CHAPTER 12: Working with Diverse Cultures: Exploring Sociocultural Influences and Realities

1. CHAPTER 12:Working with Diverse Cultures: Exploring Sociocultural Influences and Realities Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

2. Overview of Chapter • American Indians and Alaskan Natives • Asian Americans • African Americans • Hispanics

3. American Indians and Alaskan Natives • Alcohol use is a relatively new phenomenon in Indian/Native life. • Began with the arrival of Columbus and the principle of Manifest Destiny • Alcoholism death rates for Indians/Natives range to about six times that of the national average (IHS, 2000). • Cultural Values • Sharing: mechanism to gain both honor and respect. Generosity is tightly intertwined with sharing. • Cooperation: grounded in the value of groups and others.

4. American Indians and Alaskan Natives • Cultural Values cont. • Noninterference: a value based on the sociospiritual orientation. • Grounded in the underlying belief that as human beings we intrinsically know the right way to act or at a minimum are capable of learning to act in a good way. • Time orientation: Time is seen as a spiral – the “here and now”. • Spirituality: a belief that spirit, mind, body are all interconnected; the belief that there is a higher being and that all things have spirit. • Humor • Humility

5. American Indians and Alaskan Natives • Risk Factors • Biological Factors • Physiology: the body’s response to substances that influence substance dependence • Psychological Factors • Individual’s and community’s response to the stresses of oppression • Other stressors that affect sobriety or abuse

6. American Indians and Alaskan Natives • Risk Factors cont. • Sociocultural Factors • Educational levels are low • The average education is completion of the ninth grade • Only 50% obtain a high school education • The use of alcohol and drugs is related to the 50% dropout rate from school. • Unemployment rate exceeds 90% • Stress: Precipating or causal factor • Acculturative stress • Deculturative stress

7. American Indians and Alaskan Natives • Barriers to Treatment • Historical distrust • Difficulties in cross-cultural communication stemming from a lack of shared meaning • Use of family systems, which can be misunderstood as child neglect or social instability within the family unit • Unfamiliarity of non-Indian counselors with Indian/Native conversational styles among traditional and transitional family groups • Resistance to providing home-based services, which is interpreted by the Indian community as a fear of cultural differences on the part of non-Indian providers

8. American Indians and Alaskan Natives • Prevention and Intervention • Intervention specialists and providers need to have: • Knowledge of Indian/Native characteristics, such as tribalism (an attitude toward other tribes), identity issues, level of acculturation of the client and the community they come from and commitment to traditional Indian Native religions, and issues surrounding biculturalism, which is essential for mainstream and traditional healing techniques • An understanding that there is no single explanation for Indian/Native substance abuse; and • An understanding that a treatment orientation based on the notion that alcoholism is a disease excludes the social and cultural aspects of drinking.

9. Asian Americans • Between group differences within the Asian American population are great, and within-group differences also compound the difficulty of making any generalizations about this population • Research on alcohol and drug use among Asian Americans is relatively small, but suggests that this population uses and abuses substances less frequently than do members of other racial/ethnic groups (Zane & Kim, 1994). • Partially attributed to “model minority” stereotype • Suicide rated as 8th cause of death for this group compared to the overall population as 11th greatest cause of death

10. Asian Americans • Cultural Values • Filial piety: the respectful love, obligation, and duty to one’s parents. • Shame as a behavioral control: “Lose face” ideal • Self-control • Awareness of the social milieu: Social esteem and self-respect are maintained by complying with the social norms. • Fatalism: “What will be will be” • Role and Status: Hierary of the Asian family and community – Based on a cultural tradition of male dominance • Somatization

11. Asian Americans • Risk Factors • Cultural Values, traditions, attitudes, and beliefs • The degree to which one is socialized to the native culture • The degree of acculturation to the dominant values of the host culture, acculturation that leads to conflict, including conflict across a generation gap • Family conflicts • Role conflicts • Alienation and identity conflict • Racism • Other factors related to immigration and economic stress • Feelings of personal failure • Family role reversals • Economic Stress

12. Asian Americans • Southeast Asian refugees are at highest risk of stressors • Categorizations of Asian Americans: • Traditionalists • Marginal persons • Individuals attempting to develop a New Identity

13. Asian Americans • Prevention and Intervention • Areas for successful treatment: • Acknowledge the diversity of the many cultures within the Asian/Pacific Islander American population. • Involve community members in treatment efforts whose voices command the respect of both parents and youth • Help recent immigrants adapt to the English language and American culture • Acknowledge and respect prevention/healing practices of traditional cultures • Conduct outreach about important substance abuse treatment issues in newspapers, magazines and media that provide information in Asian/Pacific Islander languages. • Provide education to young people on ethnic heritage and customs to promote positive cultural identity, self-esteem, and family communications. Education for parents on U.S. life and substance abuse issues will help them understand their children’s acculturation and the stressors related to that process.

14. African Americans • For many urban African American adolescents, life is complicated by problems of poverty, illiteracy, and racism (Sue & Sue, 2003). • Homicide rate for African American youth between the ages of 15 and 24 was nearly 10 times that of White youth • Suicide rate increased to over twice that of other teenagers between 1990 and 1992 • Although these statistics are bleak, Ford (1997) concluded that much of our literature is based on individuals of lower SES, welfare recipients or underemployed, while failing to examine other segments of the African American population. • More than 1/3 of the African American population are now middle-class or higher.

15. African Americans • Risk Factors • Concerns for Black youth • Concern that African American who are concentrated in urban environments may be at greater risk for the transmission of HIV • Gap in service to African American population • Other problems leading to depression, substance abuse, and other mental health problems

16. African Americans • Cultural Values • Strength of African American family • Strong kinship bonds across a variety of households • Strong work, education, and achievement orientation • A high level of flexibility in family roles • A strong commitment to religious values and church participation • Elderly persons are highly respected in the African American family • As a group, African Americans tends to be more group centered and sensitive to interpersonal matters and to stress community, cooperation, interdependence, and being one with nature (McCollum, 1997) • Spirituality and religion are essential elements of the African American way of life.

17. African Americans • Barriers to Treatment • Wicker and Brodie (2004) contend that African Americans underuse counseling services because they perceive counselors as insensitive to their needs, believe that counselors fail to provide equal energy and time working with underrepresented groups, and feel that counselors do not accept, understand, or respect cultural differences. • Counselors need to understand that African Americans rely heavily on their church for help. • Other barriers that contribute to underusing mental health services for the African community include: • The lack of historical perspective on the development of the family and support systems within the African American community • A lack of awareness and understanding of the unique characteristics of the value systems of African American families • Communication Barriers that hinder the development of trust between the African American client and the non-African American therapist.

18. African Americans • Prevention and Intervention • It is often beneficial to being up the client’s reaction to a counselor of a different ethnic background • If the client was referred, determine the feelings about counseling and how it can be made useful. • Identify the expectations and worldview of the African American client. • Establish an egalitarian relationship. • Determine how the client has responded to discrimination and racism in both unhealthy ways. Also examine issues around racial identity. • Assess the positive assets of the client, such as family, community resources, and church. • Determine the external factors that might be related to the presenting problem. This may involve contact with outside agencies for assistance. • Help the client define goals and appropriate means of attaining them. Assess ways in which the client, family members, and friends handled their problems successfully.

19. Hispanics/Latinos • Hispanic term generated by the U.S. government to conveniently classify different subgroups and subcultures of people who are of Cuban, Mexican, Puerto Rican, and South or Central American descent (Gloria & Perregoy, 1996). • Latino and Latina: a person of Latin-American or Spanish-speaking descent; a person of Hispanic, especially Latin-American, descent, often one living in the United States (Wikipedia)

20. Hispanics/Latinos • Cultural Values • The family is the basis of Hispanic cultures • The difference between the cultural orientation of the family and the cultural orientation of the child may cause intergenerational conflicts. • The Hispanic family provides support, identity and security for its members • The Hispanic nuclear family is embedded in the extended family • During times of stress, the family is the first resource for advice before help is sought from others • The cultural value of personalism (highly individualistic mode of expression or behavior) defines an individual’s self-worth and dignity from inner qualities that give self-respect. • Sex-Role Norms and Hierarchy of Leadership and authority • Spiritual values and the importance of religion can be a strong influence on the behavior of Hispanics • Catholicism is the primary religion for Hispanics

21. Hispanics/Latinos • Barriers to Treatment • The disproportionate number of Hispanics enrolled in programs that emphasize pharmacological treatment rather than psychological treatment (Caetano, 1989) • Immigrant legal status • Illegal immigrants may not seek assistance owing to the fear of deportation

22. Hispanics/Latinos • Prevention and Intervention • Prevention and Intervention with Hispanic groups need to be cultural sensitive to the individual client’s life circumstances, including the level of acculturation, availability of natural support systems, and environmental conditions. • Mental health professionals working with Hispanic populations need to incorporate such cultural concepts as trust, dignity, and respect; current time orientation; preference for action-oriented advice; and the belief that human beings are at the mercy of supernatural forces (Cuadrado & Lieberman, (1998). • Prevention programming can use characteristics of Hispanic communities such as strong family units and extended tie to support efforts aimed at adolescents and adults. • Community and school programming that focuses on leadership skills and problem solving can be helpful