Working with Minorities

1. Working with Minorities Jasmine James Jason Simpson SOWK 7273 August 2, 2011

2. What is a minority group? • A subordinate group whose members have significantly less control or power over their lives than members of a dominant or majority group (University of Dayton School of Law, 2010). • A group that experiences a narrowing of opportunities (success, education, wealth, etc) that is disproportionately low compared to their numbers in the society.

3. Types of Minorities • Ethnic • Gender • Racial • Religious

4. Racial/Ethnic Minorities • African Americans • Native Americans • Hispanics • Asian/ Pacific Islanders

5. Population Statistics About 15.1% of the total US population is of Hispanic Origin Current U.S. Population: 311,845,970

6. Minority Populations and Substance Abuse • Substance abuse in the form of alcohol and other drugs is large problem among various minority populations. This may stem from social indicators such as poverty, lack of education, unemployment, crowded living conditions, single-parent families, etc (Sharma, 2008). • Lack of economic opportunities and high incarceration rates are impactful in causing substance dependence in racial and ethnic minorities.

7. Treatment Considerations in Working w/ Minorities • Treatment of minorities, particularly African Americans, needs to take into account that “to survive in a brutalizing, inhospitable world, minorities have a higher tolerance for emotional pain. So they become an enabling community that tolerates addiction” (O’Connell, 1991). • Minorities are more likely to enter treatment through the courts than through formal intervention processes or 12-step programs, and they are more likely to access treatment much later and thus have a more difficult recovery process (Straussner, 2004).

8. Brief Video • Laura Scmidt, Ph.D. - Overview of Racial and Ethnic Disparities in Substance Abuse Treatment • http://www.youtube.com/watch?v=GOTCcLgxrbY

9. African AmericanCulture • African American culture in the U.S. refers to the cultural contributions of Americans of African descent to the culture of the U.S • Slavery has a great impact on African American culture. • African Americans share a history of enslavement, acculturation, and racial oppression. • African American culture value religion/ spirituality, family ties, food, music, dance, art, and literature. • The church is a very important coping resource.

10. African AmericanRisk Factors For Substance Use Socioeconomic Factors • Poverty • Illiteracy • Limited job opportunities • Poor education • High availability of drugs • crowded living conditions • single-parent families • Stresses of Inner city living Environmental factors • Large number of liquor stores in African American communities

11. African American Drug/ Alcohol Use • African Americans are less likely to drink alcohol than other adults and have lower rates of binge drinking but their rate of illicit-drug use is higher (SAMHSA). • For those entering substance abuse treatment, research indicates that alcohol is the leading problem for African American males (35%), followed by cocaine (28%), and marijuana (19%).

12. African AmericansTobacco Use • African Americans suffer disproportionately from deadly and preventable diseases associated with smoking (American Lung Association, 2011). • African Americans accounted for approximately 12% of the 46 million adults who were current smokers in the United States during 2008. • Black women tend to smoke less than white women but the two groups have similar lung cancer rates. • Among African Americans, as with other U.S. populations, the prevalence of smoking declines as education level increases.

13. African AmericanProcess Addictions • Eating Disorders • In communities of black women, the types of disordered eating that predominate are compulsive eating, the consumption of high fat diets, and simple overeating which result in obesity. • Obesity can lead to illnesses like hypertension, heart disease and cancer, and lead to premature death. • African American women have the highest rates of being overweight or obese compared to other groups in the U.S. • About four out of five African American women are overweight or obese.

14. African AmericansTreatment Considerations • African Americans are less likely to seek treatment than any other group (Lawson, 1989) • Ethnically and culturally sensitive treatment programs. • First step is getting the person into treatment, particularly one that is located within the community for those with lower income who rely on public transportation. • Address social and survival factors • Involvement of the black community, church, family, and social groups.

15. Native AmericansCulture • Native Americans are persons having origins in and maintaining cultural identification with any of the original peoples of North America, including American Indian tribes and Alaskan Natives. • There also Native American Indian cultures from Mexico and Central and South America. • There are many different tribes and each of them are diverse in that they have tribe-specific beliefs, customs, and languages. • Their culture values storytelling, dancing, drum beating, clothing (feathers, jewelry, beads), moccasins, arts and crafts, pottery, weavings, etc.

16. Native AmericansRisk Factors For Substance Use and Alcohol • Poverty • Poor education • Availability of alcohol • Life stressors or problems (i.e. forcible relocation of many Native American communities, the loss of traditional way of life, etc.)

17. Native AmericansDrug/ Alcohol Use • Native Americans refer to alcohol as firewater. • Current drinking and heavy drinking are most prevalent among American Indians. • Alcohol has been associated with as much as 90% of all homicides involving Native Americans and has been implicated as a factor in many suicides, accidental-injury deaths, and vehicular safety issues. • Marijuana and cocaine use has risen gradually among Native Americans while methamphetamine addiction has skyrocketed.  The low cost and high availability of the drug is responsible for its popularity, especially among adolescents.

18. Native AmericansTobacco Use • Native Americans, as a whole, have an especially high risk of suffering from tobacco-related death and disease because they have the highest prevalence of smoking and other tobacco use compared to any other population group in the United States. • While smoking rates vary considerably from one Tribe to another, American Indians and Alaska Natives (AI/AN) are, overall, more likely than any other racial/ethnic subgroup to be current smokers. • According to the National Health Interview Survey (NHIS) of adults, 18 and over,23.2% of AI/AN currently smoke, compared to 22.1% of Whites, 21.3% of African-Americans,14.5% of Hispanics, and 12% of Asian-Americans.

19. Native AmericansProcess Addictions • Gambling • The Native American casino is a thriving industry. • On many Indian reservations, gambling is legal. • Native American reservations offer casinos, Bingo, gaming, and resorts, as well as other businesses related to the gaming industry such as hotels and restaurants. • Native Americans regard gaming as part of their culture and part of the cycle of life, death, and rebirth. They also regard gaming as important to the health of their tribal culture overall.

20. Native AmericansTreatment • Treatment for Native Americans should incorporate traditional culture and spiritual beliefs. • Nativized substance abuse treatment programs are more effective. Treatment typically includes social and coping skills training, cognitive behavioral modification, AA (that has been culturally sensitized), and relapse education/prevention. • Also during intervention the use of traditional singing/dancing are increasingly becoming a part of Native American treatment programs (Peterson et al, 2003).

21. HispanicCulture • Family is viewed as the primary source of support. Family is broadly defined, close knit, and emotionally and financially supportive. • The eldest male is typically the authority figure. • Gender roles are traditional. Important decisions are made by the whole family, not the individual. • Children are taught to avoid confrontations with their parents and older persons, and to be obedient, respectful and shy.

22. HispanicRisk Factors for Substance Abuse • Hispanics are more likely than non-Hispanic whites to live in poverty. In 2002, 21.4 percent of Hispanics were living in poverty, compared to 7.8 percent of non-Hispanic whites. • More than two in five Hispanics aged 25 and older have not graduated from high school. • Familial Factors

23. HispanicDrug/Alcohol/Substance Abuse • Current illicit drug use among persons aged 12 or older was 7.9% for Hispanics. • The rate of binge alcohol use was 25% for Hispanics. • The current smoking rates for Hispanics were 7.5 percent among youths aged 12 to 17, 29.9 percent among young adults aged 18 to 25, and 21.7 percent among those aged 26 or older.

24. HispanicProcess Addictions • In 2005, Hispanic and white non-Hispanic female students engaged in disordered eating at a higher rate than non-Hispanic black female students (7 percent for both Hispanics and non-Hispanic whites, versus 4 percent for non-Hispanic blacks).

25. HispanicTreatment Considerations • 13% of substance abuse treatment admissions reported to the Treatment Episode Data Set (TEDS) for 2003 involved Hispanics. • In 2003, the most common primary substances of abuse among Hispanic admissions were alcohol (36 percent), opiates (28 percent), and marijuana (15 percent). • How drug use began? • Machismo/Marianismo (Expectations) http://www.nlatinoaddiction.org/main.asp

26. AsianCulture • Family, art, music, and cuisine, as well as literature, are important parts of Asian culture. • Religion plays a large part of many Asian’s lives. The various religions practiced by Asians include: Hinduism, Taoism, Confucianism, Buddhism, Christianity and Islam.

27. AsianRisk Factors for Substance Abuse • Family • Friends • Isolation • Depression/Stress DRUG USE BEHAVIORS AMONG ASIAN DRUG USERS IN SAN FRANCISCO

28. AsianDrug/Alcohol/Substance Abuse • Have the lowest occurrence of illicit drug use at 3.7% • The rate of binge alcohol use was lowest among Asians at 11.1% • The prevalence of current use of a tobacco product among persons aged 12 or older was 11.9% for Asians (2009)

29. AsianProcess Addictions •  A 1999 poll in San Francisco's Chinatown, commissioned by a social services agency, found that 70% of 1,808 respondents ranked gambling as their community's No. 1 problem. • In a follow-up poll, 21% of respondents considered themselves pathological gamblers and 16% more called themselves problem gamblers -- rates significantly higher than in the overall population. 

30. AsianTreatment Considerations • Pride/Shame • Reasons for using drugs • Knowledge of Substance Abuse • http://asianamericanhealth.nlm.nih.gov/index.html Multilanguage Resources:

31. Resource for All Racial/Ethnic Populations • http://www.mocmhc.org/documents/Bibliography%20of%20Cultural%20Competence%20in%20Substance%20Abuse%20Treatment.pdf

32. Group Therapy Role Play • Mandated Pre-Trial Diversion Program • Initial Meeting • Various Backgrounds of Participants • All participants are either in contemplation or precontemplation.

33. Psychosocial Overview of Clients • Alcohol/Drug History • Stage of Change Analysis of Client • The processes of change that will be a point of focus in group therapy for the client

34. Client 1 • Rihanna is a 27 year old African American female. She has been a cocaine addict for 5 years. She started using cocaine at the age of 22. Rihanna does not use alcohol. She does smokes cigarettes. Rihanna is in the maintenance stage of addiction. She feels that she has to use cocaine in order to function properly. She is in the contemplation stage of recovery. Rihanna has considered to change but the positives of using cocaine such as it makes her feel good and it helps her cope with her problems influences her to continue use. Rihanna was referred to treatment after she was found possessing cocaine during a routine traffic stop. She must complete treatment before being offered probation. The cognitive/ experiential processes of change that will be a point of focus for her is consciousness raising, self reevaluation, and environmental reevaluation. The behavioral processes of change for her is self liberation, stimulus generalization or control, and helping relationships.

35. Client 2 • Len is a 25 year old Native American male. Len is an alcoholic. He started drinking when he was 16 years old. Len is in the maintenance stage of addiction. Len has to start his day off with an alcoholic beverage. Len does not smoke or use in any other substances. Len is in the precontemplation stage of recovery. Len is not even considering changing. He does not see his drinking as a problem. However, he can not keep a job due to his drinking. Len was mandated to treatment after being receiving his third DUI. If he does not complete treatment, he may face jail time. The cognitive/ experiential processes of change that will be a point of focus for him is consciousness raising, self reevaluation, and environmental reevaluation. The behavioral processes of change for him is self liberation, stimulus generalization or control, and helping relationships.

36. Client 3 Lily is a 25 year old Hispanic female. Lily has a meth addiction. Lily has been addicted to meth for 4 years. Lily began using meth with her boyfriend and when they broke up, started using more and more. Lily is in the maintenance stage of addiction and is in the contemplation stage of recovery, especially after her recent arrest due to stealing money from her employer to buy meth. Lily does not know how she would cope without meth as she uses frequently and especially in times of high stress. Lily must complete treatment to receive a lower sentence on the theft charge. The cognitive/ experiential processes of change that will be a point of focus for her is consciousness raising, self reevaluation, and environmental reevaluation. The behavioral processes of change for her is self liberation, stimulus generalization or control, and helping relationships.

37. Client 4 Roy is a 21 year old Asian male. Roy is addicted to cocaine. Roy began experimenting with cocaine regularly at the age of 15 with friends from high school that he met after he moved from Japan. Roy still regularly uses with these friends, and considers them his best friends. Roy works for his family’s business, and is school part-time though his grades are dismal. Roy is in maintenance stage of addiction and the precontemplation stage of recovery. Roy believes that cocaine is what binds him to his friends, and without that, they would not talk to him. Roy cares about his family, and believes his drug addiction does not bother them. Roy was arrested after attempting to buy cocaine from an undercover police officer and was mandated to treatment to lessen his sentencing. The cognitive/ experiential processes of change that will be a point of focus for him is consciousness raising, self reevaluation, and environmental reevaluation. The behavioral processes of change for her is self liberation, stimulus generalization or control, and helping relationships.

38. Questions for Consideration • What are some of the difficulties you see in working with minorities? • Do you think a social worker who identifies with an ethnic/racial minority (i.e. African American, Hispanic) would be more effective than a social worker who identifies as White, non-Hispanic, especially with mandated clients? • What are some other things that could be addressed when working with minorities in addition to the role of the family, spirituality, etc.?

39. Overview of a Useful Website • Substance Abuse and Mental Health Services Administration (SAMHSA) • http://www.samhsa.gov/

40. Explanation of Handouts • Handout-Statistics on Illicit Drug Use Involving Minorities • Handout- Culturally Competent Treatment Services • discuss treatment needs and appropriate counseling techniques for minorities.

41. References • DiClimente, C.C. (2006). Addiction and change: How addictions develop and addicted people recover. New York: The Guilford Press. • Finn, P. (1994) Addressing the needs of cultural minorities in drug treatment. Journal of Substance Abuse Treatment, 11, 4, pp. 325-337. • National Institute on Drug Abuse (NIDA) (2011). Drugs of abuse. Retrieve July 14, 2011 from http://www.nida.nih.gov/NIDAHome.html • O’Connell, T. (1991). Treatment of minorities. Drug and Alcohol Dependence, 15(10), 13. • Office of National Drug Control Policy (n.d.). Minorities and drugs: Facts and figures. Retrieved July 8, 2011 from http://www.whitehousedrugpolicy.gov/drugfact/minorities/minorities_ff.html#note2 • Substance Abuse and Mental Health Services Administration (SAMHSA) (2011). Highlights of reports on substance abuse and mental health. Retrieved July 14, 2011 from http://oas.samhsa.gov/Highlights2k10.htm • Sharma, M. (2008). Substance abuse in minorities. Journal of Alcohol and Drug Education. 52(3), 3-6. Retrieved July 9, 2011. • Straussner, S.L. (2004). Clinical work with substance-abusing clients. 2nd ed. New York: The Guilford Press. • The University of Dayton School of Law,(2010). What is a minority group? Retrieved July 15, 2011 from http://academic.udayton.edu/race/01race/minor01.htm • U.S. Department of Health and Human Services(1999). Cultural issues in substance abuse treatment. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment .