Latinos, Culture Change and Substance Abuse: Implications for Substance Abuse Treatment and Preventi

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Latinos, Culture Change and Substance Abuse
Implications for Substance Abuse Treatment and
Prevention

• Dr. Juana Mora
• California State University, Northridge
• juana.mora_at_csun.edu

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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.

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Latinos still the largest, fastest-growing
minority(LA Times, May 1, 2008)

• The nations Latino population grew by 1.4
  million in 2007 to reach 45.5 million Latinos, or
  15 of the total U.S. population.

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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

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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.

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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.

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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.

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Latino-Cirrhosis Death Link Found

• Latinos have the nations 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 6.0
• Black Males 5.7
• Hispanic Males 12.4
• Source www.niaaa.nih.gov

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Cultural Competency Substance Abuse among
Latinos

• Few tested models of culturally competent
  substance abuse treatment prevention for
  Latinos.
• Gap between research and practice.

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Cultural CompetencyCurrent Approaches

• Adaptation or Tailoring of models developed for
  the dominant population.
• 2. Cultural specific models.
• 3. What can we learn from other fields?

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Content vs. Process Models of Cultural Competency

• The substance abuse field has relied too much on
  content models of cultural competency.

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Content Models of Culture (static)

• Personalismo
• Respeto
• Confianza
• A static application of culture may miss
  important aspects of Latino cultural social
  life.

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Process Models of Culture(dynamic)

• Includes immigration experience.
• Process of adaptation (or not)
• Minority Status Stress.
• Historical trauma theory

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Latinos, Culture Change and Substance Abuse

• .some considerations..

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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.

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Culture as Process

• We need to refocus our attention on process
  models of culture and cultural competency.

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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)

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We can learn from other fields

• Ethnic minority psychology
• Social work
• Indigenous Psychology
• Ethnic cultural studies

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Immigration

• This whole thing about el pais de las
  oportunidadesI 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)

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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.

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The men in this study reflected on their
vulnerability to drug and alcohol use after
migration

• As mainly working class immigrants, the mens
  socioeconomic marginalities and migration and
  settlement related psychological stressors make
  them susceptible to alcohol use.

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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.

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When I asked Fermin why he started to use
alcohol, marijuana, and cocaine in Los Angeles,
he replied

• Well, I think its because when you come over
  here, you dont end up living with a family. In
  my case, I came by myself, and wherever I ended
  up living, I had to take it.

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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.

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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).

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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

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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.

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Discrimination

• Discrimination is a source of chronic stress that
  is detrimental to mental and physical health.
• Source Flores, et al.

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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).

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Historical Trauma originates with the subjugation
of a.

• population by a dominant group. Successful
  subjugation requires at least four elements
• Overwhelming physical psychological
• violence.
• Segregation and/or displacement.
• Economic deprivation.
• Cultural dispossession.

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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

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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
  individuals heritage adaptational challenges
  to maximize the effectiveness of assessment,
  diagnosis, and treatment

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• 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)

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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.

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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.

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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.

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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.