The importance of cross-cultural research in addictions

To the Editor

Addictions exist in almost every culture and cause a huge social burden in the Asia-Pacific region (Australian Government, 2011; Bart, 2013). Addictions are strongly influenced by cultural elements since they involve a social factor (substance or behavior) that usually has relevant historical and cultural roots.

Cross-cultural psychiatry (CCP) may help advance the field of addiction in several ways. First, CCP may improve our understanding of the differences between cultures within a country. This is interesting since ethnic minorities, such as the Aboriginal population, appear to be more vulnerable to addictions (Australian Government, 2011). Second, CCP may enhance our knowledge of the presentation of addictions in countries with different social backgrounds. Given that the majority of the studies in this field come from the United States (Helinski and Spanagel, 2011), this is a notable gap in our current knowledge. Third, by enhancing our knowledge on how culture affects addiction, we may better understand its etiology.

To illustrate how CCP may contribute to the understanding of addiction, we assessed demographics, gambling behavior and psychiatric lifetime comorbidities in 1446 adults with gambling disorder. They were recruited in Brazil (n = 923) and in the United States (n = 523), two countries with significant sociocultural differences. The two samples were recruited using similar strategies and consisted of treatment-seeking individuals. The data collection process was approved by the ethics committee of the three universities involved in this research. We used a Bonferroni correction and set the significance level at 0.002 (0.05/26 = 0.002), and we included corrections to account for demographic differences.

Our sample had a mean age of 45.67 years (standard deviation [SD]: 1.3 years); 52.9% were male. Brazilians were mainly males (56% vs 47.4%; χ² = 9.896; p = 0.002), had a lower proportion identifying as Caucasian (75.5% vs 88.5%; χ² = 35.629; p < 0.001), achieved a lower educational level (54.8% with high school or less vs 46.1%; χ² = 10.214; p < 0.001) and were more frequently partnered (63.2% vs 40.9%; χ² = 66.783; p < 0.001). With respect to the clinical variables, Brazilian gamblers more frequently reported bingo as their primary method of gambling (10.9% vs 3.3%; χ² = 22.69; p < 0.001) and also reported lower rates of lifetime substance-use disorders (3.1% vs 10.3%; χ² = 9.380; p = 0.002).

This research demonstrated that there are important differences between Brazil and American gamblers. Our findings may support some adaptations in therapeutic approaches as, for example, in cognitive and behavioral strategies to account for cross-cultural differences. Similar cross-cultural studies in the Asia-Pacific region could improve our understanding of addictions and help the delivery of more customized treatments.