Latinos, Culture Change and
Substance Abuse:
Implications for Substance Abuse
Treatment and Prevention
Dr. Juana Mora
California State University,
Northridge
[email protected]
1
Why do we need culturally
competent treatment & prevention
in substance abuse?
•
Demographic changes toward more
cultural diversity in the U.S.
•
Ethnic/racial disparities in health
outcomes.
2
Latinos still the largest, fastestgrowing minority
(LA Times, May 1, 2008)
The nation’s Latino population grew by
1.4 million in 2007 to reach 45.5 million
Latinos, or 15% of the total U.S.
population.
3
California
California had the largest Latino
population of any state last year, with
13.2 million accounting for 36% of the
state population.
www.census.gov
4
What We Know about Latino
substance abuse?
•
1991-1993 National Household
Survey on Drug Abuse (NHSDA)
•
Over sampled: Chicago, Denver,
Los Angeles, Miami, New York City,
Washington, D.C.
5
N = 87,000
Native-Americans, Asian/Pacific
Islanders, non-Hispanic blacks,
non-Hispanic whites, Caribbeans,
Central Americans, Cubans,
Mexicans, Puerto Ricans, South
Americans & other Hispanics.
6
“Relative to the total U.S.
population,…..
Mexicans and Puerto Ricans have
high prevalences of illicit drug use
(marijuana, cocaine, & other illicit
drugs), heavy alcohol use, alcohol
dependence, and need for illicit
drug abuse treatment.
7
Latino-Cirrhosis Death Link
Found
Latinos have the nation’s highest rate of death from
alcohol-related cirrhosis of the liver.
The overall U.S. alcohol-related cirrhosis death rate in
2004 per 100,000:
White Males
Black Males
Hispanic Males
6.0%
5.7%
12.4%
Source: www.niaaa.nih.gov
8
Cultural Competency &
Substance Abuse among
Latinos
Few tested models of culturally
competent substance abuse
treatment & prevention for Latinos.
Gap between “research” and
“practice.”
9
Cultural Competency
Current Approaches
1.
Adaptation or Tailoring of models
developed for the dominant
population.
2. Cultural specific models.
3. What can we learn from other
fields?
10
Content vs. Process Models
of Cultural Competency
The substance abuse field has
relied too much on “content” models
of cultural competency.
11
Content Models of Culture
(static)
Personalismo
Respeto
Confianza
A static application of culture may
miss important aspects of Latino
cultural & social life.
12
Process Models of Culture
(dynamic)
Includes immigration experience.
Process of adaptation (or not)
Minority Status Stress.
Historical trauma theory
13
Latinos, Culture Change and
Substance Abuse
….some considerations…..
14
Some Considerations…..
Culture change is perhaps more
important than a static view of
culture for understanding substance
abuse among Latinos and how to
prevent and treat it.
15
Culture as Process
We need to refocus our attention on
“process” models of culture and
cultural competency.
16
“Culture can be defined as a
dynamic process….
…involving worldviews and ways of living
in a physical and social environment
shared by groups, which are passed from
generation to generation and may be
modified by contacts between cultures in
a particular social, historical, and
political context.”
Whaley & Davis (2007)
17
We can learn from other
fields:
Ethnic minority psychology
Social work
Indigenous Psychology
Ethnic & cultural studies
18
Immigration
“This whole thing about el pais de
las oportunidades…I will change
the name, I will change the version.
I will call it el pais de las
enfermedades…..
Erotic Journeys: Mexican Immigrants and Their Sex
Lives (Gonzalez-Lopez)
19
Eugenio, a forty three year old
from Mexico City…
Spoke in a melodic Spanish rhythm
as he described the various health
problems he has suffered in the
United States, including relapse
and recovery from alcoholism and a
pattern of addiction that sometimes
made him behave in sexually risky
ways.”
20
The men in this study reflected on
their vulnerability to drug and
alcohol use after migration…
As mainly working class immigrants,
the men’s socioeconomic
marginalities and migration – and
settlement related psychological
stressors make them susceptible to
alcohol use.
21
Immigration
“Immigrant men with a previous history of
substance abuse became more
vulnerable after immigration, due to such
contributing factors as emotional
distress, geographic dislocation,
economic hardship, racism, uncertain
legal status, language limitations,
isolation, peer pressure, and crowded
housing.”
22
When I asked Fermin why he started to
use alcohol, marijuana, and cocaine in
Los Angeles, he replied:
“ Well, I think it’s because when you
come over here, you don’t end up
living with a family. In my case, I
came by myself, and wherever I
ended up living, I had to take it.”
23
Cultural Adaptation (or not) : living
in the borderlands
Several Chicana and
Latina writers describe
the process of culture
change as living in the
“borderlands” between
two worlds, languages,
set of customs and
expectations, not
belonging
to one or the other.
24
Culture Change has long-term
inter-generational effects:
The grief and pain
associated with culture
loss has inter-generational
effects far beyond the
immigrant generation
and sometimes it is the
second and third
generations who exhibit
the deleterious effects of
this trauma (Falicov,
1998).
25
According to Pedro Noguera….
“…unlike their parents who arrived in
the U.S. with their identities intact,
immigrant Latino youth often find
themselves between two worlds,
neither fully American, nor fully
part of the country of their
parents…”
26
Minority Status Stress
Model
Researchers have noted that people who
are exposed to multiple adverse
conditions such as poverty, crowded
housing, unsafe neighborhoods,
unequal health care treatment, and
racial discrimination tend to suffer from
poorer mental and physical health.
Source: Flores, et al.
27
Discrimination
Discrimination is a source of chronic
stress that is detrimental to mental
and physical health.
Source: Flores, et al.
28
Historical Trauma Theory
The premise is that populations
historically subjected to long-term,
mass trauma exhibit a higher
prevalence of disease even several
generations after the original
trauma occurred (Holocaust
survivors & offspring).
29
Historical Trauma originates
with the subjugation of a….
…population by a dominant group.
Successful subjugation requires at
least four elements:
1.
2.
3.
4.
Overwhelming physical & psychological
violence.
Segregation and/or displacement.
Economic deprivation.
Cultural dispossession.
30
Extreme trauma may lead
to:
1. Inter-generational health effects.
2. Impairments in the capacity to
parent.
3.Depression, mental illness, PTSD.
4.Self-destructive behaviors.
5.Disease & illness
31
We view cultural competency
as a set of problem-solving…..
…skills that includes, (a) the ability to
recognize & understand the dynamic
interplay between the heritage and
adaptation dimensions of culture in
shaping human behavior; (b) the ability
to use the knowledge acquired about an
individual’s heritage & adaptational
challenges to maximize the effectiveness
of assessment, diagnosis, and treatment;
32
…and (c) internalization of this
process of recognition, acquisition,
and use of cultural dynamics so
that it van be routinely applied to
diverse groups.
Whaley & Davis (2007)
33
References
1. Castro, F. & Garfinkle, J. (2003). Critical Issues in the
Development of Culturally Relevant Substance Abuse
Treatments for Specific Minority Groups. Alcoholism:
Clinical and Experimental Research, Vol. 27, No. 8,
1381-1388.
2. Flores, E., et al., (unpublished manuscript). “Perceived
Discrimination, Perceived Stress, and Mental and
Physical Health Among Mexican American Adults.”
3. Goldstein, M.J. & Noguera, P.A. (March 25, 2006).
Designing for Diversity: How Educators Can
Incorporate Cultural Competence in Programs for
Urban Youth. In Motion Magazine: New York.
34
References
4. Garro, L. C. (2000). Cultural Knowledge as resource in
illness narratives: Remembering through accounts of
illness. In C. Mattingly, L. & Garro, L.C. (Eds) Narrative
and the Cultural Construction of illness and healing.
Berkeley: University of California Press.
5. Gonzalez-Lopez, G. (2005). Erotic Journeys: Mexican
Immigrants and Their Sex Lives. Los Angeles: University
of California Press.
35
References
6. Sotero, M. (2006). A Conceptual Model of
Historical Trauma: Implications for Public
Health Practice and Research. Journal of
Health Disparities Research and Practice, Vol.
1, No. 1, 93-108.
7. Whaley, A.L. & Davis, K.E. (2007). Cultural
Competence and Evidence-Based Practice in
Mental Health Services. American
Psychologist, Vol. 62, No. 6,
563-574.
36
Recommendations
1.
Expand definition of culture & cultural competency to
include immigration stress, acculturation stress,
minority status model & historical trauma.
2.
Utilize other disciplines to expand our understanding of
the interplay between culture, immigration, minority
status, poverty, etc. and substance abuse.
3.
Identify & evaluate existing models/program of
culturally competent substance abuse treatment &
prevention.
37
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