Multicultural Issues in Substance Abuse Counseling

Prior to the 1980s, the American Psychological Association regarded the treatment of substance abuse as culturally neutral. Official policy dictated that therapists treat clients' addiction issues without regard to their race or ethnicity. As the American population grew increasingly diverse, therapists saw that this "one size fits all" approach to substance abuse failed to adequately serve their multicultural client base. Clients from different ethnic or racial backgrounds encountered issues that impeded their treatment.

Language Barriers

• Language barriers present a number of issues including accuracy of assessment, therapeutic bonding, and confidentiality. The successful treatment of substance abuse depends on accurate assessment of underlying issues. Language barriers interfere with the communication and mutual understanding necessary for such assessments. The lack of a shared language introduces distance between the therapist and client, which impedes therapeutic bonding. When the language barriers are sufficient to require a translator be present, issues of confidentiality arise.

Stereotypes and Biases

• Stereotypes and biases compromise the forming of a therapeutic relationship between therapist and client. A biased therapist or one operating from incorrect and stereotypical assumptions risks misdiagnosing the form of substance abuse or incorrectly diagnosing substance abuse issues where none exist. One particularly damaging stereotype is the attribution of specific types of substance abuse to certain ethnic or racial groups.

Cultural Norms

• Ignoring the influence of a client's cultural or ethnic identity diminishes the effectiveness of treatment. For example, different cultures have very different beliefs regarding the use of alcohol. Also, many cultures do not believe in the "addiction as disease" model used in most current substance abuse programs and attach considerable shame to seeking treatment for substance abuse issues. In order to effectively treat their clients, therapists must understand how the client views their own addiction and their treatment.

Alienation

• Ethnic minorities are overrepresented among inpatient hospitalizations for substance abuse, particularly involuntary hospitalizations. Clients belonging to ethnic or racial minorities drop out of treatment programs more frequently. Studies indicate that cultural alienation is a key factor in unsatisfactory treatment outcomes for minority clients who may feel isolated from staff and treatment providers in a culturally insensitive setting. To combat this, the American Psychological Association has established guidelines requiring that multicultural competency be a part of every therapist training program.