Written by: Travis Thompson, LMFT, Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
Getting treatment for substance abuse can be daunting. It can take everything within someone to finally step out of their addiction and push towards recovery. The individual that finds themselves at the doors of a treatment center may not recognize who they have become, or how they even got there. They hope that their entrance into treatment will be custom-tailored to their needs that can support their weaknesses and help build the skills necessary for long-term recovery. Substance abuse treatment has come a long way, from AA rooms and moral failures to a medically minded view of how addiction impacts a whole range of life concerns.
While addiction treatment has become more informed, it has not embraced a culturally informed view of the clients that may come through the door. Many substances use histories walk through the door seeking a last-chance opportunity, but even more diverse individuals with culturally unique perspectives enter. Higher rates of substance use for racial and ethnic minorities combined with the lack of overall research and specific barriers to treatment present a significant concern. These cultural differences and possible barriers are the next frontiers of personalization in the addiction treatment realm both in ethical intervention, as well as effective treatment planning.
Addiction Treatment Barriers
The jump into recovery is daunting, with family and loved ones also along for the drastic changes that will inevitably come along the way. From a cultural diversity perspective, there are many barriers both externally and internally that affect an individual’s admission to treatment. First, there is the understanding of whether the individual sees a need for treatment. This desire for admission also is influenced by the addicted individual’s belief in the accessibility of treatment itself, thus pushing an internal narrative of what the purpose of treatment is.
These dynamics can be especially potent within minority and impoverished communities, as well as cultural groups that have a distrust of the medical system or going through treatment at all. For instance, many African Americans today were alive when the Tuskegee Syphilis Study was finally ended in 1972. This horrific examination of African American men was allowed to rampage past the time of the Civil Rights
Movement, well into recent memory of families across the United States. While not an immediate influence on all of today’s families, the sentiment of distrust of the government and medical providers rightfully presents its relevance. Hispanic individuals also may have an inherent distrust in a treatment setting if they or a family member has felt unsafe due to documentation status or beliefs about whether medical providers are being fully confidential due to bias.
Aside from direct barriers in culture and personal experience, there are significant factors that influence how culturally diverse communities enter and experience treatment. First, intensive treatment for severe addiction is incredibly expensive. At a minimum, a detoxification and monitoring protocol is necessary to address a sober mind that can comprehend change. Beyond that, addiction treatment is often geared in a step-down model that lowers intensity and cost along the way. Ideally, this model would allow for a flexible change with long-term results. However, in-patient treatment without insurance can be over $1,000 per day.
Even with insurance, approval for covered days may not even provide enough time for someone to become aware of themselves and their situation enough to make a substantial change. Those without the means to attain treatment can find themselves locked out of the “standard” of addiction treatment, thus continuing a cycle of impoverishment and distance from potentially life-saving treatment. This is not limited to race or ethnicity, but even communities that lack resources and outside intervention.
Another factor that can influence the connection to treatment is the ability to see and speak to someone relatable and familiar. This is also not limited to race or ethnicity but could include skin color, as well as personal history and appearance. For instance, someone who has been to jail many times for substances may have become enveloped in a cultural group that embraces certain speech patterns, lifestyle patterns, and even personal appearance. This supposed individual may not find a counselor or intake worker particularly welcoming if they are wearing a suit and tie and appear “highbrow.” Without a continual embrace of cultural humility, counselors and even treatment centers may find themselves outside of the comfort of clients and be limited by their own experience, alienating entire populations.
A final example of a barrier to admission and engagement in treatment is the lack of culturally minded interventions and ideologies presented in the intake process or during the overall treatment experience itself. This can be seen through how questions are asked before treatment, how interventions are carried out throughout the treatment process, as well as inherent assumptions that providers can have about a people or belief system. Again, race and ethnicity can provide various points of contact for a treatment team to work with. However, entirely different cultural backgrounds from different countries and generations inform individuals about the understanding of what health and treatment are, as well as what is even considered unhealthy and in need of change. If a treatment facility were to consider addiction as a strictly biological issue with medication and specific interventions as the only way to help someone, then individuals who align themselves with more community-minded values and support may find themselves to be either alienated or unable to be helped. Also, treatment focused on only ethical and moral values to change addictive behaviors could discourage the individual who considers themselves educated and from a community that values knowledge and advancement.
What can be Done Differently
Addiction and individuals who suffer from it come from many different backgrounds, cultures, ethnicities, and stories. Their diversity produces a recognition that it takes cultural humility to establish what an individual needs for effective treatment and recovery. This is particularly important as those from culturally and linguistically different populations show an increased risk than the overall population. A standard of treatment either comprises ideas and general programming to serve multiple populations, or it is simplified to meet the criteria of a general population, thus making it potentially ineffective for those from diverse backgrounds.
To push against a sterilized version of the treatment that does not present itself as accessible to all populations, consideration should be made of the foundation of employees that facilitate and model treatment. These employees should not only embody diversity in outer expression but their personalities and understanding of cultural concerns. Far from enforced diversity standards, those that represent a company or treatment center should come from many different backgrounds and cultural influences. This is simply due to diversity in interpersonal interaction embodies support for those needing care and comfort in sharing their story.
Another facet of addiction treatment that can be improved is the inclusion of marketing and outreach practices that allow for those with lower access to financial resources to receive care. Treatment centers and practitioners are somewhat limited in their outreach due to their physical location and the connections that they have. To some degree, geographic location will dictate clientele, but outreach to different people groups is important to engage the vast population of those suffering from addiction. An engaged treatment community would find both moral, social, and financial benefits from engaging in diversity by having a larger population to pull from.
In all, a treatment program can easily find itself in a rigid implementation of recovery intervention that is molded towards a generalized understanding of individuals and communities. Alignment with a supposed majority provides a low-resistance approach that is easily accepted by a financial mindset but can easily neglect the inherent diversity present within the recovery community. To progress forward, it is the responsibility of those driving addiction and recovery programs to engage in more cultures and belief systems than their own. This will provide more individuals seeking their care as well as gain a deeper understanding of what recovery is to diverse groups and how they can inform the rest as well.
Please feel free to contact me about discussion, intervention, or effective change at travisthompsoncounseling@hotmail.com
Travis Thompson, LMFT, Executive Contributor Brainz Magazine
Travis Thompson, is a researcher, teacher, and therapist focused on healing the lives of those in addiction. With a drive to see effective, long-term change in his community, he has dedicated himself, his practice, and his doctoral work on both research, education, and implementation of recovery. He strives to further the mental health field towards a holistic and advanced understanding of what addiction truly is, where it comes from, and how we all can help.
Sources:
Center for Substance Abuse Treatment. (2006). Substance abuse: Clinical issues in intensive outpatient treatment. Treatment Improvement Protocol 47. (HHS Publication No. (SMA) 06-4182). Substance Abuse and Mental Health Services Administration.
Miller, G. (2010). Learning the language of addiction counseling. John Wiley and Sons.
