Journal of Urban Health

, Volume 90, Issue 6, pp 1112–1129 | Cite as

The Relationship between Perceived Discrimination and Psychotherapeutic and Illicit Drug Misuse in Chicago, IL, USA



Based on several stress-coping frameworks, recent studies have suggested that perceived experiences of discrimination, a psychosocial stressor, may be associated with various risky health behaviors. The 2001 Chicago Community Adult Health Study (n = 3,101), a face-to-face representative probability sample of adults in Chicago, IL, USA, was used to examine the relationship among lifetime everyday discrimination, major discrimination, and the use of illicit and psychotherapeutic drugs for nonmedical reasons. We used negative binomial logistic and multinomial regression analyses controlling for potential confounders. Approximately 17 % of the respondents reported using one or more illicit drugs and/or misusing one or more psychotherapeutic drug. Adjusting for socio-demographic characteristics, other stressors and various personality-related characteristics, results from negative binomial regression suggest that respondents who experienced moderate to high levels of everyday discrimination misused on average 1.5 different kinds of drugs more than respondents that experienced relatively low levels of everyday discrimination (p < 0.05). Similarly, an increase in one lifetime major discrimination event was associated with an increase of misusing 1.3 different drugs on average regardless of experiences of everyday discrimination (p < 0.001). When examining the types of drugs misused, results from multinomial logistic regression suggest that everyday discrimination was only associated with illicit drug use alone; however, lifetime major discrimination was associated with increased odds of using any illicit and both illicit/psychotherapeutic drugs. Mental health and substance use clinical providers should be aware of these potential relationships and consider addressing the harmful effects of perceived discrimination, in all patients not only among racial/ethnic minority patients.


Social determinants of health Stress Coping behavior Discrimination Drug misuse 


  1. 1.
    Substance Abuse and Mental Health Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville: Substance Abuse and Mental Health Services Administration; 2012.Google Scholar
  2. 2.
    Horgan CSK, Strickler G. Substance Abuse: The Nation’s Number One Health Problem. Key Indicators for Policy. Princeton: The Robert Wood Johnson Foundation; 2001.Google Scholar
  3. 3.
    Holahan CJ, Moos RH. Risk, resistance, and psychological distress: a longitudinal analysis with adults and children. J Abnorm Psychol. 1987; 96(1): 3–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Conger JJ. Reinforcement theory and the dynamics of alcoholism. Q J Stud Alcohol. 1956; 17(2): 296–305.PubMedGoogle Scholar
  5. 5.
    Sher KJ. Subjective effects of alcohol: the influence of setting and individual differences in alcohol expectancies. J Stud Alcohol Drugs. 1985; 46: 137–46.Google Scholar
  6. 6.
    Khantzian EJ. The self-medication hypothesis of addictive disorders—focus on heroin and cocaine dependence. Am J Psych. 1985; 142(11): 1259–64.Google Scholar
  7. 7.
    Wills TA, Shiffman S. Coping and Substance Abuse: A Conceptual Framework. Orlando: Academic; 1985.Google Scholar
  8. 8.
    Sinha R, Fox H, Tuit K, et al. Chronic alcohol and peripheral and neural changes in stress arousal: effects on relapse susceptibility and treatment outcome. Alcohol. 2011; 45(3): 280–280.Google Scholar
  9. 9.
    Paradies Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol. 2006; 35(4): 888–901.PubMedCrossRefGoogle Scholar
  10. 10.
    Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009; 32(1): 20–47.PubMedCrossRefGoogle Scholar
  11. 11.
    Yen IH, Ragland DR, Greiner BA, et al. Racial discrimination and alcohol-related behavior in urban transit operators: findings from the San Francisco MUNI health and safety study. Public Health Rep. 1999; 114(5): 448–58.PubMedCrossRefGoogle Scholar
  12. 12.
    Yen IH, Ragland DR, Greiner BA, et al. Workplace discrimination and alcohol consumption: findings from the San Francisco Muni health and safety study. Ethn Dis. 1999; 9(1): 70–80.PubMedGoogle Scholar
  13. 13.
    Borrell LN, Jacobs DR Jr, Williams DR, et al. Self-reported racial discrimination and substance use in the coronary artery risk development in adults study. Am J Epidemiol. 2007; 166(9): 1068–79.PubMedCrossRefGoogle Scholar
  14. 14.
    Borrell LN, Roux AVD, Jacobs DR Jr, et al. Perceived racial/ethnic discrimination, smoking and alcohol consumption in the multi-ethnic study of atherosclerosis (MESA). Prev Med. 2010; 51(3–4): 307–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Landrine H, Klonoff EA. The schedule of racist events: a measure of racial discrimination and a study of its negative physical and mental health consequences. J Black Psychol. 1996; 22(2): 144–68.CrossRefGoogle Scholar
  16. 16.
    Kwate NO, Valdimarsdottir HB, Guevarra JS, et al. Experiences of racist events are associated with negative health consequences for African American women. J Natl Med Assoc. 2003; 95(6): 450–60.PubMedGoogle Scholar
  17. 17.
    Bennett GG, Wolin KY, Robinson EL, et al. Perceived racial/ethnic harassment and tobacco use among African American young adults. Am J Public Health. 2005; 95(2): 238–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Guthrie BJ, Young AM, Boyd CJ, et al. Dealing with daily hassles: smoking and African-American adolescent girls. J Adolesc Health. 2001; 29(2): 109–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Harris R, Tobias M, Jeffreys M, et al. Effects of self-reported racial discrimination and deprivation on Maori health and inequalities in New Zealand: cross-sectional study. Lancet. 2006; 367(9527): 2005–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Harris R, Tobias M, Jeffreys M, et al. Racism and health: the relationship between experience of racial discrimination and health in New Zealand. Soc Sci Med. 2006; 63(6): 1428–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Chae DH, Takeuchi DT, Barbeau EM, et al. Unfair treatment, racial/ethnic discrimination, ethnic identification, and smoking among Asian Americans in the national Latino and Asian American study. Am J Public Health. 2008; 983(3): 485–92.CrossRefGoogle Scholar
  22. 22.
    Guthrie BJ, Young AM, Williams DR, et al. African American girls’ smoking habits and day-to-day experiences with racial discrimination. Nurs Res. 2002; 51(3): 183–90.PubMedCrossRefGoogle Scholar
  23. 23.
    Landrine H, Klonoff EA, Corral I, et al. Conceptualizing and measuring ethnic discrimination in health research. J Behav Med. 2006; 29(1): 79–94.PubMedCrossRefGoogle Scholar
  24. 24.
    Klonoff EA, Landrine H. Cross-validation of the schedule of racist events. J Black Psychol. 1999; 25(2): 231–54.CrossRefGoogle Scholar
  25. 25.
    Landrine H, Klonoff EA. Racial discrimination and cigarette smoking among blacks: findings from two studies. Ethn Dis. 2000; 10(2): 195–202.PubMedGoogle Scholar
  26. 26.
    Gee GC, Delva J, Takeuchi DT. Relationships between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence among Filipino Americans. Am J Public Health. 2007; 97(5): 933–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Yoo HC, Gee GC, Lowthrop CK, et al. Self-reported racial discrimination and substance use among Asian Americans in Arizona. J Immigr Minor Health. 2010; 12(5): 683–90.PubMedCrossRefGoogle Scholar
  28. 28.
    MacKinnon D, Krull J, Lockwood C. Equivalence of the mediation, confounding and suppression effect. Prev Sci. 2000; 1: 173–81.PubMedCrossRefGoogle Scholar
  29. 29.
    Feagin JR, Sikes MP. Living with Racism: The Black Middle-Class Experience. Boston: Beacon Press; 1994.Google Scholar
  30. 30.
    Clark R, Anderson NB, Clark VR, Williams DR. Racism as a stressor for African Americans. A biopsychosocial model. Am Psychol. 1999; 54: 805–16.PubMedCrossRefGoogle Scholar
  31. 31.
    Swim JK, Hyers LL, Cohen LL, Ferguson MJ. Everyday sexism: evidence for its incidence, nature, and psychological impact from three daily diary studies. J Soc Issues. 2001; 57: 31–53.CrossRefGoogle Scholar
  32. 32.
    Brondolo E, Thompson S, Brady N, Appel R, Cassells A, Tobin JN, et al. The relationship of racism to appraisals and coping in a community sample. Ethn Dis. 2005; 15(S5): 14–9.Google Scholar
  33. 33.
    Broudy R, Brondolo E, Coakley V, Brady N, Cassells A, Tobin JN, et al. Perceived ethnic discrimination in relation to daily moods and negative social interactions. J Behav Med. 2007; 30: 31–43.PubMedCrossRefGoogle Scholar
  34. 34.
    Gibbons FX, Etcheverry PE, Stock ML, Gerrard M, Weng CY, Kiviniemi M, et al. Exploring the link between racial discrimination and substance use: what mediates? What buffers? J Personal Soc Psychol. 2010; 99: 785–801.CrossRefGoogle Scholar
  35. 35.
    Borders A, Liang CTH. Rumination partially mediates the associations between perceived ethnic discrimination, emotional distress, and aggression. Cult Divers Ethn Minor Psychol. 2011; 17: 125–33.CrossRefGoogle Scholar
  36. 36.
    Huynh VW. Ethnic microaggressions and the depressive and somatic symptoms of Latino and Asian American adolescents. J Youth Adolesc. 2012; 41: 831–46.PubMedCrossRefGoogle Scholar
  37. 37.
    Lee H, Turney K. Investigating the relationship between perceived discrimination, social status, and mental health. Soc Mental Health. 2012; 2: 1–20.CrossRefGoogle Scholar
  38. 38.
    Williams DR, John DA, Oyserman D, Sonnega J, Mohammed SA, Jackson JS. Research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues. Am J Public Health. 2012; 102: 975–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Brondolo E, Brady ver Halen N, Pencille M, Beatty D, Contrada R. Coping with racism: a selective review of the literature and a theoretical and methodological critique. J Behav Med. 2009; 32: 64–88.PubMedCrossRefGoogle Scholar
  40. 40.
    Smith TW. Personality as risk and resilience in physical health. Curr Dir Psychol Sci. 2006; 15: 227–31.CrossRefGoogle Scholar
  41. 41.
    Huebner DM, Nemeroff CJ, Davis MC. Do hostility and neuroticism confound associations between perceived discrimination and depressive symptoms? J Soc Clin Psychol. 2005; 24: 723–40.CrossRefGoogle Scholar
  42. 42.
    Pope MK, Smith TW, Rhodewalt F. Cognitive, behavioral, and affective correlates of the Cook and Medley Hostility Scale. J Pers Assess. 1990; 54: 501–14.PubMedGoogle Scholar
  43. 43.
    Abramson LY, Metalsky GI, Alloy LB. Hopelessness depression: a theory-based subtype of depression. Psychol Rev. 1989; 96: 358–72.CrossRefGoogle Scholar
  44. 44.
    Palanco-Roman L, Miranda R. Culturally related stress, hopelessness, and vulnerability to depressive symptoms and suicidal ideation in emerging adulthood. Behav Ther. 2013; 44(1): 75–87.CrossRefGoogle Scholar
  45. 45.
    Ezenwa MO, Fleming MF. Racial disparities in pain management in primary care. J Health Disparities Res Pract. 2012; 5(3): 12–26.Google Scholar
  46. 46.
    Woicik PA, Stewart SH, Pihl RO, Conrod PJ. The Substance Use Risk Profile Scale: a scale measuring traits linked to reinforcement-specific substance use profiles. Addict Behav. 2009; 34(12): 1042–55.PubMedCrossRefGoogle Scholar
  47. 47.
    Weishaar ME, Beck AT. Hopelessness and suicide. Inte Rev Psychiatr. 1992; 4(2): 177–84.CrossRefGoogle Scholar
  48. 48.
    Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009; 135(4): 531–54.PubMedCrossRefGoogle Scholar
  49. 49.
    Broman CL, Neighbors HW, Delva J, Torres M, Jackson JS. Prevalence of substance use disorders among African Americans and Caribbean blacks in the national survey of American life. Am J Public Health. 2008; 98(6): 1107–14.PubMedCrossRefGoogle Scholar
  50. 50.
    Bhui K, Stansfeld S, McKenzie K, Karlsen S, Nazroo J, Welch S. Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom. Am J Public Health. 2005; 95(3): 496–501.PubMedCrossRefGoogle Scholar
  51. 51.
    Karlsen S, Nazroo JY, McKenzie K, Bhui K, Weich S. Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychol Med. 2005; 35: 1795–803.PubMedCrossRefGoogle Scholar
  52. 52.
    Greene ML, Way N, Pahl K. Trajectories of perceived adult and peer discrimination among black, Latino, and Asian American adolescents: patterns and psychological correlates. Dev Psychol. 2006; 42: 218–38.PubMedCrossRefGoogle Scholar
  53. 53.
    Major B, Kaiser CR, O’Brien LT, McCoy SK. Perceived discrimination as worldview threat or worldview confirmation: implications for self-esteem. J Personal Soc Psychol. 2007; 92: 1068–86.CrossRefGoogle Scholar
  54. 54.
    Smokowski P, Bacallao M. Acculturation, internalizing mental health symptoms, and self-esteem: cultural experiences of Latino adolescents in North Carolina. Child Psychiatry Hum Dev. 2007; 37: 273–92.PubMedCrossRefGoogle Scholar
  55. 55.
    Panchanadeswaran S, Dawson BA. How discrimination and stress affects self-esteem among dominican immigrant women: an exploratory study. Soc Work Public Health. 2011; 26: 60–77.PubMedCrossRefGoogle Scholar
  56. 56.
    Crocker J, Major B. Social stigma and self-esteem: the self-protective properties of stigma. Psychol Rev. 1989; 96: 608–30.CrossRefGoogle Scholar
  57. 57.
    Shorey HS, Cowan G, Sullivan MP. Predicting perceptions of discrimination among Hispanics and Anglos. Hisp J Behav Sci. 2002; 24: 3–22.CrossRefGoogle Scholar
  58. 58.
    Kobrynowicz D, Branscombe NR. Who considers themselves victims of discrimination? Psychol Women Q. 1997; 21: 347–63.CrossRefGoogle Scholar
  59. 59.
    Ruggiero KM, Taylor DM. Why minority group members perceive or do not perceive the discrimination that confronts them: the role of self-esteem and perceived control. J Personal Soc Psychol. 1997; 72: 373–89.CrossRefGoogle Scholar
  60. 60.
    Pearlin LI, Lieberman MA, Menaghan EG, et al. The stress process. J Health Soc Behav. 1981; 22(4): 337–56.PubMedCrossRefGoogle Scholar
  61. 61.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001; 116: 404–16.PubMedGoogle Scholar
  62. 62.
    Zvolensky MJ, Sachs-Ericsson N, Feldner MT, Schmidt NB, Bowman CJ. Neuroticism moderates the effect of maximum smoking level on lifetime panic disorder: a test using an epidemiologically defined national sample of smokers. Psychiatry Res. 2006; 141: 321–32.PubMedCrossRefGoogle Scholar
  63. 63.
    Cohen S, Kessler RC, Gordon LU. Measuring Stress: A Guide for Health and Social Scientists. New York: Oxford University Press; 1997.Google Scholar
  64. 64.
    Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003; 93(2): 200–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Morenoff JD, House JS, Hansen BB, et al. Understanding social disparities in hypertension prevalence, awareness, treatment, and control: the role of neighborhood context. Soc Sci Med. 2007; 65(9): 1853–66.PubMedCrossRefGoogle Scholar
  66. 66.
    Williams DR, Yu Y, Jackson JS, et al. Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol. 1997; 2(3): 335–51.PubMedCrossRefGoogle Scholar
  67. 67.
    Dohrenwend BS. Events as stressors: a methodological inquiry. J Health Soc Behav. 1973; 14(2): 167–75.PubMedCrossRefGoogle Scholar
  68. 68.
    Kessler RC, Andrews G, Mroczek D, et al. The World Health Organization Composite International Diagnostic Interview Short-Form (CIDI-SF). Int J Methods Psychiatr Res. 1998; 7(4): 171–85.CrossRefGoogle Scholar
  69. 69.
    Spielberger CD, Jacobs G, Russell S, et al. The Experience and Expression of Anger: Construction and Validation of an Anger Expression Scale. In: RH CMR, ed. Anger and hostility in cardiovascular and behavioral disorders. New York: Meisphere; 1985: 5–30.Google Scholar
  70. 70.
    Cook WW, Medley DM. Proposed hostility and pharisaic-virtue scales for the MMPI. J Appl Psychol. 1954; 38: 414–8.CrossRefGoogle Scholar
  71. 71.
    Everson SA, Kaplan GA, Goldberg DE, et al. Hopelessness and 4-year progression of carotid atherosclerosis—the Kuopio ischemic heart disease risk factor study. Arterioscler Thromb Vasc Biol. 1997; 17(8): 1490–5.PubMedCrossRefGoogle Scholar
  72. 72.
    Beck AT, Weissman A, Lester D, et al. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974; 42(6): 861–5.PubMedCrossRefGoogle Scholar
  73. 73.
    Adams G, Tormala TT, O’Brien LT. The effect of self-affirmation on perception of racism. J Exp Soc Psychol. 2006; 42(5): 616–26.CrossRefGoogle Scholar
  74. 74.
    Rosenberg M. Society and the Adolescent Self-Image, Revised Edition. Middletown: Wesleyan University Press; 1989.Google Scholar
  75. 75.
    Buhi ER, Goodson P, Neilands TB. Out of sight, not out of mind: strategies for handling missing data. Am J Health Behav. 2008; 32(1): 83–92.PubMedGoogle Scholar
  76. 76.
    Hunte HER. Association between perceived interpersonal everyday discrimination and waist circumference over a 9-year period in the midlife development in the United States cohort study. Am J Epidemiol. 2011; 173(11): 1232–9.PubMedCrossRefGoogle Scholar
  77. 77.
    Vines AI, Baird DD, Stevens J, et al. Associations of abdominal fat with perceived racism and passive emotional responses to racism in African American women. Am J Public Health. 2007; 97(3): 526–30.PubMedCrossRefGoogle Scholar
  78. 78.
    Alaniz ML. Alcohol availability and targeted advertising in racial/ethnic minority communities. Alcohol Health Res World. 1998; 22: 286–9.PubMedGoogle Scholar
  79. 79.
    Hackbarth DP, Silvestri B, Cosper W. Tobacco and alcohol billboards in 50 Chicago neighborhoods: market segmentation to sell dangerous products to the poor. J Public Health Policy. 1995; 16: 213–30.PubMedCrossRefGoogle Scholar
  80. 80.
    Pasch KEKK, Perry CL, Hearst MO, Farbakhsh K. Does outdoor alcohol advertising around elementary schools vary by the ethnicity of students in the school? Ethn Heal. 2009; 14: 225–36.CrossRefGoogle Scholar
  81. 81.
    Schmidt L, Greenfield T, Mulia N. Unequal treatment: racial and ethnic disparities in alcoholism treatment services. Alcohol Res Health. 2006; 29: 49–54.PubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2013

Authors and Affiliations

  1. 1.Department of Social and Behavioral Sciences, School of Public Health, Robert C. Byrd Health Sciences CenterWest Virginia UniversityMorgantownUSA
  2. 2.Center for Poverty and Health InequitiesPurdue UniversityWest LafayetteUSA
  3. 3.Division of Health Management and Policy, Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA

Personalised recommendations