Racial discrimination, socioeconomic position, and illicit drug use among US Blacks

  • Hannah Carliner
  • Erin Delker
  • David S. Fink
  • Katherine M. Keyes
  • Deborah S. Hasin
Original Paper



We assessed the relationship of self-reported racial discrimination with illicit drug use among US Blacks, and whether this differed by socioeconomic position (SEP).


Among 6587 Black participants in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004–2005), we used multiple logistic regression models to test the association between racial discrimination (measured on the 6-item Experiences of Discrimination scale) and past-year illicit drug use, and whether this differed by SEP.


Racial discrimination was associated with past-year drug use [adjusted odds ratio (aOR) 2.32; 95 % confidence interval (CI) 1.70, 3.16] and with frequent drug use (aOR 1.91; 95 % CI 1.22, 2.99). For frequent illicit drug use, this relationship was stronger among higher SEP participants (aOR 3.55; 95 % CI 2.09, 6.02; p interaction < 0.01).


The stronger association between racial discrimination and frequent illicit drug use among higher SEP Blacks suggests a complex interplay between disadvantaged and privileged statuses that merits further investigation. The finding of a significant difference by SEP highlights the importance of considering differences within heterogeneous race/ethnic groups when investigating health disparities.


Racial discrimination African-Americans Substance use Socioeconomic position Intersectionality 



The National Epidemiologic Survey on Alcohol and Related Conditions was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support from the National Institute on Drug Abuse. This study was supported in part by NIDA Grant# T32DA031099 (HC, DSF; PI: DSH), NIAAA Grant# K01AA021511 (KMK), New York State Psychiatric Institute, and the Columbia University Mailman School of Public Health Department of Epidemiology (DSH).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

Informed consent was obtained for participation and study procedures were approved by the US Office of Management and Budget. Human subjects research approval for the NESARC study was granted by the US Census Bureau and the US Office of Management and Budget.


  1. 1.
    Moos RH (2007) Theory-based processes that promote the remission of substance use disorders. Clin Psychol Rev 27(5):537–551. doi: 10.1016/j.cpr.2006.12.006 PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Kaplan HB (1996) Psychosocial stress from the perspective of self theory. In: Kaplan HB (ed) Psychosocial stress: perspectives on structure, theory, life-course, and methods. Academic Press, San Diego, CA, pp 175–244Google Scholar
  3. 3.
    Gerrard M, Stock ML, Roberts ME, Gibbons FX, O’Hara RE, Weng C-Y, Wills TA (2012) Coping with racial discrimination: the role of substance use. Psychol Addict Behav 26(3):550PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Clark TT (2014) Perceived discrimination, depressive symptoms, and substance use in young adulthood. Addict Behav 39(6):1021–1025. doi: 10.1016/j.addbeh.2014.01.013 PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Holahan CJ, Moos RH, Holahan CK, Cronkite RC, Randall PK (2001) Drinking to cope, emotional distress and alcohol use and abuse: A ten-year model. J Stud Alcohol 62(2):190–198PubMedCrossRefGoogle Scholar
  6. 6.
    Cooper ML, Krull JL, Agocha VB, Flanagan ME, Orcutt HK, Grabe S, Dermen KH, Jackson M (2008) Motivational pathways to alcohol use and abuse among Black and White adolescents. J Abnorm Psychol 117(3):485PubMedCrossRefGoogle Scholar
  7. 7.
    Cooper ML, Frone MR, Russell M, Mudar P (1995) Drinking to regulate positive and negative emotions: a motivational model of alcohol use. J Pers Soc Psychol 69(5):990–1005PubMedCrossRefGoogle Scholar
  8. 8.
    Sinha R (2008) Chronic stress, drug use, and vulnerability to addiction. Ann N Y Acad Sci 1141(1):105–130. doi: 10.1196/annals.1441.030 PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Sinha R (2001) How does stress increase risk of drug abuse and relapse? Psychopharmacology 158(4):343–359PubMedCrossRefGoogle Scholar
  10. 10.
    Carpenter KM, Hasin D (1998) A prospective evaluation of the relationship between reasons for drinking and DSM-IV alcohol-use disorders. Addict Behav 23(1):41–46PubMedCrossRefGoogle Scholar
  11. 11.
    Carpenter KM, Hasin DS (1999) Drinking to cope with negative affect and DSM-IV alcohol use disorders: a test of three alternative explanations. J Stud Alcohol 60(5):694–704PubMedCrossRefGoogle Scholar
  12. 12.
    Degenhardt L, Baxter AJ, Lee YY, Hall W, Sara GE, Johns N, Flaxman A, Whiteford HA, Vos T (2014) The global epidemiology and burden of psychostimulant dependence: findings from the Global Burden of Disease Study 2010. Drug Alcohol Depend 137:36–47. doi: 10.1016/j.drugalcdep.2013.12.025 PubMedCrossRefGoogle Scholar
  13. 13.
    Degenhardt L, Hall W (2012) Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 379(9810):55–70. doi: 10.1016/S0140-6736(11)61138-0 PubMedCrossRefGoogle Scholar
  14. 14.
    Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, Hall WD, Freedman G, Burstein R, Johns N, Engell RE, Flaxman A, Murray CJ, Vos T (2013) Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet 382(9904):1564–1574. doi: 10.1016/S0140-6736(13)61530-5 PubMedCrossRefGoogle Scholar
  15. 15.
    National Institute on Alcohol Abuse and Alcoholism (2006) Alcohol use and alcohol use disorders in the United States: Main findings From the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) National Institutes of Health 8Google Scholar
  16. 16.
    Chae DH, Lincoln KD, Adler NE, Syme SL (2010) Do experiences of racial discrimination predict cardiovascular disease among African American men? The moderating role of internalized negative racial group attitudes. Soc Sci Med 71(6):1182–1188. doi: 10.1016/j.socscimed.2010.05.045 PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Chae DH, Nuru-Jeter AM, Lincoln KD, Jacob Arriola KR (2012) Racial discrimination, mood disorders, and cardiovascular disease among Black Americans. Ann Epidemiol 22(2):104–111. doi: 10.1016/j.annepidem.2011.10.009 PubMedCrossRefGoogle Scholar
  18. 18.
    Krieger N, Sidney S (1996) Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Publ Health 86(10):1370–1378. doi: 10.2105/AJPH.86.10.1370 CrossRefGoogle Scholar
  19. 19.
    McLaughlin KA, Hatzenbuehler ML, Keyes KM (2010) Responses to discrimination and psychiatric disorders among Black, Hispanic, female, and lesbian, gay, and bisexual individuals. Am J Publ Health 100(8):1477–1484CrossRefGoogle Scholar
  20. 20.
    Williams DR, Mohammed SA (2013) Racism and health I: pathways and scientific evidence. Am Behav Sci 57(8):1152–1173. doi: 10.1177/0002764213487340 CrossRefGoogle Scholar
  21. 21.
    Brondolo E, Brady Ver Halen N, Pencille M, Beatty D, Contrada RJ (2009) Coping with racism: a selective review of the literature and a theoretical and methodological critique. J Behav Med 32(1):64–88. doi: 10.1007/s10865-008-9193-0 PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Williams DR, Mohammed SA (2009) Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32(1):20–47PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Brody GH, Kogan SM, Y-f Chen (2012) Perceived discrimination and longitudinal increases in adolescent substance use: gender differences and mediational pathways. Am J Publ Health 102(5):1006–1011. doi: 10.2105/AJPH.2011.300588 CrossRefGoogle Scholar
  24. 24.
    Gibbons FX, Etcheverry PE, Stock ML, Gerrard M, Weng C-Y, Kiviniemi M, O’Hara RE (2010) Exploring the link between racial discrimination and substance use: what mediates? What buffers? J Pers Soc Psychol 99(5):785–801. doi: 10.1037/a0019880 PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Gibbons FX, Gerrard M, Cleveland MJ, Wills TA, Brody G (2004) Perceived discrimination and substance use in African American parents and their children: a panel study. J Pers Soc Psychol 86(4):517–529. doi: 10.1037/0022-3514.86.4.517 PubMedCrossRefGoogle Scholar
  26. 26.
    Gibbons FX, Yeh HC, Gerrard M, Cleveland MJ, Cutrona C, Simons RL, Brody GH (2007) Early experience with racial discrimination and conduct disorder as predictors of subsequent drug use: a critical period hypothesis. Drug Alcohol Depend 88(Suppl 1):S27–S37. doi: 10.1016/j.drugalcdep.2006.12.015 PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Otiniano Verissimo AD, Gee GC, Ford CL, Iguchi MY (2014) Racial discrimination, gender discrimination, and substance abuse among Latina/os nationwide. Cult Divers Ethn Minor Psychol 20(1):43–51. doi: 10.1037/a0034674 CrossRefGoogle Scholar
  28. 28.
    Terrell F, Miller AR, Foster K, Edward Watkins Jr C (2006) Racial discrimination-induced anger and alcohol use among black adolescents. Adolescence 41(163):485–492PubMedGoogle Scholar
  29. 29.
    Borrell LN, Jacobs DR, Williams DR, Pletcher MJ, Houston TK, Kiefe CI (2007) Self-reported racial discrimination and substance use in the coronary artery risk development in adults study. Am J Epidemiol 166(9):1068–1079. doi: 10.1093/aje/kwm180 PubMedCrossRefGoogle Scholar
  30. 30.
    Hunte H, Finlayson T (2013) The relationship between perceived discrimination and psychotherapeutic and illicit drug misuse in Chicago, IL, USA. J Urban Health 90(6):1112–1129. doi: 10.1007/s11524-013-9822-y PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Yen IH, Ragland DR, Greiner BA, Fisher JM (1999) Racial discrimination and alcohol-related behavior in urban transit operators: findings from the San Francisco Muni Health and Safety Study. Publ Health Rep 114(5):448CrossRefGoogle Scholar
  32. 32.
    Yen IH, Ragland DR, Greiner BA, Fisher JM (1998) Workplace discrimination and alcohol consumption: findings from the San Francisco Muni Health and Safety Study. Ethn Dis 9(1):70–80Google Scholar
  33. 33.
    Martin JK, Tuch SA, Roman PM (2003) Problem drinking patterns among African Americans: the impacts of reports of discrimination, perceptions of prejudice, and “risky” coping strategies. J Health Soc Behav 44(3):408–425PubMedCrossRefGoogle Scholar
  34. 34.
    Whitbeck LB, Hoyt DR, McMorris BJ, Chen X, Stubben JD (2001) Perceived discrimination and early substance abuse among American Indian children. J Health Soc Behav 42(4):405–424PubMedCrossRefGoogle Scholar
  35. 35.
    Whitbeck LB, Chen X, Hoyt DR, Adams GW (2004) Discrimination, historical loss and enculturation: culturally specific risk and resiliency factors for alcohol abuse among American Indians. J Stud Alcohol 65(4):409–418PubMedCrossRefGoogle Scholar
  36. 36.
    Jackson PB, Williams DR (2006) The intersection of race, gender, and SES: health paradoxesGoogle Scholar
  37. 37.
    Krieger N (2011) Epidemiology and the people’s health: theory and context. Oxford University Press, New YorkCrossRefGoogle Scholar
  38. 38.
    Krieger N (2014) Discrimination and health inequities. Int J Health Serv 44(4):643–710. doi: 10.2190/HS.44.4.b PubMedCrossRefGoogle Scholar
  39. 39.
    Schulz AJ, Mullings L (2006) Gender, race, class, and health: Intersectional approaches. Jossey-Bass, San FranciscoGoogle Scholar
  40. 40.
    Bauer GR (2014) Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity. Soc Sci Med 110:10–17PubMedCrossRefGoogle Scholar
  41. 41.
    Bowleg L (2012) The problem with the phrase women and minorities: intersectionality—an important theoretical framework for public health. Am J Public Health 102(7):1267–1273. doi: 10.2105/AJPH.2012.300750 PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Garnett BR, Masyn KE, Austin SB, Miller M, Williams DR, Viswanath K (2014) The intersectionality of discrimination attributes and bullying among youth: an applied latent class analysis. J Youth Adolesc 43(8):1225–1239. doi: 10.1007/s10964-013-0073-8 PubMedCrossRefGoogle Scholar
  43. 43.
    Huebner DM, Davis MC (2007) Perceived antigay discrimination and physical health outcomes. Health Psychol 26(5):627–634. doi: 10.1037/0278-6133.26.5.627 PubMedCrossRefGoogle Scholar
  44. 44.
    Watson JM, Scarinci IC, Klesges RC, Slawson D, Beech BM (2002) Race, socioeconomic status, and perceived discrimination among healthy women. J Women Health Gend based Med 11(5):441–451CrossRefGoogle Scholar
  45. 45.
    Forman TA (2003) The social psychological costs of racial segmentation in the workplace: A study of African Americans’ well-being. J Health Social Behav:332–352Google Scholar
  46. 46.
    Pieterse AL, Carter RT (2007) An examination of the relationship between general life stress, racism-related stress, and psychological health among black men. J Couns Psychol 54(1):101–109. doi: 10.1037/0022-0167.54.1.101 CrossRefGoogle Scholar
  47. 47.
    Fuller-Rowell TE, Doan SN, Eccles JS (2012) Differential effects of perceived discrimination on the diurnal cortisol rhythm of African Americans and Whites. Psychoneuroendocrinology 37(1):107–118. doi: 10.1016/j.psyneuen.2011.05.011 PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Paradies Y (2006) A systematic review of empirical research on self-reported racism and health. Int J Epidemiol 35(4):888–901. doi: 10.1093/ije/dyl056 PubMedCrossRefGoogle Scholar
  49. 49.
    Grant BF, Goldstein RB, Chou SP, Huang B, Stinson FS, Dawson DA, Saha TD, Smith SM, Pulay AJ, Pickering RP, Ruan WJ, Compton WM (2009) Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Mol Psychiatry 14(11):1051–1066. doi: 10.1038/mp.2008.41 PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Grant BF, Harford TC, Dawson DA, Chou PS, Pickering RP (1995) The alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug Alcohol Depend 39(1):37–44PubMedCrossRefGoogle Scholar
  51. 51.
    Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R (2003) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71(1):7–16PubMedCrossRefGoogle Scholar
  52. 52.
    Ruan WJ, Goldstein RB, Chou SP, Smith SM, Saha TD, Pickering RP, Dawson DA, Huang B, Stinson FS, Grant BF (2008) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend 92(1–3):27–36. doi: 10.1016/j.drugalcdep.2007.06.001 PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM (2005) Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med 61(7):1576–1596. doi: 10.1016/j.socscimed.2005.03.006 PubMedCrossRefGoogle Scholar
  54. 54.
    Hasin D, Carpenter KM, McCloud S, Smith M, Grant BF (1997) The alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability of alcohol and drug modules in a clinical sample. Drug Alcohol Depend 44(2–3):133–141PubMedCrossRefGoogle Scholar
  55. 55.
    US Department of Health and Human Services (2004) The 2004 HHS guidelines, vol 70. Federal registerGoogle Scholar
  56. 56.
    Lynch J, Kaplan G (2000) Socioeconomic position. In: Berkman L, Kawachi I (eds) Social epidemiology. Oxford University Press, New YorkGoogle Scholar
  57. 57.
    Ardington C, Lam D, Leibbrandt M, Welch M (2006) The sensitivity to key data imputations of recent estimates of income poverty and inequality in South Africa. Econ Model 23(5):822–835. doi: 10.1016/j.econmod.2005.10.009 PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Businelle MS, Mills BA, Chartier KG, Kendzor DE, Reingle JM, Shuval K (2014) Do stressful events account for the link between socioeconomic status and mental health? J Publ Health Oxf 36(2):205–212. doi: 10.1093/pubmed/fdt060 CrossRefGoogle Scholar
  59. 59.
    Krieger N (2012) Methods for the scientific study of discrimination and health: an ecosocial approach. Am J Publ Health 102(5):936–944CrossRefGoogle Scholar
  60. 60.
    Williams DR, Wyatt R (2015) Racial bias in health care and health: challenges and opportunities. JAMA 314(6):555–556. doi: 10.1001/jama.2015.9260 PubMedCrossRefGoogle Scholar
  61. 61.
    Stewart QT (2006) Reinvigorating relative deprivation: a new measure for a classic concept. Soc Sci Res 35(3):779–802. doi: 10.1016/j.ssresearch.2005.07.001 CrossRefGoogle Scholar
  62. 62.
    Williams DR, Collins C (2001) Racial residential segregation: a fundamental cause of racial disparities in health. Publ Health Rep 116(5):404CrossRefGoogle Scholar
  63. 63.
    Williams DR, Mohammed SA, Leavell J, Collins C (2010) Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities Race, SES, and health. Ann N Y Acad Sci 1186(1):69–101. doi: 10.1111/j.1749-6632.2009.05339.x PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Borrell LN, Kiefe CI, Williams DR, Diez-Roux AV, Gordon-Larsen P (2006) Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study. Soc Sci Med 63(6):1415–1427. doi: 10.1016/j.socscimed.2006.04.008 PubMedCrossRefGoogle Scholar
  65. 65.
    Dailey AB, Kasl SV, Holford TR, Lewis TT, Jones BA (2010) Neighborhood- and individual-level socioeconomic variation in perceptions of racial discrimination. Ethn Health 15(2):145–163. doi: 10.1080/13557851003592561 PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Lewis TT, Cogburn CD, Williams DR (2015) Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues. Annu Rev Clin Psychol 11:407–440. doi: 10.1146/annurev-clinpsy-032814-112728 PubMedCrossRefGoogle Scholar
  67. 67.
    Williams DR, John DA, Oyserman D, Sonnega J, Mohammed SA, Jackson JS (2012) Research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues. Am J Publ Health 102(5):975–978. doi: 10.2105/AJPH.2012.300702 CrossRefGoogle Scholar
  68. 68.
    Krieger N (1999) Embodying inequality: a review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Serv 29(2):295–352PubMedCrossRefGoogle Scholar
  69. 69.
    Sue DW (2010) Microaggressions in everyday life: race, gender, and sexual orientation. Wiley, New JerseyGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Hannah Carliner
    • 1
  • Erin Delker
    • 2
  • David S. Fink
    • 1
  • Katherine M. Keyes
    • 1
  • Deborah S. Hasin
    • 1
    • 2
    • 3
  1. 1.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  2. 2.New York State Psychiatric InstituteNew YorkUSA
  3. 3.Department of PsychiatryColumbia UniversityNew YorkUSA

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