When considering the relationship between cultural context and substance abuse, a great number of variables, influences, and phenomena must be considered. There are numerous cultural factors and stressors that are related to such factors that potentially exacerbate the likelihood of substance abuse. Clinicians must be sensitive to these cultural components by being understanding, culturally aware, and nonjudgmental as a means of helping their clients.
Dimensions of Culture that Affect Adolescent Substance Abuse
The face of substance abuse has been dramatically changing over the course of time (Landmann, 2001). Countless new substances are reaching neighborhoods in the United States each year, as are new people from different parts of the world (Landmann, 2001). Because of the interaction of these two factors, counselors will be faced with clients experiencing new sets of difficulties that are associated with substance abuse and cultural stressors and concerns (Landmann, 2001).
One of the major stressors facing adolescents is a bicultural identity, which occurs when their identity straddles that of their traditional family and a larger culture that the family is attempting to assimilate into (Grand Canyon University, 2008).
Balancing and embracing these two cultural contexts can be challenging and stressful. These sets of stresses can trigger alcohol and other drug use as a way of self-medicating and seeking relief (Grand Canyon University, 2008; Matheson & McGrath, Jr., 2012).
During this cultural balancing act, teens may fall in with peer groups that hold different values than those of their family and, in many cases, may condone substance use as a part of their subculture (Grand Canyon University, 2008). Not only might this cause a teen to engage in substance use and abuse, but it might also trigger intergenerational conflict within the family, as more traditional family members might find peer groups composed of individuals from other cultures problematic (Grand Canyon University, 2008). The teen is put in a difficult position as they attempt to balance the identity assigned by their traditional family culture and that of their peer group.
In this sense, stress, confusion, and a desire for peer acceptance all seem to play a role in substance abuse during the acculturation process. Teens who view themselves to be experiencing negative feelings and stress have been shown to engage in substance abuse (Matheson & McGrath, Jr., 2012).
Teens from various cultures and subcultures might be more at risk for substance abuse than others. For example, adolescents involved in gang life, college drinking cultures, impoverished neighborhoods, and peer groups where lack of supervision is common are all potentially at risk.
Stressors that are combined with a lack of effective coping strategies have been known to put adolescents at an even higher risk. This can be seen with mental health diagnoses that lack appropriate treatment services. In subcultures where this behavior is the norm, substance use may be adopted through social learning, modeling, or a simple desire for peer acceptance during a stressful transition period (Matheson & McGrath, Jr., 2012).
However, family life also can be an influence on an adolescent’s avoidance of substance abuse. Research has demonstrated that families are often the first line of defense in regard to adolescent substance abuse prevention and are often effective in preventing substance abuse in their children when healthy roles, behaviors, and rituals are demonstrated (Matheson & McGrath, Jr., 2012).
Treatment and Prevention
Research has demonstrated that, traditionally, most models of prevention and treatment of substance abuse are culturally “blind” and fail to take cultural variables into consideration when making attempts at explaining the behavior, stressors, and preventing problems of clients (Castro & Alcaron, 2002).
The effectiveness of treatment and prevention programs depends on their ability to reach out into the communities to determine the needs of the individuals in that community and, thus, tailor the services available accordingly (Castro & Alcaron, 2002).
Instead of taking a blind approach to offering services, prevention and treatment programs can become aware of the needs of adolescents and their families in the community and offer viable, effective services to address their unique needs. The needs of one neighborhood are most likely entirely different from those of another and this must be taken into consideration if professionals seek to establish and maintain culturally relevant and effective services.
By not tailoring services to the needs of a given community, programs are essentially communicating that they do not grasp the gravity of the community’s needs and concerns. Trust also must be built between providers and community members.
For example, research has demonstrated that cultural stereotypes about certain groups deter adolescents from some cultural groups from seeking substance abuse treatment services (Pacific Institute for Research and Evaluation, 2007). Service providers must consider their own biases and how they affect the services provided to their clients (Pacific Institute for Research and Evaluation, 2007).
Furthermore, it has been found that adolescents from many cultural groups, due to the stereotypes placed upon them, might be distrustful of clinicians from other cultural backgrounds (Pacific Institute for Research and Evaluation, 2007). Not only is building trust absolutely imperative, but so is employing clinicians from similar cultural backgrounds. Various cultural groups demonstrate various types of emotional responses to problems, which must be considered during treatment and prevention (Grand Canyon University, 2008).
What is Cultural Competency?
As has been stated, clinicians are responsible for practicing cultural competency when working with clients who come from cultural backgrounds that differ from their own (Grand Canyon University, 2008). In the event that we cannot identify a client’s cultural background, we are responsible for uncovering this information and learning about it. Being culturally competent includes possessing knowledge of the culture, understanding of what makes up cultural systems, and acknowledging the roles of subcultures and other variations within larger cultures (Grand Canyon University, 2008).
Based on this understanding, clinicians must possess the skills to establish a rapport with clients to gain more information about their culture and the skills to use this knowledge during the counseling process (Grand Canyon University, 2008). During the course of treatment, the counselor must keep judgmental, ethnocentric beliefs and perceptions about the client’s cultural group at bay if treatment is to be successful and effective (Grand Canyon University, 2008).
The Impact of the Explanatory Model of Substance Abuse
The explanatory model seeks to emphasize what the client believes is the origin of their problems, and seeks to explore the client’s views on onset, origin, severity, desired results, and effective treatment (Grand Canyon University, 2008). Of course, these responses and beliefs will vary between cultures. Some cultures might believe in medicine men over psychiatric treatment. Others might believe in the family sorting the problem out over involving clinicians who are perfect strangers. However, as counselors, we are ethically bound to respecting the client’s cultural wishes.
Regardless, by discussing their concerns, understanding their views, and showing that we value respect their opinions, we can engage a client in the treatment process, which will ultimately help us to facilitate recovery through various avenues (Grand Canyon University, 2008), even if it involves pairing our treatment with that of other providers valued by the client.
There are countless cultural variables that may inspire, or prevent, substance abuse in adolescents from particular cultural backgrounds. Cultural assimilation comes with its own set of unique stressors for each individual. However, family life that features support, involvement, and positive modeling behavior toward adolescents can also serve to be a preventer of substance abuse.
Counselors are responsible for acknowledging, understanding, and respecting the cultural standpoints of their clients if effective treatment is to ensue. This includes examining one’s own biases and removing them from the equation when working with clients who come from backgrounds different than one’s own. By doing so, meaningful dialogue, rapport, and progress will potentially be made.
Castro FG & Alarcon EH, Integrating cultural variables into drug abuse prevention and treatment with racial/ethnic minorities. The Journal of Drug Issues 2002;426:783-810.
Grand Canyon University. (2008). Lecture 7: Cultural competency with adolescent populations. Lecture conducted from Grand Canyon University, Phoenix, AZ.
Landmann K. The Impact of Culture on Substance Abuse Treatment. Paper presented at: 25th Annual Convening of Crisis Intervention Personnel; April 20–22, 2001; Chicago, IL. Retrieved March 16, 2013 from http://www.uic.edu/orgs/convening/VIF.htm.
Matheson JL & McGrath Jr., RT (2012). Adolescent alcohol and other drug abuse. Colorado State University. Retrieved on March 2nd, 2013 from http://www.ext.colostate.edu/pubs/consumer/10216.html.
Pacific Institute for Research and Evaluation. (2007). Culture can affect access to alcohol, drug abuse treatment for rural youth. Medical News Today. Retrieved March 16, 2013 from http://www.medicalnewstoday.com/releases/87178.php.
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