Addressing the needs of cultural minorities in drug treatment

Roman Catholic Priests as Referral Sources and Treatment Aides for Hispanics with Substance Misuse/Abuse Problems

This self-administered mail survey study, conducted along the USA-Mexico border, examines Roman Catholic Priests' involvement in aiding Hispanic individuals with substance abuse problems. The Priests were found to be highly involved or willing to be involved in: (1) participating in juramentos (pledge usually to Virgin of Guadalupe, with Priest as witness, to temporarily abstain from substance use), (2) providing referrals, and (3) working with family and/or treatment resources in the community in order to help the person seeking their help. Fluency in Spanish, regardless of Hispanic ethnicity, was found to positively impact involvement in juramentos, providing referrals, and willingness to work with community resources.

Targeting Khat or Targeting Somalis? A Discourse Analysis of Project Evaluations on Khat Abuse among Somali Immigrants in Scandinavia

Background

In Denmark, Norway and Sweden, the use of the psychoactive plant khat is widely seen as a social and health problem exclusively affecting the Somali immigrant population. Several projects by governmental and municipal bodies and agencies have been initiated to reduce khat use and abuse within this target population.

Aim

This article analyses the khat abuse discourse as it is presented in evaluation reports describing projects initiated by the social services to reduce khat abuse.

Methods

Six publicly available and formally evaluated khat projects conducted in the Scandinavian countries were found, and these evaluation reports were subjected to a Foucauldian discourse analysis. The “What's the problem represented to be?” approach was used to generate questions, which were then applied to the material.

Results & CONCLUSIONS

The problem of khat abuse is represented to be that it is the cause of unemployment, lack of integration and relationship issues among Somali immigrants. The analysis shows that the notion of cultural competence is used instrumentally to govern the target population and that the Somali immigrant group is exclusively targeted. This instrumental use of cultural competence partly places the onus on the “Somali community” itself to reduce khat use, which may engender stigmatisation of Somali immigrants in general. The author maintains that an overreliance on cultural explanations overlooks socioeconomic issues and that the focus should be on potentially problematic patterns of khat use rather than Somali immigrants in general.

Illicit drug abuse in second-generation immigrants: a register study in a national cohort of Swedish residents

Aims: This study investigates ethnic and socioeconomic risk factors for hospital admissions related to illicit drug abuse in second-generation immigrants in Sweden. Method: Cox analyses of proportional hazards were used to estimate the relative risk of sociodemographic covariates in analyses of register data on hospital admissions because of illicit drug abuse during 1990 - 99. The study population was a national cohort of 1.25 million residents (aged 10 - 30 years). Results: Second-generation immigrants had two- to three fold higher age and sex-adjusted relative risks (RRs) for hospital admissions because of illicit drug use compared with the Swedish majority population with a limited variation between different ethnic groups. The RRs decreased greatly after the model was adjusted for socioeconomic indicators of the childhood household. Intercountry adoptees had the highest risk for hospital admission related to illicit drug abuse of all study groups after adjustment for sociodemographic variables (RR 2.8). Conclusions: Second-generation immigrants are at particular risk for illicit drug abuse in Sweden. Adverse socioeconomic living conditions are very important in explaining this high risk.

Treatment Motivation Among African American Drug-Using Arrestees

The purpose of this study was to identify correlates of treatment motivation among African American drug users. Working from Andersen 's (1968) model of health behavior, the authors examined demographic factors, drug-problem severity indicators, social resources, and treatment perceptions as potential correlates. Their sample was 122 African American drug-using arrestees with no prior experience in drug-use treatment. Findingsfrom a multivariate regression analysis suggested that recognition of drug-related interpersonal problems was a key determinant of treatment motivation in this sample. Other relevant factors included legal income, conventional moral beliefs, perceived treatment benefit, and social stigma associated with treatment. In addition, a test fir interaction found that treatment motivation was highest among African American drug users who scored high on both drug problem recognition and endorsement of Africentric values. The authors cite implications of these findings for treatment motivation and treatment entry among African American drug users.

Hispanic Use of Juramentos and Roman Catholic Priests as Auxiliaries to Abstaining from Alcohol Use/Misuse

This self-administered mail survey study conducted along the US-Mexico border replicates and expands on research conducted in Florida regarding the prevalence of juramento use as an intervention technique for alcohol misuse. Juramentos are pledges to abstain from alcohol use for a time determined by the user. The pledge is usually to the Virgin of Guadalupe and is often done in the presence of a Roman Catholic Priest. As in Florida, the majority of Priests along the border reported they were familiar with the practice of juramentos and had already witnessed at least one. The majority of Priests who had done juramentos viewed them as effective. Since the vast majority of Priest indicated that they would begin or continue witnessing juramentos, this makes juramentos and Roman Catholic Priests a viable culturally sensitive aide for treatment among Hispanics, in particular those of Mexican descent.

Travellers accessing addiction services in Ireland (2007 to 2010): analysis of routine surveillance data

By accessing addiction treatment services recorded in routine national drug treatment data, the characteristics of Irish Travellers were analyzed to understand their needs and develop policies to tackle issues faced by this community. The number of Traveller cases accessing services increased by 163% between 2007 and 2010. Alcohol and opiates were the most common problem substances reported. Traveller women reported high rates of problem opiate use and risky injecting behaviors, contrary to the perception that problem substance use is a predominantly male issue. This presents a challenge to services to provide targeted, effective services to Travellers with problem substance use.

Overview of substance use disorders and incarceration of african american males

Incarceration affects the lives of many African American men and often leads to poverty, ill health, violence, and a decreased quality of life. There has been an unprecedented increase in incarceration among African American males since 1970. In 2009, the incarceration rate among black males was 6.7 times that of white males and 2.6 times of Hispanic males. Substance abuse in African American males leads to higher mortality rates, high rates of alcohol-related problems, more likely to be victims of crimes, and HIV/AIDS. African Americans comprised only 14% of the U.S. population but comprised 38% of the jail population. The cost of incarcerating persons involved in substance related crimes has increased considerably over the past two decades in the U.S. A reduction in the incarceration rate for non-violent offences would save an estimated $17 billion per year. Substance use disorder makes the individual more prone to polysubstance use and leads to impulse control problems, selling drugs, and other crimes. The high rate of incarceration in U.S. may adversely affect health care, the economy of the country, and will become a burden on society. Implementation of good mental health care, treatment of addiction during and after incarceration will help to decrease the chances of reoffending. Therapeutic community programs with prison-based and specialized treatment facilities, cognitive behavioral therapy treatment for 91-180 days, and 12-step orientation with staff specialized in substance abuse can be helpful. It is essential for health care professionals to increase public awareness of substance abuse and find ways to decrease the high rates of incarceration.

The Virgin of Guadalupe as an ancillary modality for treating Hispanic substance abusers: Juramentos in the United States

During a 6-month research study of substance abuse outreach and retention methods in Mexico, the authors learned about the common practice of a self-control mechanism to abstain from substance abuse: Juramentos. Juramentos are pledges usually made to the Virgin of Guadalupe in the presence of a Catholic priest. The Jurado promises not to drink during a specified period of time. The authors discuss the dynamics of Juramentos and present data from an exploratory study indicating that Juramentos are being used among Mexican migrants in Florida and may provide a culturally sensitive adjunct for treatment of Mexican and other Hispanic clients in the United States.

Improving cultural competency among hospice and palliative care volunteers: recommendations for social policy

This case study of 14 hospice and palliative care volunteers looked for recommendations and suggestions on how to increase cultural competency among hospice volunteers. In-depth interviews were conducted with a hospice in Toronto, Canada, and findings reveal that volunteers have very specific and diverse recommendations on how they prefer to be briefed and educated on cultural competency issues surrounding their patients. Findings also reveal hospice volunteers want more cultural competency training and acknowledge the importance of being culturally competent. This article concludes with a précis on recommendations for increasing cultural competency in hospice and palliative care for both volunteers and agencies and discusses the top 4 future trends in cultural competency for hospice care.

Adolescent alcohol and illicit drug use among first- and second-generation immigrants in Sweden

Aim: This article compares adolescent alcohol and illicit drug use among first- and second-generation immigrants from Nordic, non-Nordic European and non-European countries with that of the native Swedish majority population. Methods: Using data from a 2005 survey, multilevel logistic regression analysis was performed on a sample of 13,070 adolescents. The survey was conducted in three Swedish regions containing 24 municipalities. Results: Second-generation immigrants from Nordic countries were more likely to use alcohol and to binge drink, while first generation immigrants from non-European countries were less likely to; this difference is mainly explained by the relatively low use by girls from non-European countries. All immigrant groups were more likely to use illicit drugs than were the majority population. The highest drug use was found among first-generation Nordic immigrants and non-European immigrants. Consumption patterns among second-generation immigrants were more similar to those of the Swedish majority population, implying more alcohol use and less illicit drug use. Conclusions: Preventive policy for alcohol use should target Nordic immigrants in Sweden (second generation), while preventive policy for drug use, which is a more general immigrant phenomena, should mostly target both Nordic and non-European immigrants.

Engaging minority men at HIV risk in integrated mental health and drug treatment

This article describes Walden House's Enhanced Planetree Intervention Component (EPIC), enhanced substance abuse treatment services that offered minority men mental health services integrated with services for substance abuse and HIV. Of clients entering EPIC in a one-year period, 93% successfully completed treatment, compared to a significantly lower 65% for a group in mainstream treatment that did not receive EPIC services two years before. Interviews with EPIC clients and staff indicated that despite client ambivalence about entering a program for people at HIV risk or minorities, skilled minority therapists helped make EPIC more attractive than standard treatment and contributed to important gains in insight, including insight about sexuality and about cultural expectations. The therapy was perceived to help reduce risk behaviors and helped some stay in treatment. The combination of individual therapy and nonconfrontational small groups appeared culturally sensitive and flexible in meeting varied needs. Although clients who relapsed or left early could continue in EPIC outpatient treatment, the agency's general emphasis on abstinence deterred some. Issues in implementing counseling programs for minority men are discussed.

Palliative Care of the Terminally Ill Drug Addict

Palliative care with terminally ill drug addicts is a major challenge for medical professionals to face. With growing problems of prescription drug abuse in this country, the problem is only going to continue to grow and be faced more often. To date, very little has been done focusing on this special population of end-of-life care patients. This review article attempts to explore the terminology and definitions for identifying addiction in the terminally ill as well as exploring management options for healthcare professionals. As with other opioid treated pain patients, relying on terms such as "physiological dependence" and "tolerance" is inappropriate for use in this population, who are likely to have been on opioids for extended periods of time requiring dose escalation for progressive disease. Thus, these terms have little utility for identifying problem patients. Rather, understanding the context of the drug abuse as it reflects on the concepts of use despite harm and the damage inflicted to the physical, psychological, or social make-up of the patient is necessary. Recommendations include careful monitoring and assessment of patients, utilizing multidisciplinary team approaches, encouraging participation in recovery programs, and utilization of pill counts and urine toxicology screenings as necessary. Implications for the field are discussed.

Comparable efficacy of contingency management for cocaine dependence among African American, Hispanic, and White methadone maintenance clients

Cocaine use is a significant problem among methadone maintenance clients. Contingency management (CM) is a reinforcement-based approach with demonstrated efficacy for reducing cocaine use. This study examines whether the efficacy of CM treatment for cocaine-dependent individuals receiving methadone maintenance for opioid dependence differs by ethnicity. Participants were 191 African American, Hispanic, and White cocaine-dependent methadone maintenance clients, randomly assigned to standard methadone treatment or standard methadone treatment plus CM for 12 weeks. Hispanic participants were younger, less educated, and reported fewer years of cocaine use than did African American and White participants and reported fewer years of heroin use than did African American participants. African American participants were less likely to report a history of psychiatric symptoms or treatment in comparison with Hispanic and White participants. While CM was associated with longer duration of continuous cocaine abstinence and a greater proportion of submitted urine samples negative for cocaine, ethnicity was not related to treatment outcomes, and there was no significant interaction between treatment and ethnicity. CM appears to be an efficacious treatment for cocaine dependence among methadone maintenance clients, regardless of ethnicity. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Factors predicting drop out from, and retention in, specialist drug treatment services: a case control study in the North West of England

BACKGROUND

In the United Kingdom (UK), the National Treatment Agency for Substance Misuse (NTA) considers retention to be the best available measure of drug treatment effectiveness. Accordingly, the NTA has set local treatment systems the annual target of retaining 75% of clients for 12 weeks or more, yet little assessment of this target or factors that improve retention has occurred. This study aims to quantify the proportion of people retained in treatment for 12 weeks in the North West of England and to identify factors associated with premature drop out.

METHODS

The North West National Drug Treatment Monitoring System (NDTMS) was used to identify treatment durations for everyone beginning a treatment episode between 1st April 2005 and 31st March 2006 (N = 16626). Odds ratios, chi-square and logistic regression analyses compared clients retained for 12 weeks to clients whose discharge record showed they had prematurely dropped out before 12 weeks. Individuals with other outcomes were excluded from analyses.

RESULTS

75% of clients (N = 12230) were retained for 12 weeks and 10% (N = 1649) dropped out prematurely. Multivariate analysis showed drop out was more likely among Asian drug users (adjusted odds ratio 1.52, 95% CI 1.12 to 2.08) than their white equivalents. Drop out was more likely among residents of Cumbria and Lancashire (adjusted odds ratio 1.80, 95% CI 1.51 to 2.15) and Greater Manchester (adjusted odds ratio 2.00, 95% CI 1.74 to 2.29) than Cheshire and Merseyside and less likely among alcohol users (adjusted odds ratio 0.73, 95% CI 0.59 to 0.91). A significant interaction between age and deprivation was observed. For those aged 18 to 24 years and 25 to 34 years, drop out was significantly more likely among those living in affluent areas. For those in the older age groups the converse effect was observed.

CONCLUSION

In combination, the drug treatment systems of the North West achieved the Government's retention target in 2005/06. A number of factors associated with drop out were identified; these should be considered in strategies that aim to improve retention. Drop out and retention are measures that capture the joint effect of many factors. Further work is required to evaluate the effect of deprivation.

Role of culture in gambling and problem gambling

There has been a significant gap in the gambling literature regarding the role of culture in gambling and problem gambling (PG). This paper aims to this such gap by presenting a systematic review of the cultural variations in gambling and PG as well as a discussion of the role cultural variables can play in the initiation and maintenance of gambling in order to stimulate further research. The review shows that although studies investigating prevalence rates of gambling and PG among different cultures are not plentiful, evidence does suggest certain cultural groups are more vulnerable to begin gambling and to develop PG. Significant factors including familial/genetic, sociological, and individual factors have been found in the Western gambling literature as playing important roles in the development and maintenance of PG. These factors need to be examined now in other cultural groups so we can better understand the etiological processes involved in PG and design culturally sensitive treatments. In addition, variables, such as cultural values and beliefs, the process of acculturation, and the influence of culturally determined, help-seeking behaviors need to be also examined in relation to the role they could play in the initiation of and maintenance of gambling. Understanding the contribution of cultural variables will allow us to devise better prevention and treatment options for PG. Methodological problems in this area of research are highlighted, and suggestions for future research are included.

Antisocial behavioral syndromes and return to drug use following residential relapse prevention/health education treatment

This study compared residential addiction treatment clients meeting full DSM-III-R criteria for antisocial personality disorder (ASPD) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS) on time to and severity of first posttreatment drug use. Antisocial syndrome and selected other mental disorders were assessed using the Diagnostic Interview Schedule, Revised for DSM-III-R, and validity of self-reported posttreatment drug behavior was measured against results of hair analysis. Among subjects followed within 180 days after treatment exit, individuals with ASPD were at modestly increased risk of a first lapse episode compared to those with AABS. However, the two groups did not differ in severity of lapse. Participants with ASPD demonstrated poorer agreement between self-reported posttreatment drug behavior and hair data. These results add to the evidence suggesting that the DSM requirement for childhood onset in ASPD may be clinically important among substance abusers in identifying a severely antisocial and chronically addicted group at elevated risk for early posttreatment recidivism. Our findings support the importance of careful classification of antisocial syndromes among substance abusers and the identification of characteristics of these syndromes that underlie clients' risks for posttreatment return to drug use to provide optimally individualized treatment planning.

Effectiveness of screening instruments in detecting substance use disorders among prisoners

This study examined the effectiveness of several screening instruments in detecting substance use disorders among prison inmates. A sample of 400 male inmates were administered eight different substance abuse screening instruments and the Structured Clinical Interview for DSM-IV (SCID-IV), Version 2.0, Substance Abuse Disorders module. The latter was used as a diagnostic criterion measure to determine the presence of substance use disorders. Based on positive predictive value, sensitivity, and overall accuracy, the Texas Christian University Drug Screen, the Simple Screening Instrument, and a combined instrument-Alcohol Dependence Scale/Addiction Severity Index-Drug Use section were found to be the most effective in identifying substance abuse and dependence disorders.

Drug abuse treatment as an HIV prevention strategy: a review

We review drug abuse treatment as a means of preventing infection with HIV. Thirty-three studies, with an aggregate of over seventeen thousand subjects, were published in peer-reviewed journals from 1988-1998. Research on the utility of drug abuse treatment as an HIV prevention strategy has focused primarily on methadone maintenance treatment (MMT) rather than other modalities such as residential or outpatient drug-free treatment. Recent research provides clear evidence that MMT reduces HIV risk behaviors, particularly needle-use, and strong evidence that MMT prevents HIV infection. There is less definitive evidence that MMT reduces needle-sharing and unsafe sexual behavior, or that other treatment modalities prevent HIV infection. Future research should take into account patient self-selection processes and investigate other treatment modalities for heroin and stimulant abuse to determine their effects on HIV risk behaviors and HIV infection.

Interaction effects of client and treatment program characteristics on retention: an exploratory analysis using hierarchical linear models

This paper applied a hierarchical linear modeling approach to explore the interaction effects of treatment program and client characteristics on client retention in treatment for drug users. Program characteristics included services provision, funding sources, and staff-client gender congruence, and client characteristics included gender, age at admission, and drug use level prior to admission. The same model was applied separately to three modalities: residential, methadone maintenance, and outpatient drug-free programs. Data were obtained from 59 treatment programs and 3,764 of their clients who had discharge records. The most noteworthy significant interaction effect detected was program's funding source and client's gender on treatment retention in the outpatient drug-free modality. For example, female clients remained less time in the programs that accepted only public funding than in the programs that accepted both public and private funding. Male clients remained in the treatment an average of 25.3 fewer days than female clients in drug-free programs that only accepted public fund, but stayed about the same time as females if the programs received mixed funding.

Consideration of special populations in the drug treatment system of a large metropolitan area

This article provides a descriptive overview of the characteristics of a large metropolitan drug treatment system in relation to special populations of substance abusers enrolled in the system and the services provided. The findings are based on self-report responses to a comprehensive survey of 294 drug treatment programs in Los Angeles County. The special populations are grouped by health status, ethnic background, language needs, and gender-related needs. The groups are not mutually exclusive. Survey results indicated a generally high proportion of programs capable of meeting the unique needs of a variety of special population clients and most programs having some mix of special population clients in their current caseload. The types of services offered varied by modality and by special populations being served. Implications for program planning and service delivery include consideration of whether or not to offer specialized programs for unique client types.

Drug treatment careers. A conceptual framework and existing research findings

While outcomes for any single intervention are important to determine, the long term evaluation of multiple, sequential interventions is at least equally important. One strategy for examining this process is that of the treatment career. A treatment careers perspective applies a longitudinal dynamic approach to identify and understand key factors influencing the development of, and transitions in the course of, drug dependence and its treatment. After presenting an overview of the treatment careers perspective, this paper reviews and discusses relevant research issues and findings on treatment seeking, utilization and resistance, entry and reentry, engagement and retention, client treatment matching, and outcomes. Key findings include high resistance to entering treatment by many drug users, late development of treatment careers relative to addiction and criminal careers, short durations of most treatment episodes, cumulative and facilitative effects of treatment experiences, and beneficial effects of matching clients to treatment. The treatment careers perspective provides a useful framework within which findings on drug treatment can be better integrated and critical issues can be identified for further research, leading to a better understanding of drug dependence and its treatment.

Desire for Help among African-American Drug Users

We examined demographic factors, drug-problem severity indicators, and social and personal resources of African-American drug users as correlates of their self-reported desire for help with problems related to drug use. Avoiding the “ethnic gloss” of earlier research, we included ethnicity-related attitudes, perceptions, and experiences among the factors tested. Findings suggested that interpersonal problem recognition was a key determinant of desire for help in this sample. Two additional factors associated with desire for help in multivariate analysis were conventional moral beliefs and expected benefit of drug treatment. We cite implications of these findings for patterns of help-seeking and recovery among treatment-naive African-American drug users.

An examination of racial and ethnic differences within a sample of Hispanic, white (non-Hispanic), and African American Medicaid-eligible pregnant substance abusers. The MOTHERS Project

White (n = 213), African American (n = 210), and Hispanic (n = 104) Medicaid-eligible, chemically-dependent, pregnant women were interviewed during their stay in stay in publicly-funded detoxification centers in Massachusetts. Comparisons of demographic, psychosocial, and substance abuse variables revealed significant intergroup differences in almost all instances. There appears to be as much heterogeneity within the treatment population subgroup of pregnant women as there is across different treatment populations. Ramifications of the observed differences for treatment planning and service provision are discussed.

Drug treatment for women: traditional models and new directions

Drug treatment is a diverse field in which a variety of treatment frameworks and formats exist, few of which have been tailored to women's circumstances and needs. Most drug treatment is based on insight-oriented and behavioral approaches, often accompanied by pharmacologic treatments. Complementary approaches such as acupuncture and biofeedback also are available. Feminist criticisms of traditional therapy have prompted development of woman-centered treatment, which provides a safe environment for empowerment and building relationship skills. Nurses can provide supportive interventions using mutuality and avoiding confrontation, and can advocate for access to woman-centered drug treatment and harm reduction measures to minimize the damage caused by alcohol and drugs.

Ethnic matching of caseworker and patient in methadone maintenance

The relation of ethnic matching of caseworker and patient to treatment outcomes was evaluated in a cohort of 610 opioid users admitted to methadone maintenance. At admission, the subjects were assigned to caseworkers in rotation. Thirty-seven percent of the Anglo subjects, 11% of the African-American subjects, and 60% of the Hispanic subjects were matched with caseworkers of their own ethnic group. In all ethnic groups, the matched and nonmatched subgroups did not differ significantly on 11 pretreatment characteristics. The subgroups also did not differ significantly on 3 treatment variables, with the exception of methadone dose in the Anglo group. The Anglo-matched subgroup had a slightly higher mean dose (61 mg) than did the not matched subgroup (52 mg). In all ethnic groups, the matched and nonmatched subgroups did not differ significantly on 12 outcome variables. No relation was found between ethnic matching and treatment outcomes.

Cultural responsiveness of drug user treatment programs: approaches to improvement

Many drug user treatment programs have difficulty recruiting, retaining, and successfully treating minority clients. Coupled with the fact that cultural diversity among clients is likely to increase, this consideration makes it critical that programs take steps to increase their responsiveness to minority clients. Among the steps which administrators and clinicians recommend that programs take are conducting a needs assessment; implementing special outreach approaches; hiring additional minority staff; providing staff training and education in cultural sensitivity; and identifying client cultural characteristics at intake.