Prevalence and correlates of substance use disorders in Puerto Rico

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)

First Committee Member

Clyde McCoy, Committee Chair


This dissertation reports the results of the first household survey specifically designed to study substance use disorders in Puerto Rico. The study utilized a probability sample of 4,709 household residents, over sampled high-risk areas and high-risk sub-populations, and implemented DSM-IV diagnostic criteria. As part of the larger study, a substudy was conducted to examine the validity of self-reports of drug use. For the substudy, a sub-sample of 114 respondents from the larger household sample and 74 previously confirmed chronic drug users were asked to provide a hair sample after the study interview. The results of the validity substudy showed that the sensitivity of self-reports among respondents of the regular household sample were all low. The sensitivity of self-reports of recent cocaine use was particularly low, 7.1%. In contrast, among chronic drug users the sensitivity of self-reports was 69.6% for reports of recent cocaine use and 78.6% for reports of recent heroin use. Sensitivity also increased among subjects reporting DSM-IV drug use disorder symptoms. In the larger study, 14.7% of the sample met criteria for a lifetime substance use disorder, and 4.9% for a past year substance use disorder. The rate of lifetime disorders was 13.1% for alcohol abuse or dependence and 4.1% for illicit drug abuse or dependence. Past year abuse or dependence was 4.3% for alcohol and 1.3% for illicit drugs. Alcohol use disorders were associated with male gender, higher family annual incomes, being employed, and being married. Illicit drug use disorders were significantly associated with male gender and younger age. Only 13.0% of respondents with a past year substance use disorder reported using any service for their alcohol or drug problem. Several socio-demographic factors affected differently the rates of use and dependence, a finding congruent with previous research showing differences in the risk factors for different stages of drug use and arguing for their separate examination. A program of continuous monitoring of the population's alcohol and drug using behaviors and disorders is critical to further our understanding, assist in establishing effective policies and realistic objectives, and periodically assess the progress achieved.


Health Sciences, Public Health

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