Culture and Substance Abuse
Substance abuse treatment programs in America are failing in how they successfully treat addiction. The way that substance abuse treatment programs are designed now, the majority of patients' relapse and there is only a 30% success rate. The United States is a country of immigrants coming from different backgrounds with different traditions and beliefs, including those beliefs surrounding substances and addiction. Patients with different cultural backgrounds bring different perspectives and require treatment that addresses their heritage and background that makes up their culture. A patient that is a white Euro-American has certain values and understandings. A patient that is an African American male has different cultural values and understandings. The cultural background of someone suffering from substance abuse affects how he or she will respond to addiction treatment in the United States.
Addiction treatment in the United States consists of medication therapy, counseling, and treatment of underlying medical, physical, or psychological issues. Medication therapy is the treatment of addiction through FDA approved pharmaceuticals that support the weaning off addictive, life-altering substances. An example of medication treatment is Methadone, which is used to manage opiate addiction. This medication is taken orally and the patient has to come to a clinic every day to receive their dose. For some patient's doctors recommend Naltrexone or Suboxone to treat opiate addiction. For alcohol abuse, doctors may prescribe Disulfiram. This medication is taken daily or as needed and causes the individual to get sick if you drink while on the medication. The thought here is that the physical illness will deter the patient from drinking out of fear of illness. "A relatively new area of exploration has been the field ethnopsychopharmacology, where studies indicate that racial and ethnic groups may respond to psychiatric medications differently. Studies in pharmacokinetics and pharmacodynamics indicate that some ethnic and racial groups such as Asians, African Americans, and Hispanics metabolize medications differently, leading to interesting differences in drug and medication sensitivity and tolerance, side effects, and medication effectiveness." (Upsher, p.4).
In addition to medication, therapy or counseling is utilized in substance abuse treatment as a way of providing tools to cope with life's challenges that would normally attempt to be coped with utilizing illicit substances. Group therapy has shown to be very effective and should be considered in all treatment for substance abuse. One of the most important factors to rectify in the mental health of an addict is the feeling that they are alone and no one will understand them. Group therapy is effective because addicts can talk in a group setting to share in experiences and know that they are not alone in the way they feel or in their experiences. Individual therapy is important for the patient to have a chance to have one on one time with their counselor or therapist and address the individualized concerns or contributing factors in their substance abuse journey. "It is estimated that up to 60% or more of persons entering into drug and alcohol treatment programs present with both mental and substance abuse disorders." (Upsher, p. 3); these underlying, untreated illness that has helped to lead them to a life of coping through substance abuse. Some examples of these illnesses include mental illness, with the most common being depression and anxiety, but also illness such as autism or physical disabilities, including chronic pain. Treatment of these concurring diagnoses need to be addressed at the same time as the addiction for a more successful outcome. Some patients have other issues that if not treated, lower the chance of being successful in treatment. Patients with depression will most likely be unsuccessful if the depression is not treated. Patients with chronic pain will most likely not be successful if the pain is not somehow simultaneously treated. It is important to take each type of treatment and apply the patients cultural views and beliefs on each component of the treatment plan.
Native Americans cultural backgrounds have to be considered in their addiction treatment to be more successful. Understanding how Native Americans view alcohol will help in treating someone of this descent diagnosed with alcoholism. Native Americans did not have access to alcohol until the Euro-Americans settled on their land. "Native American elders believe that many substance abuse problems are related to the loss of traditional culture." (Abbott), and that can be blamed by the white settlers from foreign lands influencing the natives. Since there is some contempt on white settlers, Native Americans may resist being treated by medications being made by white man and would prefer to use the methods of their ancestors to treat the addiction. Native Americans have spiritual beliefs that we might not understand that could conflict with American treatment. Native Americans have family values that differ from Americans. In Native American culture, they have a lot of beliefs surrounding tradition. Some traditions are passed down from generation to generation. The beliefs also include various legends, for example, one that may result in a curse on someone for bad karma, etc.; an understanding if a patient believes he or she has a curse on them while treating them through therapy would be important to address.
Latinos & Hispanics face different problems than Americans. "The [ancient Aztecs] use of alcohol was heavily regulated and was only for ceremonial purposes. Non-ceremonial use of alcohol was strictly forbidden under penalty of death." (Abbott) and due to this, the Hispanic culture originating from Mexico do not consume alcohol. Higher rates of drug use have been found in Hispanics and Latinos aged 12-17 (Alvarez, 116); these individuals are not as rooted in their ancestors beliefs as their parents or grandparents. This makes this specific group more susceptible to becoming an addict because the earlier the age of someone starts using a substance increases the likelihood of addiction. Hispanics and Latinos are very family oriented in their cultures and do not use alcohol or drugs as much as some other ethnicities, however, when they come to the United States, the become acculturated and participate in the norm of alcohol consumption. Understanding the family roots, as well as the native ancestor's beliefs when trying to treat a Hispanic individual for substance abuse is critical. In the situation of their ancestors, the patient may feel shame for not respecting their ancestors or the patient may lack support from their family because of the beliefs of their ancestors. Understanding the patient's support system is an important part of being able to treat them both through therapy and medication.
"African-Americans are overrepresented among drug abusers in the United States when compared to European-Americans, and have lower rates of recovery from drug addiction after treatment." (Bowser and Rafiq, 391). African Americans race is not seen or studied as a culture, but should be, especially when it comes to addiction. Culture is a set of beliefs based on an upbringing similar to those around you and African Americans often grow up in similar socioeconomic surroundings with a higher level of poverty. When the existence of poverty is present, more drug use for coping with life's struggles and sales for a way of making fast money. African Americans are still overcoming racism that has happened in America. The cultural background of African Americans has given them a different set of obstacles to overcome while coming up in America. One obstacle they face is that drug use is normalized generation over generation and seen as a normal behavior, and when periodic use turns to abuse, the support system around this patient, may not be able to recognize that there is a problem. Additionally, it may be difficult for the patient to recognize there is a problem because the use of the substance is reinforced by generations of using the substance.
The LGBTQ community has its own difficulties that it faces when trying to seek treatment here in America. Being gay or bisexual can make it difficult to openly talk to someone about your problems of addiction. Because it is not the social norm, some people are treated differently because they may be gay or bisexual. This can also be difficult because someone that is part of this community also has a cultural background. Someone that is gay and African American faces more than one cultural influence. Addiction treatment for these individuals can be more difficult to understand because their ethnic culture may be more important than their sexual identity culture or vice versa. When it comes to therapy, it is important for "counselors should keep in mind how the client's culture views LGBT individuals and the effect this viewpoint has on the client." (Skinstad, p. 10). Additionally, understanding that the support system of the patient could be lacking because of their family's beliefs or feelings surrounding their sexual orientation.
Substance abuse treatment in the United States has a 30% success rate, focusing on the individualized culture of each patient is critical in success. If the patient does not feel that the thought process behind their treatment plan is for them, then they will not stick with it. If their culture is opposed to medication as a form of treatment and that is part of their plan, then they will not commit to the program. If their family does not believe in alcoholism and offers them a drink at social gatherings and their therapist has not provided them the tools to abstain, then they will relapse. As demonstrated in the above examples for Native American, Latino, African American and the LGBTQ cultures are all very different and an understanding of each of their perspectives is important to be successful in treating a patient for substance abuse. The cultural background of someone suffering from substance abuse affects how he or she will respond to addiction treatment in the United States.
Abbott, Patrick. "Culture and Substance Abuse: Impact of Culture Affects Approach to Treatment." Psychiatric Times, 1 Jan. 2008
Alvarez, Josefina et al. "Substance abuse prevalence and treatment among Latinos and Latinas." Journal of ethnicity in substance abuse vol. 6,2 (2007): 115-41.
Bowser, Benjamin P., and Rafiq Bilal. "Drug Treatment Effectiveness: African-American Culture in Recovery." Journal of psychoactive drugs 33.4 (2001): 391-402. ProQuest. 17 Oct. 2020
Skinstad, Anne Helene. "LGBT Cultural Competency Challenges Are Many and Complex." RESOURCE LINKS, vol. 7, no. 2, 2008, p. 10.
Upsher, Curtis. "Cultural Competency and Its Impact on Addiction Treatment and Recovery." Resource Links, vol. 7, no. 2, 2008, pp. 1-4.