Week 8: Substance Use in Minority Populations

Barriers to Treatment for Minority Women

- Access to childcare is a major obstacle to treatment - Financial restrictions (e.g. cannot afford treatment or take time off of work) - Isolation, feelings of shame and guilt, and depression - Double stigma: SUD + other stigmatized conditions (e.g., single mother, lower economic status, lower education level) - Supportive social networks, such as family systems, are especially important for the recovery and treatment of minority women.

More Barriers to Treatment for Minority groups

- Ignorance about the prevalence of drug and alcohol problems in the Asian American community; Saying the problem does not exist - Being seen as the model immigrant (e.g., successful, hardworking, educated) - Social problems related to migrating from an unstable country or situation (e.g., being a refugee, living in poverty, discrimination) - Model immigrant stereotype leads to denial, shame, and embarrassment from individual, family and community

Substance Use in Native Americans

200+ Native American tribes face problems related to illicit substance use American Indian adolescents have 2X the prevalence of cigarette, alcohol, marijuana, and cocaine use than Hispanics, blacks, or whites Substance use is linked to social, political, and environmental factors (e.g., casino development in the community, lack of funding for treatment and prevention services) Native communities experience higher suicide rates than all other racial and ethnic groups in the U.S. Suicide is the second leading cause of death for Native American youth between the ages of 10 to 24 yrs (2.5X higher than the national average)

Substance Use in Minority Adolescents

Adolescents have a 15% prevalence of having a SUD. Native American youth have the highest prevalence (47.7%) for meeting criteria for a SUD Hispanic youth have the earliest initial use White adolescents progress to alcohol dependence faster Black youth are more likely to be arrested for drug use despite less use overall. They also receive less treatment for psychiatric comorbidities. The focus is more on criminal punishment. For Asians, low-income background is a risk factor for substance use

Substance Use in Minority Women

African, Asian, and Latin American women may be more insulated from alcohol-related social problems by their families, communities, and religious institutions (e.g., church). African American women in treatment may have myriad needs (more needs) (e.g., employment, childcare, treatment for psychiatric symptoms). Loss of a loved one, separation from partner, or loss of child custody can exacerbate drug use Women in substance use treatment are oversampled in terms of sexual abuse. Mexican American women suffer higher rates of physical and sexual assault

Treatment Approaches for Native Americans

Alcohol treatment services in Native American communities have helped decrease the alcohol mortality rate Better documentation of illicit drug use among Native Americans - Role of hallucinogens in religious rituals (e.g., extent of use, toxic effects) - Prevalence of drug use across different communities and cultural groups Combining traditional healing methods and spirituality with CBT and contingency management models can lead to more effective treatment Reducing resistance and mistrust toward evidence-based medicine. This is why it was important to integrate their healing practices into treatment

Substance Use in Asian Americans

Asian Americans are 5.6 percent of the total American population. Whom does it include? - Includes people of Chinese, Vietnamese, Korean & Japanese descent. - Includes people of South Asian and Southeast Asian descent (Thailand, Burma, Singapore, India, Nepal, Pakistan, Afghanistan, etc. ) Many religions, cultures, and political beliefs are represented in this population (e.g., Christian, Jewish, Hindu, Muslim)

Treatment Approaches for Asian Americans

Asian Americans represent 1.3% of patients in publicly funded treatment entering treatment for the first time. For those who enter, stimulants are the major drug of use Adapting treatment approaches to make them more culturally sensitive and adaptive has proven to be effective: - Web-based mother daughter substance use prevention program - Alternative medicine approaches (e.g., traditional herbs, acupuncture) Better documentation of substance use prevalence in Asian Americans can help increase funding for developing culturally tailored education and treatment More treatment programs that incorporate cultural considerations - Preference to keep things in the family (privacy, reputation, honor) - Role of family and community in patient's life - Including family members in the treatment Reintegrate patient back into the family and community if possible ^ Family support can be very important to an individual even if their families are not extremely supportive

Cultural Considerations in Treatment

Culture shapes how clients understand their problems Questions to assess client understanding: - What do you call your problem (illness, distress)? - What do you think your problem does to you? - What do you think the natural cause of your problem is? (How do they think it developed?) - How do you think this problem should be treated? - Who else (e.g., family, religious leaders) do you turn to for help? ^Gives an understanding of how the client views the problem

Substance Use in African Americans

Heavy alcohol use among black youth is low in the early yrs. (.7% vs. 3.4% in white youth) but peaks in middle age before declining. Increased drinking with age could be due to limited opportunities and racism Black and white men show similar patterns of frequency and max amounts of alcohol consumed, but black men are less likely to binge drink or drive under the influence Low socioeconomic status has a more profound influence on alcohol use for black men than white men Strong pro-black identity may serve as a protective factor against drinking. Black men who have pride in their identity or community may be protective against drinking.

Barriers to Treatment for Minority Groups

Ja & Aoki (1993) Substance Abuse Treatment: Culture and Barriers in the Asian-American Community: - Ignoring or denying the problem with the hope that it will disappear - Hiding the problem from the community to avoid embarrassment and shame - Shaming and punishing the user - Turning to extended family members, elders, and eventually community leaders for help (Not reaching outside of the community for help) - Deep sense of failure on the family's part before turning to outside, professional help - Turn over user to treatment program

Summary

Minority groups experience substance use disorders and significant structural, economic, and cultural barriers to seeking treatment. Culture shapes how clients understand their substance use problems. Incorporating cultural beliefs and practices into treatment programs can help increase their efficacy. Cultural competency from psychologists and clinicians is crucial (e.g., knowledge of diverse cultures). There is great variability within cultural, religious, and ethnic groups. It is important to take both an individual approach and a community approach to understanding the problem and providing treatment.

Alcohol Use in Asian Americans

More than 1 in 3 people with East Asian heritage will experience facial flushing when drinking alcohol The flushing effect is due to a deficiency in aldehyde dehydrogenase which helps break down alcohol by degrading acetaldehyde ALDH2 deficiency is associated with lower rates of alcoholism in Asian American communities. NOTE: Native Americans also experience facial flushing, but it is associated with higher rates of alcohol use disorder.

Substance Use in Asian Americans

Religion plays a role in what substances are deemed acceptable or unacceptable: Islam: Alcohol and all drugs are prohibited Hinduism & Buddhism: avoidance of alcohol and other mind-altering substances is recommended Christianity & Judaism: more lenient view toward alcohol use, which is incorporated into some religious ceremonies

Barriers to Treatment for African Americans

Substance use in European Americans is associated with greater psychopathology; for African Americans may be more related to social and environmental factors. Black Americans exhibit good coping skills but have fewer treatment resources than white Americans. Good coping skills can be involvement in church. Illicit drug use (e.g. illegal drug use) disproportionately affects African Americans African Americans are closely scrutinized when receiving pain treatment. They may be less likely to receive narcotic pain medication that may be indicated for their treatment. Discharged from medical facilities more rapidly War on Drugs has resulted in overrepresentation in jails and prisons of African Americans arrested for drug-related charges (e.g., crack vs. cocaine use).

Overview

Substance use in different minority groups: - Minority Adolescents - Minority Women - African Americans - Asian Americans - Native Americans We will talk about the barriers to treatment for minority groups and the need for cultural competency in treatment approaches. There will always be more within-group differences than there are between-group differences

Opioid in Muslim Community

The failure of the child is taken on as failure of the family. You may have the families saying it an different type of problem (diabetes) rather than an opioid problem. Usually parents will send the child to the home country.

Growing Diversity in the U.S.

U.S. census data from 2020 show: - Nearly 4 in 10 Americans identify with a race or ethnic group other than white - White: 60.1% (Non-Hispanic) - Hispanic: 18.5% - Black: 12.2% - Asian: 5.6% - American Indian: 0.7% - Pacific Islander: 0.2% - Multiple Races: 2.8% By 2060 it's expected for the American majority to be non-white