Alex Joyel as Elliot in New City Players’ Production of *Water by the Spoonful*

While Water By The Spoonful represents a diverse selection of characters, many of whom are in recovery from addiction and all of whom are facing unique challenges related to their identity, another important aspect of the piece is the Puerto Rican heritage of the Ortiz family, who we find at the play’s center. And, considering the ample share that people of Hispanic heritage make up of the South Florida population, that’s another factor that makes it a particularly fitting one for the here and now.

Compared to 18.5 percent nationwide and 27 percent in Florida as a whole, people of Hispanic descent make up 30 percent of the population in Broward County, NCP’s home base, 23 percent of the population in northward Palm Beach County, and a whopping 70 percent of the population in neighboring Miami-Dade.

And though a first glance at the statistics may actually suggest that addiction is slightly less of a problem for the Hispanic community than it is for the white one given the slightly lower rate of substance use disorder reported by individuals who belong to it, other data shows a more complex picture of the unique factors that drive addiction within the demographic.

Such factors can also complicate Hispanic individuals’ road to treatment and to recovery, with some estimates even suggesting that they may be half as likely to seek addiction treatment than white people. Those of Hispanic descent also have greater rates of relapse and persistent dependence than white people once an addiction has taken root, and significantly more Hispanic than white adults named addiction as a major problem in their community in a recent survey.

While the reasons for this are complex, quite a few of them can be boiled down to the downstream effects of institutionalized racism on the prevalence of poverty in the Hispanic community, since poverty affects up to 20 percent of those in the demographic. According to a 2019 report, Hispanic households were also over one and a half times as likely to be living in poverty than white ones, with Hispanic workers earning only 74 percent of what white workers do.

And though addiction is a disease that can cut across all class lines, poverty becomes a significant risk factor for poorer mental health and higher risk of addiction by making day to day life more difficult, increasing stress, decreasing self-esteem, and instilling a sense of hopelessness when opportunities for escape seem limited.

Unemployment rates have also been consistently higher in the Hispanic American demographic—and unemployment itself has been associated with a twofold higher risk of addiction. The tendency of substance abuse to make it more difficult to obtain or maintain a job can also sometimes become part of some people’s addiction cycle.

One study also showed experiences of discrimination to be a significant factor in fueling drug use among Hispanic and other marginalized populations. Those with Hispanic heritage may also be more likely to reside in poor neighborhoods, where not only individuals but entire communities may be blighted by lack of opportunities and other poverty related stressors—and both practical and emotional support can be harder to come by when resources are uniformly scarce.

As Water By The Spoonful character Odessa describes her underprivileged North Philly neighborhood:

In my neck of the woods staying clean is like trying to tap-dance on a minefield.

Arlette Del Toro as Odessa in New City Players’ Production of *Water by the Spoonful*

We can also see through the events in the play how directly poverty plays a role in threatening Odessa’s sobriety, and how both her and her son Elliot’s mental health have been shaped by patterns of generational trauma that have in turn been shaped by their ethnicity. Though Odessa’s decision to surrender Elliot to her older sister Ginny when he was a young child because her addiction to crack cocaine rendered her unable to safely care for him was necessary to save his life, it has significant emotional fallout for him that contributes to his own mental health challenges.

Water By The Spoonful also explores the fact that Elliot is also afflicted by symptoms of post traumatic stress disorder, a biologically based disorder with psychological symptoms that is caused by exposure to extremely high stress or existentially threatening situations such as those that one might experience in combat. But the play’s prequel, Elliot: A Soldier’s Fugue, deepens this experience even further by revealing that he is a third generation soldier, a fact that may not be entirely unrelated to his ethnicity. Especially in recent years, the US military has shown an increasingly greater proportion of Hispanic enrollment, partially because of its appeal as a stable and respectable career path with lower barriers to entry than many other less accessible ones.

Additionally, one of the more interesting things that came up for me as a dramaturg during the Water By The Spoonful rehearsal process was an idea inspired by the significant age difference between Ginny and Odessa suggested by information presented in Elliot: A Soldier’s Fugue about Ginny’s service as a nurse during the Vietnam war.

This 20+ year gap indicated that it was quite likely that the two are not biological sisters but relatives of some other sort that came together after Odessa was handed off to a family member to raise under similar circumstances, as it is also more common in Puerto Rican culture for children to be transferred from one nuclear family to another within the extended system in times of crisis, a practice referred to as hijos de crianza.

Further evidence for this theory can be found in the fact that all we learn about Odessa’s relationship to her parents in the play is that she was apparently raised by a single mother, referencing a father left behind in Puerto Rico who she meets for the first time in an airport. Her recollection of mournfully waiting for him at the baggage claim suggests a sense of abandonment that can be inferred to have played a part in both the efforts to fill the void with sexual attention that left her a single mother by age 15 and her efforts to fill it with the crack cocaine abuse that nearly destroyed her and Elliot alike.

Pryscila Cassiano Salinas as Yaz in New City Players’ Production of *Water by the Spoonful*

Elliot’s cousin, Yaz, describes her extended family’s landscape thus, comparing it to the “normal” family life she imagines is enjoyed by a passing man on the street.

YAZ: I bet in his family, funerals are rare occasions. I bet he’s never seen a cousin get arrested. Let alone one under the age of eighteen. I bet he never saw his eight-year-old cousin sipping rum through a twisty straw.

Even the unusual closeness of families and communities in Hispanic cultures can sometimes work against them in terms of substance abuse—for instance, drug use can quickly spread amongst such communities because of strong social ties. Hispanic populations may have more insider access to drugs that come in via cartels from Spanish speaking countries, and substance abuse has even been known to spread between generations in intergenerational households.

The tight-knit community and family systems also leaves many Hispanic people less likely to trust those outside their family or community, especially those who do not appear to be members of or have an understanding of their own distinct subculture. This can be especially problematic when it comes to reaching out for help, since both the mental health practitioners and social work fields tend to be predominantly white.

Fear of reflecting badly on one’s family or of familial disapproval may also affect the lack of willingness to admit to a drug problem—one study also found that those of Hispanic descent were more likely than other groups to mention stigma as a barrier to treatment.

They also more frequently mentioned concerns about colleagues physically seeing them at a treatment center and about the judgment that could ensue, which certainly makes plenty of sense given how highly stigmatized substance abuse issues can be. If one already has a sense of being judged due to their ethnicity or heritage, then a stronger fear of having any other perceived problem count against them may be quite understandable.

The high value Hispanic people tend to place on family may also mean that they are unwilling to commit to addiction treatment if they suspect that doing so will somehow be detrimental to their family. They may, for instance, be less likely to take time off from their role as a family breadwinner to pursue help for themselves.

Other obstacles come from the fact that Hispanic populations are far more likely than white ones to have lower English proficiency. Though some Spanish language addiction treatment programs exist, they are few and far between, and consistently high demand often drives wait times for treatment at such institutions up to over a year. Educational materials about addiction also may not be adequately accessible to non-English speakers, and other mental health services may be less accessible to them as well.

If a non-English speaker does attempt to enroll in an English speaking treatment program, they may have trouble understanding programming or attending therapy appointments because of inconsistent access to translators. And while Spanish-speaking incarnations of twelve step fellowships like Alcoholic Anonymous do exist, they are significantly sparser, and Hispanic people still appear less likely to make use of them, for reasons that may be related to the barrier of stigma discussed above.

Language barriers may also result in less Hispanic people being informed about options like medication assisted treatment, which can significantly lower the risk of death in opioid abusers. Additionally, fewer Spanish speaking physicians have the capacity to prescribe these medications, partially due to unwarrantedly harsh regulations around their distribution. The all or nothing view of recovery held by the treatment establishment also may serve as a barrier to entry, as some who abuse substances but are unwilling to commit to abstinence could still be helped to reduce their drug use to less problematic levels.

Other obstacles to treatment have more to do with the other socioeconomic barriers discussed above; poverty is obviously a barrier to paying for treatment, and Hispanic people are two and a half times more likely to be uninsured as compared to white people. Transportation may also be a challenge, especially for those who live in rural areas and far from treatment infrastructure.

Even if they do make it into addiction treatment, these barriers often mean that Hispanic individuals feel less satisfied with their treatment, stay in programs for shorter lengths of time, and find their treatment less successful. Poverty’s interference can also result in less internet access, but, on the brighter side, Hispanic people are actually one and a half times more likely to use online treatment services than white people, as the internet serves to eliminate some of both the practical and social barriers to seeking help.

While the pandemic-led increase in the availability of telehealth addiction services makes this an intriguing avenue for exploration, it’s also worth noting the fact that the pandemic also magnified the socioeconomic inequalities afflicting marginalized communities, which in turn magnified the rate of mental health challenges affecting those communities. For instance, Hispanic individuals also reported higher levels of stress during the pandemic related to basic needs like those for food and housing.

Hispanic people were 59 percent more likely than non Hispanic whites to report symptoms of depression during the pandemic era, making them the group reporting the highest amount of such symptoms. And 37 percent reported an increase in substance use or that they had started using substances due to pandemic stress, compared to 16 percent of both black and white people reporting such symptoms.

There are also instances in which the pattern rather than the rate of abuse of a certain substance is the indication of where trouble may lie. For instance, while Hispanic individuals are less likely to drink alcohol, those who do drink alcohol are more likely to binge drink, with 26 percent of Hispanic drinkers engaging in heavy drinking at least once a month. This is also particularly worrisome given that Latino men seem to be at greater risk of alcohol-related health problems.

Though discrepancies in the ability to seek pain treatment and the tendency of doctors to prescribe less painkillers to non-white patients, perceiving them as in less need of care, also may have ironically protected some Hispanic individuals from the evils of opioids, manual and military jobs that more of them undertake can lead to greater chronic pain, which can in turn raise the risk of opioid painkiller abuse.

And despite the fact that Hispanic individuals still abuse prescription opioids at a lower rate than do white ones, the opioid overdose death rate for Hispanics increased more sharply than for white people in recent years. Additionally, because prescription opioid abuse is considered a “white” problem, a non-white user may more easily fly under the radar.

There’s also a fascinating pattern of note in which the more acculturated a Hispanic person becomes to the US, the more likely they are to misuse prescription opioids. Among immigrants, having higher English scores and having lived longer in the US was linked with being at higher risk of prescription opioid abuse, and those whose generational American roots passed a certain threshold actually had a higher risk of prescription opioid abuse than white Americans. Unfortunately, it seems that with all of America’s opportunity comes all of America’s demons.

So, what is there to be done about all this? Well, for one thing, a multifaceted problem means multifaceted solutions, but making addiction treatment more financially and culturally accessible would be a good place to start. More extensive social services that help Hispanic populations to be assured child care, food, housing, and employment would also create a safety net that would both lessen the stressors that can contribute to addiction and make treatment easier to pursue.

Informational campaigns specifically aimed at Hispanic communities and efforts to ameliorate stigma more generally could also end up having an outsized positive effect on Hispanic individuals. A society that is kinder to and more inclusive of people from specific communities is, in the end, often a society that is kinder and more inclusive of us all, and New City Players is proud to continue our efforts to focus on telling stories that explore the experiences of diverse characters in all their glorious complexity, hopefully increasing understanding and empathy in turn.

Blog crossposted on recointensive.com

Our Water by the Spoonful blog series is sponsored in part by Reco Intensive. To learn more about Reco Intensive, a Delray Beach addiction treatment center whose holistic and compassionate approach aligns with NCP’s vision of helping South Florida to become a more empathetic and thoughtful community, visit their website.

Understanding How Addiction Affects The Hispanic Community by Ilana Jael

Water by the Spoonful

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