Mexican and Central American migrant laborers (both urban day laborers and farmworkers) are at high risk for developing substance use disorders (SUDs). When they seek treatment for severe SUDs, they encounter substantial barriers (e.g., employment demands, limited English proficiency, lack of health insurance, non- eligibility due to citizenship status). Given the significant size of the Latino migrant laborer population in the U.S. (estimated at around 3 million), their importance to the US economy, and the high cost of substance use- related health problems, it is critically important to identify SUD recovery resources that are cost-effective, culturally accepted, and accessible for migrant laborers with SUDs. The proposed exploratory study will investigate a transnational recovery model that is widely used by Mexican and Central American migrant laborers, but is absent from the literature: anexos (annexes). The anexo is a modified Mexican recovery program that was introduced into the U.S. twenty years ago by migrant laborers struggling with SUDs. These residential, mutual-help recovery programs provide a structured daily routine, peer support, and daily Spanish- language Alcoholics Anonymous (AA) meetings that incorporate specific language, rituals, and other cultural elements from AA in Mexico. The proposed qualitative R21 study will explore (1) the structure and practices of these transnational recovery programs, and (2) how and why Latino migrant laborers access them.
The specific aims of this exploratory study are: (1) to identify the individual-level factors (e.g., age, marital status, migration histoy, income), program-level factors (e.g., program language and rituals), and structural factors (e.g., immigration policy, health access policy, labor conditions) that shape the help-seeking pathways of Mexican and Central American migrant laborers who use anexos;(2) to examine the recovery-promoting practices (e.g., AA meetings, peer support, rules, daily routine) of U.S.-based anexos and identify variations in practices (if any) across the anexos;and (3) to ascertain clients'perceptions of the benefits (e.g., low cost, Spanish language, cultural familiarity) and possible drawbacks (e.g., overcrowding, wait list, non-professional staff) of the anexos. We will use ethnographic research methods (participant observation, exploratory interviewing, and case studies) to gather qualitative exploratory data at 3 California anexos. Our long-term goal is to use our exploratory findings to design and conduct a nationwide study of anexos, thereby refining knowledge of low-cost, culturally accepted and accessible SUD treatment options for Latino migrant laborers.

Public Health Relevance

The proposed qualitative study will examine Latino migrant laborers'use of anexos (annexes), a mutual-help substance abuse recovery model that originated in Mexico. Given these workers'importance to the US economy, it is critically important to identify cost-effective, accessible recovery resources for them. Our findings will help to inform cultural competence efforts among treatment providers by identifying culturally salient elements from this grassroots recovery approach, and will also serve to develop a nationwide study of anexos to refine our knowledge of accessible recovery options for Latino migrants.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Community Influences on Health Behavior (CIHB)
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Wiley, Tisha R A
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Pacific Institute for Research and Evaluation
United States
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Pagano, Anna; Lee, Juliet P; García, Victor et al. (2018) Ethnographic research in immigrant-specific drug abuse recovery houses. J Ethn Subst Abuse 17:79-90
Garcia, Victor; Pagano, Anna; Recarte, Carlos et al. (2017) The Anexo in Northern California: An Alcoholics Anonymous-Based Recovery Residence in Latino Communities. J Groups Addict Recover 12:158-176
Pagano, Anna; García, Victor; Recarte, Carlos et al. (2016) Sociopolitical contexts for addiction recovery: Anexos in U.S. Latino communities. Int J Drug Policy 37:52-59