The country of residence with the highest frequency of DD was the US, followed by Central America and finally Mexico and these differences were statistically significant. Immigration from Mexico to the US was significant associated with an increase in the diagnosis of SUD. These increased rates of SUD in US residents and in Mexican subjects that immigrated to the US, compared to subjects living in Mexico, is consistent with the data of Vega (Vega and Sribney, 2003) and others who suggest that acculturation to the US might be associated with increased psychiatric comorbidity for both genders, as well as a risk factor for SUD in non- psychiatric samples (Buchanan and Smokowski, 2009; Prado et al., 2009). It has been suggested that the more typical interconnectedness of large families and other cultural factors among Latinos may represent protective dynamics contributing to lower rates of DD among Latinos and that these factors may begin to break down or have less effect once Latinos are exposed to a different culture through residence in the US (Alegria et al., 2006; Montross et al., 2005;
