This book presents a culturally informed framework for understanding and treating substance abuse problems. From expert contributors, chapters cover specific ethnocultural groups in the United States, including Americans of African, Native American, Latino, European, Middle Eastern, and Asian descent. Authors examine how ethnocultural factors may affect a person's attitudes toward alcohol and other drugs, patterns of substance use, reasons for seeking treatment, and responsiveness to various interventions. Themes addressed include the impact of migration and acculturation issues, spiritual values and traditions, family structures, gender roles, and experiences of prejudice and discrimination. Featuring a wealth of illustrative clinical material, the book makes concrete recommendations for more competent, effective assessment and intervention. It also guides clinicians toward greater awareness of the ways their own ethnocultural backgrounds may affect their interactions with clients.
|Publisher:||Guilford Publications, Inc.|
|Edition description:||New Edition|
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About the Author
Shulamith Lala Ashenberg Straussner, DSW, LCSW, is Professor at the Shirley M. Ehrenkranz School of Social Work at New York University, where she is also Director of the Post-Master's Program in the Treatment of Alcohol- and Drug-Abusing Clients. She was a Fulbright Senior Scholar to Israel in 2003; Distinguished Visiting Professor at Ben-Gurion University of the Negev in Beer-Sheva, Israel, in January 2002; and Visiting Professor at the Omsk State Pedagogical University in Siberia, Russia, in the spring of 2000. Dr. Straussner has authored and edited numerous publications dealing with substance abuse and is the founding editor of the new Journal of Social Work Practice in the Addictions. She has served on the National Center on Substance Abuse Treatment panel on workforce issues and is a founding board member of the New York State Institute for Professional Development in Addictions. She serves as a consultant to various hospitals, agencies, and other organizations in New York and lectures on a variety of topics throughout the United States and abroad. She also has a private therapeutic and supervisory practice in New York City.
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Ethnocultural Factors in Substance Abuse Treatment
The Guilford PressCopyright © 2002 The Guilford Press
All right reserved.
Chapter OneEthnocultural Issues in Substance Abuse Treatment An Overview
Shulamith Lala Ashenberg Straussner
America is the melting pot where nothing melted. -Tony Kushner, Angels in America
The traditional view of the United States as an "ethnic melting pot" (Glazer & Moynihan, 1970; Park, 1950) in which all ethnic and cultural groups lose their cultural identifications and form a new American ethnocultural "puree" has changed. This change is a reflection of what had been termed the "unmeltable ethnics" (Novak, 1973) and the desire of different ethnic groups "to affirm their right to a separate identity within the framework of a pluralistic nation" (Steinberg, 1981, p. ix). The current view may be best conceptualized as having the various ethnocultural groups in the United States form a "mosaic," or better yet, an "ethnocultural salad"-a mixture in which all the ethnic and cultural ingredients of various groups are tossed together while still retaining their unique "flavor and taste." It is those unique ethnocultural "flavors" that make working with substance-abusing clients today so fascinating, yet so challenging.
The increase in ethnic pride among Blacks and Hispanics during the 1960s and 1970s (Steinberg, 1981; Sue & Sue, 1990), combined with the diversity amongimmigrants during the past two decades, has led to a renewed interest in the uniqueness of different ethnocultural groups in the United States. As pointed out by Hayton (1994), "One of the ironies of our time is that the unique customs, values and traditions of cultural groups have become more important as the world has become smaller and the inhabitants of the planet realize that they live in a global village" (p. 99). Yet, despite the growing recognition of the need for ethnoculturally sensitive provision of services and a tremendous increase in the literature on this topic among all mental health professions, the application of such knowledge to the field of addictions remains limited, with much of it focused on prevention of substance abuse among people of color-a reaction to the earlier focus on substance abuse among Whites (Amodeo & Jones 1997, 1998; Amodeo, Robb, Peou, & Tran, 1996; Bennett & Ames, 1985; de la Rosa & Recio Adrados, 1993; Gordon, 1994; Griffith et al., 1996; Maddahian, Newcomb, & Bentler, 1988; Mayers, Kail, & Watts, 1993; National Institute on Drug Abuse [NIDA], 1995; Orlandi, Weston, & Epstein, 1992; Philleo, Brisbane, & Epstein, 1995; Szapocznik, 1995; Trimble, Bolek, & Niemcryk, 1992; Tucker, 1985; Turner & Cooper, 1997).
This chapter provides an introduction to ethnocultural issues as they apply to alcohol and other drug (AOD)-related problems and treatment approaches. It explores such concepts as race, culture, and ethnicity. And, in order to avoid stereotyping, it focuses on variables such as social class, encounters with prejudice, migration, acculturation, language, socioeconomic status, family roles, and gender-factors that create diversity even among specific ethnic and cultural groups. The relationship of these variables to substance abuse problems and the implications for treatment with alcohol-and drug-abusing individuals and their families are considered.
THE MEANING AND IMPORTANCE OF RACE, ETHNICITY, AND CULTURE
As pointed out by Hays (1996), "despite distinct differences in their meanings, the terms race, ethnicity, and culture continue to be used interchangeably and in ways that reinforce Eurocentric assumptions" (p. 333). Thus it is important to have a clear understanding of these concepts and the impact they have on the treatment of those affected by substance abuse problems.
Definition of Race
Although awareness of racial differences has existed for ages, the modern notion of "race" originated in the 17th century as an attempt to classify people on the basis of genetically transmitted physical characteristics, such as skin color and hair texture (Hays, 1996; Orlandi et al., 1992). Although most scientists today agree that the concept of race has no scientific meaning, it remains a powerful sociopolitical construct that plays an important role in understanding social attitudes, prejudice, stereotypes, and discrimination, as well as in the interactions between patients and clinicians (Davis & Proctor, 1989; Lu, Lim, & Mezzich, 1995; McGoldrick, Giordano, & Pearce, 1996).
Moreover, what may be viewed as racial characteristics are frequently manifestations of socioeconomic and cultural differences, thereby confounding the use of race an explanatory factor in behavior-particularly in relationship to the use and abuse of alcohol and other drugs. Thus the typical classification of substance use and abuse within such population categories as "White, Black, and Hispanic" and the more recently added "Asian/ Pacific Islanders" is not helpful because it obscures the ethnic and cultural background of those so classified. Such classification is particularly problematic in relation to those of Hispanic/Latino background, because a substance-abusing "Hispanic" client can be of Black, White, or of Native American or other indigenous racial background, representing a variety of different cultures. Furthermore, such classification negates the identification of the growing number of people of mixed racial backgrounds.
Definition of Culture
As stated by Devore and Schlesinger (1996), "culture is a commonly used concept that is difficult to define. It revolves around the fact that human groups differ in the way they structure their behavior, in their world view, in their perspectives on the rhythms and patterns of life, and in their concept of the essential nature of the human condition" (p. 43). In essence, culture is the sum total of life patterns passed on from generation to generation within a given community. It includes institutions, language, religious ideals, artistic expressions, and patterns of social and interpersonal relationships. Culture also includes values, attitudes, customs, and beliefs that are shared by group members (Lu et al., 1995; Lum, 1996; Sue & Sue, 1990). Cultural beliefs, moreover, determine who will be oppressed and who will benefit from socioeconomic and political privileges in any given society.
It is within a cultural context that attitudes and reactions to the use and abuse of alcohol and other drugs are formed. And it is only within such a context that we can understand the differential meaning of the snorting of methamphetamine by a group of White upper-class teens at a private club, the drinking of beer at a local bar by a group of Polish American working-class men, or the passing of a bottle of wine by a group of underemployed African American men on an inner-city street corner. As found by Maddahian and colleagues (1988) in their exploration of risk factors for adolescent substance abuse: "One of the most interesting findings of our research was that the same behavior [drug use] may have different causes among different demographic groups or populations because of their unique traditions, cultures, and expectations from life" (p. 12).
Definition of Ethnicity
Whereas the concept of culture is a global one, the concept of ethnicity is more narrow: "Ethnicity refers to the sense of peoplehood experienced by members of the same ethnic group" (Devore & Schlesinger, 1996, p. 45). The term "ethnicity" comes from the Greek work ethnos, meaning "people" or "nation," and refers to the notion that members of an ethnic group share common identity, ideals, and aspirations and a sense of continuity (Gordon, 1964). These commonalities provide an individual with an "ethnic identity"-a major form of group identification. According to Alba (1985), it is the "self-definition in terms of the past [that] makes an ethnic group different from most other kinds of social groups and constitutes the sine qua non of its existence" (p. 17).
Ethnic values and identification are retained for many generations: "Second-, third-, and even fourth-generation Americans, as well as new immigrants differ from the dominant culture in values, life-style and behavior.... Ethnicity patterns our thinking, feeling and behavior in both obvious and subtle ways. It plays a major role in determining what we eat, how we work, how we relax, how we celebrate holidays and rituals, and how we feel about life, death and illness" (McGoldrick, 1982, p. 3). Thus, although the surrounding culture may affect an individual's access to a given substance such as alcohol, crack cocaine, or Ecstasy, one's ethnic identity plays an important role in when and how a substance is used and in one's reactions to these substances.
Although an exclusive focus on the ethnic and cultural backgrounds of people can readily lead to stereotyping of individuals and communities, ignoring them can lead to inadequate understanding of a client and inappropriate provision of services. As pointed out by Cunningham (1994):
The cultural beliefs of a group of people are directly related to how alcohol and other drug problems are defined. The very definition of health differs by ethnicities and cultures. Therefore, it is of critical importance to understand how the members of an ethnic group define alcohol and other drug problems; what is considered to be a positive outcome; and what they feel are appropriate ways to prevent these problems from occurring. (p. viii)
Moreover, because ethnicity and culture interact and influence each other, clinicians and agencies need to focus on both the specific ethnicity and the broader cultural context, that is, to become ethnoculturally competent, in their delivery of substance abuse services.
Ethnocultural competency can be defined as the ability of a clinician to function effectively in the context of ethnocultural differences. Ethnocultural competency has been shown to influence client-clinician communication and trust (Tirado, 1998) and is a crucial component in the effective provision of substance abuse services and the retention of clients. It includes awareness and acceptance of differences-differences that need to be explored respectfully, nonjudgmentally, and with curiosity (Dyche & Zayas, 1995).
Ethnocultural competency is a developmental process that moves beyond "cultural sensitivity" and includes cognitive, affective, and skills dimensions (Orlandi, 1992). It includes an understanding of one's own ethnocultural background and values; a basic knowledge about the ethnoculture of clients with whom one is working; a commitment to working with diverse clients; and an ability to adapt practice skills to fit the client's ethnocultural background, including flexibility in reaching out to appropriate cultural resources in a given ethnic community (Amodeo & Jones, 1998; Center for Mental Health Services, 1997; Gordon, 1994; Hays, 1996; Lum, 1996; Orlandi et al., 1992).
Ethnocultural competence includes not only the individual clinician but also the setting in which the individual works (Tirado, 1998). A substance abuse clinician cannot provide ethnoculturally competent services in a setting that does not support and validate such values. The agency should strive to include some recognition and celebration of ethnocultural holidays, customs, and rituals-including food, music, and art-of the diverse ethnic groups seen in the agency; to hire professional and paraprofessional staff that reflect the ethnic and linguistic diversity of clients; and to provide ongoing training and supervision to help the counseling staff understand their clientele and their own countertransferential reactions to them.
Establishing close linkages with community groups that represent the ethnocultural background of clients and cross-training of staff can be extremely beneficial to all. For example, a substance abuse clinic with a number of Russian or Dominican immigrant clients may offer to provide a lecture on the signs and symptoms of AOD addictions to an ethnic Russian or Dominican community organization while inviting staff from such an organization to offer in-service training regarding issues that affect the particular ethnic group.
In addition, ethnoculturally competent organizations use computerized management information systems that have the capacity to record data regarding clients' ethnicity, migration and immigration information, religious and spiritual beliefs, and languages spoken. They also track information regarding accessibility to and frequency of the need for interpreters (Tirado, 1998). Moreover, an ethnoculturally competent organization makes use of treatment outcome research in order to identify its abilities and deficits in providing ethnoculturally competent treatment services to its clientele.
SUBSTANCE ABUSE AMONG DIFFERENT ETHNOCULTURAL AND RACIAL GROUPS
Recognition of variation in substance abuse patterns among different ethnocultural groups is not new; neither are its political implications. As pointed out by Room (1985),
The social sciences have considered ethnic differences in the United States at least as far back as the Progressive era, when the descendants of earlier immigrants became concerned about the living conditions and cultural patterns of the new waves of immigrants crowding into American cities. Not least among the concern, both of "know-nothing" nativists and of well-wishing social reformers were the drinking patterns and problems of the new immigrants.... (pp. xi-xii)
Consequently, the early years of the 20th century saw numerous studies focusing on drinking patterns among different ethnic groups and on the interplay of ethnicity and alcoholism. Most sociological studies of ethnic variations dropped out of favor following World War II because "such a focus went against the prevailing melting-pot ideology of American society ... [and] any emphasis on ethnic differentiation was uncomfortably reminiscent of the Nazis' racist ideology and its genocidal consequences" (Room, 1985, p. xii). Nevertheless, studies of ethnic difference in drinking patterns continued. These studies were viewed, in today's terminology, as "politically correct," because their findings "cut against the grain of racist and nativist assumptions of cultural superiority. In terms of their drinking practices, ethnicities that had borne the brunt of racist and nativist attacks-such as Italians, Jews, and the Chinese-could be presented as paragons others might aspire to copy" (Room, 1985, p. xii).
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Table of Contents
1. Ethnocultural Issues in Substance Abuse Treatment: An Overview, Shulamith Lala Ashenberg Straussner
II. Working with Clients of African Background
2. Substance Abuse in African American Communities, Ednita M. Wright
3. Substance Abuse Issues among English-Speaking Caribbean People of African Ancestry, Eda F. Harris-Hastick
III. Working with Clients of Native American and Latino Backgrounds
4. Native Americans and Substance Abuse, Hilary N. Weaver
5. Substance Abuse among Cuban Americans, Eugenio M. Rothe
6. Substance Abuse in the Mexican American Population, Louis R. Alvarez
7. Toward an Understanding of Puerto Rican Ethnicity and Substance Abuse, Catherine Medina
IV. Working with Clients of European Background
8. Substance Abuse among Americans of British Descent, Katherine Stuart van Wormer
9. Substance Abuse Treatment with Clients of French Background, Ann A. Abbott
10. The Irish and Substance Abuse, Philip O'Dwyer
11. Italian Culture and Its Impact on Addiction, Pia Marinangeli
12. Polish Identity and Substance Abuse, Jim Gilbert and Jan Langrod
13. Russian-Speaking Substance Abusers in Transition: New Country, Old Problems, Helen Kagan and Kathryn C. Shafer
V. Working with Clients of Middle Eastern Background
14. Substance Use among Arabs and Arab Americans, Nuha Abudabbeh and Andrew Hamid
15. Jewish Substance Abusers: Existing but Invisible, Shulamith Lala Ashenberg Straussner
VI. Working with Clients of Asian Background
16. Substance Abuse Treatment Issues with Cambodian Americans, Mary Ann Bromley and Chhem Sip
17. Ethnocultural Background and Substance Abuse Treatment of Chinese Americans, Ting-Fun May Lai
18. Ethnocultural Background and Substance Abuse Treatment of Asian Indian Americans, Daya Singh Sandhu and Ruby Malik
19. Substance Abuse Interventions for Japanese and Japanese American Clients, Jun Matsuyoshi
20. Substance Abuse among Korean Americans: A Sociocultural Perspective and Framework for Intervention, Young Hee Kwon-Ahn
Therapists and counselors working in a wide range of settings; students and teachers of clinical psychology, social work, psychiatry, addictions counseling, and related fields. Serves as a text in advanced undergraduate and graduate-level courses.