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What is the role of cultural sensitivity in addiction treatment?

A black man with dreadlocks lies, despondent, on a gray loveseat before a therapist holding a clipboard.

According to the 2019 SAMHSA (Substance Abuse and Mental Health Services Administration) National Survey on Drug Use and Health, 2.3 million Black Americans experienced substance use disorder in the past year, 90% of whom did not access treatment. The same study found that 2.9 million Hispanic adults and approximately 745,000 Asian and Native Hawaiian or Pacific Islander adults experienced substance use disorder and had similarly low rates of treatment.

While Black adults were most likely to access care through outpatient rehab facilities, Hispanic and Asian and Native Hawaiian or Pacific Islander adults were more likely to seek self-help groups.

The report underscores the importance of increased access to care as well as sociocultural patterns around substance use and mental health care. Alma member Evans Rochaste, NP, expanded upon the importance of cultural sensitivity in addiction psychiatry, calling attention to the risk of perpetuating trauma or stigma by not taking the time to understand the culture in which a client lives.

This Q&A was originally posted on Medium on July 27, 2020. The following has been edited and condensed for clarity.

Q: What is the relationship between addiction and mental health?

A: Mental health and addiction go hand in hand. Many times, those who struggle with a mental health disorder experience symptoms like emotional pain, physical pain, or both, that can be temporarily eased or taken away with the use of a substance. As long as the underlying pain is there, medicating may feel necessary and addiction may follow. Pain can be extremely difficult to cope with, especially if it feels like there is no other way to handle it.

Although the initial cause of substance abuse may be to help ease symptoms of mental illness, addiction can lead to further symptoms that affect mental health and cause even more pain or discomfort. This can create a dual diagnosis for someone over time and deepen their original issues. This happens because the brain changes when substances are used, and these changes occur in some of the same brain areas that are disrupted in mental disorders such as depression and anxiety.

An example of this could be someone struggling with a mood disorder and a substance use disorder simultaneously. To add to this, it is proven that those suffering from mood or anxiety disorders are twice as likely to suffer from an addiction use disorder. However, it’s important to know that one does not necessarily cause the other, and understanding each unique case is vital to helping someone on their path to recovery.

Addiction and mental health are also tied together in terms of factors that can potentially lead to issues with both. Substance use disorders and other mental illnesses can be caused by overlapping factors like genetic vulnerabilities and early exposure to stress or trauma. The stress that is caused by these factors can result in mental health issues such as depression or anxiety, adding to the likelihood of substance use and addiction. An example of this would be someone who has a genetic predisposition to mental health issues and who witnesses trauma while growing up, then develops chronic anxiety, then develops an alcohol addiction to ease the symptoms of their anxiety.

Overall, addiction and mental health can co-exist in many complex ways. Along with this, addiction and mental health can both be socially stigmatized. Having a better understanding of how they relate to one another is vital to help those who are struggling achieve holistic healing.

Q: What does culturally sensitive addiction treatment look like?

A: It’s important to understand a client’s perspectives and beliefs about addiction psychiatry and medication management from the onset. Diagnosis, medication, and therapy can be stigmatized or considered unacceptable within some cultures and communities. Being sensitive to this allows the client to feel seen, safe, and understood. Because of this, my goal is to do my due diligence in uncovering sociocultural issues that would affect acceptance, retention, and treatment outcomes for my clients.

Cultural sensitivity is important specifically for people of color who have been and continue to be negatively affected by prejudice and discrimination in the healthcare system across the United States.

Evans Rochaste, Medication Management, NP

Misdiagnoses, misconceptions, and both conscious and unconscious bias often lead to inadequate treatment. A lack of cultural competence among health professionals causes distrust and repeated traumatic exposure, which subsequently prevents many people of color from seeking or staying in treatment. As a result, people of color often bear a disproportionately high burden of disability resulting from mental health disorders.

Within communities of color, there is often a misconception that a mental health condition is a personal weakness or punishment at the behest of a higher religious or spiritual power. Practicing faith can be grounding and protective, but it shouldn’t be the sole, end-all-be-all path for mental health.

It’s equally important to recognize that faith communities can be a source of stigma and distress. Some religious communities can alienate individuals who identify in a particular fashion or who experience specific symptoms, leading to increased symptom burden.

Men of color, at times, may experience an additional layer of stigma. Society portrays men as individuals who are supposed to be reliable, unbreakable, and emotionally stoic from a very young age. This model of masculinity can be toxic, especially for men of color. Society has begun to open the dialogue surrounding mental health and wellness, which is encouraging. As we normalize our experiences, we can lessen the stigma.

Q: What other factors are important to recognize when treating addiction through a culturally sensitive lens?

A: As mental health care professionals, we can continue to educate ourselves in terms of cultural competency and be honest about any of our own biases toward certain groups. For many of us, we can stigmatize certain cultures or issues, and if they go unchecked we can add further harm to those we’re trying to help.

Be willing to offer a safe and judgment-free space where empathy is in high supply. We need to learn and understand how identification with one or more cultural groups influences each client’s worldview, beliefs, and traditions surrounding the initiation of substance use, healing, and treatment.

Along with this, it’s important to understand that there can be multiple “drug cultures” that influence clients’ substance use or abuse and the behaviors they engage in to manage mental disorders. This usually has a strong correlation with the desire for belonging and acceptance. Someone who gains acceptance from a group, even if mainstream society discriminates against them because of substance use or mental illness, will many times choose to engage and accept that group’s behavior and beliefs. Prejudice from mainstream society can make ties with the drug culture even stronger and the client may feel as if there is no other place to turn for social and cultural support.

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Alma employee Emily Singer pictured at Alma's headquarters.
Emily Singer

About the Author

Emily Singer is an early-stage marketing Swiss Army Knife who thrives in collaborative, inclusive environments built on trust and transparency. She has a track record of developing low-cost, high-impact solutions that scale and equip teams with actionable insights. Emily came up through media before moving into marketing and is most interested in companies that use their power to facilitate positive change. She is a lifelong learner and active questioner who leads from a place of curiosity and empathy.

Her interests lie in inclusive storytelling, shifting consumer cultures, and marketing trends.

Emily is a graduate of Middlebury College, where she studied art history, English literature, and French.

Article Reviewed by Evans Rochaste

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