Epidemiology of Substance Abuse among Migrants Compared to Native Born Population in Primary Care Adil Qureshi, PhD, 1 Javier Garcia Campayo, MD, 2 Francisco Jose Eiroa‐Orosa, PhD, 3 Natalia Sobradiel, PhD, 2 Francisco Collazos, MD, 1,3 Mercedes Febrel Bordejé, MD, 2 Carlos Roncero, MD, 1,3 Eva Andrés, PhD, 2 Miguel Casas, MD 1,3 1 Department of Psychiatry, University Hospital Vall d’Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain 2 Department of Psychiatry, University Hospital Miguel Servet, Zaragoza University, Barcelona, Spain 3 Department of Psychiatry and Legal Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain Background and Objectives: Research in the United States tends to indicate that immigrants from most sociogeographic regions have considerably lower substance use disorder (SUD) rates than native born individuals. We aimed to analyze the differences between immigrants and native born population regarding substance abuse and dependence. This objective was approached using data from the ARACATcross‐sectional multicenter study in primary care settings of two different Spanish regions: Aragon and Catalonia. Methods: Three thousand six patients (1,503 immigrants randomly selected and 1,503 native born paired by age and gender) were interviewed using the Mini‐International Neuropsychiatric Interview. Results: Reported substance abuse and dependence were more prevalent in the native born population than in immigrants (alcohol abuse 5.1% vs. 2.6% p < .0001, alcohol dependence 3.3% vs. 2.6% n.s., other abuse 3.4% vs. .4% p < .0001, other dependence .5% vs. 4.0% p < .0001). Large differences were detected between different ethnic groups. Sociodemographic characteristics such as female gender, older age, higher level of education or stable housing (among others), were found to be protective against different SUDs. Conclusions and Scientific Significance: Immigrants have lower levels of alcohol and substance abuse, however, those that do consume show higher levels of both comorbid mental disorders and problematic alcohol/substance use. It would appear to be the case that issues specific to immigrant cultures, such as extreme stigmatization of substance and alcohol use, may serve to promote social marginaliza- tion and inhibit treatment access. (Am J Addict 2013;XX:000–000) INTRODUCTION The relationship between immigration, culture, and sub- stance abuse, as with most other psychiatric conditions, is complex. Research in the United States tends to indicate that immigrants from most sociogeographic regions have consid- erably lower substance and alcohol abuse rates than native born individuals. 1–3 It would appear that immigrants bring with them the prevalence rates from their region of origin, which, in general is lower than that found in Western Europe and North America. 4,5 The bulk of research in the area of immigrant and substance and alcohol use has been carried out in the United States, and it is unclear to what extent the findings are generalizable to other countries. Spain, a country with a relatively recent immigra- tion, on the one hand, and elevated levels of substance abuse on the other, can provide an interesting point of comparison. Primary care, particularly in countries that have very low threshold health care systems, is a first line entry point into the mental health and substance abuse treatment network. 6 This may be particularly the case for immigrants who either are not aware of specialized drug treatment services, or, due to stigma associated with drug and sometimes alcohol use, avoid being seen receiving substance abuse treatment. Thus it would also appear that primary care represents not only a potential screening site, but also a “safe” place for attending to substance or alcohol use problems, precisely because there is no stigma associated with primary care visits. To date, no studies have been identified which examine alcohol and substance use rates in immigrants attending primary care in Spain or elsewhere. A few studies were identified that looked at ethnicity and substance abuse in primary care. One study carried out in New York City found that White Americans had a substance use disorder prevalence of 11.8%, followed by Black Americans (9.1%), Hispanic Americans (7.5%), and other ethnic group (5.3%). Immigration status was not specified. 6 In a study carried out in Rhode Island, it was found that 14.3% of Black women smoked marijuana during the previous month, followed by 10.8% of White women, 7.7% of other ethnic group women, and 4.6% of Received April 2, 2013; revised June 12, 2013; accepted July 14, 2013. Address correspondence to Dr. Qureshi, Department of Psychia- try, Hospital Universitari Vall d’Hebron, Passeig Vall d’Hebron, 119‐ 129, Barcelona 08035, Spain. E‐mail: aqureshi@vhebron.net. The American Journal on Addictions, XX: 1–6, 2013 Copyright © American Academy of Addiction Psychiatry ISSN: 1055-0496 print / 1521-0391 online DOI: 10.1111/j.1521-0391.2013.12103.x 1