Cultural Elements in Treating Hispanic Populations

Maria del Mar Garcia, MSW, MHS

22nd Annual Multicultural SymposiumJune 8-9, 2006

CBHATTC CBHATTC HeadquartersHeadquarters

BayamónBayamón

St. ThomasSt. Thomas

CBHATTC Mission

• Help address the drug use problem and its consequences by developing the workforce and promoting organizational change in Puerto Rico, US Virgin Islands and Hispanic communities in the United States, utilizing culturally appropriate activities and products.

Objectives

• Discuss common cultural beliefs, attitudes and behaviors among Latinos that can help service providers

• Gain an understanding of how cultural change among Latinos can influence drug use

• Discuss helping strategies to treat Latinos drug users

Introduction• Hispanics/Latinos (H/L) now comprise the

largest minority group in the United States (14.2%)

• As a group• They are young

• 40% are under the age of 21

• Have a disproportionately low-income level• 23% live below the poverty line

• Have a low level of educational attainment• More than half of H/L under the age of 25 have not

graduated from high school

Introduction

• Hispanics/Latinos accounted for about 50% of the national population growth of 2.9 million between July 1, 2003, and July 1, 2004.

• Hispanic growth rate of 3.6% over a year was more than 3 times that of total population (1%).

• Over 13 million (32.7%) Hispanics lack health insurance

6.2

11.1

5.3

10.1

6.3

11.9

7.2

15.2

7.8

14.5

0

5

10

15

20

25

30

1999 2000 2001 2002 2003

Past Month Past Year

Illicit Drug Use in the Past Month and Past Year Among Hispanics Aged 12 or Older

U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. NATIONAL SURVEY ON DRUG USE AND HEALTH, 1999-2003 [Computer file]. ICPSR version. Research Triangle Park, NC: Research Triangle Institute [producer], 2004. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2004.

Drug Use among Adolescents

• 12th grade Hispanic students reported the highest rate of use for some drugs:– Crack– Heroin– Heroin with a needle– Methamphetamine– Rohypnol

2004 Monitoring the Future

Treatment Admissions by Hispanic Population 1992-2002Percent distribution

9.910.5

1110.7

10.4

12.7121211.911.310.9

0

2

4

6

8

10

12

14

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) – 3.01.04. U.S. population: US Bureau of the Census, Population Projections of the United States by Hispanic Origin: 1995 to 2050. Population Electronic Product#45

Distribution Map by ATTC Region

< 5% 5-10% > 10%Hispanic PopulationProviders serving Hispanic

What is culture?

• Is the conceptual system that structures the way we view the world– Beliefs– Norms– Values

Ethnicity

• Refers to the social identity and mutual belongingness that defines a group of people on the basis of common origins, shared beliefs and standards of behavior

Ethnocentrism

• The tendency to view one’s own culture as best and to judge the behavior and beliefs of culturally different people by one’s own standards

Acculturation

• Process of cultural transformation that takes place when two different cultures interact resulting in assimilation, partial or total, of one of the cultures by the other one

Diccionario de la Lengua Española

Multicultural Practices

• Key Factors

– Impacts Relationship building

– Communication among people

Multicultural Practices

• Requires three domains

– Awareness of oneself and others– Knowledge of self and others– Skills-interpersonal and intervention

Personal Dimensions of Identity

• Dimension A– Age– Ethnicity– Gender– Race– Language– Physical ability/disability– Sexual orientation– Social Class

Personal Dimensions of Identity

• Dimension B– Education background– Geographical location– Income– Marital Status or Relationship Status– Religion– Work experience– Citizenship Status– Military experience– Hobbies or recreational habits

Personal Dimensions of Identity

• Dimension C

– Historical Moments

– Historical Eras

How culture change affects Latinos and their drug use

• Immigration– Represents two major sources of stress

• 1-Family dislocation-fragmentation and reconstruction

• 2-Culture Change

Familism in the Latino Culture

• Strong commitment to family life that values collective goals over individual well-being

Indicators of Familism

• Early childbearing

• Higher average fertility levels

• Large family households, often extended to include grandparents, aunts

Indicators of Familism

• Tendency to live with kin instead of unrelated individuals or alone

• Patriarchal structure

• Gender roles clearly defined

Familism

• A multidimensional concept– Structural dimension

– Behavioral dimension

– Attitudinal dimension

How is drug use seen by the Latino Family?

• Adolescent drug use

– Shock, anger, disappointment, feel betrayed, embarrassed, sense of failure

– Ungrateful and failing to appreciate parent’s sacrifices

Females addicts with children

• Experience guilt and shame about neglecting their children

• Parents will blame her for failing her duties as a good mother

• Partner may be seen by family the responsible for woman’s drug use

Cultural Based Evaluation

• Questions that may help – Information about life in the country of origin– Immigration history– Length of time in the USA– Frequency of traveling between countries

Cultural Based Evaluation

• View about drug use

• Experiences with loss, persecution, torture, war and deprivation

• What mayor changes have the client experience as a result of coming to this country

• Language of preference

Barriers that keep Latino clients away from treatment

• Language barrier

• Problems with immigration authorities

• Role identification as provider or protector

• Treatment for drug dependence is difficult to access

• Fear to reveal to family their use and consequences

• Shame, stigma

• Feeling of being out of control

Barriers, cont.

• Lack of a continuum of care services that address the recovering Latino’s needs

• Inability to pay for private care because lack of insurance

• Fear of “official” inquiries or action by child protective services

Helping strategies in treatment

• Remedial academic work

• Vocational training

• Emphasis in values of family loyalty and

Spirituality

• Trans-cultural/multicultural approach

• Motivational Intervention approach

Treatment strategies

• Focus on establishing trust (confianza)

• Encourage participation in different creative activities

• Assess when to involve family members

• Discuss with family the use of medication in treatment

What concepts from this presentation can I apply in my

agency?

What concepts from this presentation I am already applying in my agency?

• Consider how dull life would be if we all looked alike, thought alike, and acted alike!!!!!!!!!!!

References

• Vega, W.A. (2006). Cultural Elements in Treating Hispanic Populations. Universidad Central del Caribe.

• Miller, W.R., & Rollnick, S. (1991) Motivational Interviewing: Preparing People to Change Addictive Behaviors. New York: The Guildford Press