Cultural responsiveness of drug user treatment programs: approaches to improvement

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.

Trauma history and relapse probability among patients seeking substance abuse treatment

We estimated the prevalence of trauma history and relapse in a sample of 959 patients at two outpatient chemical dependence clinics of a managed healthcare organization. A large majority (89%) reported a history of at least one traumatic event. The most common traumatic events were serious accidents, being robbed, seeing someone killed or seriously injured, and partner violence. One third of the patients had a history of substance abuse disorder relapse. There were gender and ethnic differences in the types of traumatic events reported. There were ethnic differences in relapse rates, which were highest among African American and multicultural patients. The types of traumatic events reported differed in patients of various sexual orientations. Bisexual patients had the highest rates of relapse, even when trauma exposure was controlled. Clinical implications of the findings are discussed.

CULTURALLY SENSITIVE TREATMENT OF AFRICAN AMERICANS WITH SUBSTANCE-RELATED DISORDERS

1. Recent data indicate African Americans are the largest ethnic/racial population in the United States, and psychiatric nurses are in pivotal positions to develop culturally sensitive mental health care. 2. Spirituality, religion, families, and communities play key roles for African Americans with substance-related disorders. 3. Barriers to culturally sensitive mental health care include diagnostic bias and mistrust, stigma, and cost.

Culturally competent treatment practices and ancillary service use in outpatient substance abuse treatment

To engage and retain minority clients in treatment, clinicians and researchers often suggest employing culturally competent treatment practices (CCTPs). This study provides a quantitative assessment of the association between CCTPs and the utilization of ancillary services. Using data from a nationally representative sample of 618 outpatient substance abuse treatment (OSAT) organizations (88% response rate), we looked at five CCTPs and found that OSAT units employ them to varying degrees. In addition, the CCTPs showed varying associations with the four utilization measures. Physical exams and financial services appeared more responsive to CCTPs than did mental health and transportation services. Overall, certain CCTPs may influence the use of specific medical and psychosocial services, but may not be uniformly effective in promoting utilization of all services.

Whanaungatanga - a process in the treatment of Măori with alcohol- and drug-use related problems

Măori, the indigenous people of New Zealand have advocated that culturally-based care requires goals and processes specifically defined within their ethnocultural context. Positive cultural identity and pride have been posited as integral to achieving wellbeing for Măori. A sample of Măori in treatment for alcohol- and drug-use associated problems was reported to believe that a sense of belonging to an iwi ("tribe") could contribute to the recovery process. Data relating to "tribal" affiliation, cultural self-identity and upbringing of that sample is presented. The key concepts of whănau ("family") and whănaungatanga ("relationships") in the treatment process for Măori are explored and the implications of their utility discussed. The findings highlight the complexity of providing treatment that is cognizant of ethnocultural factors.

Clinician beliefs and practices related to increasing responsivity to the needs of Măori with alcohol and drug problems

Culturally responsive treatments are often cited as essential for successfully addressing substance use-associated problems in indigenous and other ethnic groups. However, there has been little investigation of the support for this assertion among alcohol and drug-user treatment workers, or how it might translate into clinical practice. The current paper reports on the results of a survey of the New Zealand alcohol and drug-user treatment field, which canvassed these issues. Eighty-six percent of respondents advocated adjustment of clinical practice when working with Măori. Two key strategies were referral to specialist Măori groups or individuals and/or contacting/meeting with whănau (family). Comparisons were made between respondents who referred clients on and those who provided intervention themselves. Implications of results, limitations and future research are discussed.

Drug treatment services for ethnic communities in Victoria, Australia: an examination of cultural and institutional barriers

Under-representation of ethnic minorities at drug treatment services represents under-utilisation rather than a lower need. To explore barriers to drug treatment among ethnic communities we undertook a comprehensive review of international and Australian literature to identify problems their members experience upon the discovery of illicit drug use in their community, how drug treatment is addressed and challenges for improved drug treatment outcomes. The concepts and themes derived from the literature were then compared with our research findings from key informant interviews and consultations with non-illicit drug-using spokespersons from eight ethnic communities in Victoria, Australia. Intense shame and loss of face linked to illicit drug use was common in ethnic communities and as a consequence seeking help for drug treatment was fraught with difficulties. Accessing drug treatment services often occurred following a crisis, but a sense of despair and confusion often prevailed owing to a lack of knowledge of available assistance. Even when treatment services were accessed most key informants and ethnic communities viewed them as culturally insensitive, inflexible and with language barriers that obstructed the flow of effective information. Understanding of the ethnic family ethos was of pivotal importance but frequently ignored by treatment services, contributing to the exclusion of ethnic communities from appropriate assistance. Ethnic communities need to be assisted to participate in drug issue discussions and community development strategies in order for their utilisation of drug treatment services to be improved.

Optimal treatment for Maori with alcohol and drug-use-related problems: an investigation of cultural factors in treatment

There is an increasing emphasis on taking account of the diversity of social, psychological, and cultural factors in the assessment and treatment of alcohol and drug-use-related problems. In New Zealand the increasing use of customary Maori values, beliefs, and practices in the treatment of Maori with alcohol and drug-use-related problems has also been accompanied by the adaptation and integration of Western approaches to fit contemporary Maori sociocultural needs. This paper reports on an investigation of cultural factors and cultural identity in the alcohol and drug-user treatment of a clinical sample of Maori. The essential finding was a very high endorsement of the importance of cultural factors in treatment--irrespective of age, gender, mood, level of dependence, previous admissions, cultural connectedness, or whether they were treated in a Maori dedicated program or not. A significant number believed that a sense of belonging to an Iwi (tribe), identifying as a Maori and having pride in being Maori were also important in the recovery/healing process. The findings of this study support the need to investigate the relationship between specific "cultural factors" and other clinical components of effective treatment for Maori.

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.