Native Americans appeared in 1820, Chinese in 1870, Japanese in 1890, Filipino, Hindu and Korean in 1920, Mexican in 1930, Hawaiian and Eskimo in 1960. In 1977, the Office of Management and Budget , which sets the standards for racial/ethnic classification in federal data collections including the US Census data, established a minimum set of categories for race/ethnicity data that included 4 race categories and two ethnicity categories . In 1997, OMB announced revisions allowing individuals to select one or more races, but not allowing a multiracial category. Since October 1997, the OMB has recognized 5 categories of race and 2 categories of ethnicity . In considering these classifications, the extent to which dominant race/ethnic characterizations are influenced both by bureaucratic procedures as well as by political decisions is striking. For example, the adoption of the term Asian-American grew out of attempts to replace the exoticizing and marginalizing connotations of the externally imposed pan-ethnic label it replaced, i.e. “Oriental”. Asian American pan-ethnic mobilization developed in part as a response to common discrimination faced by people of many different Asian ethnic groups and to externally imposed racialization of these groups. This pan-ethnic identity has its roots in many ways in a racist homogenizing that constructs Asians as a unitary group , and which delimits the parameters of “Asian American” cultural identity as an imposed racialized ethnic category . Today, the racial formation of Asian American is the result of a complex interplay between the federal state, diverse social movements, and lived experience. Such developments and characterizations then determine how statistical data is collected. In fact, the OMB itself admits to the arbitrary nature of the census classifications and concedes that its own race and ethnic categories are neither anthropologically nor scientifically based . Issues of ethnic classification continue to play an important role in health research. However, some researchers working in public health have become increasingly concerned about the usefulness or applicability of racial and ethnic classifications. For example, as early as 1992, a commentary piece in the Journal of the American Medical Association, challenged the journal editors to “do no harm” in publishing studies of racial differences .

Quoting the Hippocratic Oath, they urged authors to write about race in a way that did not perpetuate racism. However, while some researchers have argued against classifying people by race and ethnicity on the grounds that it reinforces racial and ethnic divisions; Kaplan & Bennett 2003; Fullilove, 1998; Bhopal, 2004, others have strongly argued for the importance of using these classifications for documenting health disparities . Because we know that substantial differences in physiological and health status between racial and ethnic groups do exist, relying on racial and ethnic classifications allows us to identify, monitor, and target health disparities . On the other hand, estimated disparities in health are entirely dependent upon who ends up in each racial/ethnic category, a process with arguably little objective basis beyond the slippery rule of social convention . If the categorization into racial groups is to be defended, we, as researchers, are obligated to employ a classification scheme that is practical, unambiguous, consistent, and reliable but also responds flexibly to evolving social conceptions . Hence, the dilemma at the core of this debate is that while researchers need to monitor the health of ethnic minority populations in order to eliminate racial/ethnic health disparities, they must also “avoid the reification of underlying racist assumptions that accompanies the use of ‘race’, ethnicity and/or culture as a descriptor of these groups. We cannot live with ‘race’, but we have not yet discovered how to live without it” .Reinarman and Levine have argued that investigations of ethnicity in alcohol and drugs research have typically taken the form, whether intentionally or not, of linking “a scapegoated substance to a troubling subordinate group – working-class immigrants, racial or ethnic minorities, or rebellious youth” . Different minority ethnic groups have often been framed at one time or another by their perceived use of alcohol and illicit drugs, regardless of their actual substance using behaviors and regardless of their relative use in comparison with drug and alcohol use among whites .In mainstream drug and alcohol research, traditional ethnic group categories continue to be assessed in ways which suggest little critical reflection in terms of the validity of the measurement itself.

This is surprising given that social scientists since the early 1990s have critiqued the propensity of researchers to essentialize identity as something ’fixed’ or ’discrete’ and to neglect to consider how social structure shapes identity formation. Recent social science literature on identity suggests that people are moving away from root edidentities based on place and towards a more fluid, strategic, positional, and context-reliant nature of identity . This does not mean, however,growing racks that there is an unfettered ability to freely choose labels or identities, as if off of a menu . An individual’s ability to choose an identity is constrained by social structure, context, and power relations. Structural constraints on identity formation cannot be ignored, as people do not exist as free floating entities but instead are influenced and constrained in various ways by their socioeconomic and geographical environment . As such, an identity is not just claimed by an individual but is also recognized and validated by an audience, resulting in a dialectical relationship between an individual and the surrounding social structures . Similarly, a ‘new’ perspective on ethnic identity specifically has emphasized the fluidity and contextually-dependent nature of ethnicity, minimizing notions about ethnicity as a cultural possession or birthright and instead emphasizing ethnicity as a socially, historically, and politically located struggle over meaning and identity . Ethnicity or ethnic identity is not some immutable sense of one’s identity but rather something produced through the performance of socially and culturally determined boundaries . Hence, individuals are not passive recipients of acquired cultures but instead active agents who constantly construct and negotiate their ethnic identities within given social structural conditions .In spite of these sociological contributions, which have enriched our understanding of identity generally and ethnicity specifically, the alcohol and drugs fields have not adequately integrated these perspectives, thwarting our ability to understand the relationships between ethnicity and substance use. As such, the field is ripe with correlations between ethnic group categories and substance use problems, resulting in solutions to problems that focus on reifying questionable social group categorizations and revealing little about how drugs are connected to identities and shaped by broader social and cultural structures. It is important to note that we do not intend to argue that existing categories of ethnicity be disregarded in the alcohol and drugs fields. As Krieger and colleagues have noted in another context , surveillance data documenting health disparities, in our case in substance use, are exceedingly important in terms of identifying potential inequities in health. However, without understanding the complexity of ethnic identity and its relationship to substance use, these surveillance data may perpetuate stereotypes and the victimization of specific socially-delineated ethnic groupings, obfuscate the root causes of substance use and elated problems, and reify politicized categories of ethnicity which may have little meaning for the people populating those categories. While acknowledging that socially-deliented ethnic categories are important for documenting social injustices, we must also be vigilant about questioning the appropriateness of those categories .

Conceptually this type of critical approach is important for considering how substance use is related to negotiations of ethnicity over time and place and bounded by structure. Maintaining a static and homogenous approach towards ethnic categorizations in the alcohol and drugs fields presents at least two problems. First, it risks overlooking how drugs and alcohol play into a person’s negotiation of identity, particularly ethnic identity, thus revealing little about the pathways that lead to substance use. Cultural researchers have long emphasized the importance of commodity consumption in the construction of identities and lifestyles , particularly within youth cultures , and how it can be an important factor in demarcating and constituting social group boundaries . A limited body of research in the alcohol and drugs field has emphasized the role of substance use in constructing and performing identities , particularly ethnic identities , uncovering how subgroups within traditionally-defined ethnic minority categories use drugs and alcohol to distinguish themselves from ethnically similar others. For example, in a qualitative study of Asian American youth in the San Francisco Bay area in the US, narratives illustrated how youths’ drug use and drug using practices were a way of constructing an identity which differentiated them from “other Asian” youth groups, specifically allowing them to construct an alternative ethnic identity that set them apart from the “model minority” stereotype . Thus taste cultures and consumption-oriented distinctions highlight the continuing salience of and interconnections not just between substance use and changing notions of ethnicity but also between substance use, class and ethnicity. Ethnic identity gets translated into social captial which in turn has ramifications for one’s economic and social standing . Second, failing to critically appraise our use of fixed and homogenous ethnicity categories in the alcohol and drugs fields jeopardizes our ability to identify the broader social and structural determinants of alcohol and drug use and related problems—like poverty, social exclusion, and discrimination—which are crucial issues for addressing social injustices. So often studies revealing correlations between ethnic categories and substance use related problems result in discussions about the importance of developing culturally-appropriate prevention and treatment interventions, overlooking the structural conditions that adversely affect socially-defined ethnic groupings and may result in some form of engagement with alcohol and/or drugs. For example, research on street cultures, where ethnic identifications and drugs play a central part, illustrates how some ethnic minority youth use and/or sell drugs to actively construct counter-images or ethnically-infused street cultures of resistance within their neighborhoods, which some researchers have called “neighborhood nationalism” , as a way of resisting or transcending “inferior images” ascribed to them by the wider society . These street cultures provide alternative definitions of self-identity, especially for young men, who live in communities marked by poverty and marginalization and who have little access to masculine status in the formal economy .

Temporal information provides a good starting point for actionable EMI information. Date and time stamps can be passively collected without user burden and provide quantifiable information, such as weekend or weekday categories,wholesale vertical grow factories that can be incorporated into classifiers that trigger EMI. Cravings provided useful self-reported data, with strong cravings more frequently reported on AOD use days. Cravings can be categorized in a binary fashion with reporting operationalized as a button on a phone’s desktop for easy access and more frequent reporting. Random prompts can be used throughout the day to query cravings similar to Piasecki et al. . This offers an improvement over our study design in the ability to better understand temporal context for AOD use. Affective states are multi-faceted and more difficult to quantify. Happiness tended to be the most frequently reported affective state across CEMA strategies, but were reported to the same degree when AOD use did and did not occur. Thoughts of wanting to get buzzed were more common for alcohol use alone and thoughts of relaxation were more common for marijuana and other substances. Reports of context, cravings and affect were robust to CEMA reporting strategy, whether reports were based on recall or in the moment. An exception was that marijuana use was most commonly reported in the morning based on recall and only reported in the afternoon based on EBA. In-the-moment RA does not provide a comparison as youth were not prompted in the morning. Further study is needed to see if time-of-day differences in reporting marijuana hold in larger samples. Overall robustness in reporting context is encouraging and suggests that there is flexibility in using different CEMA strategies. Flexibility in assessment is important with youth in consideration of school activities and other events that may make it difficult to implement one assessment strategy. Next steps call for studies with larger sample sizes to examine overlap between contextual factors and explore temporal relationships with AOD use, similar to multilevel analyses by Piasecki et al. that analyzed nicotine use in mostly white youth.

The small number of participants, low rates of AOD use, and missing data due to non-response made this impractical in our study and are limitations. This hampered our ability to provide subgroup analyses by age and gender; both characteristics are linked to AOD use and context . There is variation in the degree of AOD use across participants that may also relate to context but was impractical to explore in our sample. Caution is also warranted in generalizing our findings for normative samples of AOD users as participants were in a substance abuse treatment program. Lastly, RA occurred once a day after school hours and more closely mimicked EoDA than true RA that typically occurs multiple times a day. Our assessment scheme limited our ability to address the second hypothesis and explore if different assessment methods elicited different types of AOD use-related context. Notwithstanding sample size limitations, our sample is representative of Latino youth in outpatient treatment. We did not see evidence of self-selection to participate in our study; there was a lot of interest to participate. The use of a study phone and free cell phone minutes that accompanied participation provided strong incentives. Enrollment was limited by the number of study phones. Interest in our study highlights an important opportunity to develop substance use interventions for youth through a medium they already use in their daily lives.Spontaneous EBR has become increasingly popular as a putative behavioural marker of endogenous dopamine. Interestingly, most of the past studies that have used sEBR in this capacity have loosely referred to ‘dopamine function’ or ‘dopamine activity’, perhaps reflecting the current dearth of knowledge regarding which specific aspect of the dopamine system correlate with sEBR. Here we tested the hypothesis of a positive relationship between sEBR and striatal dopamine synthesis capacity, based on the proposal that sEBR is positively related to striatal dopamine function , and previous results showing a positive correlation between sEBR and striatal dopamine levels measured in post-mortem monkey brains . Both frequentist and Bayesian statistics, as well as ROI and voxel-wise analyses, argue against the existence of such a positive relationship in our sample and show that, if anything, the evidence is in favour of a negative relationship.

While we prefer to refrain from making speculative interpretations regarding the existence of a negative relationship, given the moderate level of evidence, we believe these data provide a strong cautionary message against the use of sEBR as a positive predictor of pre-synaptic striatal dopamine. Importantly, our data speak specifically to dopamine synthesis capacity and do not preclude correlations of sEBR with other aspects of the dopamine system, including dopamine D2 receptor availability. It has been suggested that sEBR might primarily reflect striatal D2 receptor activity, based on the observation of a positive correlation with D2 receptor availability in monkeys , and the observation that sEBR better predicts D2-mediated punishment learning than D1-mediated reward learning . However, this relationship between sEBR and dopamine D2 functioning has been recently questioned by a PET study which failed to replicate it in humans . Also, such a relationship remains difficult to reconcile with recent findings showing a positive association between dopamine D2 receptor availability and dopamine synthesis capacity , as this would predict a positive relationship between sEBR and dopamine synthesis capacity, in contrast to our results. These inconsistencies certainly call for further research to better elucidate the dopaminergic mechanisms underlying sEBR. This study is not devoid of limitations. First, our sample size is relatively small, although one should note that it is larger than the samples used in many of the psychopharmacological studies that have investigated dopaminergic drug effects on sEBR . In fact, a power analysis performed with GPower3.1 suggests that a sample size of 12 individuals should have been sufficient to replicate with 95% power the positive relationship reported by Taylor et al. between striatal dopamine levels and sEBR in monkeys . In addition,grow rack as argued by Dang et al. , the use of sEBR as a reliable predictor of dopamine function implicitly requires that the positive relationship between these two variables should be strong and thus observable even in small samples. For these reasons, we believe that the preliminary evidence reported here is valuable, even though a replication in a larger sample size is warranted. Another aspect that may be perceived as a limitation is the use of a mixed population of healthy participants and pathological gamblers. While we acknowledge that pathological gamblers are not typical individuals and are characterized, among other things, by elevated striatal dopamine synthesis , we believe that this is not necessarily an issue in the context of the current study. Indeed, our goal was to examine whether individual differences in sEBR and dopamine synthesis were positively related, regardless of the origin of these individual differences. If sEBR is to be used as proxy measure of dopamine levels, it should be insensitive to the underlying causes of individual variations, so that it can be effectively used in both clinical and non-clinical populations. In fact, a large portion of the literature that has led to the hypothesis of a link between sEBR and dopamine function is based on the study of clinical populations characterized by dopamine dysfunctions. Finally, one should note that restricting our analyses to healthy individuals did not affect the results, still showing moderate evidence against a positive correlation.

To conclude, our study does not support the hypothesis of a positive relationship between sEBR and striatal dopamine synthesis, and if anything, provides evidence against it. Even though it is based on a modest sample size and needs to be replicated in a larger sample – which we are currently attempting to do, it warrants caution for future studies that may be tempted to use sEBR as a proxy measure of striatal dopamine synthesis capacity.Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Globally, 3.5 million people die from alcohol and illicit drug use each year. Over 20 million Americans had a substance use disorder in 2018, 73% had an alcohol use disorder, 40% had an illicit drug use disorder, and 13% had both alcohol and illicit drug use disorders. Approximately half of Americans with an SUD had a co-occurring mental illness. Treatment of depression and anxiety, the most common psychiatric comorbidities among patients with SUDs, may reduce craving and substance use and enhance overall outcomes. In 2018, less than 1 in 5 individuals with a SUD received addiction treatment. Alcohol and illicit drug misuse and addiction cost the United States over US $440 billion annually in lost workplace productivity, health care expenses, and crime-related costs. Potential effects on individuals include an array of physical and mental health problems, overdose, trauma, and violence. Web-based interventions and digital health apps may reduce or eliminate common, significant barriers to traditional SUD treatment. Preliminary evidence suggests that digital SUD interventions affect substance use behavior and have the potential to reduce the population burden of SUDs. To date, most digital SUD interventions have been delivered on a web platform, rather than via mobile apps. The widespread use of smartphones makes app-based intervention delivery a viable and scalable medium. In 2019, about 8 out of 10 White, Black, and Latinx adults owned a smartphone. Although lower-income adults were less likely to own a smartphone than higher-income adults, they were more likely to rely on smartphones for internet access. In a 2015 survey, 58% of mobile phone owners reported downloading a health app. Texting is the most widely and frequently used app on a smartphone, with 97% of Americans texting at least once a day. Automated conversational agents can deliver a coach-like or sponsor-like experience and yet do not require human implementation assistance for in-the-moment treatment delivery. As recent meta-analytic work suggests, conversational text-based agents may increase engagement and enjoyment in digitized mental health care, whereas most general mental health care apps face difficulty sustaining engagement with high dropout. Conversational agents can provide real-time support to address substance use urges, unlike traditional in-person frameworks of weekly visits. The scale potential of conversational agents is unconstrained, immediate, and available to users in an instant. Being nonhuman based also reduces perceived stigma.