Bridges to Recovery: Addiction, Family Therapy, and Multicultural Treatment

Bridges to Recovery: Addiction, Family Therapy, and Multicultural Treatment

by Jo-ann Krestan

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Overview

Bridges to Recovery: Addiction, Family Therapy, and Multicultural Treatment by Jo-ann Krestan

At last, a book that defines a new language for treating substance abuse in an increasingly culturally diverse population. Until now, therapists, counselors, and teachers who treat addiction within the context of the whole family have had to make do with outdated one-size-fits-all theories and treatment programs.
Bridges to Recovery is the first book to bring together experts from three major fields within psychotherapy -- family therapy, addiction counseling and multicultural treatment -- to provide a practical and flexible framework for working with families within their individual cultural contexts. Drawing upon case studies, clinical anecdotes and proven treatment methods, Bridges to Recovery provides practitioners with a unique insight into the individual cultural nuances that make addiction recovery a very personal journey.
Jo-Ann Krestan, co-author of the classic book The Responsibility Trap: A Blueprint for Treating the Alcoholic Family, and her contributors integrate the latest ideas and research to offer a foundation for addiction treatment that brings to the forefront the cultural thinking that affects alcohol and drug use/abuse among Native Americans, Jewish Americans, African Americans, West Indians, Asian Americans, Mexican Americans, Puerto Ricans and groups of European origin. This book will be an invaluable asset to teachers and students in clinical social work, psychology and substance abuse counseling programs, setting the standard for education and treatment at the beginning of the 21st century.

Product Details

ISBN-13: 9780684846491
Publisher: Free Press
Publication date: 03/15/2000
Pages: 336
Product dimensions: 6.12(w) x 9.25(h) x 1.20(d)

About the Author

Jo-Ann Krestan is a leading marriage and family therapist and addiction counselor who has appeared on such shows as Oprah and 20/20 and is co-author of The Responsibility Trap: A Blueprint for Treating the Alcoholic Family. Her other books include Singing at the Top of Our Lungs and Too Good for Her Own Good. She lives in Surry, Maine, and Castle Valley, Utah.

Read an Excerpt

Chapter One: Addiction, Power, and Powerlessness

Jo-Ann Krestan


The ecology of addiction in a multicultural society requires us, as family therapists and addiction counselors, to re-examine two core ideas that have historically guided our treatment of addiction in the United States: power and powerlessness. Pride, false pride, and shame are closely related concepts and must also be viewed in a multicultural context.

Power and powerlessness are concepts laden with multiple meanings. Understanding the ecology of addiction as it relates to a particular individual or group requires us to first think about these concepts in a generic way and to then particularize them to the individual or group. The founders of Alcoholics Anonymous and family systems thinkers like Gregory Bateson based their beliefs about the nature of addiction on the Western European view, which is primarily "power over." I will address the concept of "power over" at some length, because traditional addiction treatment in the United States, often wedded to a twelve-step approach, evolved from this Western European view. It is in the context of this view that addicts are asked to embrace the idea of powerlessness over their addiction. Only then, we tell them, can they regain power over their life. The first step in recovery in Alcoholics Anonymous, the dominant paradigm for most addiction treatment in the United States, occurs when addicts recite, "[We] admitted we were powerless over alcohol, that our lives have become unmanageable." This admission of powerlessness that AA insists on is key to the shift in the addict's belief system and crucial to dismantling what Karen Horney (1937) calls "neurotic pride." In his concept of the symmetrical structure of "alcoholic pride" Gregory Bateson (1972) too recognized the necessity for addicts to shift their stance from one that asserts domination over the self, others, and the environment to one that accepts the reality of limitation, a concept that is foreign to our Western culture.

It is necessary to broaden our thinking about what it means to have power or to be powerless and examine what it is about these prevailing views of power that can set the stage for addiction.

Kinds of Power

In her book Understanding Race, Ethnicity, and Power, Pinderhughes(1989) wrote:

People experience the presence or absence of power in many areas of life. For power is a systemic phenomenon, a key factor in functioning....Internal power is manifest in the individual's sense of mastery or competence. The power relationships between people determine whether their interactions are characterized by dominance-subordination or equality. These styles of interaction are, in turn, affected by the status and roles assigned within the group or the larger society.

There are four related kinds of power:

Individual

Interpersonal

Socio/Cultural

Spiritual

Let us first deconstruct these kinds of power and posit how addicts think of each of them. I believe that addicts, in their addiction, identify with the dominant discourse of "power over" and that they must learn to view this discourse as "power to" if they are to recover from their addictions.

Individual Power

Individual "power to" is synonymous with empowerment and includes feelings of self-control, subjectivity, and the ability to define one's own life. It is the power to choose. For example, although we have no say about the family of origin we are born to, we can learn to make choices about family relationships that empower rather than victimize us. For the addict, "power to" is the power to surrender, a paradox I examine later in this chapter.

Individual "power over" may extend to total control of one's feelings or to the illusion of total control over one's life. Gender-linked messages about the control of feelings, such as the suppression of male vulnerability or of female anger, teach people that they have individual power over their feelings, thereby constricting normal emotional behavior. Individual "power over" denies the need to act in a context with others. Those who insist on having this kind of power will have difficulty submitting to authority. Any absence of control is viewed by them as being controlled and therefore out of control. For example, being a member of the crew on a sailboat rather than the captain may be experienced as being powerless, rather than simply as being a team player. The individual who must have "power over" will have difficulty relinquishing control when cooperation is needed. For example, the addict says, "I can control my habit. I have power over my addiction."

Interpersonal Power

Interpersonal "power to" is the power to be heard in a group, perhaps to become the leader. It is the power to make choices and take positions about what one will or will not do, rather than just react to situations in relationships. For the addict, "power to" means the ability to leave bar friends and go to an AA meeting. It empowers addicts to exercise a healthy choice, such as to amend their relationships in sobriety.

However, interpersonal "power to" can lead to "power over." One's power to enlist in a cause may become institutionalized leadership, a legitimized form of "power over." Although "power over" may start benignly, it is vulnerable to becoming a power over others that denies equality and becomes exploitative, unjust, and even violent. There can be no "power over" without relative inequality (Sebastian, 1992). Our institutionalized "power over" that emanated from the Eurocentric subjugation of what became these United States is White, male, Protestant, and heterosexual.

The addict, desperate to hold on to "power over," says, "I will overpower your efforts to control my chemical use. I will control you." The addict's expression of "power over" might be annoying manipulative behavior or actual physical coercion.

Culture, like power, is a systemic rather than a static process. Falicov (conversation with author, 1998) points out that it is a dialogical process, with certain cultural attributes being highlighted in interaction with others.

Sociocultural Power

Sociocultural power is group power. For a group, "power to" may mean a centralized position (rather than marginalization), access to resources, or political power. That is, "power to" is the right to define the rules, control the discourse, select the language. For the addict, sociocultural "power to" means becoming part of a reference group that values sobriety.

Sociocultural "power over" is power that privileges certain groups at the expense of others, as demonstrated by race and class discrimination. A group that exerts "power over" creates inequality among groups. For example, immigrants come to the United States to find the "good life" portrayed in the media, but their success often depends on which race or class they belong to. It is clear that success and power in the United States are synonymous with material comfort. Immigrants of color are frequently denied access to the better-paying jobs. These people may be highly skilled, well-educated individuals who were relatively well compensated for their work in their country of origin. It is a shock for them to come in search of the "good life" only to experience a profound loss of status inflicted by a more powerful sociocultural group (Espiritu, 1997).

The original European colonists decimated the American Indians and warred with the Mexicans who once were in possession of much greater territory; their descendants interned the Japanese during World War II, despised the first Catholic Irish and Italian immigrants, and were, in general, intolerant of difference. Those addicts whose sociocultural reference group has "power over" feel more powerful than do those whose group lacks such power. This encourages the illusion in the former that they have power over their addiction.

Spiritual Power

Spiritual power comes from how we think about our relationship with the world around us. This larger picture includes self and others, spirit (in AA terms, "Higher Power"), the natural world, destiny or fate, the meaning of death. Spiritual "power to" is the ability to transform the self. It gives us courage and compassion when we meet our existential edges. spiritual "power to" is the power of Gandhi and the Dalai Lama. For the addict, it is the ability to, in the face of powerlessness, find the spiritual strength to exert power to obtain a whole, healthy, sober life.

Spiritual "power over" stems from the belief that one has a direct line to God, a relationship that ultimately privileges one to have power over others. Such a belief may be inflicted by a leader, doctrines of the church, laws of state, or cultural expectations. Spiritual "power over" is demonstrated by our efforts to control the natural world with technology. As I write this, there is a summit in Kyoto to address a result of power over nature -- global warming. The U.S. Army Corps of Engineers has dammed rivers and flooded whole towns, overgrazing has decimated vast grasslands, and altering the landscape has caused houses on hillsides in California to slide into mud. The Eurocentric values held by the early colonists in this country encouraged them to subdue the wilderness, tame the rivers, and conquer indigenous peoples. Man's persistent efforts to control nature are demonstrated everywhere.

For the addict, spiritual "power over" is invincibility, perfection. The addict says, "I am my own Higher Power. No God has power over me. I am the master of my fate. I can control my own destiny."

Whatever their "values of origin" on power, addicts entering the treatment system in the United States will be exposed to the hegemony of the twelve-step approach to recovery. This approach has created widespread belief that recovery begins with admission of powerlessness over a drug, but what powerlessness means to each of us is intimately tied to our ideas about power. We must understand the sometimes equivocal uses of power in our dominant discourse.

Power and the Dominant Discourse

A dominant discourse is the central story of a culture as it arises from assumptions about what is normative. It is sustained by language. Discourses are not equally privileged. According to Hare-Mustin (1994), "The dominant discourse is the one that supports and reflects the prevailing ideology of those in power" (p. 20).

The dominant discourse on power in the United States is "power over" as opposed to "power to." Hayton (1994) asserts that it evolved from European beliefs and traditions that came with the colonization of North America.

The traditions that Europeans brought to America were:


  • an attitude of moral superiority,
  • a belief that the universe was created to serve the needs of man,
  • an intellectual and religious intolerance,
  • advanced military equipment, and
  • a natural inclination to be violent toward one another. (P. 105)



These beliefs and traditions became the framework for the dominant discourse on power, by those in power, in the United States today.

Language and Induction into the Dominant Discourse

Language constructs reality in ways that marginalize or centralize, because of the assumptions of power inherent in the dominant discourse. Social lines are often constructed between sexual orientations, races, classes, and genders. In the United States these lines translate to institutionalized "power over." Although we have supposedly shunned the assimilationist ideology of the melting pot, we still attempt to induct newcomers into our values.

Race

We use the word race as though it were an objective reality instead of a social construction. Race is historically a biological term referring to physical characteristics of different peoples. However, as Zack (1995) points out, "There are no genetic markers for race....The ordinary concept of race has dialectically ridden on an assumption of racial purity that has been used to racialize dominated groups as it suited dominant interests" (p. xvi). Pinderhughes (1989) concurs: "Over time, race has acquired a social meaning in which these biological differences, via the mechanism of stereotyping, have become markers for status assignment within the social system...a status assignment based on skin color" (p. 71).

Historically, the dominant discourse on race in the United States placed "Whiteness" at the center, largely unexamined. Racism was studied for years in terms of its effects on Black identity rather than its effects on White identity; that is, the dominant discourse has portrayed racism as a problem for people of color rather than as a problem for all. Fine, Weiss, Powell, and Wong (1997) point out that "White standpoints, privileged standpoints, are still generally taken as the benign norm or, in some cases, the oppressive standard -- either way escaping serious scrutiny" (p. viii). McIntosh (1998) examines the context that defines a White person's experience:

As a White person, without even consciously defining myself as White, there are dozens of ways in which my skin color privileges me in everyday life, and I may barely realize them.


  • When I am told about our national heritage or about "civilization," I am shown that people of my color made it what it is.
  • I can remain oblivious to the language and customs of persons of color who constitute the world's majority without feeling in my culture any penalty for such oblivion.
  • I can easily buy posters, postcards, picture books, greeting cards, dolls, toys, and children's magazines featuring people of my race. (P. 149)



It is Whites, however, who are most often unconscious of race. People of color are always conscious of it. Toni Morrison (1997) says, "I have never lived, nor has any of us, in a world in which race did not matter" (p. 3).

Gender

Language creates gender as dichotomous: heterosexual or homosexual; male or female. The centrality of White male heterosexuality is at the center of our discourse on gender. Building on McIntosh's work, Crowfoot and Chesler (1996) built their own list of White male privileges and behaviors, which often remain just below our level of consciousness. Here are two examples:


  • We [White males] feel and act freer than others to deviate from group ground rules, expectations, and "appropriate" group behavior (e.g., sitting outside a circle, coming late to a meeting, announcing alternative pressing tasks, etc.)
  • We can afford to limit our efforts to talk with, seek out, and work with women and people of color to those with whom we agree or feel comfortable. (Pp. 210-211)



Although other cultures value power differently in some spheres, male heterosexual power is almost universally valued:

Our response to the idea of power cannot be separated from what women have known about power, not only from being powerless but from watching the powerful. As we explore the issue of power, we necessarily use language and concepts which contain the assumptions of a destructively power-using, power-seeking culture, and these are reflected in the choices we see for ourselves. (Goodrich, 1991a, p. 4)

The powerful who are being watched by Goodrich's women are those who enlist in the White, male, heterosexual Euro-American worldview of who has power and why. The women are watching, and so are the indigenous peoples in the United States, who have historically been overpowered, enslaved or colonized, and the immigrants, who have been pressured to assimilate, acculturate, abide by, and even emulate this Euro-American dominant discourse about power. When people from other cultures move to this country, they are expected to conform to the dominant discourse. Part of the acculturation process includes the gradual acquisition of views about what power is and who has it. Those who acquire these views of "power over" may soon despair of having it.

The results of women's socialization are pathologized. The inflammatory Moynihan Report in the 1960s pathologized female heads of household among African Americans, shifting, many scholars feel, the responsibility for Black poverty to the Black family rather than to the institutionalized structures of oppression. In the 1980s, the addiction recovery movement used language to define a whole syndrome, namely, codependency (Beattie, 1987); the idea subtly reconstructed women's experience (Krestan and Bepko, 1990).

It is significant that the universal risk factor for alcoholism, across all cultures, is gender. That is, men are more at risk for addiction than women. Women are at risk for addiction primarily consequent to their relationships with men.

Sexual Orientation

Sexual orientation is another example of how the lens of the dominant discourse distorts our vision and privileges one group at the expense of another while allegedly creating static categories between people.

The lyrics of a song in Kiss of the Spider Woman(Ebb, McNally, & Kander, 1992), a musical that depicts two men, a political rebel and a gay drug addict, sharing a jail cell, express the divisiveness between categories of sexual orientation. Valentin, the Marxist revolutionary, angrily sings to Molina, the homosexual: You're making me sick, that prissy whine. Watch me now, I draw the line. So you stick to your side, and I'll stick to mine. Never, ever cross this line! The dominant discourse on individual sexual preference has drawn lines, and the assumptions both creating and deriving from those lines serve to perpetuate the discourse on sexual preference as clear, divisive, and necessary.

Class

The dominant discourse on class in America is that anyone with enough will can achieve the upward mobility of the American dream. Those who share this attitude about achieving "success" insidiously punish those who don't acquire, or aspire to acquire, it. People of color, women, the less educated, those for whom English is a second language, the differently abled -- all are frequently prevented from acquiring "success" and are then shamed or held back because they are not "successful." McGoldrick and Giordano (1996) state, "Class increasingly organizes the United States in very insidious ways, including structuring the relationships among ethnic groups" (p. 16).

Of the relationships between class and other demographics, Kliman (1998) writes as follows:

Class involves multiple relationships to economic and other social structures: race, ethnicity, religion, gender, sexuality, physical and mental well-being, and geography. It also involves relationships between classes. One's economic and social circumstances exist in relation to those of others. (Pp. 50-51)

Definitions of class shift with context...as economic And other forms of domination operate together. (P. 51)

The media creates and promotes the language and images that support a dominant discourse on class.

The Broadway musical Miss Saigon depicts a seventeen-year-old Vietnamese orphan girl who falls in love with an American GI during the fall of Saigon in the Vietnam War. (This production created a huge controversy about casting when it was originally cast with mixed-race actors.) The "Engineer" is first her pimp and later her hope when he sees that her mixed race child, Tam, can be their ticket to America. This fictional love story accurately depicts how people from other cultures frequently view living in the United States. The pimp sings:

What's that I smell in the air,

the American dream?

Sweet as a new millionaire,

the American dream!

Luck by the tail! How can you fail?

And best of all, it's for sale!

The American Dream! (Boublil, Maltby, & Schönberg, 1990)


The American dream the Engineer sings about promises a life of freedom, freedom to own land, start a business. The American dream includes the promise that if you work hard enough, you can, with a little luck, succeed in the United States. It is the promise that has lured immigrants since the discovery of America. Hayton (1994) claims that the first people to come were "dissenters, misfits, criminals, adventurers, indentured servants, and other risk-takers...[they had] the characteristics that helped the settlers survive in the wilderness, and these are the characteristics that stimulated invention and creativity and accounted for material progress throughout American history" (p. 105). People come to America to find material wealth and freedom from a repressive government.

Differences Among Differences

One difficulty with understanding difference is the human predilection to promote personal differences as so unique that no one else can understand them. Kliman and others demonstrate that it is the intersections between class, race, gender, and other demographics that construct "hierarchies" of oppression and shape family life. Almeida's (1994) hierarchy of oppression is created by demographics that describe collective consciousness and the external experience of self-power. Shame, in contrast, is the internalized experience. For example, a White, middle-class lesbian who is not "out" may be externally located higher up on the hierarchy of oppression. Her internalized experience, however, may place her somewhere else. Although one may claim that one's oppression is worse than another's, no one totally knows another's shame. In the United States, African Americans as a group are more oppressed externally than are Jews. However, a Jew may be more oppressed or internally feel more shame than an African American.

Whether one tells Polish jokes or queer jokes, language creates difference, and the resulting relationships of equal or unequal power. The perceived right to use language to make a joke at the expense of another illustrates an attitude of "power over."

Values of Origin in Western Culture

In describing her concept of ecological niche, Falicov (1995) writes, "Multiple contexts and the borderlands that result from the overlapping of contexts call to mind ecological spaces where access is allowed or denied, locations of partial perspectives where views and values are shaped and where power or powerlessness are experienced" (pp. 377-378).

Whatever ecological niche describes a particular family at a particular point in time, it is the values that extend across the parameters of that niche, that are, in my view, most relevant as risk or protection factors for addiction.

I am indebted to a friend (Lacy, personal communication, Feb. 12, 1997) for first using the phrase values of origin to signify the range of values that relate to the other ecologies as class, religion, and education, among others, but that derive from one's country of birth or ancestry.

In the United States the values of origin derive from European colonization and prize "power over" in all spheres: individual, interpersonal, sociocultural, and spiritual. These values of origin assume superiority. The induction of immigrants into this dominant discourse is so thorough that it disrupts the original values of immigrant groups. In general, "power over" is a Western value. It is maintained by those in power to protect their power. The dominant discourse on values in the United States today promotes competition, individuality, mastery, youth, health, ability, and material success. It allows one person, or a few, to exert all four kinds of power.

A notable example of this is one man, Bill Gates, CEO of Microsoft, who allegedly has said, "There won't be anything we won't say to people to try and convince them that our way is the way to go."

Gates, who is, according to USA Today (Mar. 4, 1998, p. 1), "...the nation's richest, most powerful businessman," is also the first business leader to defend himself before Congress. Gates was testifying in response to charges from his business rivals that Microsoft competes unfairly. The Senate is investigating whether to create new anti-trust legislation. Microsoft is "accused by competitors of ruthlessness. It is generally getting a public image as a greedy company out to control the world (p. 2A)."

The natural way these power holders think about their world was created and is supported by our country's dominant discourse. Those who have "power over" may not be conscious of their position, because it is their context, their difference, that predominates. It is only natural that the corrective context for recovery from attitudes dominated by Eurocentric idealization of "power over" -- of excess and exploitation -- and from the addictions they spawn is one of "power with."

Values of Origin in Other Cultures

Other cultures, compared to our Euro-American culture, have a very different discourse on power. For example, American Indians do not believe in power over the natural world. They strive for harmony with the environment and with nature. "A traditional Indian lives in harmony with the forces of life." (Simonelli, personal correspondence, January 15, 1998). As Coyhis puts it in chapter 3, "Indians look at it differently: you work with nature or the situation you are in; you understand that everything is interconnected. One of our values is to 'share the deer.' This value is the opposite of control; it's about sharing, it's about flow, it's about balance, and it's about rhythm."

Hispanic cultures view competition very differently from Euro-American culture. "White middle-class Americans stress individualism and actually value the individual in terms of his ability to compete for higher social and economic status. The Hispanic culture values those inner qualities that constitute the uniqueness of the person and his goodness in himself. To the Hispanic, family (familism) is more important than the individual" (Ho, 1987, p. 125).

Spirituality and religion are central to African Americans. Pinderhughes, Knox, McAddoo, and Boyd-Franklin emphasize the role of spirituality in the lives of African American clients and their families. Concepts of alcoholism among Whites, Blacks and Hispanics in the United States show widespread support for the concept of alcoholism as a disease, independent of ethnicity (Caetano, 1989). However, Blacks and Hispanics are more likely to think that alcoholism results from a violation of spiritual values and that addiction represents moral weakness. "Hispanics value the spirit and soul as much more important than the body and worldly materialism. A Hispanic person tends to think in terms of transcendent qualities such as justice, loyalty, or love. He is not preoccupied with mastering the world" (Ho, 1987, p. 127).

Spirituality is also central to the many different Indian nations in this country. Although belief systems vary widely among the more than five hundred federally recognized tribes, there are commonalities. These include a desire for harmony, a belief in the unseen world, and a belief in the interconnectedness of all life (Fleming and Manson, 1990).

Asian American and Pacific Islander communities have their own view of spirituality, one that is based on a history influenced by Confucianism and Buddhism. The tenets of their belief system include moderation in behavior, self-discipline, and harmony in relationships, derived from mutual loyalty and respect (Ho, 1987).

Interestingly, one of the most significant predictors of addiction -- religious affiliation -- is less studied than other demographic variables. Yet religious proscriptions regarding drinking, gambling, and other potential addictions are often highly correlated with drinking patterns.

The dominant discourse in the United States overtly prescribes equality for men and women, but covert power relationships between men and women are far from equal. African Americans are more likely than Whites to practice interpersonal gender equality. In her review of the literature on power relationships between Black spouses of varying social classes, Boyd-Franklin (1989) concludes that Black families appear to be more egalitarian than White couples. However, a high incidence of domestic violence suggests that this claim may represent more of an ideal than a reality.

Other countries with majority White populations also have different values of origin on some parameters as compared to the dominant discourse in the United States. The United Nations Development Report(1994) states:

Traditionally, women in Europe have enjoyed greater equality with men than have women in any other region. For example, Sweden, Norway, Finland, Denmark and France top all other countries in having women's health, education and income levels approach those of men....Today, however, the gaps between men and women in Eastern Europe and the Commonwealth of Independent States are widening as a result of recent changes that have taken place in these countries...i.e., the rapid transfer from centrally-controlled to market economies.

Power and Addiction

The dominant discourse on "power over" in the United States creates a context in which those with this power inevitably fear losing it and those without it experience shame for not having it. Fear and shame are extremely uncomfortable feelings. Most of us spend our lives trying to avoid them. They are the demons that make our knowledge and acceptance of human limitation so painful.

Pinderhughes (1989) has noted a paradox in relation to power and vulnerability: "Paradoxically then, power can create greater vulnerability to powerlessness....Those in positions of power can also develop a tendency to deny their own personal pain and ignore their experiences of powerlessness" (pp. 122-123).

Different ecological contexts have different levels of significance in the evolution of, an individual's addiction and in his or her recovery from it. Different ecological contexts also produce differing experiences of power and powerlessness in people, experiences that may seemingly contradict one another. Someone with a strongly developed sense of spiritual "power to" may sustain relative powerlessness in the socio-cultural arena without feeling powerless, and one whose sense of power is diminished interpersonally within the family may invoke race, class, or heterosexual privilege in order to feel powerful. Almeida (1994) suggests that there are hierarchies of oppression, but a person seemingly high on the objective hierarchy (e.g., being male) may still feel oppressed if he is low on another (e.g., class) in a context where gender is less important than class.

Understanding addiction requires us to recognize power and powerlessness on all levels and in all their complexities. I have worked with clinicians who believed that "objective" powerlessness causes addiction and that recovery from addiction is irrelevant to those who are socially oppressed; these clinicians claim that their clients have "nothing to get clean and sober for." I have also worked with clinicians who failed to realize the ravages of addiction in families who appear to be powerful (e.g., White, materially successful, and well educated). Power can make one peculiarly vulnerable to feelings of powerlessness, and power comes with a high price (e.g., the price of power that is attached to male privilege).

Celia Falicov stresses the interactional nature of power and how supposed power forms a culture all its own (Falicov, personal communication, 1998). For example, White physicians in a setting where they are expected to help those who are culturally different often experience powerlessness.

If it were only the powerlessness of the oppressed that leads to addiction, we would expect higher than average rates of drinking and addiction in marginalized groups. However, most studies indicate that African Americans drink less than Whites and that Hispanics in the United States have rates of drinking that are lower than the national average. It seems that, with very few exceptions, acculturation to dominant White values produces more addiction problems. In many groups, adolescents, who acculturate more readily, have higher rates of drinking and drug use than adults.

Feelings of powerlessness are significant stressors in the development of addiction, whether or not those feelings are tied to actual powerlessness. The founders of Alcoholics Anonymous -- two White, heterosexual men (one a Wall Street broker and the other a physician) -- understandably based their beliefs about addiction and its relationship to power on the Western view of "power over." The program they founded provides a set of beliefs designed to be an antidote for this kind of power.

Addicts take false pride in an idealized image of self as "illimitable." They experience limitation as powerlessness (Bepko and Krestan, 1985). Since limitation is the human condition, the necessary and inevitable outcome for those who hold any belief system that insists on absolute power or control is intense shame. Addicts and cultures addicted to "power over" do not tolerate limitation easily. They both thrive on the denial of human limitation. Yet the intoxication of feeling invincible is necessarily compromised by reality.

Addiction can seem like a near-perfect defense against reality for a while, a seemingly effective denial of limitation. Heroin can anesthetize the despair of powerlessness. Cocaine can create an illusion of invincibility. Alcohol can do both. Gambling's illusion of limitlessness can be exciting. Addiction becomes a means of overcoming feelings of powerlessness and, temporarily at least, eliminating fear and shame.

At first, addiction feels like power over feelings, others, circumstances. Then it overpowers the addict. The addict gradually loses all feelings of power; fear and shame replace them. At that point, the addict's only defense against the feelings of fear, shame, and powerlessness is to increase the consumption of alcohol or drugs in an effort to retrieve the feelings of power. The greater the effort addicts make to have power over their addiction, the more the substance overpowers them. Ultimately and paradoxically, the addiction renders them totally powerless. Reduced to powerlessness, addicts lie to themselves about their need for the addiction. They must sustain this lie with more addictive behavior.

Vicious Cycles

Addiction is a specialized example of power gone awry. Indeed, "power over" can never be sustained. When one's power is threatened, one must exert more energy to acquire and maintain it. Similarly, addiction to alcohol or other drugs requires more alcohol or drugs to sustain the same level of euphoria, or freedom from discomfort. Addiction and "power over" create a vicious cycle in which the individual first insists on absolute "power over" and then recognizes and fears limitation or powerlessness.

For example, the alcoholic with false pride in his heart and a drink in his hand asserts that he is master of his fate and captain of his soul. He will not hear the word no to himself. He cannot recognize his own weakness or limitations and cannot say, "I can't do this. I'm too tired, I'm too frightened. I don't know how."

In the film Clean and Sober, Michael Keaton plays a White, middle-class addict. While in a rehab center, he is told that he cannot make a phone call to his broker. Nonetheless, he uses his counselor's phone without permission to make the call. He is, after all, master of the universe. He is like the alcoholic described in the early alcoholism literature as "his majesty, the Baby" (Tiebout, 1954). When the counselor, who is Black, again tells Keaton that he cannot use the phone, Keaton rages at him, cursing him and mocking the amount of money he makes. Rendered powerless, Keaton reacts to his fear with rage-filled racism in an attempt to invoke power over the counselor. Pinderhughes (1989), in her understanding of power in all its complexity, would interpret this scene as portraying Keaton's use of the "stance, 'better than' to manage anxiety" (p. 120).

Anyone who works with addiction recognizes this scene, recognizes the rage of the powerless asserting power. In Clean and Sober the addict is one-down, with respect to the counselor. However, in the larger social context the counselor's skin color places him one-down with respect to the addict's privileged Whiteness. The struggle feels symmetrical to the character Keaton plays as he shouts that he is equal, or even one-up. Denial of his powerlessness manifests as a need to feel power over someone else. Shamed by his powerlessness over addiction, the addict tries to shame the other by resorting to classism and racism in an attempt to bolster his false pride in his superiority and independence.

Singer, Valentin, Baer, and Jia (1992) deconstructed the case of Juan, an alcoholic Puerto Rican immigrant, by placing his "disease" of alcohol dependence within the socioeconomic, sociocultural, and political contexts of his life. Citing research data on unemployment and alcohol consumption and on the sense of powerlessness as a correlate to drinking, they presented Juan as someone who, deprived of economic power, drank to assert his masculinity in other culturally prescribed ways. They cited other researchers who concluded that "increased drinking and rising rates of problem drinking were products of the consequent sense of worthlessness and failure in men geared to defining masculinity in terms of being un buen proveedor(Canino and Canino, in Singer et al., 1992, pp. 537-538).

Machismo is widely assumed to be integrally related to Latino definitions of masculinity. However, stereotypical machismo neglects broader meanings in favor of constricted negative ones. Bacigalupe (in press) discusses the distortion of the idea of machismo: "Machismo ideology spreads the belief that men are violent because they are 'crazy, alcoholic, uneducated, poor, or from under-developed countries.'" These expressions narrow the scope of the problem, so it is perceived as an issue that affects only some individuals and not others, thus making unequal gender arrangements invisible. When machismo is used to explain power dynamics, the original meaning of the term is distorted. Traditionally, machismo was utilized as a label to name the efforts that men make at being in charge of the well-being of their family. When addiction results from a failure at being un buen proveedor, it also prevents the man from being employable. -- a vicious cycle.

In cultures where drinking is defined as a male prerogative, or a badge of masculinity, drinking and using drugs are ways to assert masculinity when other avenues of power are closed. This is as true in dominant cultures as in marginalized cultures. I am not aware of any culture that sanctions women's drinking more than men's. For many years I practiced family and marital therapy in an affluent suburb of Manhattan. Among my clients were men who held seats on the stock exchange. Following the market correction in 1987 called Black Monday, the number of marriages affected by addiction escalated sharply. (I also saw an increase in related problems, such as spouse abuse. I shall never forget one woman who, having gone to her doctor after being beaten by her alcoholic husband, also a physician, was told that she suffered from "husbanditis." I told her I guessed that meant "inflammation of the husband.")

d

Even where providing is not an issue, as for immigrant men who are well off, drinking is associated with status. Almeida (personal communication, 1998) points out that for affluent Asian Indian men "it's even more about their definition of capitalism and making it in the White world. If they drink Dewar's and make deals they have made it." In these examples the vicious cycle goes like this:

1. He feels/has power and is afraid of losing it. He is ashamed of his fear, or He feels powerless and is ashamed of his powerlessness: He engages in addictive behavior, i.e., drinking, drug abuse, violence, competitiveness: he gains illusory control over the fear and shame.

2. The control begins to slip, and he is more frightened, more ashamed.

3. He tries harder to regain control and power, but it now takes more of the drug, the drink, the power, to achieve the same effect.

4. He finally becomes totally powerless to stop the addiction.

5. Admitting powerlessness creates more fear and shame. He is again caught in the addiction.

The Pride Cycle: Replacing "Power Over" with "Power To"

Bateson (1972) viewed interactions as either symmetrical or complementary. Initially, addicts assert a symmetrical relationship with their drug, insisting that they are "equal to" it, that they can control themselves and it. As they become increasingly out of control, their relationship to the drug becomes complementary. The drug is one-up, and they are one-down. The struggle of addicts to continually prove mastery over their addiction is isomorphic with the dominant discourse of "power over" in the United States. Either power or addiction, when out of control, eventually establishes a complementary interaction wherein the greater the power of one side, the greater the powerlessness of the other. Alcoholics Anonymous provides a context for recovery from addiction that acknowledges the need to break the reciprocal cycle of power and powerlessness of the addiction. In breaking the denial of their powerlessness over the drug and the denial of their need for others, and in breaking the myth of self power when they feel temporarily powerful, addicts are restored to empowerment, or "power to." Bepko and Krestan have called this context of recovery the restoration of a "correct complementarity" with the world; it is an acknowledgment of Mitakuye Oyasin, which is Lakota for "all my relations" or interconnectedness.

The top of the pride cycle in Figure 1-1 depicts the addict as master of the universe. Aided by alcohol or other drugs, addicts maintain an image of being in control, needing no one, being all-powerful and unconstrained by limitation. In its publication Twelve Steps and Twelve Traditions(1952) Alcoholics Anonymous describes this spiritual state as "self-will run riot." In this position, alcoholics are in the complementary, or one-up, position to others. They insist on "power over." This is very similar to the dominant discourse on power in the larger society.

Alcoholics cannot maintain this state, because they are not perfectible and are never really beyond needing others. They need a drug to bolster their illusions. The drug, which they use to maintain the illusion of remaining in control, then paradoxically renders them powerless and out of control. They topple from Olympus. At the bottom, they experience themselves as shame bound, as nothing, as inadequate. Here they have "hit bottom, surrendered" (Alcoholics Anonymous, p. 19). Now they are teachable; they acknowledge their powerlessness, the unmanageability of their life. They accept help from others.

f0 Paradoxically, once they admit powerlessness, addicts receive the power to rebuild their life. Berenson (1991) says, "Optimally powerlessness is a way-station between control and empowerment" (p. 75). The addict is now in what Figure 1-1 depicts as the middle zone of right relationship. Addicts at this point have an appropriate appreciation for their interconnectedness and interdependency with others. They accept limited control ("I cannot take the first drink"). They accept limited dependence on a community that acknowledges interconnectedness. The zone of right relationship is the zone of limitation, humility, moderation, balance, and mutuality. In terms of race and gender issues, it is a zone of sharing of power and psychological androgyny. This is "correct complementarity."

Addicts do not stay in this zone of right relationship for long before they tell themselves that they got sober because they were the chosen one, that they got sober because they were smart. They believe that they survived the earthquake not because they were lucky but because they were special. Before long, they begin to inch up to the top of the cycle again. They might not do this with alcohol, they might do it with sex, they might do it with cocaine. They might substitute working an eighty-hour week or gambling, or they might substitute power over others. Before long they are vulnerable again to toppling. If at the top they suffer from "self-will run riot," an excess of self, destruction of the self is inevitable and they are back down at the bottom of the cycle. Hubris calls forth nemesis. Grandiosity breeds self-destruction.

The Powerlessness over Addiction

Clearly, power and powerlessness are key ideas in the dominant paradigm for addiction treatment in the United States, which is based on the model of treatment promoted by AA. This organization maintains general service offices in more than forty-three countries, and there are meetings in more than one hundred.

Let's look at the first steps in the Twelve Step program of AA: "[We] admitted we were powerless over alcohol and that because of it our lives had become unmanageable." Whatever the language of surrender, it is through accepting powerlessness over addiction that the addict is empowered to resume a sober life. A context for recovery from addiction provides a space where the addict can replace false pride in "power over" with healthy pride in "power to." Such a context promotes interconnectedness and community, a recognition of one's interdependence with others. It is a corrective context, correcting for the false beliefs in absolute power and autonomy. This context need not be the twelve-step programs and their derivatives. However, the principles of the twelve-step programs -- primarily, accepting that one is not God and accepting "limited control" and "limited dependence" (Kurtz, 1982) -- are, I believe, fundamental to recovery from addiction.

The principles of a twelve-step program are actually more syntonic with the values of origin of marginalized groups than they are with the values of the culture's dominant group. Living in the zone of right relationship is fundamentally more in concert with the values of those whose values have traditionally fallen outside the dominant discourse of "power over." It is precisely the "power over" of the dominant discourse that requires the in-depth ego deflation of hitting bottom. Native Americans, African Americans, Latinos, and Asian Americans -- all prescribe the humility, balance, moderation, mutuality and acceptance of limitation that characterize the zone of right relationship, which is inherent in the recovery process.

The Dominant Discourse On Difference

Despite a growing ethnic diversity in the U.S. population, it is still White male Euro-American ideas about power that prevail. Those ideas are refuted by a program of recovery that values "power to" and avoids "power over." Sixty-five years from now the White Euro-American majority will be in the minority in the United States. The continuing ethnic shift in our population will present rich and exciting opportunities for learning and experiencing different cultures. It will also necessitate a shift in the power structure at every level of society. When the present majority becomes the minority, White Euro-Americans will have to integrate a new reality about their power position: their dominance in the United States is eroding.

Asking the Culturally Powerless to Accept Powerlessness in Recovery

The dominant discourse tells us that everyone can attain "power to," but this is a falsehood in a society that still oppresses and marginalizes so many groups: women, people of color, the poor, the differently abled, and so on. Addiction helps those without power feel temporarily powerful. Although it can frequently substitute an illusory, distorted feeling of power for real empowerment, ultimately it robs the powerless of any chance to have "power to."

It is difficult to ask a person who is part of a powerless group to accept powerlessness. We need, then, to separate powerlessness due to oppression from powerlessness due to the addiction, which may have arisen to ease the pain of the original powerlessness. Only then can we ask members of already disempowered groups to accept powerlessness over their addiction. We cannot ask disempowered peoples to fight the "disease" of alcoholism without also locating this "disease" within a larger social system whose diseases include racism, sexism, classism, and oppression of all kinds.

Powerlessness, as Alcoholics Anonymous uses it, means relinquishing power over the addiction or relinguishing illusory power over one's self and others in exchange for the power to be in community and the power to direct one's own life. Such acceptance of powerlessness over the chemical (as opposed to "power over") is itself an empowering act.

White Bison, a Native American Indian consulting group, teaches a road to sobriety that integrates the medicine wheel with the twelve-step teachings of AA to adapt substance abuse recovery to Native American culture. In an ongoing dialogue with Richard Simonelli, a staff member of White Bison, I exchanged views on the pride cycle and its application to American Indian groups. In personal correspondence with me in 1997, Simonelli wrote the following:

What hit me immediately is that the band running through the middle of the pride cycle (the zone of right relationship) might be called the Red Road in the current Indian sobriety movement. The Red Road is free of harmful extremes and cultivates human decency. What also struck me is that the top of the pride cycle really characterizes most of our culture. The dominant culture plays God while those who are different are forced to the bottom of the pride cycle. Is it any wonder that there is so much addiction and hurt?

My other reflection is about powerlessness and surrender. Since the White male system is about dominance and power, it is natural that an alcoholic would finally feel humbled when he hits bottom. He finally meets something that is more powerful than he -- alcohol, which is cunning, baffling, powerful. Since he's on a power trip, he calls it "powerlessness" when he finally meets something bigger than he is. He surrenders to something that has bested him. It's the language of dominance and challenge, win and lose. An Indian person who still lives in his or her culture might not use the same language. Power is not the issue. Rather, it's simple healing from misuse/abuse of a substance....A traditional Indian lives in harmony with the forces of life. You might say he or she lives in surrender. But there is a language gap there. Surrender is harmony, but a person can have "power with" rather than "power over" while living in harmony. I think Indians see these distinctions intuitively.

This passage illustrates beautifully how even our language of recovery uses the language of the dominant discourse to explain what it is we are recovering from. Addicts in AA say, "[We] admitted we were powerless over alcohol and that because of it our lives had become unmanageable." In the dominant discourse, pride is in having power and in managing one's life. Addicts have to admit that addiction robs them of power and of the ability to manage. Other treatment groups may use language that is more meaningful to them. Many of these groups start by rewording the Twelve Steps. One Native American first step reads as follows: "We admit that because of our abuse of alcohol and other drugs, we have been unable to care for ourselves." In this example, one's recovery is from the inability to take responsibility for caring for oneself.

In Many Roads, One Journey, Charlotte Kasl offers sixteen steps for "discovery and empowerment." The first step reads as follows:

"We admit we were out of control with/powerless over -- -- , but have the power to take charge of our lives and stop being dependent on substances or other people for our self-esteem and security."

The universality is striking. Each version of the first step in an addiction treatment program requires that the addict realize that he or she is not the Higher Power. Each version of the program stresses balance, interconnectedness, "power to," and "power with." These are precisely those values that the dominant discourse has minimized. I am not implying that all addicts need to get clean and sober through a twelve-step program of recovery. I am suggesting that addicts recover in a context that stresses community, interconnectedness, deflation of false pride or ego, and acknowledgment and subsequent healing of shame. I am further suggesting that this context approximates the values of origin of many groups that are not White and Eurocentric.

The Shame of Difference and Empowerment Through Community

I have discussed here the vicious cycle of power and powerlessness, how power needs constant reinforcement to maintain itself and how any hint of powerlessness may give rise to attempts at "power over." Power and powerlessness are reciprocally related. They may be external or internal. Both may provoke shame.

There is a human hunger to belong. Our initial feelings of powerlessness and shame are often inseparable from experiences of difference. Difference, like power, is relational, interactional. It is a feeling that is experienced only in particular contexts. My ecology -- that is, my race, gender ethnicity, religion, class, or sexual orientation -- may make me feel a difference that is profoundly alienating, in either the context of my traditional culture of origin or in the context of the culture I am acculturating to. A Latina adolescent who wants the freedom to go out with her girlfriends and faces her mother's restrictions and anxieties about the threat to her virginity if she is given freedom may feel ashamed of being different (Garcia-Preto, 1998). A college-educated Anglo woman who has been sexually molested (as have many female addicts) may feel a shame she attributes to being different. An African American male who is lighter skinned than his siblings may be tormented for looking different. Shame frequently arises from feeling different whether or not that difference is discriminated against by society in a particular instance, and whether the shame is created by external or internal circumstances.

Finally, the shame that attends addiction can be a shame that robs the addict of all dignity, all hope. Since shame does not heal in isolation, some sort of healing group context is optimal for healing shame. As Kurtz (1982) points out, "The typical meeting of Alcoholics Anonymous is a model of the living out of the shared honesty of mutual vulnerability openly acknowledged that the historical narrative has pointed out to be the essential dynamic of AA therapy" (p. 75).

Lili

Lili, a recovering alcoholic and heroin addict is Chicano and Navaho. Lili learned at a tender age the price that is too frequently paid for being different:

"In public school all of us who spoke any language other than English were severely punished...my brother was three years older and I was six...I noticed that if any of us spoke our native language the White teachers, because that's all there was, would either smack us on the hand or hit us on the head. I was so tiny...would just observe, I remember once that my oldest sister disappeared from the classroom...they had locked her up in the cellar because she wouldn't speak English that day...and my brother had already been to the cellar; he had been whipped with paddles, and he had been whipped with horse harness straps, and his hands had bruises from rulers, his head had bumps...and he was a lot slower at learning...they threatened to take him to the outhouses and hang him upside down inside the toilet...he was bigger and stronger...he was bigger and they couldn't hit him so easily any more...he would take the paddles away...they dragged him out of the room..."

Through a blend of Alcoholics Anonymous and return to her cultural traditions, Lili experienced the liberation that comes from locating powerlessness in the addiction experience and then claiming the power of community.

Mike

Throughout this chapter I have inveighed against the White heterosexual male Euro-American dominant discourse. However, the White heterosexual male Euro-American often experiences himself as different and feels inadequate to embody dominant values.

Mike was the youngest child of seven and the only boy in an Irish Catholic family. His sisters dressed him in doll's clothes. His mother insisted that he quit the football squad after a high school injury. His father, however, shamed him for any indication that he was less than a 100 percent man. Mike enlisted in the Marines and saw action in Vietnam, where he was severely wounded and saw several of his buddies die. He came into therapy to explore his fears of weakness, fears that had made him increasingly vulnerable to drinking and using drugs. His greatest shame was that he remembered longing for his mother when he was wounded. He wondered whether that made him homosexual.

Larry

Larry, a recovering addict, tells the following story:

"In the spring of 1946 I was born an outcast on the Ki-on-twog-ky (Cornplatter) reservation in the state of Pennsylvania, the ancestral land of the Seneca Indian. Today it is the Kinzua Valley, now covered by water. Being born neither White nor o(h)n-weh-o(h)n-weh (of the real people), I wondered which race would claim me. To which culture did I belong? I soon lost any identity I may have had, resenting the Senecas, hating White society, and angry at both. I would get even! I would show them! Prejudice, racial slurs, hatred, and indifference were my life. I did not fit in the workplace, the social circle, even religion. So alcohol became my master and I turned my back on everything. My spirit was dead. My life of self-destruction had begun. For the next three decades I saw the edge of the world through the bottom of a whiskey, wine, or beer bottle." (Grapevine, October 1997, p. 34).

Marta and Rachel

I led a small group in an exploration of difference, using some questions about ethnicity from Pinderhughes' 1989 work, Understanding Race, Ethnicity, and Power. A woman in the group named Marta told us the following about herself: "I am Mexican American; I grew up on the border, on the southernmost tip of New Mexico, five miles from the Mexican border, but I am sixth generation here in the United States. My family does not remember when we came over...but to look at me people don't think that."

Marta's family had been in New Mexico for many generations before the United States, in the war with Mexico, annexed the lands in 1848. Respeto formed the basis of her interpersonal relationships with the Mexican American community, and she experienced little or no prejudice until she went to college and interacted with the dominant Anglo culture. Then her story changed. She experienced discrimination based on her skin color and she also experienced loneliness in her family of origin: "I am the first woman who is educated, and like many of you I feel different and not fully accepted...I mean my family is very proud of me but I am isolated." Marta experienced herself as different not only from her culture of origin, but also from the dominant culture. She experienced difference based on ethnicity, education, gender roles, and acculturation.

Of course, one need not turn to alcohol or drugs in an effort to cope with feelings of being different. One might, for example, seek empowerment through education. Education moves one to a less vulnerable place on the external hierarchy of oppression. However, the internal pain of shame may still be there. Rachel, another woman in the group who had not become addicted spoke: "I find this very difficult. My ethnic background is mixed. My father is Jewish and my mother is German. There was conflict in my family whenever the news came on television. At one point I thought I could have created a group around being Jewish, but I could not swallow the traditional Jewish upbringing because of my feminism. I did not know which of my identities to choose -- Germany or Palestine." This woman's shame lay in having no reference group.

Neither Rachel nor Marta were addicts. Although they had to struggle with the pain of difference, they did not have the additional struggle of addiction. Lili, Mike, and Larry, on the other hand, felt the initial powerlessness over the shame of difference, but they had the secondary shame of the addiction, as well.

I remember hearing a television star talk at an AA meeting about the five words that changed his life, words that were spoken to him by his sponsor: "I know how you feel."

Ronald

The red sandstone cliffs of Canyon de Chelly rise two thousand feet from the valley floor. Ronald, my tour guide, and I stand before the petroglyphs, next to the dry wash and under the golding cottonwoods. We have just shared our personal histories of addiction and our roads to recovery. We are in awe at our commonality.

Ronald is Navaho. He had four brothers once. A drunk driver killed one, cirrhosis claimed another, a third hanged himself, and a fourth died in a bar fight. Now there is only Ronald. He hasn't had a drink in eight years. He is fifty-three now. When he was nine, he was sent off the reservation to boarding school. He can neither read nor write in his own language.

Ronald's Nation has the power to keep us Anglos from Canyon de Chelly unless we let them guide us. Ronald doesn't think about his power that way, however. He thinks in terms of protecting the land. I have the power of money to hire Ronald to give me a private tour. I have not always had power. I am a woman, never married, only child of a first-generation Bohemian father and a second-generation Irish English mother. Because of my white skin, I don't have trouble hailing a taxi in New York City. I was, however, paid less than a man for similar work for most of my career.

Ronald and I have each known the powerlessness of addiction, which nearly destroyed us. Now we share the power of the past in this sacred place, the power of the ancient ones who came before, the power of community, and the power of a belief system that transcends our differences of gender and class and ethnicity and our ideas of "race." We share the power of having embraced the powerlessness over addiction, thereby finding the liberating empowerment of connectedness and community. This kind of power and powerlessness each of us knows, despite our differences. This kind of power and powerlessness is in a language each of us speaks, a voice each of us owns.

To create a recovery context for others, we must understand the nature of power and powerlessness in different cultures. We must relanguage powerlessness to refer to the addiction and create other kinds of empowerment that do not include "power over" but liberate us to find "power to." We must understand the particulars of another's shame story. We must be able to say to one another, "I know how you feel."

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Copyright © 2000 by Jo-Ann Krestan

Table of Contents

Contents

About the Contributors

Acknowledgments

Introduction

Jo-Ann Krestan

Part One Perspectives

1. Addiction, Power, and Powerlessness

Jo-Ann Krestan

2. Kaleidoscopes and Epic Tales: Diverse Narratives of Adult Children of Alcoholics

Laura Chakrin Cable

Part Two Ethnic Ecologies

3. Culturally Specific Addiction Recovery for Native Americans

Don Coyhis

4. Addiction Treatment for Jewish Americans and Their Families

Jeffrey Ellias-Frankel, Alan Oberman, and Kelly Ward

5. Addiction, African Americans, and a Christian Recovery Journey

Deniece J. Reid

6. Addiction Recovery Among West Indians

Amy Bibb and Georges J. Casimir

7. Treating Asian/Pacific American Addicts and Their Families

Peter Chang

8. Addiction Treatment for Mexican American Families

Moises Barón

9. Puerto Rican Families and Substance Abuse

Miguel Hernandez

10. Addiction and Groups of European Origin

Jacqueline Hudak

Index

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