Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Chapter 17 Cross-Cultural Counseling: Engaging Ethnic Diversity Updated by Melinda Haley, Walden University

Why Does Culture Matter In Substance Abuse Treatment? Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Five major groups in multicultural U.S. society Differences among cultural, racial and ethnic groups in use, addiction, and treatment Substance abuse not an equal opportunity phenomenon Treatment providers racially stratified “Drug Wars” are racially, culturally and politically driven

Disparities in Use Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Variation within groups Generalizations lead to erroneous beliefs Greater acculturation associated with higher use in all groups

Racial and Ethnic Issues in Substance Abuse Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Absent from research until 1970 Race and culture ignored in the treatment community Evolved into the use of (ineffective) colorblind doctrine Culturally-based approaches still lack empirical support/consensus

Treatment Needs and Issues for People of Color Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved New paradigms, more research needed Racial and ethnic groups overrepresented in addiction and treatment Need strong relationships with counselors Assume culture and race are always present and operating Cultural, ethnic and racial issues may or may not be relevant for clients

Native Americans and Alaskan Natives Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved 3 million Native Americans in U.S. 550 federally recognized tribes Extremely diverse Only 1/3 live on reservations Forced relocations, family division Lack of economic opportunity Higher drug and alcohol use than any other population groups Expectations about use vary with tribes

Treatment for Native American and Alaska Native Clients Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Considerations Cultural stereotypes Chronic, historic trauma – distrust Institutional racism Collectivism, human interrelatedness with nature, Respect for spiritual and elder wisdom Emphasis on youth Skills Include extended kin Integrate spirituality Understand importance of communalism to recovery Collaboration not confrontation Ceremony and spiritual renewal Studies are sparse identifying successful treatments; however

Asian Americans/Pacific Islanders Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Extremely diverse cultural/racial group 14 million, growing quickly Significantly different use patterns among subgroups Absence of enzyme affects metabolism of alcohol Face flushing, nausea, and headache Occurs in 47-85% of Asian people

Treatment for Asian American Clients Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Considerations: Language barriers Stigma of seeking help Treatment as forceful acculturation Family hierarchy Emotional restraint Avoidance of shame Social Harmony Skills: Collaborate with ethnic organizations Psychoeducation groups Provide for anonymity (online groups)

Latinos Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Largest and fastest-growing ethnic minority in U.S. Sub-culture heritages (Cuban, Mexican, Puerto Rican, South/Central American) Greater within than between group differences Higher prevalence of drug use (other than alcohol) among young Latinos Alcohol use by Mexican Americans may be higher than subgroups

Treatment of Latino Clients Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Considerations Language barriers “Power” of Latino family Racism and discrimination Survival skills/distrust of white culture Social-centric Gender hierarchy Skills Involve whole family Groups/psychoed. Integrate client’s spiritual, cultural, and family values Supportive confrontation Honesty and expression of emotion

African Americans Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved 39 million of U.S. population Cultural upheaval of slavery Continued disparities in education, health care, employment, and financial services Targeted for liquor and tobacco advertising Disproportionate rates of violence and health difficulties

Treatment of African American Clients Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Considerations Racism Distrust of white culture Different beliefs and attitudes about health More external stressors possible Internalized negative self-images Womanist/Feminist theory Skills Life skills training Integrate religion/spirituality Involve family, friends, religious leaders Staff of color Share own recovery experiences

Racial and Cultural Identity Models Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Race as a psychological not demographic variable Racial identity a lifelong, dynamic process Reflects attitudes and behaviors of internalized racism For Whites, identifying and moving away from racism Racial identity status related to treatment motivation and retention in study of African American clients

Multicultural Counseling Competencies Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Three domains: Counselor awareness of own cultural values and biases Counselor awareness of client’s worldview Culturally appropriate intervention strategies Within each, three sub-skills Beliefs and attitudes Knowledge Skills

One’s Own Culture Work Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Effective counseling requires awareness of one’s own cultural attitudes Mature psychosocial identity necessary Integrates self-awareness and awareness of racism, sexism, poverty Challenge own assumptions that may hinder work Values both individual difference and collective cultures Improves delivery of services, continuity of treatment, success rates

Finding Effective Strategies for Client’s Worldview Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Counselors must work outside of counseling sessions to Educate themselves about groups with which they work Learn about cultural and institutional barriers to treatment Educate clients and community to eliminate biases

Useful Web Sites Foundations of Addictions Counseling, 3e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved Motivational Interviewing Association for Multicultural Counseling