Barriers & Challenges in Substance Abuse Recovery Among Asian-Americans Ting-Fun May Lai LCSW CASAC Behavioral Health Services Hamilton-Madison House May 2, 2008 Recovery Symposium, Philadelphia, PA

Demographics Asian-Americans are not a homogeneous group, it consists of over 40 ethnic groups. The Asian-American population is a fast-growing population in the United States.(14,656, Census) Asian-Americans in US are concentrated in 10 to 15 states. 9 % US Asian-Americans live in NY state. With a high proportion of recent immigrants, more than 35 % of Asians speak an Asian language at home.

Within-group Diversity Issues Different languages & dialects Different historical & trauma background Different immigration histories Different living,clothing & customs Different family structure, inter-personal relationships Different cultural values Different substance abuse preferences Different help seeking patterns

Barriers to Treatment Underestimation of the extent of the problem Lack of dependable statistics & research data Underutilization of treatment services (delaying or not seeking treatment) due to shame & stigma & lack of knowledge, health insurance & other resources Lack of cultural & language appropriate treatment programs Lack of evidence based practice

Barriers from the Communities Strong stigma for substance abuse problems Communities hold moralistic attitude towards individuals with addiction problems Insufficient outreach & prevention services because Asian Americans being seen as a “Model Minority” not in need of services Substance abuse treatment & recovery not communities’ priority Lack of recovery support services & organizations

Services to Asian-Americans Mainstream providers often do not have bilingual staff. Major barrier to access treatment: limited language & culturally appropriate providers, not in all levels of care Community based providers often provide services but are not reimbursed Lacking language appropriate educational materials Lacking other recovery support services

Asian-American Patients Admitted to OASAS Facilities in NYC Year OASAS Service Modules Asian Admissions All NYC Admissions % of Asians in total NYC admissions 2005 Crisis Services % Inpatient Rehab % Methadone % Outpatient % Residential % Total % 2006 Crisis Services % Inpatient Rehab % Methadone % Outpatient % Residential % Total % 2007 Crisis Services % Inpatient Rehab % Methadone % Outpatient % Residential % Total %

Attitude toward Alcohol & Substance Abuse Not considering alcohol as harmful drug, using with herbal medicine & cooking Moderate use of alcohol at social & ceremonial occasions Outward drunken and acting out behavior not tolerated Some use of substance at some communities for special groups of people acceptable Alcohol & drug problems, especially related to criminal activities considered extreme shame & disgrace to family

Alcohol & Substance Abuse Patterns Insufficient credible research data & small sample sizes making meaningful analysis impossible Generally drink less, ”Flush Syndrome” & high percentage of persons not drinking at all Use less of illicit drugs Drug treatment admissions among AAPI increased by 37% (SAMHSA 2000) between 1994 and 1999 Different pattern of use for different ethnic groups, American or foreign born, age groups

Co-Occurring Problems Mental Health problems Close relations to addiction problems Strong stigma Long waiting list for MH services Gambling problems Asian-Americans have a long history of accepting gambling as a community and family recreation High prevalence of problem gambling & pathological gambling Communities’ number one concern

Recommendations for Clinicians Willing to work with client who are not ready for total abstinence; need a longer time of engagement; to start with, cut down use Avoid traditional reflective, non-directive approach Focus on external stresses in the early stage, offer crisis intervention & tangible help Respect family secrets and confidentiality Accommodate client’s work & family responsibility when scheduling appointment

Recommendations for Clinicians Proficient in client’s language/dialect, using interpreter only as last resort Avoid extensive questioning, assessment & evaluation; clarify and explain all procedures Help client develop measurable and tangible short-term treatment goals Receptive to Somatic Approach & Pharmacological Treatment

Strategies to Overcome Barriers & Underutilization Understanding the cultural and practical barriers that exist are the first step in reducing them Increase & enhance language & culturally appropriate community education, outreach, screenings & interventions Increase language & cultural appropriate treatment services in all levels of care Improve linkages within the providers networks and with community based organizations Address the workforce issues for the Asian American communities Create alternative self-help/support group that is less confrontational and more supportive & educational Work with families separately, to reduce enabling and negative feelings Support research initiatives focusing on Asian Americans

Resources from New York State go to Specialized Services go to Asian-American Services 1.Simple Screening Instruments (TIP 11): Bengali, Chinese, English, Farsi, Hindi, Japanese, Korean & Vietnamese 2. Government Performance Results Act Instruments (GPRA): Bengali, Chinese, English, Hindi & Korean 3. Other resources such as Presentation etc.

Questions & Discussions Thank you!