Addiction Treatment with Minorities

1
Addiction Treatment with Minorities

• Shannon Brown
• Kate Bullock
• Danielle Simpson

2
Cultural Competency

• A set of academic and interpersonal skills that
  allow individuals to increase their understanding
  and appreciation of cultural differences and
  similarities within, among, and between groups.
  This requires a willingness and ability to draw
  upon community-based values, traditions, and
  customs and to work with knowledgeable persons of
  and from the community in developing focused
  interventions, communications, and other
  supports.
• -Orlandi, Weston, Epsteingm 1992, p. vi.
• Culturally competent treatment approaches are
  more likely to engage the client
• Clients are more likely to be active participants
  in the treatment process

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Acculturation

• Acculturation vs. Enculturation
• Assimilation
• Increases psychosocial stress
• Evaluated by two standards
• Stress of living in two worlds
• Exposure to competing cultural values
• Generational differences in acculturation and
  values
• Substance abuse may be a response to
  acculturation stresses, particularly for
  Hispanics
• Monocultural commitment may put many at a greater
  risk for substance abuse
• Self-identity
• To what degree do they identify with their ethnic
  culture or with mainstream American culture?
• What are their attitudes towards their ethnicity?
• Erodes capacity to cope

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Risk Factors

• Stressors
• Discrimination
• Poverty
• Most common factor among minorities
• Inadequate employment
• Educational opportunities
• Pervasive sense of powerlessness
• Poor coping skills
• Inadequate healthcare
• Limited access to resources
• Drugs may be used by communities and individuals
  to help cope with this stress
• Provides a way to minimize feelings of inadequacy
  that may be placed on them by society

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Protective Factors

• Many minority populations have a lot of
  protective factors in place that may be a great
  asset in addiction treatment
• Family
• Community
• Church
• Peers
• Cultural values

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Culture and The DSM-IV

• There are wide cultural variations in attitudes
  toward substance consumption, patterns of
  substance use, accessibility of substances,
  physiological reactions to substances, and
  prevalence of Substance-Related Disorders. Some
  groups forbid use of alcohol whereas in others
  the use of various substances for mood altering
  effects is widely accepted. The evaluation of any
  individuals pattern of substance must take these
  factors into accounts. Patterns of medication use
  and toxin exposure also vary widely within and
  between countries.
• - DSM IV p. 205

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Treatment Considerations

• Treatment should promote bicultural competence
• Blend the adaptive values and roles of both the
  culture in which they were raised and the culture
  by which they are surrounded
• Coping skills, support systems, community
  building, assertiveness training, social
  competence
• Treatment retention can be a problem
• Fitting treatment into a cultural context that
  applies to your client is a challenging necessity
• It is important to understand how drug use and
  treatment are viewed within the values and
  beliefs of the culture
• Engagement and motivation

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History of Substance Abuse in Native American
Populations

• Alcohol was not a part of Native American life
  before its introduction by settlers
• Alcohol pressed upon Native Americans because it
  was a profitable trade good
• Used as diplomacy in official dealings with
  Native Americans
• There were no mechanisms within Native American
  tribes to deal with the negative consequences of
  drinking or regulate its use
• No norms or cultural values by which to regulate
  it socially
• A history of trauma
• Children forcefully removed from homes and raised
  without their cultural values and beliefs
• Very marginalized minority

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Substance Abuse among Native Americans Today

• 2 million persons and over 500 tribes
• About 20 used an illicit drug in the past year
  (versus 12 in the total US population), and
  about 7.8 were in need of illicit drug abuse
  treatment (versus 2.7)
• Many risk factors, such as poverty, unemployment,
  and low levels of education
• Alcoholism has more or less become a passed down
  tradition
• Alcohol is considered to be the number 1 killer
  of Native Americans
• Suicide, Homicide, Accidents, Cirrhosis
• Fetal Alcohol Syndrome and Inhalant abuse also
  plague this population
• FAS a huge problem in that it perpetuates a cycle
  of addiction
• Greater rates of substance abuse among those who
  identify mostly with non-Native culture and
  values
• Lowest rates of substance abuse among those who
  were bicultural, identifying with both Native and
  non-Native values

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Treatment Considerations for Native Americans

• May be necessary to foster a positive cultural
  ethnic identity before treating addiction
• Depends on level of acculturation
• Treatment modalities that incorporate tribal
  practices, Native beliefs, and tribal leaders
• Blend the adaptive values and roles of both the
  culture in which one is raised and the culture by
  which one is surrounded
• Traditional treatment practices may not appeal to
  Native Americans
• Public disclosure of personal problems
• Religious overtones
• Abstinence from all substances
• Peyote

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Treatment Considerations for Native Americans

• Many tribes are incorporating Native beliefs into
  traditional 12 step programs
• Switch from traditional AA to one that is focused
  on Native culture can increase participation by
  up to 60
• Use of talking circles, medicine wheel, sacred
  pipe, and purification sweat
• Alcoholism or substance abuse seen as a break in
  the circle
• Must educate clients about drug use and misuse
  and how it impacts the community, both physically
  and socially
• Treatment and prevention are more effective if
  they come from within the community
• Native American community must be involved
• You must create a healing forest

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Asian Americans/Pacific Islanders

• Stereotyped as being the model minority
• Youth overrepresented in higher education
• More than 40 culturally distinct groups with over
  100 different languages and dialects
• 10 major subgroups Chinese, Filipino, Japanese,
  Asian Indian, Korean, Vietnamese, Hawaiian,
  Samoan Guamanian, and other Asian or Pacific
  Islanders

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Asian Americans/Pacific Islanders

• Lowest rates of substance abuse
• Age of first substance use is higher for Asian
  population (17.5 vs. 14.5 for whites
• Percentages of Asian/Pacific Islanders aged 12
  and older who used cigarettes, alcohol, and any
  illicit drug in the past year equal about 22,
  53, and 6.5, as compared with about 31, 66,
  and 12 in the total U.S. population aged 12 and
  older
• perceived low rates of drug use may be a result
  of low surveillance
• Lower prevalence of risk factors
• Family relationships
• Education
• More recent studies are showing that drug use
  among Asian Americans in college is more
  comparable to other groups than previously thought

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Addiction in Asian Americans and Pacific Islanders

• Substance abuse varies greatly among Asian ethnic
  groups
• Depends on many factors
• Socio economic status
• Acculturation
• May result in feelings of distress, depression,
  isolation, and failure
• Education
• Relationship to family and peers
• Generational differences with parent
• Gender role conflict
• Attempting to fulfill traditional masculine
  expectations

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Addiction in Asian Americans

• Approximately half of persons of Northeast Asian
  heritage (Koreans, Japanese, Chinese) have a
  genetically defined deficiency in ALDH2 (aldehyde
  dehydrogenase)
• This results in at least one mutant ALDH2 allele
• Associated with an alcohol induced flushing
  reaction, Asian reds flushing
• Extremely rare in non Asians
• Compared with those who do not have this
  mutation, those with it drink less alcohol and
  report lower rates of alcohol abuse
• Individuals with both mutant alleles experience
  severe reactions to low doses of alcohol,
  including nausea and vomiting
• May protect Asians from abusing alcohol
• May also have a protective effect on smoking

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Treatment in Asian Populations

• May be more open to treatment
• May prefer using personal resources rather than
  professional help
• Beneficial to work with community resources and
  family members
• Will still have to overcome the stigma associated
  with treatment
• Support groups may not appeal to this population
• Disclosing personal information conflicts with
  cultural values and the belief that one should be
  discrete and quiet when it comes to mental health
• Culture emphasizes personal restraint and
  suppression of emotion
• Helping them see the impact their addiction has
  on their family is key
• Shame
• Respect

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Hispanics/Latinos

• Approximately 12.5 of the US population is
  Hispanic.
• Out of all individuals arrested nationally for
  impaired driving, 1 in 5 were Hispanic/Latino.

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Hispanics/Latinos

• The main substance used among Hispanic people is
  alcohol.
• Compared to other racial groups,
  Hispanics/Latinos come in second highest in use
  of alcohol, binge drinking and heavy alcohol use.
• The two main illegal drugs used by Hispanic
  people are marijuana and cocaine.

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Treatment Considerations for Hispanics/Latinos

• Immigration
• Acculturation
• Discrimination
• Language barriers
• Disruptions of social support

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Additional Treatment Considerations for
Hispanics/Latinos

• Hispanic/Latino families tend to keep substance
  use problems secret' within the family.
• Hispanic women often get involved with alcohol
  and drug use as a way to be supportive' of their
  partner who is using alcohol and drugs.

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Hispanics/Latinos and Drug Use

• Drug use in the Hispanic community is on the
  rise.
• Drug use is correlated with factors of
  assimilation primary use of English rather than
  Spanish, weakened cultural identity, and lower
  levels of ethnic pride.

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The Good News

• The therapists perceived empathy is still the
  strongest predictor of client success in
  recovery.
• Treatments such as motivational interviewing work
  as well with Hispanic clients as they do with
  other clients.

23
African Americans

• In 1999, African Americans made up 12 of the
  population and 23 of substance abuse publicly
  funded treatment facilities
• Alcohol and Cocaine abuse made up 2/3 of African
  American admissions to treatment
• African American females admitted for hard
  drugs such as opiates and cocaine more so than
  Black males

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African Americans and Crack/Cocaine

• African Americans made up 19 of crack cocaine
  users in 2001
• Most common among African Americans living in low
  income inner city neighborhoods
• 40 of African American females admitted to
  treatment used cocaine
• While 28 of African American men admitted to
  treatment used cocaine

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African Americans Youth and Drug Use

• One fourth of African Americans 12 years and
  older are cigarette smokers (6.5 compared to
  12.8 of Caucasians)
• The average age for African American females to
  begin smoking was 16 to 17 years old
• 80.4 of African Americans cigarette smokers
  smoke menthols
• Only 14 of African American twelfth-graders
  report drinking five or more drinks in the past
  two weeks, as compared with 32 of whites and 24
  of Hispanics.
• 5 of African American eighth graders reported
  marijuana use and 13 of African American twelfth
  graders while 6 of white eighth graders and 18
  of twelfth graders reported marijuana use

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African Americans and HIV/AIDS

• Behaviors related to drug abuse such as sharing
  dirty needles and engaging in high risk sexual
  behavior due to alcohol or drug intoxication
  influenced spread of HIV/AIDS
• In 2004, AA 13 of population and account for 50
  of AIDs cases
• 69 of HIV diagnoses between 2000-2003 were
  African American women
• In 2001, HIV was the leading cause of death for
  African American women aged 25-34 and African
  American men of all ages

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Treatment ImplicationsHistorical Hostility

• Psychological factor that can affect African
  Americans especially in treatment situations
• Pattern of responses that includes rage,
  violence, crime and substance abuse
• Originates from prolonged subjection to inferior
  treatment in American society
• Provoked from external source
• Recurring in nature
• Can impair the therapeutic alliance in
  cross-cultural therapeutic relationships
• Negative transference
• Resistance

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Treatment Considerations

• Resist models based on disease model or family
  systems model since addiction is viewed as a
  personal choice
• Often lack connection to community resources
• Include family members or social support who are
  supportive of treatment
• Develop practices that take into account the
  needs, cultural dynamics and style of African
  American culture
• Be aware of cultural differences and acknowledge
  them in order to demonstrate empathy

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Conclusion

• Working with minorities in drug treatment may
  pose different challenges depending on the
  specific group
• Be aware of the minority groups culture and
  incorporate cultural awareness in to treatment
• The therapeutic alliance and empathy are still
  the best predictors of treatment success

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Resources for Working with Minorities

• http//ncadi.samhsa.gov/
• http//www.samhsa.gov/
• http//csat.samhsa.gov/
• http//kap.samhsa.gov/products/manuals/tips/index.
  htm
• http//www.oas.samhsa.gov/race.htmAllRace

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References

• American Psychiatric Association. (2000).
  Diagnostic and statistical manual of mental
  disorders (4th edition- Text Revision).
  Washington, DC Author.
• Castro, F. G., Proescholdbell, R. J., Abeita, L.,
  Rodriguez, D. (1999). Ethnic and cultural
  minority groups. In B. S. McCrady E. E.
  Epsteon (Eds.), Addictions A Comprehensive
  Guidebook (pp. 499-526). New York Oxford
  University Press.
• Coyhis, D. Simone, R. (2005). Rebuilding
  Native American communities. Child Welfare,
  34(2). 323-336.
• Dominicus, W. S., Wong, F. Y. (2001). Alcohol,
  drugs, and substance use among Asian- American
  college students.
• Drug and Alcohol Services Information System.
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• Frank, J. W., Moore, R. S., Ames, G. M. (2000).
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• French, L. A (2004). Alcohol and other drug
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• Makimoto, K. (1998). Drinking patterns and
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• National Institute on Drug Abuse. (2003). Drug
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References

• National Institute on Drug Abuse. (2006). Drug
  abuse and the link to HIV/AIDS and o ther
  infectious diseases. U.S. Department of Health
  Human Services.
• National Survey on Drug Use and Health. (2007).
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• Orlandi, M.A., Westin, R., Epstein, L.G.
  (1992). Cultural competence for evaluators.
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• SAMSHAs National Clearinghouse for Alcohol and
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• U.S. Census Bureaus American Fact
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• Santisteben, D., Vega, R. R., and Suarez-Morales,
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• Szlemko, W. J., Wood, J. W., Thurman, P. J.
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• Terrell, M. D. (1993). Ethnocultural factors and
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References

• Vontress, C., Epp, L. R. (1997). Historical
  hostility in the African American client
  Implications for counseling. Journal of
  Multicultural Counseling and Development, 25
  (3), 170-184.
• Wall, T. L., Shoshana, H. S., Chane, K. K.,
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• Warner, L., Valdez, A., Vega, W. A., de la Rosa,
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• Wechsberg, W., Zule, W., Riehman, K., Luseno, W.,
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