKT LEAD LED TO THE 
CREATION ON OUR NATIONAL CENTER 
ON MINORITY HEALTH WHICH BECAME 
A NATIONAL CENTER.
JUST TO LOOK AT SOME OF THE COST
OF HEALTH DISPARITIES WORK, 
THERE WAS A STUDY DONE IN 2009, 
THAT FOUND THAT BETWEEN 2003 AND
2006 T COMBINED COST OF HEALTH 
INEQUALITIES AND PREMATURE DEATH
WAS COSTING US AROUND 
$1.24 TRILLION, AND THAT MUCH OF
THAT WAS EXCESS EXEND CHURS WERE
ATTRIBUTE L TO AFRICAN 
AMERICANS.
I WANT TO DO A COUPLE OF THINGS 
NOW WHICH IS LEADING ME TO DRUG 
ABUSE.
I WANT YOU TO LOOK AT THIS TABLE
ONE WHICH IS LOOKING AT THE 
LEADING CAUSES OF DEATH, AND I 
THINK MOST OF US ARE FAMILIAR 
WITH THIS TABLE AND WE SEE THE 
LEADING CAUSES OF DEATH ARE 
HEART DISEASE, CANCER, STROKE, 
AND THEN THE OTHERS, UH 
UNINTENTIONAL INJURIES, 
ALZHEIMER'S DISEASE.
I SHOW THE NUMBER OF DEATH AND 
THE DEATH RATE PER ONE HUNDRED 
THOUSAND.
I WANTED TO SHOW E THAT IN A 
DIFFERENT WAY.
IF YOU LOOK AT THE TEN PLEASE 
LEADING CAUSES OF DEATH WITHIN 
RACIAL ETHNIC MINORITY GROUPS --
AND THIS IS ONE OF THE REASONS 
WE LIKE TO LOOK WITH WHAT 
HAPPENS WITH EACH GROUP -- IS 
THAT YOU'LL SEE THAT GENERALLY, 
THE FIRST TWO OR THREE CAUSES 
WILL BE ABOUT THE SAME, BUT 
YOU'LL START SEEING SOME 
DIFFERENCES.
SO IN THIS IS BLACK NON-HISPANIC
AND WHITE NON-HISPANIC.
ONE OF THE DIFFERENCES YOU'LL 
SEE HERE IS THAT IN RANK EIGHT 
FOR BLACKS, FOR INSTANCE, IS HIV
AND AIDS, WHICH DOESN'T APPEAR 
AT ALL FOR WHITES.
AND THAT'S GOING TO BE IMPORTANT
FOR US BECAUSE HIV AND AIDS IS 
ONE OF THE CONSEQUENCES OF DRUG 
USE, IT'S RELATED TO RISKY 
BEHAVIORS.
SO WE'LL START SEEING THAT WHEN 
WE TAKE A CLOSER LOOK AT WHAT'S 
HAPPENING TO GROUPS, WE'LL START
SEEING SOME OF THE SIGNIFICANCE 
OF DRUG ABUSE.
I HAVE ANOTHER SLIDE TO SHOW 
YOU.
LEADING CAUSE OF DEATH FOR 
AMERICAN INDIANS AND WHAT'S 
INTERESTING HERE IS THAT IN 
1980, HOMICIDE WAS NUMBER SEVEN,
AND IN 2000 -- SO YOU START 
SEEING SOME CHANGE.
SOME OF THIS CHANGE HAS TO DO 
WITH IMPROVEMENTS, PERHAPS, IN 
PREVENTION AND IN TREATMENT, BUT
SUICIDE ACTUALLY WAS TEN IN 
1980, AND A THEN IT WENT UP TO 
EIGHT.
SO WE'RE STARTING TO SEE SOME 
DISTURBING THINGS THAT MAY BE 
HAPPENING WITHIN GROUPS.
SO WHY WAS UH THAT -- WHAT'S THE
SIGNIFICANCE OF DRUG USE AND 
ADDICTION?
SO I GAVE YOU THE LEADING CAUSES
OF DEATH IN THE UNITED STATES, 
BUT THERE'S THIS CONCEPT OF THE 
ACTUAL CAUSES OF DEATH.
WHAT ARE WE DOING?
WHAT IS THE BEHAVIOR THAT LEADS 
TO THAT?
AND WHAT YOU'LL SEE IS THAT THE 
ACTUAL CAUSES OF DEATH, THE 
FIRST ONE IS TOBACCO, WHICH IS A
DRUG, AND IT'S INCLUDED WITHIN 
OUR PORTFOLIO AT NIDA.
POOR DIET AND PHYSICAL ACTIVITY 
IS THE SECOND ONE, BUT I WANTED 
TO POINT OUT THAT TOBACCO, 
ALCOHOL CONSUMPTION AND ELICIT 
DRUG USE ARE AMONG THOSE THREE 
LEADING CAUSE, ACTUAL CAUSES OF 
DEATH.
SO KNOWING ABOUT DRUG USE AND 
WHAT WE CAN DO ABOUT IT WILL 
REALLY HELP WITH MORBIDITY AND 
MORTALITY FIGURES.
IT'S POSHTD, AS YOU'LL SEE, FOR 
RACIAL/ET MIK KNEW MINORITY 
GROUPS.
THIS IS JUST ANOTHER WAY OF 
SEEING THE ACTUAL CAUSE AND, 
AGAIN, I WOULD EVEN VENTURE THAT
SOME OF THESE THINGS THAT YOU 
SEE E ELICIT DRUG USE HAS SOME 
IMPACT ON SEXUAL BEHAVIOR, MOTOR
VEHICLE ACCIDENTS, ALL OF THOSE 
THINGS GET TO BE VERY RELATED.
OKAY.
AND WE TALKED ABOUT MORTALITY 
AND, BUT WHAT ABOUT DISABILITY?
SO YOU CAN -- YOU MAY DIE, BUT 
YOU MAY BE LIVING WITH SOME 
CHRONIC DISEASES AND WITH SOME 
DISABILITY.
THIS WAS FOUND THAT WORLDWIDE 
WITH THE WORLD HEALTH 
ORGANIZATION A THAT THE CAUSES 
OF DISABILITY BY ILLNESS THE 
LEADING CAUSES OF DISABILITY ARE
MENTAL ILLNESS AND ALCOHOL AND 
DRUG USE WORLDWIDE.
IT'S A REALLY IMPORTANT ISSUE TO
WE NEED TO LOOK AT.
NIDA'S MISSION IS TO LEAD THE 
NATION IN BRINGING THE POWER OF 
SCIENCE TO BEAR ON DRUG ABUSE 
AND ADDICTION, AND WE DO THAT 
THROUGH A WIDE PORTFOLIO OF 
RESEARCH THAT WE DO FROM THE 
GENETIC RESEARCH, SOCIAL 
RESEARCH, BEHAVIORAL RESEARCH, 
CLINICAL TRIALS.
SO WE HAVE THE WHOLE GAMUT OF 
RESEARCH AND WHAT WE'RE TRYING 
TO DO IS TO DEVELOP A A BODY OF 
KNOWLEDGE THAT WILL LEAD TO 
EFFECTIVE DISSEMINATION TO 
IMPROVE PREVENTION, TREATMENT 
AND POLICY.
THIS IS -- OKAY.
[LAUGHTER]
THIS IS THE WRONG SLIDE.
[LAUGHTER]
OKAY.
I DON'Thc> HAVE THE RIGHT -- 
SOMEHOW WE MUST HAVE COPIED THE 
WRONG SLIDE OR IT DIDN'T SAVE IT
FOR ME.
DO YOU HAVE THE ONE THAT I SENT 
YOU?
THIS WAS THE FIRST DRAFT?
[LAUGHTER]
OKAY.
ALL RIGHT.
I DON'T KNOW.
BECAUSE THIS IS NOT GOING BE 
RIGHT, NOW, SO I CAN EITHER GO 
AND QUICKLY TRY TO COPY IT 
AGAIN -- IT MUST NOT HAVE COPIED
DIRECTLY ON MY JUMP DRIVE, OR, 
UH -- YEAH, THIS IS JUST NOT THE
RIGHT POWERPOINT.
HUH?
UM, I CAN TALK WITHOUT IT, BUT 
IT WON'T PROPERLY BE AS 
EFFECTIVE WITH THE GRAPHS THAT 
YOU CAN SEE.
SO, AND THIS IS REALLY -- THIS 
WAS LIKE THE FIRST DRAFT, I AM 
SO SORRY, I DON'T KNOW WHAT 
HAPPENED TO THE, UM, TO IT.
COULD YOU GO AND TRY TO COPY IT 
FOR ME AND I'LL TALK WHILE 
CLAIRE GOES.
THIS HAS BEEN MY NIGHTMARE OF 
ALL MY CAREER IS THAT SOMEHOW 
YOU PUT THAT FLASH DRIVE IN AND 
IT DOESN'T REALLY SAVE IT.
OKAY.
>> [LOW AUDIO].
I WAS GOING TO TALK TO YOU ABOUT
SOME OF THE EPIDEMIOLOGICAL WORK
THAT WE'VE DONE THAT HAS BEEN 
DONE ON DRUG USE, AND SO I'M 
JUST GOING TALK THROUGH SOME OF 
THOSE AND HOPEFULLY YOU'LL BE 
ABLE TO SEE SOME OF THE CHARTS.
SO THAT DRUG USE IN THE UNITED 
STATES, THERE ARE ABOUT 
20.1 MILLION AMERICANS, AGE 12 
AND OVER, WHO WERE CURRENT 
ELICIT DRUG USERS IN 2008.
THAT'S ABOUT 8% OF THE ENTIRE 
POPULATION.
ABOUT 70.9 OR ABOUT 80 MILLION 
AMERICANS AGE 12 AND OVER WERE 
CURRENT USERS OF TOBACCO 
PRODUCTS, AND ABOUT 
39.8 MILLION, ABOUT 60 MILLION 
OF THEM WERE USING CIGARETTES.
ABOUT 126.8 MILLION AMERICANS OR
ABOUT 52% OF THE POPULATION, AGE
12 AND OVER, WERE CURRENT USERS 
OF ALCOHOL, AND ABOUT 
28.1 MILLION OF THEM INDULGE IN 
BING DRINKING AND ABOUT 
17.3 MILLION OF THEM WERE HEAVY 
DRINKERS.
FROM ELICIT DRUGS TO CIGARETTE 
SMOKING TO ALCOHOL, WE CAN SEE 
THAT THE MOST HEAVILY USED DRUG 
IS ALCOHOL.
NOW, UM, THE RATES OF USE IS 
DECREASING BETWEEN BOYS AND 
GIRLS.
AT ONE POINT, MALES ALWAYS USED 
MORE THAN FEMALES.
NOW THERE WERE CULTURAL REASONS 
FOR THAT, SOME SOCIALIZATION 
REASONS FOR THAT.
NOT SURE IF THERE ARE ANY 
GENETIC REASONS FOR THAT, BUT 
THAT HAD BEEN THE TREND.
SIT STILL TRUE FOR ADULTS, BUT 
FOR BOYS AND GIRLS, ADOLESCENCE,
PEOPLE WHO ARE YOUNGER, WE'RE 
STARTING TO SEE THAT THE 
DIFFERENCE IS DECREASING.
SO GIRLS ARE STARTING TO USE A 
LITTLE BIT, ALMOST EQUAL OR 
GROWING IN RATES THAT'S BECOMING
EQUAL TO THAT OF BOYS.
THE OTHER DISTURBING TREND 
WITHIN THE
AFRICAN AMERICAN AND HISPANIC 
FEMALES TRADITIONALLY WERE NOT 
BIG USERS OF ANY DRUG.
THEY MIGHT START USING LATER.
SO THE PATTERNS OF USE WITHIN 
GROUPS DIFFERED IN TERMS OF WHEN
IT WAS, WHEN THE ONSET OF DRUG'S
CURED, WHEN THEY STARTED USING 
AND WHAT KINDS OF DRUGS THAT 
THEY USED.
IN THE LAST TWO YARS, WE'RE 
STARTING TO SEE AN INCREASE, 
ACTUALLY, IN AFRICAN AMERICAN 
GIRLS, AND I BELIEVE SOME 
HISPANIC GIRLS IN THEIR USE OF 
DRUGS.
WE'RE STARTING TO SEE SOME SHOP 
SHIFTS AND THINGSES WE NEED TO 
LOOK AT.
BUT THE WHEN WE LOOK AT THE 
CURRENT ELICIT DRUG USE, IF WE 
LOOKED AT THE HIGHEST NUMBER 
THAT WERE USING ELICIT DRUGS, IF
THEY WERE INDICATED THAT THEY 
WERE TWO OR MORE RACES -- SO IF 
THEY INDICATED THAT THEY WERE 
WHITE AND BLACK, BLACK AND 
ASIAN -- THAT WAS A GROUP THAT 
ACTUALLY HAD THE HIGHEST REPORT 
USING OF ELICIT DRUG USE.
THAT WAS FOLLOWED BY AFRICAN 
AMERICANS AT 10.1%; AMERICAN 
INDIAN AND WHITE, THEY WERE 
AROUND FROM 8-10%.
SO THEY WERE AROUND THERE 
CLUSTERING TOGETHER.
THAT WAS FOLLOWEDED BY HISPANICS
AND ASIANS.
IN THE PAST MONTH A SELECT OF 
SOME DRUG USE, YOU'LL START 
SEEING THE SAME KIND OF PATTERN.
SO THAT WHEN YOU LOOK WITHIN 
RACE ETHNICITY BY SUBSTANCE, YOU
START SEEING DIFFERENCES IN HOW 
PEOPLE USE.
PERSONS WITH SUBSTANCE ABUSE, 
SUBSTANCE DEPENDENCE IN 2008, WE
FIND THAT THERE WERE OVER 22 
MILLION PEOPLE WHO WERE 
DEPENDENT ON SUBSTANCES, AND 
18.3 MILLION WERE DEPENDENT ON 
ALCOHOL, WHICH WAS ABOUT 7.3% OF
THE POPULATION, AND 7 MILLION 
WERE DEPENDENT ON ELICIT DRUGS.
OF THE ELICIT DRUGS MOST OF 
THOSE WERE DEPENDENT ON 
MARIJUANA, PAIN RELIEVERS AND 
COCAINE.
IF YOU LOOKED AT SUBSTANCE 
DEPENDENCE BY RATE/ETHNICITY.
YOU'LL FIND AMERICAN INDIAN AND 
ALASKAN NATIVES WERE MORE LIKELY
TO SHOW SIGNS OF SUBSTANCE 
DEPENDENCE, FOLLOWED BY PERSONS 
REPORTED TWO OR MORE RACIAL 
IDENTIFICATIONS OR RACE 
ETHNICITY IDENTIFICATIONS, 
FOLLOWED BY HISPANICS, WHITE, 
BLACK AND ASIAN.
SO THAT WHEN YOU CUT IT IN ANY 
WAY, YOU START SEEING SOME 
PATTERNS, BUT IT'S NOT AS CLEAR 
AS YOU MIGHT THINK.
SO YOU START LOOKING ALSO AT 
ALCOHOL DEPENDENCE, ELICIT DRUG 
DEPENDENCE.
YOU START SEEING THAT.
SO IT WAS BRINGING ME TO 
SOMETHING I WANT TO TALK ABOUT; 
MYTH AND REALITY.
SO THE MYTH IS, HAS OFTEN BEEN 
THAT MINORITY POPULATIONS, 
PARTICULARLY AFTERNOON AMERICAN 
AND HISPANICS USE DRUGS MORER 
THAN ANYBODY ELSE, AND THAT IS 
NOT TRUE.
SO THAT IF YOU LOOK AT OVERALL 
DRUG USE, IT IS AN EQUAL 
OPPORTUNITY OCCURRENCE.
EVERYBODY USES IT.
EVERYBODY HAS A PROBLEM WITH IT,
BUT BECAUSE THERE ARE 
DIFFERENCES IN HOW WE USE, WHEN 
WE START TO YUSHGZ HOW IT 
PROGRESSES TO PROBLEMS OR 
DEPENDENCE IS I, IT IS IMPORTANT
FOR US TO UNDERSTAND WHAT'S 
HAPPENING WITHIN THE GROUP.
SO THAT WE START SEEING THAT 
THIS IS A PROBLEM THAT ALL OF US
MUST EMBRACE AND NEED TO 
ADDRESS, BUT SIT A MYTH TO 
ASSUME THAT ANY ONE GROUP IS 
ALWAYS MUCH WORSE AT IT THAN ANY
OTHER.
THE OTHER THING THEY WARRANTED 
TO TALK ABOUT WAS THAT IS THAT 
THERE ARE SOME SELECTED -- THERE
ARE SOP CONSEQUENCES OF 
SUBSTANCE USE, SO THAT WHEN YOU 
START USING, FOR INSTANCE, CIG 
GRETS LEADS TO LUNG DISEASE, 
STROKE, A NUMBER OF CANCERS THAT
MOST OF US KNOW ABOUT, SOME 
KIDNEY DISEASE, ADVERSE 
PREGNANCY OUTCOMES AND 
ADDICTION.
ALCOHOL CAN LEAD TO EMOTIONAL 
VOLATILITY.
IT CAN LEAD TO -- I THINK IT'S 
THE HIGHEST CAUSE OF MENTAL L 
RETARDATION IF PREGNANT WOMEN 
ARE USING.
MARIJUANA CAN RELATE TO SLOWED 
REACTION TIME, INCREASED HEART 
RATE, PANIC ATTACKS.
COCAINE CAN LEAD TO INCREASED 
HEART RATE, BLOOD PRESSURE, 
IRRITABILITY, REMORSE, AND 
ADDICTION.
SO THAT EACH DRUG HAS ITS OWN 
EFFECTS BUT THERE ARE SOME 
CONSEQUENCES TO THOSE EFFECTS 
AND THEY TEND TO BE TRUE ACROSS 
GROUPS.
HOWEVER, THERE ARE -- THIS IS 
NOT A MYTH -- THERE ARE SOME 
DISPARITIES AND CONSEQUENCES OF 
DRUG USE, AND THOSE DISPARITIES 
ARE MOST OFTEN EXPERIENCED BY 
PEOPLE OF COLOR.
AND SO THAT ONE OF -- I'M JUST 
GOING NAME A COUPLE OF THOSE 
DISPARITIES, AND ONE OF THE 
REASONS THAT WE NEED TO MAKE 
SPECIAL EFFORT TO UNDERSTAND 
WHAT'S HAPPENING IN THOSE 
POPULATIONS AND LATER WHAT WE 
CAN MAYBE PERHAPS DO ABOUT IT.
ONE IS THAT THERE IS A 
DISPROPORTIONATE EXPERIENCE OF 
HIV/AIDS BY AFRICAN AMERICANS 
AND HISPANICS GIVEN THEIR RISKY 
BEHAVIORS.
SO IF THEY'RE ABOUT 12 OR 13% OF
THE POPULATION, AFRICAN 
AMERICANS RANGE FROM 50-60% OF 
THE PEOPLE INFECTED WITH 
HIV/AIDS AND THAT STILL EXISTS.
THE OTHER DISPARITY -- AND 
REALLY WISH I COULD -- SEE THIS 
ONE.
I'M GOING TO TAKE A CHANCE TO 
SEE IF THIS SLIDE SHOWED UP.
MAYBE NOT.
UM.
OH YEAH.
SOME OF THESE WE CAN TALK ABOUT.
I'LL JUST IGNORE THE OTHER 
SLIDES AND WE LOOK AT THESE.
THIS TALKS ABOUT SUBSTANCE 
DEPENDENCE BY RACE ETHNICITY -- 
AND THE NUMBERS DIDN'T SHOW UP.
OH O, I SEE WHAT HAPPENED -- 
THIS IS NOT RIGHT.
LET'S SEE IF QUESTION DO IT THIS
WAY., I SEE WHAT HAPPENED -- THIS
IS NOT RIGHT.
LET'S SEE IF QUESTION DO IT THIS
WAY., I SEE WHAT HAPPENED -- THIS 
IS NOT RIGHT.
LET'S SEE IF QUESTION DO IT THIS
WAY.
OKAY.
WE'RE GOING TO SEE WHAT I CAN 
DO, HOW FAR I CAN GO.
OKAY.
THANK YOU.
ALL RIGHT.
SO WE SAW SOME OF THE PAST MONTH
USE OF SELECTED DRUGS, AND 
AGAIN, UM, FOR AFRICAN 
AMERICANS -- AND THIS WAS JUST 
TO ILLUSTRATE SOME THINGS THAT I
WAS TALKING TO YOU ABOUT THAT WE
HAVE TO LOOK WITHIN THE GROUPS 
TO SEE WHAT THEY USE AND HOW 
OFTEN THEY USE IT.
WE'RE GOING TO GO HERE.
I WANT TO LOOK AT ELICIT DRUG 
USE AND EMPLOYMENT AND EDUCATION
MAINLY BECAUSE THIS IS A 
WORKFORCE PRESENTATION, SO I 
WANTED FOR US WHO ARE LUCKY 
ENOUGH TO BE EMPLOYED.
FOR THOSE UNEMPLOYED, YOU'LL SEE
THIS HIGHER USE OF ELICIT DRUG 
USE.
THAT MAKES SENSE ON A COUPLE OF 
LEVELS.
IF THEY WERE EMPLOYED IT CAN BE 
GROUNDS OF DISMISSAL OR IF 
THEY'RE STRESSED.
IF  YOU LOOK AT EMPLOYMENT, A 
PERSON WHO ARE COLLEAGUE 
GRADUATES ARE LESS LIKELY TO 
REPORT USE.
INTERESTINGLY ENOUGH, SOME 
COLLEGE REPORTS MORE THAN HIGH 
SCHOOL GRADUATES.
SO THERE'S NOT THAT MUCH 
DIFFERENCE HERE.[
SO THAT THERE IS -- THERE ARE 
DISPARITIES IN!
NOW HERE'S A SLIDE I WAS GOING 
TO SHOW YOU, WHICH IS THE 
DISPARITIES AND THIS WAS SOME 
INFORMATION WAS PROVIDED BY ONE 
OF OUR DIVISIONS.
IF YOU HAVE THE POPULATION, SAY 
YOU'RE BLACK -- IN THIS ONE 
ABOUT 11% OF THE POPULATION -- 
IF YOU USED INJECTION DRUGS WITH
HIV/AIDS, YOU ACCOUNT FOR LIKE 
ABOUT 50% THERE.
THE SAME THING HERE.
IF UMP ABUSE-DEPENDENT, ABOUT 
16% HERE.
OKAY.
SO THE BIG THING IS TO LOOK TO 
HERE AND THIS CONSEQUENCE OF 
HIV/AIDS.
THIS IS AN OLD SLIDE AND WANTED 
TO SHOW YOU THIS VERY OLD SLIDE 
TO SHOW YOU ADMISSIONS TO STATE 
AND FEDERAL PRISONS.
THIS IS FROM 1930-1990.
IT JUST HAS WHITES AND BLACKS 
BECAUSE AT THAT TIME, THAT WAS 
THE MOST RELIABLE DAY THE TA 
THEY HAD.
WHEN WE TALK ABOUT DISPARITIES 
IN HEALTH AND THE GAP, THIS IS 
WHAT WE'RE TALKING ABOUT IS THE 
DIFFERENCES BETWEEN E HERE.
THESE DIFFERENCES BETWEEN WHAT 
HAPPENS HERE AND WHAT HAPPENS 
WITH THIS GROUP WHICH IS USUALLY
THE WHITE COMPARISON GROUP.
THE GOAL OF HEALTH DISPARITIES 
IS TO TRY TO REMOVE THIS 
DIFFERENCE, THAT EVERYBODY 
SHOULD BE AT ABOUT THE SAME IN 
TERMS OF EITHER BENEFIT OF CARE 
SO YOU SHOULD NOT SEE THESE 
DIFFERENCES BY LARGE POPULATION 
GROUPS.
BUT YOU'LL SEE HOW THESE NUMBERS
START GOING WAY UP AROUND 1980s.
OKAY.
[LAUGHTER]
WE'RE GOING TO HAVE TO TRY TO DO
THE NEW ONE.
SO WHAT I WAS GOING TO SHOW YOU 
IS THAT IN THE 1980s -- COULD I 
GET SOME HELP WITH TRYING TO SEE
IF WE COULD GET THIS NEW ONE IN?
THAT IN THE 1980s, YOU SAW THIS 
GREAT INCREASE IN THE CRIMINAL 
JUSTICE CONSEQUENCE OF DRUG USE,
AND SO WHAT HAPPENED WAS THAT 
THERE WAS SOME SENTENCING 
GUIDELINES AND THEN THERE ARE 
SOME OTHER DIFFERENCES IN TERMS 
OF WHEN PEOPLE WERE CAUGHT USING
DRUGS.
WHAT HAPPENED WAS THAT YOU SAW 
THIS INCREASED CRIMINALLIZATION 
OF THEM, AND THAT INCREASED 
CRIMINALLIZATION WAS 
DISPARENTALLY EXPERIENCED, 
PARTICULAR BY AFRICAN AMERICANS.
I HAVE A GRAPH THAT SHOWS THAT, 
BUT MEANWHILE, I CAN TALK ABOUT 
SOME CRIMINAL JUSTICE FACTS.
BETWEEN 1980 AND 1995, DRUG 
OFFENDERS IN STATE PRISONS 
INCREASED 1000%.
DRUG OFFENDERS ACCOUNTED FOR 
MORE THAN 80% OF THE TOTAL 
GROWTH IN THE FEDERAL INMATE 
POPULATION.
42% OF INMATES THAT WERE PUT IN 
FOR DRUGS FOR BLACK.
30% OF THE U.S. PERSONS ON 
PROBATION PR BLACK AND 41% OF 
THE PERSONS ON PAROLE FOR BLACK.
THIS WAS SOME WORK THAT WAS DONE
OUT OF OUR HIV AND 
CRIMINALLIZATION AMONG AFRICAN 
AMERICAN RESEARCH THAT WAS DONE 
BY A FEW YEARS AGO.
LET'S SEE.
LET'S HOPE THAT THIS ONE WORKS.
SO FAR, SO GOOD.
OKAY.
GREAT.
I THINK WE ARE SET.
SO WITH THIS ONE, UM, WE FOUND 
THAT THIS WAS ONE OP OUR 
RESEARCHERS, AND WHAT THEY DID 
WAS TO RUN SOME STUDIES.
YOU COULD SEE THAT EARLIER SLIDE
THAT I SHOWED YOU, THEY HAD 
DISPARITIES -- YOU SAW THOSE 
GAPS, BUT LOOK AT THE BIG INE 
CREASE IN THIS GAP, AND WE HAVE 
THE HISPANIC POPULATION NOW 
INCLUDED IN THIS DATA.
YOU CAN SEE, THIS IS WHAT 
HAPPENED TO WHITES.
SOME INCREASE.
WE ACTUALLY PROBABLY INCARCERATE
TOO MANY PEOPLE, NO MATTER WHAT 
RACE.
WE'RE ONE OF THE LEADING 
COUNTRIES IN THE WORLD THAT DOES
THAT, BUT LOOK AT THIS BIG 
INCREASE HERE.
AND THESE GAPS.
THIS IS WHAT HAPPENED HAPPENING 
PARTICULARLY TO HISPANICS AND 
WHITES.
THIS JUST TO SHOW YOU SOME 
IMPRISONMENT FIGURES.
WHEN IT HAPPENS TO PULLING 
AUTOOF THESE MALES OUT OF THESE 
COMMUNITIES AND YOU SEE ALL 
THESE BIG DIFFERENCES HERE.
THIS IS JUST TO SHOW SOME 
CONSEQUENCES.
THIS WAS AN OLD SLIDE, BUT IT 
SHOWED THAT ALSO ASIAN STUDENTS 
AND SOMETIMES THERE ARE GROUPS 
WE THINK DON'T HAVE THE SAME 
CONSEQUENCES, AND THEY 
EXPERIENCED.
SO ALL A OF THESE GROUPS 
EXPERIENCED MORE PROBLEMS AS AN 
EFFECT OF DRINKING IF YOU WERE A
MEMBER OF AN ETHNIC GROUP, YOU 
EXPERIENCED MORE PROBLEMS THAN 
THE WHITE CONTROL.
LET'S LOOK AT AIDS CASES.
I'M JUST POINTING OUT A FEW 
THINGS HERE.
AGAIN, THIS GAP.
SO WHAT WE SAW THAT IN THE EARLY
1985 WHEN WE REALLY STARTED 
DOING WORK TO ADDRESS HIV/AIDS, 
WHITES WERE WAY UP HERE AND OUR 
WORK SEEMED TO BE EFFECTIVE AND 
THOSE RATES
THE AIDS CASES, BUT AT THE SAME 
TIME THEY WERE GOING UP, UM, IT 
LOOKS LIKE WE'RE SEEING SOME 
IMPROVEMENT NOW BUT WE ACTUALLY 
KIND OF CREATED A NEW DISPARITY 
HERE IN GOING THIS WAY.
WHILE THIS IS ALWAYS GOING DOWN,
THESE FOR THE HISPANICS AND FOR 
THE AFRICAN AMERICANS NEVER SEEM
TO TAKE A REAL DECREASE.
SO WE REALLY IS TO START LOOKING
AT THESE ISSUES AND FIND OUT 
WHAT'S HAPPENING.
OKAY.
SOME MORE CONSEQUENCES.
THERE HAS BEEN REPORTS THAT 
AFRICAN AMERICAN AND HISPANIC 
DRINKERS -- THIS IS ALCOHOL 
AWARENESS MONTH AS WELL -- WERE 
MORE LIKELY UH TO REPORT 
CONSEQUENCES OF DRINKING 
DEPENDENCE IS I AND TO 
EXPERIENCE MORE PROFOUND 
CONSEQUENCES.
WE KNOW THERE ARE COMORBIDITY 
AND THAT JUST MEANS A 
SIMULTANEOUS OCCURRENCE.
WITH DRUG ABUSE IT'S OFTEN 
COMORE BIT WITH OTHER HEALTH 
CONSEQUENCE JUST WITH THE 
CRIMINALLIZATION, HIV/AIDS BUT 
ALSO WITH HEPATITIS, SEXUALLY 
TRANSMITTED DISEASES, POVERTY, 
OTHER KINDS OF CANCERS AND 
SUBSTANCE ABUSE ITSELF MAY LOWER
INHIBITION AND BECOME THAT RISKY
BEHAVIOR THAT PEOPLE MAY ENGAGE 
IN.
SO THE REALITY IS THAT DESPITE 
SIMILARITY IN DRUG USE, RACIAL 
ETHNIC MINOR TOY POPULATIONS 
EXPERIENCED DISPROPORTIONATE 
CONSEQUENCES OF DRUG USE AND 
INVOLVEMENT EVEN GIVEN THE SAME 
BEHAVIOR.
SO WHAT IS A ADDICTION?
ADDICTION IS A CHRONIC RELAPSING
BRAIN DISEASE THAT CAUSES 
COMPULSIVE DRUG SEEKENING USE 
DESPITE HARMFUL CONSEQUENCES TO 
THE ADDICTED INDIVIDUALS AND TO 
THOSE AROUND HIM OR HER.
ALTHOUGH PEOPLE MAY INITIALLY 
VOLUNTARILY TAKE A DRUG, ONCE IT
PROGRESSES TO DEPENDENCY, THAT 
BECOMES ANOTHER MATTER.
IT DOES BECOME, INVOLVES SOME 
BRAIN -- AN INTERACTION BETWEEN 
THE BRAIN, THE BODY, THE 
ENVIRONMENT.
SO WHAT ARE SOME FEATURES OF 
SUBSTANCE DEPENDENCE?
MOST OF YOU WILL KIND OF KNOW 
THIS.
A PATTERN REPEAT 
SELF-ADMINISTRATION.
SOMETHING YOU DO TO YOURSELF.
YOU DEVELOP A GREATER TOLERANCE.
THE MORE YOU USE, SOMETIMES THE 
MORE YOU NEED.
THERE MIGHT -- IF YOU STOP USING
THERE MIGHT BE SOME WITHDRAWAL.
THERE IS A CRAVING FOR THE DRUG 
WHEN YOU DON'T USE IT.
YOU MIGHT BE UNABLE TO CUT DOWN 
OR CONTROL THE SUBSTANCE.
YOU MIGHT STEND SPEND A GREAT 
DEAL OF TIME AND ACTIVITIES 
NECESSARY TO OBTAIN THE 
SUBSTANCE OR RECOVER FROM ITS 
EFFECTS, OR YOU MAY IGNORE SOME 
IMPORTANT SOCIAL OCCUPATIONAL OR
OTHER ACTIVITIES.
WORK MAY SUFFER.
YOUR PERSONAL LIFE MAY SUFFER.
THIS IS REALLY KEY, THAT 
KNOWLEDGE OF THE HARM DOES NOT 
LEAD TO CHANGE IN BEHAVIOR.
YOU CAN KNOW ALL OF THESE 
THINGS, BUT YOU CAN'T 
NECESSARILY CHANGE IT.
SO HERE ARE SOME SIGNS OF 
ADDICTION.
HOW DO YOU KNOW THERE'S A 
PROBLEM?
DO YOU FEEL THE NEED -- THESE 
ARE SOME THINGS THAT PEOPLE CAN 
GO THROUGH, READ FOR THEMSELVES.
DO YOU BECOME CONCERNED OR 
ANXIOUS ABOUT KEEPING THE DRUG?
DO YOU COTHINGS TO OBTAIN THE 
DRUG THAT YOU WOULDN'T 
ORDINARILY DO?
REMEMBER, WHEN I'M SAYING DRUG, 
I'M TALKING ABOUT TOBACCO, 
CIGARETTES, ALL RIGHT.
[LAUGHTER]
ALCOHOL AND THE ELICIT ILLEGAL 
DRUGS AND THE PRESCRIPTION 
DRUGS.
ALL OF THOSE THINGS CAN BE 
ABUSED.
HAVE YOU HURT SOMEONE YOU LOVE 
OR CARE ABOUT BECAUSE OF YOUR 
DRUG USE?
HAS SOMEONE WHO LOVES YOU OR 
CARES ABOUT YOU TOLD YOU THAT 
THEY THINK YOU HAVE A PROBLEM?
THESE SUGGEST SOME OF THE SIGNS.
DO YOU SPEND MONEY ON DRUG, EVEN
THOUGH YOU CAN'T AFFORD IT?
I HAVE A COUSIN WHO'S MISSION 
NOW SINCE SHE AND A HER HUSBAND 
ARE RETIRED IS TO CUT HIS 
SMOKING DOWN, SO SHE STARTS 
TALKING ABOUT HOW MUCH IT COSTS 
THEM OUT OF THAT RETIREMENT 
CHECK TO PAY FOR THOSE 
CIGARETTES.
SO, UM, DO YOU FOCUS MORE OF 
YOUR TIME AND ENERGY ON GETTING 
AND USING THE DRUG?
HERE ARE SOME OTHER SIGNS THAT 
IT MAY BE A PROBLEM?
DO YOU NEED IT FIRST THING IN 
THE MORNING?
DO YOU -- HAVE YOU WITHDRAWN 
FROM NORMAL CIRCLE OF FRIENDS 
AND FAMILY?
THESE ARE SIGNS YOU CAN LOOK AT 
FOR YOUR TEENAGERS AND LOVED ONE
IN THE HOME.
DO SCHOOL PERFORMANCE CHANGE?
DO THE WAY THEY CARRY THEMSELVES
AND THEIR PERSONAL HABITS 
CHANGE?
ARE THEY UNCOMFORTABLE TALKING 
ABOUT THE DRUG USE?
DO THEY HIDE IT FROM YOU?
HOW DOES ONE BECOME ADDICTED?
WE DONL DON'T REALLY KNOW 
COMPLETELY, BUT WE DO KNOW THAT 
IT'S A COMPLEX COMBINATION OF 
GENETIC, PHYSIOLOGICAL, 
PSYCHOLOGICAL ALL IN INTERACTION
WITH EACH OTHER.
WE'RE DOING A LOT OF WORK TO TRY
TO UNDERSTAND ALL OF THOSE 
FACTORS AND THEN TO SEE HOW THEY
WORK IN COMBINATION TO LEAD TIE 
DICTION.
-- LEAD TO ADDICTION.
THIS IS JUST A GRAPHIC TO TRY TO
SHOW THAT.
AND THEN SHOW -- THEY HAD A VERY
COMPLEX ONE, BUT I DIDN'T WANT 
TO SHOW THAT BECAUSE WE'RE STILL
TRYING TO FIGURE OUT WHAT'S 
GOING ON HERE, BUT YOU'RE 
PREVIOUS HISTORY, THE DRUG, 
ITSELF, WHAT HAPPENS IN THE 
BRAIN.
HOW MANY OF YOU HAVE KNOWN 
PEOPLE WHERE ONE BROTHER IS 
ADIKTED AND THE OTHER ONE IS 
NOT?
HOW MANY FROM THE SAME FAMILY?
IT'S THAT KIND OF THING.
THINK OF IT IN THAT WAY.
THERE IS NO GUARANTEED WAY OF 
KNOWING WHO'S BECOMING ADIKTD OR
WHO IS NOT, BUT WE KNOW WHAT 
SOME OF THE PREDISPOSING 
FEATURES ARE, OR FACTORS, CAN 
BE.
BUT IT HAS TO BE AT THE RIGHT 
TIME THAT KIND OF TRIGGER IT AND
TO PUSH IT FORWARD TO SEE THAT 
VULNERABILITY.
WE NEED NO KNOW WHAT THE RISK 
AND PROTECTIVE FACTORS ARE.
ONCE YOU KIND OF KNOW THAT -- 
NOW THE RISKS WILL KEEP YOU 
FROM, UM -- THE RISK ARE THOSE 
THINGS THAT WILL MAKE YOU 
VULNERABLE TO DRUGS.
I PULLED THIS OUT OF ONE OF OUR 
PUBLICATIONS BECAUSE I WANTED TO
SHOW THE DOMAINS.
SO RISK CAN BE AROUND THE 
INDIVIDUAL, THEMSELVES, THE 
FAMILY AND PEERS AROUND THEM T 
SCHOOL, THE LARGER COMMUNITY.
IT CAN BE POLICIES AND PROGRAMS,
AND SO THESE ARE RISK FACTORS 
LACK OF PARENTAL SUPERVISION, 
SUBSTANCE ABUSE.
FOR INSTANCE F YOU'RE AROUND A 
FAMILY WHERE THERE'S SUBSTANCE 
ABUSE T DRUG AVAILABILITY, HOW 
EASY SIT FOR YOU TO GET SOME 
DRUGS.
DO YOU LIVE IN A NEIGHBORHOOD 
WHERE THERE'S A LIQUOR STORE ON 
EVERY CORNER?
ARE DRUGS, CIGARETTES SOLD TO 
KIDS BECAUSE NOBODY'S CHECKING 
THEIR I.D.?  POVERTY HAS BEEN 
TALKED ABOUT AS BEING A RISK 
FACTOR, BUT THAT'S A VERY 
COMPLEX ONE.
NOW, WHAT ARE SOME OF THE 
PROTECTIVE FACTORS FOR EACH OF 
THOSE RISK FACTORS?
IF WE KNOW THE RISK FACTORS 
WHAT, DO WE KNOW ALSO ABOUT WHAT
MAY KEEP YOU FROM SUCCUMBING TO 
THAT VULNERABILITY?
THERE ARE SOME MEASURES THAT 
PEOPLE HAVE WITHIN THEMSELVESES.
SOME PEOPLE SEEM TO BE MORE 
RESILIENT.
THERE MAY BE SOME OF YOU WHO 
HAVE HAD THOSE MAMAs AND DADDIES
AND NEIGHBORS THAT DID A LOT OF 
SUPERVISING AND MONITORING WHERE
YOU ARE, WHEN DO YOU NEED TO BE 
IN THE HOUSE AND WHO YOU CAN 
CANNOT HANG AROUND WITH.
ACADEMIC COMPETENCE, STRONG 
NEIGHBORHOOD ATTACHMENT.
I WANED TO TALK ABOUT SOME OTHER
COMMON RISK FACTORS THAT SEEM TO
INCREASE VULNERABILITY.
WE'VE TALKED ABOUT FAMILY 
HISTORY, IF THERE'S A GENETIC 
PREDISPOSITION.
IF SOMEBODY'S AN ALCOHOLIC, YOU 
MIGHT BE AT AN INCREASED RISK OF
BECOMING AN ALCOHOLIC.
ALMOST 70, MAYBE 8 O 0% OF WOMEN
WHO ARE IN TREATMENT FOR DRUG 
ADDICTION OFTEN REPORT CHILDHOOD
OR SOME KIND OF PHYSICAL OR 
SEXUAL ABUSE OR TRAUMA.
SO WE KNOW THOSE KIND OF GO 
TOGETHER.
SO BEING AWARE OF TRAUMA, BEING 
AWARE THAT IF YOU UH HAVE TRAUMA
IN YOUR PAST HISTORY, THAT THAT 
CAN STILL MAKE YOU VULNERABLE 
AND YOU NEED TO BE AWARE OF IT 
SO THAT YOU CAN WATCH AND SEEK 
SUPPORT WHEN YOU NEED IT.
SO INTIMATE PARTNER VIOLENCE 
SUCH AS DOMESTIC ABUSE, 
PSYCHIATRIC PROBLEMS AND STRESS.
I'M GOING TO TALK ABOUT STRESS 
BECAUSE THAT IS BEING 
INVESTIGATED MORE AND MORE, AND 
WE'RE LOOKING ABOUT STRESS MAY 
INCREASE VULNERABILITY TO 
ADDICTION.
IT MAY AFFECT YOUR REGULATION, 
STRESS REGULATION, IMPULSE 
CONTROL.
IT'S A PHYSIOLOGICAL RESPONSE 
THAT YOUR BODY HAS TO STRESS, SO
WE'RE TRYING TO UNDERSTAND IT 
FROM THAT BASIS AS WELL AS 
BEHAVIORAL AND SOCIAL BASIS.
WHAT'S GOING ON IN YOUR BODY IF 
YOU ARE IN STRESS?
WE LIVE IN A VERY STRESSFUL 
TIMES NOW.
WE HAVE SOME OF US HERE -- ALL 
OUFS HERE, I GUESS ARE WONDERING
IF WE'LL HAVE A JOB NEXT WEEK.
[LAUGHTER]
AND SOME PEOPLE MAY BE LIVING 
FROM PAYCHECK TO PAYCHECK, SO 
THAT CAN CREATE ANOTHER LAYER OF
STRESS.
WE'RE LIVING IN A WORLD WHERE 
THERE'S A LOT OF WARS GOING ON.
SO IF YOU HAVE CHILDREN WHO MAY 
BE GOING TO THE ARMED FORCES.
SO THERE'S STRESS EVERYWHERE AND
HOW WE COPE WITH IT AND WHAT IT 
DOES TO YOUR BODY IS IMPORTANT 
TO KIND OF RECOGNIZE AND THEN 
WHAT THAT DOES TO YOUR BRAIN AND
IN INTERACTION WITH ALL OF THAT 
CONCERN YOU KNEE MODEL WE SAW 
WHERE WE NEED TO UNDERSTAND 
THAT, UM, YOU NEED TO BE AWARE 
AND IDENTIFY THOSE SOURCES OF 
STRESS AND HOW IT CAN AFFECT 
YOUR BODY.
WE TALK A LITTLE BIT ABOUT POST 
TRAUMATIC STRESS DISORDER.
THAT IS THAT WHAT YOUR BODY DOES
AND WHAT YOU DO IN RESPONSE TO 
EXPOSURE TO A TRAUMATIC EVENT, 
THAT EVENT COULD HAVE BEEN WAY 
IN THE PAST.
MOST OF US ARE FAMILIAR WITH IT 
FROM PEOPLE WHO HAVE BEEN IN THE
SERVICE.
DURING THE TIME I WAS COMING UP,
A LOT OF PEOPLE COMING FROM 
VIETNAM.
A LOFT FRIEND WHO IS HAD 
HUSBANDS AND BOYFRIENDS THAT 
CAME BACK OR EXHIBITED A LOT OF 
PTSD.
SO THERE ARE SOME CONSEQUENCES 
OF THAT, AND CONSEQUENCES OF 
THAT INCLUDES, UM, SUBSTANCE 
DEPENDENCE AND THERE IS A LOT OF
STUDIES TO TALK ABOUT THAT.
SO I JUST TALK ABOUT SOME 
STRESSORS FOR PEOPLE OF COLOR 
BECAUSE, UM, THE UNEMPLOYMENT, 
THE JOBS SECURITY AND 
ADVANCEMENT, DEBT THAT YOU'RE 
ALREADY IN, THE THINGS THAT'S 
HAPPENING TO HOUSING AND PEOPLE 
LOSING THEIR HOMES, IMMIGRATION 
STATUS FOR A LOT OF PEOPLE, 
PARTICULARLY IN LATINO GROUP 
POPULATIONS, FAMILY 
RESPONSIBILITIES.
IF PEOPLE ARE UNMROITD AND 
YOU'RE TAKING ON 
RESPONSIBILITIES NOT ONLY FOR 
YOUR HOUSEHOLD BUT FOR OTHER 
PEOPLE IN YOUR FAMILY.
THERE ARE UNIQUE STRESSORS FOR 
PEOPLE OF COLOR.
I WAS ATTENDING A SUMMIT A 
COUPLE OF MONTHS AGO AND SO I 
JUST WANTED TO SHARE SOME OF 
THIS WITH YOU.
ONE OF THE UNIQUE STRESSORS FOR 
MINORITY POPULATIONS ARE RACIAL 
MICROAGGRESSIONS.
HOW MANY ARE FAMILIAR WITH THAT?
RACIAL MICROAGGRESSIONS ARE 
BRIEF AND COMMON PLACE DAILY 
VERBAL BEHAVIORAL OR 
ENVIRONMENTAL INDIGNITIES THAT 
COMMUNICATE HOSTILE, DEROGATORY 
OR NEGATIVE RACIAL SLICE AND 
INSULTS TOWARD'S PEOPLE COLOR.
I'VE BEEN HEARING PEOPLE 
COMPLAIN ABOUT IT MORE AS THE 
COUNTRY BECOMES MORE POLARIZED 
LATELY.
PEOPLE VOFB TALKING ABOUT THAT.
I THINK IT'S IMPORTANT FOR US TO
RECOGNIZE IT BECAUSE SIT A LEVEL
OF STRESS AND FOR SOME IT SEEMS 
CHRONIC.
THESE ARE THE TYPES OF 
MICROAGGRESSIONS: MICROASSAULTS 
WHICH USED TO BE CALLED RACISM.
AND THEN THERE'S SOME 
MICROINSULTS.
COMMUNICATIONS THAT CONVEY 
RUDENESS AND INSENSITIVITY AND 
DEMEAN A PERSON'S RACIAL 
HERITAGE OR IDENTITY.
THERE COULD BE SUBTLE SNUBS.
MICROCOMMUNICATIONS, 
COMMUNICATIONS THAT EXECUTE, 
NEGATE OR NULLIFY THE 
PSYCHOLOGICAL THOUGHTS FEELINGS 
OF A PERSON OF COLOR.
THIS CAPTURES WHAT SOME OF THOSE
MIGHT BE.
MAKING PEOPLE FEEL LIKE THEY'RE 
AN ALIEN IN ONE'S OWN LAND.
THE MYTH OF [INDISCERNIBLE] AS 
IF EVERYTHING THAT HAVE HAPPENED
IN THE COUNTRY THAT PEOPLE HAVE 
GOTTEN THERE BASED ON THEIR OWN 
HARD MERIT.
WHAT THAT DOES IS NEGATE THE 
LEGAL DISCRIMINATION THAT YOU 
WEREN'T THERE FOR SOME OTHER 
REASONS; SECOND-CLASS FA STATUS 
ONE OF THEM.
ALIEN IN OWN LAND WHEN SOME 
ASIAN AMERICANS ASK WHERE YOU'RE
FROM.
CRIMINAL NALT, A STORE OWNER 
FOLLOWING A CUSTOMER OF COLOR 
AROUND THE STORE AND GIVING OFF 
THE IMFLAEGS PERHAPS YOU WANT TO
STEAL SOMETHING.
ASKING A BLACK PERSON PATHIZING 
CULTURAL VALUES.
ASK A BLACK PERSON, WHY DO YOU 
HAVE TO BE SO LOUD AND ANIMATED 
WHEN YOU SPEAK?
AT THE SAME TIME THEY MY ASK AN 
ASIAN PERSON, WHY ARE YOU SO 
QUIET?
OR THAT FAMOUS ONE OF YOU 
PEOPLE.
SOMETIMES PEOPLE DON'T INTENTD 
IT, BUT IT RINGS A BELL FOR 
FOLKS IN CERTAIN GROUPS WHEN 
THEY SEEM TO BE CATEGORIZED THAT
WAY.
THE REASON I BRING THAT UP IS 
BECAUSE I'VE JUST OBSERVE THAT 
THE MORE AND MORE PEOPLE ARE 
FEELING AS IF THEY ARE HEARING 
THAT MORE AND MORE, SOMETIMES IN
THE WORKPLACE, BUT IT CAN HAPPEN
IN YOUR SOCIAL SETTINGS, IT CAN 
HAPPEN IN THE STORES, IT CAN 
HAPPEN WHEREVER YOU ARE.
WHEN YOU WATCH THE NEWS AND 
PEOPLE START TALKING ABOUT 
URBAURBAN
AND YOU FIGURE OUT WHAT THEY'RE 
REALLY TALKING ABOUT.
WHAT CAN PEOPLE DO?
GIVEN THAT STRESS, GIVEN THAT 
WE'VE SEEN THE SIGNS, GIVEN 
WHERE WE ARE NOW WITH ABUSE AND 
USE, WHAT CAN WE DO TO PREVENT 
DRUG ABUSE?
WE CAN RECOGNIZE WHAT THE RISKS 
ARE AND WE CAN WORK TO REDUCE OR
COPE WITH THEM.
WE CAN RECOGNIZE WHAT PROTECTIVE
FACTORS ARE AND WORK TO FWIEND, 
ESTABLISH AND STRENGTHEN THEM.
SO WE HAVE PUBLICATIONS NIDA AND
NI TRIPLE A AND AT A NUMBER OF 
PLACES THAT TALK ABOUT THESE 
RISK FACTORS AND GIVE YOU WAYS 
TO DEVELOP PROGRAMS IN YOUR 
COMMUNITIESES, AT YOUR HOME, 
THINGS YOU CAN DO INDIVIDUALLY 
AT YOUR WORKPLACE.
I'M NOT GOOD AT GRAPHS BUT I'M 
GOING TO SHOW YOU THIS ONE.
WE NEED TO BUILD UP OUR 
PROTECTIVE FACTORS.
THESE ARE THE FACTORS THAT'S 
GOING TO INCREASE OUR RESILIENT 
IS I, PROVIDE SAFETY NETS SO 
THAT WHEN WE GO OFF -- REMEMBER 
THOSE CONSEQUENCES THAT I TALKED
ABOUT THAT RACIAL ETHNIC PEOPLE?
IF YOU TIP OVER, IT'S HARD TORE 
UPRIGHT YOURSELF BECAUSE YOU 
DON'T HAVE AS MUCH AROUND YOU.
SO IF YOU LOSE A TWO-WEEK 
PAYCHECK, YOU GET SO FAR BEHIND 
IT'S HARD TO CATCH UP.
SO WE'RE TALKING ABOUT FENCES 
AND PILLOWS.
SO IF YOU FALL OFF THE PATH -- 
SO WE NEED TO LEARN HOW TO LINE 
OUR PATHS.
THIS IS A ROAD HERE THAT I WAS 
TRYING TO MAKE, AND YOU CAN WALK
DOWN THE ROAD AND THEN YOU FALL.
SOME PEOPLE MAY HAVE A PARACHUTE
THAT'S GOING HELP THEM AS THEY 
DRIFT DOWN.
THEY CAN RIGHT THEMSELVES BACK 
UP.
SOME PEOPLE MIGHT FIND AN 
AMBULANCE DOWN THERE, BUT SOME 
OF US ARE WALKING DOWN ROADS 
WHERE THERE ARE NOT MANY FENCES 
AROUND US, AND WE GET TO THE 
EDGE, DON'T SEE IT COMING AND 
YOU FALL AND YOU JUST GOT THIS 
LOOK OF TER ROR AND WHAT DO I DO
NOW?
YOU'RE SCRAMBLING TO TRY TO PULL
YOURSELF BACK UP WHILE YOU'RE 
PULLING YOUR WHOLE FAMILY BACK 
UP AS WELL.
SO THAT PROTECTIVE FACTOR MEANS 
YOU'RE TRYING TO BUILD THESE 
FENCES FOR YOURSELF, STRIEING TO
HAVE SOME SOFT LANDINGS FOR YOUR
CHILDREN AND TRYING TO HAVE SOFT
LANDINGS FOR YOUR COMMUNITY.
SO IT'S NOT THAT ANYBODY DOESN'T
TAKE A RISK.
ALL OF US JUST AS A PART OF 
DEVELOPMENT AND LIVING ARE GOING
TO TAKE SOME RISKS SOMETIMES, 
BUT THOSE RISKS SHOULD NOT HAVE 
TO ALWAYS LEAD TO SUCH SEVERE 
CONSEQUENCES FOR US, FOR CERTAIN
GROUPS.
SO WHAT CAN YOU DO?
YOU CAN BUILD UP YOUR OWN 
INFORMAL SUPPORT SYSTEMS.
EVERYBODY NEEDS A SUPPORTED 
NETWORK OF TRUSTED FRIENDS AND 
COWORKERS.
YOU NEED TO PARTICIPATE IN THESE
R AND W PROGRAMS SUCH AS THE 
YOGA, THE WEIGHT MANAGEMENT -- 
REMEMBER THAT PHYSICAL EXERCISE 
AND DIET WAS NUMBER TWO UP THERE
AS THE LEADING CAUSE OF DEATH?
RUNNING AEROBICS.
I THINK THERE'S A GROUP OF NIDA,
MAYBE HERE, THAT THEY MEED METE 
TO HAVE A SPIRITUAL MEETING 
ABOUT ONCE OR TWICE A WEEK.
USE YOUR SPIRITUAL RELIGIOUS 
BELIEFS AND PRACTICE.
MEDITATE TAIT.
THESE ARE THINGS YOU CAN DO TO 
TRY TO CARE FOR YOURSELF.
IF YOU HAVE PROGRESSED AND 
PEOPLE ACTUALLY ARE, HAVE 
ADDICTION, THERE ARE A FEW 
PEOPLE WHO CAN REALLY KIND OF 
KICK THAT BY THEMSELVES, BUT FOR
MOST PEOPLE IF IT'S TRUE 
DEPENDENCE AND ADDICTION, YOU'RE
GOING NEED TO GET SOME 
PROFESSIONAL HELP, SOME KIND OF 
HELP.
THIS WAS JUST TO SHOW THAT A LOT
OF TIMES -- AND THIS IS JUST 
DENIAL.
PEOPLE WHO DEFINITELY HAVE 
DEPENDENCE DON'T FEEL THAT THEY 
NEED TREATMENT.
SO YOU KEEP STUMBLING ALONG A 
LONG TIME NEEDING IT BUT FEELING
THAT YOU HAVE IT ALL UNDER 
CONTROL AND YOU MIGHT BE NOW FOR
PEOPLE OF COLOR WHO ARE ALREADY 
KIND OF AT THIS RISK STATUS, THE
LONGER SOMEONE DOESN'T GET HELP,
IT AFFECTS EVERYBODY ELSE AROUND
THEM AS WELL, INCLUDING THEIR 
COMMUNITY.
SO WE WANT YOU TO GET INTO 
RECOVERY OR TO HELP PEOPLE GET 
INTO RECOVERY AND THE GOAL OF 
RECOVERY IS TO NOT -- IS TO STOP
THE DRUG USE, BUT THAT'S NOT 
ALL.
IT IS TO BE ABLE TO GET PEOPLE 
TO THE POINT WHERE THEY CAN 
MAINTAIN A DRUG-FREE LIFESTYLE, 
AND THEY CAN BECOME AN ACTIVE, 
PRODUCTIVE MEMBER OF SOCIETY.
GET BACK TO WORK.
GET BACK TO YOUR FAMILY.
GET BACK TO YOUR COMMUNITIES.
SO THAT'S WHAT WE WANT, NOT JUST
STOPPING THE DRUGS.
YOU TO DEAL WITH THOSE PROBLEMS 
THAT PEOPLE HAVE COMING IN.
NOW THE PROBLEM WITH PEOPLE OF 
COLOR, OFTEN, IS THAT BY THE 
TIME WE GET TO ADDICTION, WHEN 
WE GET TO TREATMENT, WE HAVE SO 
MANY SEVERE PROBLEMS THAT WE 
BRING WITH US TO TREATMENT.
MORE THAN LIKELY TO BE 
UNEMPLOYED, NOT HAVE A GOOD 
FAMILY INCOME, MAYBE ALSO OTHER 
HEALTH CONCERNS, HIV, STI AND 
SOME OTHER CONCERN THERE IS.
THERE ARE EVIDENCE-BASED 
INTERVEPGSS THAT HAVE BEEN 
DEVELOPED AND THEY'RE IN PLACE, 
AND WE WANT INTERVENTIONS AND 
APPROACHES THAT HAVE BEEN 
DOCUMENTED TO BE SUCCESSFUL.
WE KNOW THAT THERE ARE PROGRAMS 
WHERE PEOPLE GO IN AND IF IT 
WORKED FOR THE MAN DOWN THE 
STREET AND HE WANTS TO TALK TO 
YOU, HE COULD BE A VERY GOOD 
SUPPORT, BUT SOMETIMES IT WON'T 
WORK FOR YOU.
SO I KNOW I'M JUST GOING TOO FAR
OVER BUT THESE ARE SOME OF THE 
EVIDENCE-BASED TREATMENTS THAT 
WE KNOW ABOUT.
WE HAVE MEDICATIONS.
WE HAVE THERAPEUTIC COMMUNITIES.
WE HAVE BEHAVIORAL TREATMENTS 
ARE AVAILABLE, AND THESE ARE 
SOME PRINCIPLES OF EFFECTIVE 
TREATMENT, AND I WANT TO JUST 
HIGHLIGHT A COUPLE OF THEM.
TO RECOGNIZE THAT ADDICTION IS 
COMPLEX BUT TREATABLE.
NO SINGLE TREATMENT IS 
APPROPRIATE FOR EVERYBODY.
THERE IS NOT GOING TO BE 
ONE-SIZE-FITS ALL.
YOU MAY HAVE TO GO THROUGH A 
COUPLE OF TIMES OR A COUPLE OF 
AS -- APPROACHES TO FIND 
SOMETHING THAT WORKS FOR YOU.
THESE TREATMENT DOS NOT HAVE TO 
BE VOLUNTEER TAIR TO BE 
EFFECTIVE.
THIS WAS AN IMPORTANT FINDING.
WHEN WE USED TO HAVE THIS BELIEF
THAT PEOPLE NEED TO HIT ROCK 
BOTTOM AND THAT WAS GOING BE THE
ONLY WAY IT WAS GOING TO WORK.
THAT CERTAINLY HELPS, BUT IT 
WILL WORK -- AND SOMETIMES IT'S 
NOT VOLUNTARY.
A GOOD EXAMPLE.
A WOMAN WHO MIGHT LOSE CUSTODY 
OF HER CHILDREN AND IS PUT INTO 
TREATMENT, SHE E MAY BECOME MORE
CO
COMPLIANT AND WORK HARDER FOR 
THAT.
WE KNOW THAT MOST PEOPLE ARE 
GOING TO GET TREATMENT FROM SOME
SELF-HELP GROUP AND OUTPATIENT 
REHAB.
THERE'S NOT MANY OF US THAT'S 
GOING THE END UP IN SOME OF 
THESE PRIVATE PLACES, BUT LOOK 
AT THAT.
REMEMBER WHEN I TALKED ABOUT 
WHERE PEOPLE WENT WHEN THEY WERE
USING DRUGS, THEY WERE BEING 
SENT TO JAIL?
WHAT'S HAPPENING IN PRISONS AND 
JAILS?
IF YOU GET THERE, TREATMENT IS 
NOT WHAT YOU'RE GOING TO GET, 
AND DEFINITELY, THAT'S KIND OF 
WHETHER WHERE IT'S NEED RESPOND 
WE ALL NEED TO WORK TO SEE IF WE
CAN MAKE SOME DIFFERENCE THERE.
SO THESE ARE JUST SOME POINTS TO
REMEMBER.
THAT RACIAL ETHNIC MINORITY 
POPULATIONS DO NOT USE DRUGS 
MORE THAN WHITES.
THEY DO EXPERIENCE MORE SEVERE 
CONSEQUENCES OF DRUG USE AND 
ADDICTIONS.
SO WE HAVE TO ATTEND TO IT 
BECAUSE OF WHAT IT DOES TO THE 
PERSON AND WHAT IT DOES TO THEIR
FAMILIES AND COMMUNITIES.
RISKS ARE NOT NECESSARILY E 
KWIVENT ACROSS GROUPS SO SIMILAR
BEHAVIOR CAN CARRY GREATER RISK 
FOR RACIAL/ETHNIC POMLATIONS.
IN ORDER TO RECOVER FROM 
ADDICTION, A PERSON DOES NOT 
HAVE TO HIT ROCK BOTTOM.
DRUG ABUSE DOES NOT ONLY HURT 
JUST THE USER, IT HURTS THE 
FAMILY AND COMMUNITY, ESPECIALLY
FOR RACIAL/ETHNIC MINORITY 
INDIVIDUALS, AND WE NEED TO PAY 
ATTENTION TO STRESS IN YOUR 
LIVES AND TAKE CARE OF YOURSELF.
THESE ARE SOME RESOURCES AT 
NIDA, HAS PUBLICATIONS.
I SUGGEST THE INFO FACT SERIES 
WHICH TALKS TO YOU ABOUT THE 
DRUGS.
PARTICULAR FACTS, HIV, 
COMORBIDITY.
THIS IS A GOOD WEB SITE.
THE SUBSTANCE ABUSE AND MENTAL 
HEALTH SERVICES ADMINISTRATION 
PROVIDES AN ONLINE TREATMENT 
LOCATOR.
SO YOU CAN GO ONLINE AND FIND 
OUT WHERE THERE ARE SUBSTANCE 
ABUSE PROGRAMS OR REFERRALS.
ANY PLACE IN THE COUNTRY, YOU 
JUST CLICK ON THE MAP AND IT'LL 
TELL YOU WHERE TO GO.
SAMSA ALSO PROVIDES TELEPHONE 
NUMBER THAT YOU CAN CALL.
NIH HAS AN EMPLOYEE-ASSISTANCE 
PROGRAM AND HEALTH PROMOTIONS 
PROGRAMS THAT MIGHT BE HELP TO 
YOU.
THANK YOU FOR YOUR TIME AND I 
APOLOGIZE AGAIN FOR THE HIS -- 
MISHAP.
[APPLAUSE]
ANY QUESTIONS?
UH-HUH.
>> [LOW AUDIO].
>> YES.
I DON'T KNOW IF EVERYBODY COULD 
HEAR THAT, BUT, DR. LAURA FROM 
THE NATIONAL INSTITUTE ON 
ALCOHOL AND ALCOHOL ABUSE AND 
ALCOHOLISM WAS JUST CONFIRMING 
THE IMPORTANCE OF PAYING 
ATTENTION TO WHAT'S HAPPENING 
WITH OUR GIRLS, AND TO NOT MAKE 
ASSUMPTIONS THAT THEY ARE NOT 
GOING USE BECAUSE DRUG 
AVAILABILITY, DRUGS ARE MORE 
AVAILABLE TO THEM AND THEY'RE 
MAKING CHOICES TO USE DRUGS IN 
WAYS THAT WE HAVE NOT SEEN IN 
THE PAST.
>> I WANT TO THANK YOU VERY MUCH
FOR YOUR LECTURE, IT WAS VERY 
INFORMATIVE.
[APPLAUSE]
JUST AS A HEADS -- SOME 
INFORMATION FOR ANYONE WHO'S 
LISTENING TO US VIA VIDEO CAST.
ON MONDAY, APRIL THE 11th, AT 
11:00 A.M., WE WILL BE 
CONTINUING OUR FREE FITNESS FOR 
YOU YOGA CLASS.
IT'S FREE AND AVAILABLE TO ALL 
NIH EMPLOYEES AND I WOULD 
ENCOURAGE YOU TO ATTEND.
THANK YOU VERY MUCH ONCE AGAIN 
DR. BEATTY, AND THANK YOU ALL 
FOR ATTENDING.
THANK YOU VERY MUCH.
THANK YOU VERY MUCH.