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Is there a need for culture-specific treatment for substance use disorders?

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In your opinion, is there a need for culture-specific treatment for substance use disorders or behaviors with addictive features? Are there times such treatments may be indicated for a given client and those situations in which it might be contraindicated?
Posted Fri, 1 Mar 2013 in General Health
Answered by Dr. Jonas Sundarakumar 17 hours later

In the field of psychiatry, especially in the area of substance use treatments, we are gradually recognizing the growing diversity in the cultural profile of persons with substance abuse disorders.

People who are of different racial and ethnic groups, different sexual orientations, in the criminal justice system, living in rural areas, older, and who speak languages other than English are among the population groups that may experience unique challenges that affect their substance use or abuse and its treatment.

This situation prompts the need to better understand the influences of cultural differences in the design and delivery of culturally-responsive and effective substance abuse treatments.

Firstly, let us examine why culture-specific treatments are needed…

1)     People with substance use problems are not a homogenous group. They vary widely based on:
-     Nationality
-     Region
-     Language
-     Socio-economic status
-     Local cultural beliefs
-      etc. etc.

2)     Each culture’s attitude towards substance use is very different. For example, in the Western world, social drinking is widely prevalent and acceptable, whereas in many eastern countries, it is not. In some religious cultures (for example in the Islamic culture), alcohol is prohibited. In conservative societies, women smoking or drinking is even considered as a taboo. In these circumstances, women may take XXXXXXX offence even if they are questioned about substance use. On the other hand, in some cultures. So, we see that the people’s attitudes and beliefs towards substance use itself differ very widely from culture to culture. So, obviously, substance use treatments should also be geared up according to the culture-specific attitudes.

3)     There is even a good degree of variation in the nature and pattern of substance use disorders among people of different cultures. Taking alcohol use disorders for example, in certain cultures, like the Irish culture, ‘gamma’ type of alcoholism (binge drinking) is found to be the predominant pattern of presentation. Also, in certain cultures, abuse of certain types of substances may be more prevalent. For example, the chewable form of tobacco is very prevalent in south-east Asian countries. Or cannabis use may be more prevalent in countries or states where cannabis is legalized.

4)     Finally, when it comes to substance use treatments, for any treatment to be acceptable, it is important that it should be “culture-sensitive”. Certain treatments may not be applicable to all cultures and people belonging to certain cultures may even find certain treatments offensive. I’ll give you a few examples:

-     In the western culture, people expect a greater degree of autonomy and choice in treatments. On the other hand, in many eastern cultures, people may expect a more directive approach or a more paternalistic approach. Trying to apply the same directive or paternalistic approach in the west may only be met with resistance and offence.

-     Recognizing the treatment options already available in the community is also very important. In many eastern countries, religious and native methods of de-addiction are more popular, and may actually be more effective than the psychiatric deaddiction treatments. In such cases, a lack of cultural sensitivity and a blind emphasis on the psychiatric model of treatment may not be appropriate or acceptable.

-     The role of the family and significant others in substance use treatments also varies between cultures. For example in more conservative societies, the family is likely to play a significant role in treatment. In such cases, appropriate use of family therapies may actually be more useful in improving the outcome. This scenario may be entirely different in certain other contemporary cultures, where the family plays a less significant role in therapy.
There can be many more examples like this, but the core message is that because of the large diversity in the cultural attitudes, beliefs and illness or treatment models among people belonging to different cultures, it is very important to be sensitive to the cultural needs of the people and be flexible in our treatment approach towards substance use disorders.

The following principles are essential:
1)     Incorporating culturally-responsive treatments that are sensitive to the specific treatment needs of members of special populations.
2)     Developing and enriching the cultural competence of the doctor / therapist.
3)     Being more sensitive in our approach to racial and ethnic minorities.
4)     Recognizing the relevance and influence of various intra-cultural beliefs and caregiver roles.
5)     Recognizing and wisely utilizing the existent community treatment models and developing our strategies in synchronization with the existing community treatment options.
6)     Furthering our research and understanding into this subject, so that there is more information and guidelines universally available to practitioners, regarding culturally-sensitive treatments.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
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