A Cross-cultural Problem
Alcohol and drug addiction are pervasive social problems that could almost be considered universal across cultures. Addiction is one of the most difficult areas of psychological work due to the many counterproductive behaviors which addicts and alcoholics exhibit. Some of the most pronounced of these counterproductive behaviors include: lying, stealing, rationalizing, compulsive seeking of the substance, apathy, depression, and hostility (National Institute on Drug Abuse, 2009). Further complicating this area of work is the fact that professionals are often faced with cultural factors which can inhibit treatment. This problem is apparent in areas which are highly diverse such as New York State. The Casriel Institute Inc. (ACI) is an outpatient substance abuse clinic that serves the Bronx, Brooklyn, Manhattan, Queens, and Staten Island (ACI , 2015). One of the largest challenges that ACI faces is the highly diverse population of substance abusers which maintain unique cultural characteristics which impact treatment methods.
Substance Abuse Disorder
Substance abuse is characterized by a continual pattern of use of a medication, drug, or substance that causes adverse consequences for the person using it. The criteria for substance abuse is define by the DSM-IV:
Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:
1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
2. Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use)
3. Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct)
4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights) (American Psychiatric Association, 1994).
This disorder is complicated by the many nuances. For instance there are varying degrees of severity and many different theories pertaining to causes. There are also various controversies surrounding the problem which pertain to prevention, interventions, and treatment (Vaillant, 1995). Perhaps the largest nuance in the area of addiction is the concept of culture. Depending upon one’s culture, this can inhibit or enhance treatment. This is best understood through the diverse populations that clinics such as ACI must serve.
ACI being at the center of New York City’s largest areas, must treat many different ethnic and racial groups. As a result there are many different problems which must be dealt with when dealing with substance abuse on a cross cultural basis. One of the largest issues is the interpretation of symptoms and assessment of severity by clients.
Culturally speaking, ethnic and racial groups perceive problems and adversity differently. For example, many Asian groups learn to not dwell on negative or troubling issues. Culturally, these groups tend to learn to ignore or avoid substance abuse problems rather than express it openly (Surgeon General, 2001). Asians tend to try to solve problems with self-reliance and self-efficacy, as their culture emphasizes suppression of problems (Surgeon General, 2001). This can make helping a person extremely difficult because they are not willing to be as open about internal feelings and thoughts.
In contrast to Asians, African Americans are more active in their seeking assistance with problems. African Americans also tend to rely on more spiritual means of dealing with adversity and symptoms of mental illness (Surgeon General, 2001). This is problematic because dealing with substance abuse through spiritual programs such as Alcoholics Anonymous and church interventions have not proven to be effective (Vaillant, 1995).
A third example of the diversity in ACI’s target population can be seen in Caucasians seeking treatment. Caucasians tend to be the most receptive to professional treatment. This group tends to seek help more often and in larger numbers than all other groups. As a result of this cultural factor, Caucasians are also the most likely to recover from substance abuse.
One can readily see from the difference in these group’s that the manner in which they perceive their disorder and symptoms that there are large differences in the manner in which treatment can be implemented. Within the US minority groups are less likely to seek substance abuse treatment (Surgeon General, 2001). If an individual belonging to one of these groups does seek help it is far more likely that they will seek it through cultural channels such as seeking home remedy or cultural specific help such as in the case of African Americans who look to their religious authorities (Surgeon General, 2001).
This cultural specific help seeking further complicates the work of ACI because it means that therapies must become culturally sensitive. For example, in the case of African Americans, this means that the incorporation of spiritual services such as AA and churches may be needed in the treatment planning. Likewise, in the case of Asian patients cognitive and behavioral therapies which emphasize self-efficacy should be woven into the treatment process.
ACI also must employee a highly diverse staff. One of the major factors which causes minority groups to avoid seeking help is distrust (Surgeon General, 2001). In general, minorities tend to distrust therapist who are not of the same culture (Surgeon General, 2001). For this reason a highly diverse staff is essential to serving a highly diverse population.
Drug and alcohol addiction are often the centerpiece of discussion concerning causes and therapies. However, culture is an understated aspect of substance disorder which impacts all areas of the treatment process. There is a tremendous failure rate in recovery from substance abuse. While arguments concerning appropriate therapies are often used to explain this problem it would be unwise to not consider culture in the implementation of treatment. By studying the cultural differences in substance abusers in may be possible to create more effective treatment models.
ACI . (2015). Inpatient Outpatient Treatment. Retrieved from ACI: http://www.acirehab.org/treatment/inpatient-or-outpatient
American Psychiatric Association. (1994). Substance Abuse Disorder. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 181–183.
National Institute on Drug Abuse. (2009, September). DrugFacts: Treatment Approaches for Drug Addiction. Retrieved from National Institute on Drug Abuse: http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
Surgeon General. (2001, August). Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Retrieved from NCBI: http://www.ncbi.nlm.nih.gov/books/NBK44249/
Vaillant, G. (1995). The natural history of alcoholism revisited. Cambridge, MA: Harvard.