Responses to peers. Note that this is measured by both the quantity and quality of your posts. Does your post contribute to continuing the discussion? Are your ideas supported with citations from the learning resources and other scholarly sources? Note that citations are expected for both your main post and your response posts. Note also, that, although it is often helpful and important to provide one or two sentence responses thanking somebody or supporting them or commiserating with them, those types of responses do not always further the discussion as much as they check in with the author. Such responses are appropriate and encouraged; however, they should be considered supplemental to more substantive responses, not sufficient by themselves.

Read a your colleagues’ postings. Respond to your colleagues’ postings.

Respond in one or more of the following ways:

· Ask a probing question.

· Share an insight gained from having read your colleague’s posting.

· Offer and support an opinion.

· Validate an idea with your own experience.

· Make a suggestion.

· Expand on your colleague’s posting.

1. Classmate (D. Ras)

Similarities & Differences of the Prevalence, Sociocultural Factors, & Treatment Issues Associated with Hispanics & Asian American Groups (including spirituality & socio-economic status)

Culture refers to learned values, behaviors and beliefs that are shared by other group members, including patterns of language, spiritual ideals, and worldviews (Van Wormer & Davis, 2018). Culture can also be a barrier to finding and receiving professional help when faced with problems. Class or socioeconomic status impacts every aspect of a person’s life. This refers to a person’s level of education and current employment and income status (Van Wormer & Davis, 2018). Higher rates of substance use and gambling are associated with unemployment and lower education attainment (Van Wormer & Davis, 2018). I will compare the prevalence of SUD, sociocultural factors contributing to SUD, and treatment issues among the Hispanic and Asian American groups. Hispanics are the nation’s largest ethnic minority, representing various ethnic backgrounds, cultural practices, and beliefs with the common thread being the Spanish language (Van Wormer & Davis, 2018). The rate of SUD among this population is 8.6% compared to 8.2% of the national average. However, just because this population reports needing treatment doesn’t mean they are receiving it. Acculturation also affects this rate, meaning the more traditional sanctions break down with education, increasing income, and class, the more prevalent SUD becomes among this population (Van Wormer & Davis, 2018). The Asian American population remains the least at-risk group for use and abuse of alcohol, tobacco, and other drugs despite the growing numbers (Van Wormer & Davis, 2018). In 2013, the rate of illicit drug use among persons age 12 and older in this population was 3/1% and the rate of substance dependence or abuse was 4.6% (Van Wormer & Davis, 2018). This rate could be low due to underreporting and inaccurate reports for several reasons including this population was considered “other” prior, which prevented accurate data (Van Wormer & Davis, 2018).

Despite education and economic status improving among the Hispanic group, poverty is still a major risk factor (Van Wormer & Davis, 2018). Hispanics are the most undereducated of all ethnocultural groups in the U.S., which has a big impact on the attainment of well-paying jobs and stable employment (Van Wormer & Davis, 2018). Another sociocultural factor contributing to the prevalence of SUD among the Hispanic group is lack of health insurance, with this population having the highest uninsured rates than any other group (Van Wormer & Davis, 2018). Discrimination against this group has also been found to be associated with SUD, according to the U.S. census bureau (Van Wormer & Davis, 2018). HIV is one of the most devastating effects of substance misuse in the Hispanic population, with the rate being three times as high as whites which are attributed to avoiding seeking treatment or testing because of immigration status, the stigma of homosexuality, and/or traditional gender roles (Van Wormer & Davis, 2018). Among the Asian American group, levels of education and income differ. However, as a whole, the Asian groups had a higher rate of college degrees than the U.S. population as a whole at 28% (Van Wormer & Davis, 2018). Acculturation has to do with the proficiency with the English language, how long living in the U.S., and generational status. The degree of acculturation has been associated with SUD, with lower acculturation having fewer instances of SUD among this population similar to that of the Hispanic culture (Van Wormer & Davis, 2018).  Another similarity among these two groups is both views asking for help as a weakness and keeping family struggles private is a way of honoring the family (Van Wormer & Davis, 2018). The Asian population feels if a problem gets identified and family functioning is threatened, the family risks deep shame and “losing face” in the community (Van Wormer & Davis, 2018). The shame in asking for help represents a failure of the family to solve the situation, and this group places significant emphasis on appearances of normal functioning (Fong & Tsuang, 2007). Therefore, they may try to hide the person with the problem as opposed to getting them help. The Hispanic group has similar views on highly valuing family unity and gender roles (machismo & marianismo) which can be protective factors (Van Wormer & Davis, 2018). These same values can also be linked to SUD if a member feels they are not meeting these cultural expectations. Identification with these gender roles can make it even harder to admit one has a problem.

These differences among ethnic groups make it more obvious that a one size fits all approach will not work, not even within the same ethnic group. As mentioned earlier, Hispanics are less likely to receive treatment despite being more likely to need it. The machismo, meaning being brave, strong, good provider, and dominant presents barriers to admitting problems. However, this could be reframed in therapy by placing the emphasis on the change being totally up to the client and the counselor’s job is not to fix him (Van Wormer & Davis, 2018). Understanding that as a Hispanic woman entering treatment, they have broken the traditional role with their SUD, which elicits a great deal of shame. Keeping this in mind, there have to be other issues presenting in their lives that would cause them to step outside their traditional roles (Van Wormer & Davis, 2018). Understanding the cultural and practical barriers that exist among any ethnic group is the first step to reducing them. For the Asian American population, the development of alternative 12 step groups that focus less on confrontation and more on support and education would be a culturally sensitive approach (Fong & Tsuang, 2007). Additionally, having a trusted member of the Asian community present at or conducting these support groups might be helpful; this could be a local pastor or respected elder (Fong & Tsuang, 2007). Similar treatment implications for this group include substantial unmet needs for treatment (Van Wormer & Davis, 2018). Members of this group are unlikely to enter treatment unless treatment is court ordered or they fall into a more severe category of illicit drug users (Van Wormer & Davis, 2018). The implementation of the Affordable Care Act was expected to increase the availability of services to such ethnic groups who previously were uninsured, thus limiting access to substance use and mental health services (Van Wormer & Davis, 2018).

Reference

Fong, T. W., & Tsuang, J. (2007). Asian-Americans, addictions, and barriers to treatment. Psychiatry (Edgemont (Pa. : Township)), 4(11), 51–59.

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

2. Classmate (G. Sim)

In a New York Times article entitled “The Opioid Crisis Isn’t White” from February of this year, statistics were detailed counting African Americans making up 12 percent of all opioid-related fatal overdose victims in 2017, with 5,513 deaths, more than double the number in 2015. In some American urban centers, black people make up more than 80% of opioid deaths, such as in the District of Columbia, while in Massachusetts death rates have been going down in general but rising for black people. Why is this so? Dr. Tom Gilson, a medical examiner in Cuyahoga County, Ohio, told Boston NPR affiliate WBUR that there was a “fourteen-fold increase in fentanyl deaths among African Americans in the three years between 2012-2015, as rates of black men dying from cocaine overdose matched that of white men, despite the disparity in numbers (New York Times, 2019).

In cities like New York, access to addiction treatment is often segregated by income and race, thus low-income black and Latino users have to travel far from home to get methadone from clinics, while more affluent white users can afford to get prescriptions of newer drugs to treat addiction, like buprenophrine, from private doctors. And there has been criticism in some urban centers of slow response time to overdose calls to distribute naloxone, as well (New York Times, 2019). While minorities are not at a higher risk for pain-related conditions than their White counterparts, African Americans consistently receive less adequate treatment for acute and chronic pain, even after controlling for age, gender, and pain intensity. And research shows that minorities are more likely to be prescribed less-effective, non-opioid medications, or opioids at a lower dosage, even when pain severity levels are comparable (The Washington Informer, 2016). Physician bias is thought to be a large factor in this unequal picture as negative preconceptions seeps into how pain is addressed. Greater cultural competence can help eliminate these biases by understanding and appreciating patients’ heritage and beliefs. Skepticism against the health care system by African Americans is an understandable barrier preventing effective treatment, as well.

A mental health research study by students from Nova Southeastern University was done of 278 Latino migrant workers between 2008 and 2010. About one-third of the participants engaged in heavy drinking in the past 30 days prior to a baseline interview. Prior to the study, a significant segment of the Latino migrant worker population in the U.S. was at high risk for alcohol abuse and related risk behaviors. Five factors including gender, country of origin, relationship status, living arrangements, and acculturation were associated with frequency of alcohol consumption (Mental Health Weekly, 2015). Additionally, issues such as living with children, length of stay in the U.S., religious beliefs, and depression were also associated with frequent heavy drinking, abuse/dependence, and unprotected sex while under the influence of alcohol. Although a substantial proportion of the Latino migrant worker population abstains from alcohol, an equally substantial proportion reports levels of alcohol consumption that poses significant risk. Just dealing with the grim lifestyle of migrant work: back breaking work for very low pay while not being legal residents of the U.S. and trying to feed their families would seem to lend itself to a drinking habit or excessive use. More research is needed to determine the reasons and trends for drinking patterns in this community in order to design prevention strategies tailored for this population.

Mental Health Weekly Digest. (2015). Mental health research: Studies from Nova Southeastern University add new findings in the area of addiction research.

The New York Times. (27 Feb. 2019). The Opioid Crisis Isn’t White: [Op-Ed].

Maryland, P. (06 Oct. 2016). Managing Pain, Opioid Addiction in Black Community. The Informer.

3. Classmate (J. Car)

Similarities and Differences

Native Americans and Latino/Latina peoples have each been gathered under one umbrella when it comes to labels, when the groups would choose instead to identify according to one of numerous tribes, or from their country of origin. Accessibility to gambling is a risk factor both people groups with casinos marketing to Hispanics by offering culturally inclusive activities onsite, and Native Americans face a conflict with uneven distribution of casino earnings across tribes, which may be reinforcing the high rates of gambling by this group (Van Wormer & Davis, 2018). Poverty plagues both Native Americans and Hispanics and with few resources to combat a low socioeconomic status, specifically limited health insurance, the health concerns related to alcohol and drug abuse become unmanageable. Acculturation has taken its toll on both groups, bringing in more high-risk activities such as the use of hard alcohol and a move away from cultural traditions with younger individuals feeling more drawn to mainstream cultural practices which include abuse of substances and alcohol (Van Wormer & Davis, 2018).

It is critical to recognize for both groups that treatment cannot be implemented from an individualistic method, especially with the Hispanic culture who rely exclusively on familial support which may be mislabeled as codependence if not understood from a cultural perspective (Van Wormer & Davis, 2018). Both groups suffer from lack of access to effective substance abuse treatment, with Hispanics being underinsured or not visiting doctors due to threat of immigration status and Native Americans having the highest rate of alcohol abuse of any culture and a lack of evaluation research on treatments which may not be effective based on lack of cohesion with indigenous ways of knowing (Myhra & Wieling, 2014).

Statistics offer some drastic differences in the pervasiveness of addiction within the Native American and Hispanic cultures. Fetal alcohol syndrome has been documented as most prevalent in Native American children ages 7-9 years old, with 2.0 per 1,000, and least predominant in Hispanic children, with .2 per 1,000 children (Van Wormer & Davis, 2018). Gambling disorder is diagnosed in 4.6% of Hispanics as opposed to the higher percentage of 5.4% of Native Americans (Van Wormer & Davis, 2018).  The spread of HIV is a distinctive concern for Hispanics which, as a result of abusing substances, is transmitted and creates the fear of deportation and threat of being ostracized culturally. Additionally, gang involvement is a huge risk factor for Hispanics born in the United States, with 40% claiming involvement (Van Wormer & Davis, 2018).

Additional Influences

The use of addictive substances and acquiring of addictive behaviors in Hispanic individuals is predicated on the existence of an influence of cultural values, specifically within the home. If an individual comes from a home with large amounts of conflict, even if they are operating under family assistance behaviors, they are more likely to abuse substances in order to cope or assimilate to a culture outside their own (Van Wormer & Davis, 2018). According to a study by Blackson, De La Rosa, Sanchez, and Li (2015), it is important to assess Hispanic individuals who are immigrants for potential biological histories of substance abuse problems in their country of origin, as these factors may predict the onset of an alcohol use disorder. Native Americans integrate spirituality more frequently in treatment, specifically in the example of Walking On, which is a blending of cognitive behavioral therapy elements and traditional Cherokee healing, focusing on a strengths-based, culturally familiar method which allows the individual the benefit of cultural practice as well as empirically researched and evidence-based intervention (Van Wormer & Davis, 2018). For Hispanics, the use of cultural matching between a clinician and client coupled with Brief Motivational Interviewing was found to be significantly effective due to the empathy cultivated by the sharing of a cultural understanding of beliefs and values (Van Wormer & Davis, 2018).

References

Blackson, T. C., De La Rosa, M., Sanchez, M., & Li, T. (2015). Latino Immigrants’ Biological Parents’ Histories of Substance Use Problems in Their Country of Origin Predict Their Pre- and Post-Immigration Alcohol Use Problems. Substance Abuse, 36(3), 257–263. https://doi-org.ezp.waldenulibrary.org/10.1080/08897077.2014.932886

Myhra, L., & Wieling, E. (2014). Intergenerational Patterns of Substance Abuse Among Urban American Indian Families. Journal of Ethnicity in Substance Abuse, 13(1), 1. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edb&AN=94629998&site=eds-live&scope=site

Van Wormer, K., & Davis, D. R. (2018). Addiction treatment: A strengths perspective (4th ed.). Boston, MA: Cengage.

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Required Resources

• Van      Wormer, K., & Davis, D. R. (2018). Addiction treatment: A      strengths perspective (4th ed.). Boston, MA: Cengage.
• Chapter      11, “Ethnicity, Culture, and the Socioeconomic Determinants of Addiction”      (pp. 431-471)
• Gubi,      P. M., & Marsden-Hughes, H. (2013). Exploring the processes involved in      long-term recovery from chronic alcohol addiction within and      abstinence-based model: Implications for practice. Counselling      & Psychotherapy Research, 13(3), 201–209.
  Retrieved from the Walden Library databases.
• Hendricks,      P. S., & Leventhal, A. M. (2013). Abstinence-related expectancies      predict smoking withdrawal effects: Implications for possible causal      mechanisms. Psychopharmacology, 230(3), 363–373.
  Retrieved from the Walden Library databases.
• Lee,      H. S. (2015). The ethical dilemma of abstinence-only service delivery in      the United States. Journal of Social Work Values & Ethics, 12(1),      61–66.
  Retrieved from the Walden Library databases.