Substance Use Disorders


Substance use disorders can vary across nations and cultures. Substance use, abuse, or misuse prevalence rates for Hispanics generally mirror those of the general U.S. population.

In Puerto Rico and the mainland, there is a more narrowed difference between substance use for men and women with each passing decade (1,2). Puerto Ricans in the mainland have a higher lifetime prevalence of substance use disorders compared to other Latinos living in the U.S., with factors such as being born in the US, number of years living in the U.S., or being proficient in English increasing the odds of having a substance use disorder (6).

Medical complications may be the result of direct drug toxicity, or from infection acquired through drug use. According to the CDC, the overall HIV incidence rate in Puerto Rico was twice the estimated U.S. rate and 1.5 times the estimated rate for Hispanics in the United States (5). Injection-drug use continues to be the most common mode of HIV transmission in Puerto Rico (5). Puerto Ricans are more likely to share needles and engage in other high-risk behaviors than their mainland counterparts; interestingly, Puerto Rican natives who immigrate to the U.S. mainland often make positive changes to their high-risk behaviors (3).

The use and misuse of substances and the gradual loss of status is a common presenting feature. These include the following:

  • Marital status: divorce, repeated failed relationships.
  • Financial: inability to pay bills, selling property to acquire substances.
  • Employment status: jobs of brief duration, unemployment, inability to obtain a job.
  • Housing: living with friends who abuse substances, homelessness, inability to sustain permanent housing.
  • Community participation: isolation from non–substance-related groups, events, and activities
  • Legal: breaking laws, property law offenses, and assault.


For Providers

Health professionals can increase their effectiveness by inquiring about the cultural elements that the patient brings. This task begins with understanding the patient’s history from childhood to adulthood. Current and past cultural affiliations are helpful for the implementation of a successful recovery plan.

For information about local preventive services in Puerto Rico, please visit this website:



  1. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994;51:8–19.
  2. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. J Am Med Assoc 1990;264(19):2511–2518.
  3. Deren S., Kang S.-Y., Colón H.M. Migration and HIV risk behaviors: Puerto Rican drug injectors in New York City and Puerto Rico. Am. J. Public Health. May 2003;93(5):812–816.
  4. Duncan I, Curtis R, Reyes JC, Abadie R, Khan B, Dombrowski K. Hepatitis C serosorting among people who inject drugs in rural Puerto Rico. Preventive Medicine Reports
  5. CDC. HIV/AIDS surveillance report, 2006. Atlanta, GA: US Department of Health and Human Services, CDC; 2008. Report no. 18. Available at
  6. Alegría M, Mulvaney-Day N, Torres M, et al. Prevalence of Psychiatric Disorders Across Latino Subgroups in the United States. American Journal of Public Health. January 2007;97(1): 68-75.