Barriers & Challenges in Substance Abuse Recovery Among Asian-Americans

1. Barriers & Challenges in Substance Abuse Recovery Among Asian-Americans Ting-Fun May Lai LCSW CASAC Behavioral Health Services Hamilton-Madison House May 2, 2008 Recovery Symposium, Philadelphia, PA

2. Demographics • Asian-Americans are not a homogeneous group, it consists of over 40 ethnic groups. • The Asian-American population is a fast-growing population in the United States.(14,656,608 2006 Census) • Asian-Americans in US are concentrated in 10 to 15 states. 9 % US Asian-Americans live in NY state. • With a high proportion of recent immigrants, more than 35 % of Asians speak an Asian language at home.

3. Within-group Diversity Issues Different languages & dialects Different historical & trauma background Different immigration histories Different living,clothing & customs Different family structure, inter-personal relationships Different cultural values Different substance abuse preferences Different help seeking patterns

4. Barriers to Treatment • Underestimation of the extent of the problem • Lack of dependable statistics & research data • Underutilization of treatment services (delaying or not seeking treatment) due to shame & stigma & lack of knowledge, health insurance & other resources • Lack of cultural & language appropriate treatment programs • Lack of evidence based practice

5. Barriers from the Communities • Strong stigma for substance abuse problems • Communities hold moralistic attitude towards individuals with addiction problems • Insufficient outreach & prevention services because Asian Americans being seen as a “Model Minority” not in need of services • Substance abuse treatment & recovery not communities’ priority • Lack of recovery support services & organizations

6. Services to Asian-Americans • Mainstream providers often do not have bilingual staff. • Major barrier to access treatment: limited language & culturally appropriate providers, not in all levels of care • Community based providers often provide services but are not reimbursed • Lacking language appropriate educational materials • Lacking other recovery support services

8. Attitude toward Alcohol & Substance Abuse • Not considering alcohol as harmful drug, using with herbal medicine & cooking • Moderate use of alcohol at social & ceremonial occasions • Outward drunken and acting out behavior not tolerated • Some use of substance at some communities for special groups of people acceptable • Alcohol & drug problems, especially related to criminal activities considered extreme shame & disgrace to family

9. Alcohol & Substance Abuse Patterns • Insufficient credible research data & small sample sizes making meaningful analysis impossible • Generally drink less, ”Flush Syndrome” & high percentage of persons not drinking at all • Use less of illicit drugs • Drug treatment admissions among AAPI increased by 37% (SAMHSA 2000) between 1994 and 1999 • Different pattern of use for different ethnic groups, American or foreign born, age groups

10. Co-Occurring Problems • Mental Health problems Close relations to addiction problems Strong stigma Long waiting list for MH services • Gambling problems Asian-Americans have a long history of accepting gambling as a community and family recreation High prevalence of problem gambling & pathological gambling Communities’ number one concern

11. Recommendations for Clinicians • Willing to work with client who are not ready for total abstinence; need a longer time of engagement; to start with, cut down use • Avoid traditional reflective, non-directive approach • Focus on external stresses in the early stage, offer crisis intervention & tangible help • Respect family secrets and confidentiality • Accommodate client’s work & family responsibility when scheduling appointment

12. Recommendations for Clinicians • Proficient in client’s language/dialect, using interpreter only as last resort • Avoid extensive questioning, assessment & evaluation; clarify and explain all procedures • Help client develop measurable and tangible short-term treatment goals • Receptive to Somatic Approach & Pharmacological Treatment

13. Strategies to Overcome Barriers & Underutilization • Understanding the cultural and practical barriers that exist are the first step in reducing them • Increase & enhance language & culturally appropriate community education, outreach, screenings & interventions • Increase language & cultural appropriate treatment services in all levels of care • Improve linkages within the providers networks and with community based organizations • Address the workforce issues for the Asian American communities • Create alternative self-help/support group that is less confrontational and more supportive & educational • Work with families separately, to reduce enabling and negative feelings • Support research initiatives focusing on Asian Americans

14. Resources from New York State • www.oasas.state.ny.us go to Specialized Services go to Asian-American Services 1.Simple Screening Instruments (TIP 11): Bengali, Chinese, English, Farsi, Hindi, Japanese, Korean & Vietnamese 2. Government Performance Results Act Instruments (GPRA): Bengali, Chinese, English, Hindi & Korean 3. Other resources such as Presentation etc.

15. Questions & Discussions Thank you!