Multicultural substance abuse prevention and health promotion consists of the art of combining appropriate tradition with new scientific understanding. To us in the Recovery Center, state of the art health promotion recognizes the influence of culture, a broad pattern for living. To us utilizing culture means integrating missing pieces of culturally determined healthy practices taking into account various sub-cultures such as: drugs of choice, recovery status, HIV & HCV status, socioeconomic status and source of income, geography, occupation, gender, sexual orientation, ability, age, religion-spirituality, ethnicity, and race. The following reflects one piece of the program's working philosophy.
A KOAN OF CULTURE
A koan is sort of a Japanese "jawbreaker for the mind", that can provide
spiritual and psychological sustenance. A jawbreaker is a type of hard
candy, too large to swallow, which cannot be chewed initially until you
suck through all the layers. Different levels of candy are revealed the
longer the person has it in their mouth. Haiku is a form of Japanese classical
poetry which uses only 17 syllables: 5 in the first line, 7 in the second,
5 in the last line (Probably easier to do in Japanese than English!). You
can express whatever you want to say, but only within a rigid structure.
Having a structure can free you to express anything that is important,
thoughtfully and artfully. Though I am using the koan as a metaphor, a
koan is much more than a metaphor, to be returned to again and again.
A koan of culture expressed as a haiku:
CULTURE CAUSES, CURES
VIOLENCE, SICKNESS, DEATHS, DIS-EASE
ALL MUST FIND THEIR P(I)E(A)CE
It is (I), who must find (A) piece, and piece by piece find peace.
Other Koans
Before Zen Mountains are Mountains
During Zen Mountains are not Mountains
After Zen Mountains are Mountains
OR
Before enlightenment
Chopping Wood, and Carrying Water,
After enlightenment
Chopping Wood, and Carrying Water.
Think of Culture as a tree first: Yggdragsil, Oak, Bo, Ironwood, Apple, Redwood, Fir, Pinon pine, Joshua, Giant Sequoia.
Multicultural Substance Abuse Prevention Program Assumptions
Created as part of compliance with a Federal Grant.
Researched based best practices.
Prevention Assumption 1
Substance abuse and its prevention occur in a cultural context. Culture is a determinant factor in substance abuse both in positive and negative influences.
Activities: Enhance or Create Non-Abusive Culturally Appropriate Prevention Norms, Materials, Policy, and Activities.
Outcomes: Increase efficacy and longevity of "Prevention Effect", Lowered Use or Abuse in targeted populations.
Evaluation: Core or customer service survey results.
Prevention Assumption 2
Assimilation (erasure of a "native" culture in favor of a dominant
cultural norm) is associated with increased substance use. "Bi-culturality
is associated with lower levels of substance use".(Bi-cultural Competence:):
biculturally competent, ability to function successfully in both culture
of origin or tradition, and in the dominant U.S. culture. (Benard 1991)
Activities: Disseminate culturally appropriate recovery frameworks,
Cultural codes, assimilation paradigms, cross cultural matrices.
Outcomes: Increased bi-culturality
Evaluation: Customer Service surveys
Prevention Assumption 3
The greater the level of education the more likely substance use is to occur. (Hawkins, Catalano, Miller 1992) (Lusane, 1991)
Activities: Enhance bi-culturality
Outcomes: Greater Retention of students.
Evaluation: Increasing retention.
Prevention Assumption 4
Higher Education environments increase the likelihood of substance
abuse problem behavior (Wechsler 1994)
The culture of higher education replicates and reinforces abusive norms.
(More college students binge drink and use marijuana and inhalants than
their peers who are not enrolled in college)
Activities: Information and Education.
Prevention Assumption 5
Community disorganization and unclear community laws and norms are
risk factors for substance abuse. (Hawkins, Catalano, Miller 1992)
Activities: Change or tighten policy.
Outcomes: Policies and practices change and become consistently medically
based.
Evaluation:
Prevention Assumption 6
La Cultura Cura, Culture is the Healing Stuff, Prevention is the practice
of that which makes us strong. Building and enhancing culturally appropriate
resiliency factors in the appropriate domains succeeds regardless of the
"odds" or the number of risk factors in evidence. (Benard, Harris, Nobles,
Vasquez)
Activities: Enhance "bi-culturality": While still validating the student's cultural identity, language, expertise, and self esteem, the rules of the "culture of power" (The ways of talking, writing, dressing, and ways of interacting" necessary for success in the culture of power) must be taught.
Resiliency is not about mere survival or longevity. It is a life that is lived fully, actualized, as optimal as possible. To further promote this idea, we support the promotion of Natural Mind. Natural Mind is non-addictive living.
Natural Mind: The state of being in which the inherent potential in
each human being can develop, grow, be sustained, and expanded by conscious
choice.
You have everything you need to do this, with your natural body chemistry.
Addiction comes partially from using outside chemicals to achieve emotional
/ mental changes.
Different cultures have found answers to the problem we call addiction.
Can you discover the culture hidden in each recovery framework. How to
begin. ( link to Tweakers and Freakers, 12 Step Meetings on Campus. Other
recovery frameworks.)
THE TWELVE STEPS
OF
ALCOHOLICS ANONYMOUS
1.) We admitted that we were powerless over alcohol-- that our
lives had become unmanageable.
2.) Came to believe that a Power greater than ourselves could
restore us to sanity.
3.) Made a decision to turn our will and our lives over to the
care of God as we understood Him.
4.) Made a searching and fearless moral inventory of ourselves.
5.) Admitted to God, to ourselves and to another human being
the exact nature of our wrongs.
6.) Were entirely ready to have God remove all these defects of
character.
7.) Humbly asked Him to remove our shortcomings.
8.) Made a list of all persons we had harmed, and became
willing to make amends to them all.
9.) Made direct amends to such people wherever possible,
except when to do so would injure them or others.
10.) Continued to take personal inventory and when we were
wrong promptly admitted it.
11.) Sought through prayer and meditation to improve our
conscious contact with God as we understood Him, praying
only for knowledge of His will for us and the power to carry
that out.
12.) Having had a spiritual awakening as a result of those steps, we
tried to carry this message to alcoholics, and to practice these
principles in all our affairs. - Alcoholic's Anonymous, Big Book
THE TWELVE STEPS
OF
NARCOTICS ANONYMOUS
1.) We admitted that we were powerless over our addiction, that our
lives had become unmanageable.
2.) We came to believe that a power greater than ourselves could
restore us to sanity.
3.) We made a decision to turn our will and our lives over to the
care of God as we understood him.
4.) We made a searching and fearless moral inventory of ourselves.
5.) We admitted to God, to ourselves and to another human being
the exact nature of our wrongs.
6.) We were entirely ready to have God remove all these defects of
character.
7.) We humbly asked Him to remove our shortcomings.
8.) We made a list of all persons we had harmed, and became
willing to make amends to them all.
9.) We made direct amends to such people wherever possible,
except when to do so would injure them or others.
10.) We continued to take personal inventory and when we were
wrong promptly admitted it.
11.) We sought through prayer and meditation to improve our
conscious contact with God as we understood Him, praying
only for knowledge of His will for us and the power to carry
that out.
12.) Having had a spiritual awakening as a result of those steps, we
tried to carry this message to addicts and to practice these
principles in all our affairs.
-NARCOTICS ANONYMOUS (BASIC TEXT)
THE SIXTEEN STEPS
OF
DISCOVERY AND EMPOWERMENT
1.) We affirm we have the power to take charge of our lives and stop
being dependent on
substances or other people for our self-esteem and security.
2.) We believe that God/ the Goddess/ Universe/ Great Spirit/ Higher
Power awakens the
healing wisdom within us when we open ourselves to that power.
3.) We make a decision to become our authentic Selves and trust in the
healing power of
truth.
4.) We examine our beliefs, addictions, and dependent behavior in the
context of living in a
hierarchical, patriarchal culture.
5.) We share with another person and the Universe all those things inside
of us for which
we feel shame and guilt.
6.) We affirm and enjoy our strengths, talents, and creativity, striving
not to hide these
qualities to protect others' egos.
7.) We become willing to let go of shame, guilt, and any behavior that
keeps us from loving
ourSelves and others.
8.) We make a list of people we have harmed and people who have harmed
us, and take
steps to clear out negative energy by making amends and sharing grievances
in a
respectful way.
9.) We express love and gratitude to others, and increasingly appreciate
the wonder of life
and the blessings we do have.
10.) We continue to trust our reality and daily affirm that we see what
we see, we know
what we know, and we feel what we feel.
11.) We promptly acknowledge our mistakes and make amends when appropriate,
but we
do not say we are sorry for things we have not done and we do not cover
up, analyze,
or take responsibility for the shortcomings of others.
12.) We seek out situations, jobs, and people that affirm our intelligence,
perceptions, and
self-worth and avoid situations or people who are hurtful, harmful,
or demeaning to
us.
13.) We take steps to heal our physical bodies, organize our lives,
reduce stress, and have
fun.
14.) We seek to find our inward calling, and develop the will and wisdom to follow it.
15.) We accept the ups and downs of life as natural events that can
be used as lessons for
our growth.
16.) We grow in awareness that we are interrelated with all living things,
and we contribute
to restoring peace and balance on the planet.
- Charlotte Davis Kasl, Many Roads, One Journey
THE THIRTEEN CIRCLES OF RECOVERY
1.) We believe that we are not responsible for creating the oppression
that
permeates our society.
2.) We believe that a power outside ourselves and deep within us can
restore our balance and give us wholeness.
3.) We make a decision to ask for help from the Goddess and others who
understand.
4.) We acknowledge our beauty, strengths and weaknesses and look at
the
ways we have been taught to hate ourselves.
5.) We acknowledge to the Goddess, to ourselves, and to another person
our successes and shortcomings.
6.) We make a list of the ways we have acquiesced to oppression.
7.) We become ready to say no to oppression.
8) We ask for the courage to resist oppressive situations.
9.) We mend our lives with respect for all.
10.) We continue to be conscious of our actions and thoughts, promptly
acknowledging our mistakes and enjoying our successes.
11.) We seek to improve our conscious contact with the Goddess.
12.) We believe that every moment we are doing the best we can, and
that is
enough.
13.) We accept ourselves exactly as we are, trusting our experience
and
affirming that health, joy, and freedom are our Goddess-given rights.
-ANTIGA, Many Roads, One Journey
Sobriety Through The Sacred Pipe-Cannupa Wakan
1. We admit that we are powerless over alcohol, and that our Indian way of life had become unmanageable.
2. We come to believe that the power of the Sacred Pipe- Cannupa Wakan is greater than ourselves, and can restore us to our culture and heritage.
3. We make a decision to turn our will and our lives over to the care of Tunkasila-Ate through our Sacred Pipe- Cannupa Wakan.
4. We make a searching and fearless moral inventory of who we are, and understand the symbolic meaning of each of the four directions.
5. We acknowledge to the Great Mystery-Tunkasila-Ate, to ourselves, and our Indian spiritual advisor the exact nature of our struggles, wrongs, against the tide and its manifest destiny.
6. We are entirely ready to have the Great Mystery-Tunkasila-Ate remove all these defects of an alien culture.
7. We humbly ask the Great Mystery-Tunkasila-Ate to remove our shortcomings through Lakol wicoh'an, our tribal ceremonial teachings and spiritual growth.
8. We make a list of all the harms that we created to ourselves and to our people from alcohol, and become willing to make amends to them all.
9. We make direct amends to people about our struggle against the alcoholic disease wherever possible, except when to do so would injure them or others.
10. We continue to take a personal, searching an
d fearless moral inventory of who we are, and when we are wrong promptly
accept and admit it.
11. We seek through prayer and meditation to improve our conscious contact with the equality/brotherhood/sisterhood of all the Mother Earth's creatures attaining that spiritual balance of the great harmony of the total universe.
12. Having the universal understanding/wisdom of the hearts, minds,
spirits of all people, we carry this message to Indian alcoholics, and
we practice these principals in all Indian affairs.
- Adapted from Jerry, Many Roads, One Journey
RATIONAL RECOVERY - BASIC PRINCIPLES
REFUSE TO BE AN 'ALCOHOLIC.'
Drink moderately. Or don't drink.
Rational Recovery is a method of learning how to overcome self-defeating use of alcohol and other drugs. It does this by helping individuals develop healthy approaches to problem-solving and relationships. Specifically, Rational Recovery teaches clear thinking about oneself and the world, so that the desire to avoid bad habits becomes stronger than the desire to engage in short term escape from personal problems.
Rational Recovery helps its students dispute beliefs that cause perfectionism, depression, anxiety, and shame. It does this because most people use drugs to help themselves cope emotionally with such difficulties. Thus, Rational Recovery encourages a comprehensive approach to helping people feel better, and also behave better too.
The requirement for participation in RR is the desire to work at changing one's beliefs and a willingness to attempt new behaviors. There is no religious emphasis or encouragement to attend confessional-type meetings.
Rational Recovery is available in four different forms:
1.) On your own, you can force yourself to consider the disadvantages of continuing addiction. If you do this persistently and honestly, your appetite for the drug(s) will eventually fade.
2.) Purchase and study materials on Rational Recovery such as books and tapes, and work at implementing the suggestions and techniques.
3.) Attend a Rational Recovery study group to discuss with others what they have found helpful in beating addictions.
4.) Consult with a clinic that provides Rational Recovery as part of its outpatient mental health services. If such a clinic is not readily available in your community, an alternative is to seek out an individual therapist who practices Rational Emotive Therapy for assistance with learning and practicing these principles. The therapist will assist you in gaining self-awareness and discipline to avoid self-defeating behaviors.
You may want or need a combination of these four options.
- KEVIN HORNBUCKLE
Terms of Resistance
1. I will gain control of my life.
2. I will stop lying.
3. I will be honest with myself.
4. I will accept who I am.
5. I will feel my real feelings.
6. I will feel my pain.
7. I will forgive myself and forgive others.
8. I will rebirth a new life.
9. I will live my spirituality.
10. I will support and love my brothers and sisters.
FOUR ACTS IN THE DRAMA OF RECOVERY
1. Recognition
Recognize the cunning characteristics of addiction, admit our true feelings, and face whatever pain we've tried to hide through our addictions.
2. Self - Definition
We must learn to name ourselves in the midst of the confusion of the world. Am I an addict or a recovering person? Am I a helpless, powerless, weak-willed addict or a person who has anesthetized great inner pain with drugs?
Stop worrying about what others have to say about you. Listen to the voice inside of you that is telling you the truth. You have a void that needs to be filled. How are you going to fill it?
With Chemicals or Community?
With sex or real intimacy?
With lying or with honesty?
With hustling or authenticity?
3. Rebirth
Start living again.
4. Community
Move further into our relationship with our brothers and sisters of all colors and all classes. -Adapted from No Hiding Place by Cecil Williams
Nation of Islam 6 Steps
1. Admit you are a drug addict.
2. Understand that Black Drug use in America is an attempt to escape
or blunt the hurt of racism.
3. Join the Nation of Islam.
4. Belief in own self esteem and worth after association with the Nation
of Islam.
5. Non-chemical detoxification or cold turkey process.
6. Bring the message to other brothers and sisters.
IBCA (Institute on Black Chemical Abuse) prevention pamphlet.
Peter Bell, a founder of the Minneapolis based IBCA and a national
consultant on addictions in the Black community once said, that the most
effective treatment program for Black American's was not 12 step programs
but the Nation of Islam.
The Nation of Islam incorporates characteristics of culturally relevant
treatment that to date most 12 step based treatment centers ignore.
Characteristics of culturally relevant treament (adapted from IBCA Pamphlet)
That Which Makes Us Strong:
Comprehensive Multicultural Health Promotion
by Mark Harris M.A.
While what I do is a Substance Abuse Prevention Counselor, I really think of myself as a Griot: an African traditional musician, storyteller, historian, diplomat, healer. When I use appropriate cultural technology, in the place of non-existent or inadequate mainstream training, I see my addiction counselor skills as a side effect of accepting broader cultural aspects of my humanity. Without this balance I would probably see substance abuse as the only problem facing a client, a common form of social worker myopia. One African-American writer refers to this as "Preferred Problem Myopia". The myopic will decide they will only deal with one drug, one problem at a time. Inevitably it will be the one they are comfortable with, even if that is not one the client most needs to resolve. Appropriate cultural technology means using that which is compatible to the client's best interest. If the client's historical culture of origin has an effective technology for the problem, then I use it. If another culture has technology that would be effective, I use that if it does not require assimilation into that culture.
I define assimilation (negatively) as the eradication of all aspects of one's home culture in favor of a dominant cultural norm. Acculturation is retaining your original culture, while taking on other cultural artifacts such as language, and etiquette to build bridges and to avoid carelessly offending people. Culture is beyond ethnicity and race. Many who identify as white feel that only "ethnic minorities" have a culture and "white" people don't. Many compensate for this perceived lack of culture by adopting cultural artifacts of certain favored ethnic minorities, producing curious hybrids.
"Gary" (A pseudonym) was a 24 year old white male named from Pendelton
(A pseudotown). He came in wanting to know about 12 step meetings.
He stayed over an hour disclosing he was HIV+, had a wife and child somewhere,
and wasn't sure how he got the virus since he had spent time as an adolescent
male prostitute. He also shared needles with other injectable drug users
at a major Oregon timber company. Not surprisingly, he was uncomfortable
with the thought of being labeled gay. He started talking about the stupidity
of prejudice when I interrupted him.
I asked him the most pertinent question I saw: "How's your T-Cell count
today?" "How do you feel at 24 years old having a virus that may in all
likelihood kill you in a few years?" "What is your relationship to your
death?" "How will you use your death as a tool for focused self-discovery
the rest of your life?". "Life and Death prioritize one's focus in a way
that strips away layers of self and societal delusion." "What has your
culture taught you about your relationship with death or even how you speak
or think of death?"
"Well", Gary said "No one has ever asked me those questions before."
"Do you think they are questions you really need the answers to?"
" Yeah but, I never really thought about them till you asked them".
He's not alone.
The issues that Gary faced (HIV, Poly-drug addiction, injectable drug use, sexual orientation, gender, adolescent, lifespan, and career developmental issues) are common. Whether a client is HIV positive or not that still means the prevention and treatment industry must address sexuality at least, and (HIV +) death as a taboo issue. With the best insurance he would get three weeks of 12 Step oriented treatment which is largely focused only on substance abuse. Other issues might be raised or ignored according to the awareness and comfort level of the counselor. The counselor and the industry can and should become universally competent to deal with those issues. Sadly they are not.
With Gary I had to learn about and confront my homophobia (not part
of my training and only recently declared non-aberrant behavior). Some
clients of color will raise issues of race as a smoke screen, especially
with white counselors to intimidate them and thus avoid dealing with their
addiction issues. A competent counselor of any race, gender, or sexual
orientation should be able to determine how to resolve legitimate claims,
given the normative pervasiveness of ISMs. Many practitioners in take a
small town mentality: "There weren't any where I grew up so I plead ignorance."
The option to remain ignorant is one basis of Type 6 based systems of privilege.
(Race, class, gender, education) These confer "normality" upon those who
make up the "mainstream", and "deviance" on others.
Gary identified himself as white, but couldn't really articulate what that meant culturally. Finding out that over 100 Native American Languages made reference to a third gender (in either a male or female body) was useful. Even if Gary wasn't Native American, it was useful to understand that a culture older than mainstream culture, utilized sexual diversity in a way that afforded its members greater quality of life. That it happened before admits the possibility it could be recreated.
A white male former motorcycle gang member in mandated anger management classes, still had uncontrollable anger episodes. The place he liked most in himself was a cool idealized Samurai kind of place. His weapon was his size, or the threat of violence. He wouldn't lose his cool on the street doing large methamphetamine deals, amid volatile situations. These skills are highly valued on the street. He wondered why would he get angry with his family? I posed the question "If your family is more important to you than your "look good" on the street, why don't you apply that same street cool under fire mindset to your family?" In addition to my knowing how street gangs operate, this meant combining fragments of the Samurai Code, Navajo creation stories and other psycho-spiritual constructs. He managed anger more effectively thereafter.
My guide for using cultural information is: If it works outside its original culture, it has to be effective in the most hostile setting. Hostile could be indicative of the environment the people live in rather than the people. Cultural artifacts can often be effective with the genetic heirs to that technology. Sometimes spiritually and culturally compatible others can benefit as well. Assimilation usually destroys any cultural memory and capability.
Some 20 years of research finds that culture plays an integral part in causing and recovering from addictions of various kinds. Research focusing on race finds: Whites (In K -12 school based surveys) use Alcohol & Other Drugs at greater rates than ethnic minorities. Minorities use drugs less than whites until they begin to assimilate into mainstream culture, at which point they begin to use Alcohol & Other Drugs at greater rates, but still generally below those of whites. Research finds that youth who are biculturally competent, i.e. they can function successfully in both their culture of origin and in the dominant U.S. culture, have strikingly lower levels of substance use. Here are Some clues about what bi-culturality could mean for "white" people: Certain cultural values including drug use patterns act as protective factors. These are identified as Cooperation, Communality (community), Sharing, Group support, Interdependence, Social responsibility. These are the values many immigrants bring to our country, and these values keep them from practicing American addictive norms. The second generation as part of the education process loses respect for their traditional culture and starts becoming "mainstream". This was enhanced by school desegregation: the more ethnic minority youth assimilate into mainstream American values, the more likely they are to use and abuse substances. This is also an effect of eliminating bilingual education programs, hastening the assimilation process.
Research finds increased risk factors when ethnic minorities replace their home culture values with dominant culture values such as individualism, independence, competition, the acquisition of wealth or objects, valuing self over others, non-sharing, and glamorizing heavy drinking and drug use. Since education is seen as a key to success, the fact that the longer minorities remain in the educational system, the more likely they are to use and abuse substances, is particularly disturbing. We also see this with white youth well into college: typically identified as a time, even a right to party.
Historically Black Colleges and Universities (HBCU's) have dramatically lower substance abuse rates than their mainstream counterparts. White students attending HBCU's have dramatically lower substance abuse rates than their white peers in mainstream institutions. This implicates culture as a major factor to consider beyond simple ethnicity or curriculum. It is not as simple as "Whites" adopting "minority" values or minorities becoming culturally separatist neo-traditionalists to become healthy.
I practice a multicultural approach where the findings of current science fuse with traditional culturally based drug technologies. It's like combining your grandmother's wisdom with your doctor's training. Cultures use drug substances as medicines, sacraments, leisure, commodities, political tools, and weapons. Alcohol, tobacco, cocaine, chocolate, caffeine, opiates, and cannabis have all been used in these ways. Once a drug is considered "OK", conditions and instructions are put on it to increase the health of a people, and the survival of a particular culture. Advanced cultures dispensed drugs through trained health practitioners. Thus you may drink, but not to intoxication in or out of ceremony. You may smoke tobacco or "the little smoke" (marijuana) but only for prayer or vision. A medicine person might make a distinction between the sacred use of Tobacco and a two-pack a day Marlboro habit. Legal and illegal drug technology in America is in the hands of those to whom drugs are a profitable commodity. Their inherent interest is in promoting consumption i.e. profit, regardless of the public health cost. I see the current use, suppression, and spread of some drugs as weapons of cultural domination or genocide.
Soft technologies (interaction with living systems i.e. Acupuncture, Ayurveda, meditation, martial arts, yoga, tai chi, capoiera, music making) which build inner resources as side effects produce the effects one desires in drug taking behavior. These practices are generally marginalized by society. What if we taught people to do for themselves what drugs or other addictions do for them? Breathwork, body awareness, diet, dreamwork might be starting points.
I began to fuse the addiction model with racism. Racism is a process addiction, which targets co-dependents who internalize and replicate mainstream attitudes towards diversity. Wherever a human difference exists, one can expect a system to reinforce attitudes about it. I see six types of ISM's (Individual, Societal, Structural, Mentality) in operation. Type 1: Overt Individual, Type 2: Covert Individual, Type 3: Generic Institutional, Type 4. Overt Institutional (Conscious), Type 5 Covert Institutional (Conscious), Type 6 Sociostructural Violence (Unconscious).
I assess and refer substance abuse clients using the same generic diagnostic
criteria. Controlling for socioeconomic status and similar crimes uniformly
the whites would get treatment, Blacks and others of color would get no
treatment, or jail. Confronted with indisputable evidence of disparate
client treatment, white practitioners would consistently deny any racism
was present (On a Type 1 personal level). Those few black people who made
it into treatment often failed in treatment, due to "treatment non-compliance."
This non-compliance often took the form of "defocusing, " which in lay
terms means the client is focusing on issues which the counselor deems
detrimental to successful treatment, according to their theoretical framework.
This view is a form of what I call Type 6 racism: Sociostructural Violence,
i.e. we say your critical core issues are unimportant, non-existent, and
therefore fictional, because our training is silent on them. The fewer
still who succeed were most able to assimilate into 12 step culture and
chose not to raise issues of race and class.
I don't have to be a recovering heroin addict to treat heroin addicts.
I don't have to be white to treat white people. I don't have to be gay
to deal with sexual orientation issues. It may help or hinder to be any
of those things, but I should be aware of what the major presenting emotional
issues are, and be prepared to help the client through them. If this seems
like common sense and basic decency to you consider this: People by virtue
of the education they receive, the policies they follow, the scientific
or professional beliefs and attitudes they espouse, cause more discriminatory
acts, (Regardless of their personal feelings) than any of the other 5 types
of ISM's, simply by carrying out their prescribed functions. Type 6 ISMs
are normalized.
What is expected of the culturally diverse is assimilation into a cultural
regimen which focuses on substance abuse exclusively and ignores "political",
"economic", "cultural", "sexual", "gender" and "racial" considerations.
When someone is in denial about their chemical addiction a competent substance
abuse counselor should be able to distinguish when discrimination is a
legitimate complaint, and then detail the remedies to discrimination to
be addressed in addiction treatment.
When someone detoxes from substance abuse, the underlying emotional
issues come to the surface. With many women entering treatment, one could
often expect sexual abuse, domestic violence, and other conditions which
disproportionately affect women, underlying the substance abuse. Treatment
providers have slowly responded to women's treatment issues. With people
of color it would be logical to assume that racism would be a factor hindering
or altering mental health, and therefore a legitimate focus in treatment.
By and large it is not considered a legitimate focus, but one detrimental
to treatment. More than 90% of treatment programs are 12-Step based. The
12 steps were created by two middle class white men, who focused on primarily
alcohol because it was their drug of choice. That model with its quaint
attitudes towards sexuality (Page 69, no kidding) is completely silent
on socially reinforced ISM's like racism.
While the 12 Steps have been adapted to fit other populations, mainstream
treatment programs seem to follow a one size fits all or "12 steps are
for all those who are ready for them. If you aren't ready (i.e. if you
don't accept you are an addict on my terms) you just haven't hit your bottom
yet". If society places you on the bottom to begin with, admitting you
are powerless (1st Step) is acknowledging the obvious. To quote one African-American
who follows the 12 step recovery model: "Racism may not cause me to pick
up the bottle, the pipe, or the needle, but I sure do have to deal with
the pain of it while clean and sober." If it is an issue in maintaining
sobriety after treatment, it should be an issue at intake before treatment.
Seeking chemical sobriety first makes good sense. Addressing prevalent
forms of discrimination is a logical step as well. A complete recovery
must begin with undoing internal and external oppression and related addictive
patterns. Assisting with this process should be the goal of any treatment
program from the first day of intake, as well as the goal of prevention
services.
"Others" have adapted the 12 steps to their own culture or adopted recovery frameworks that fit with their world view. The Twelve Steps Of Narcotics Anonymous was adapted from Alcoholics Anonymous for those whose primary addictions were illegal drugs.
The Sixteen Steps Of Discovery And Empowerment: 2.) We believe that God/ the Goddess/ Universe/ Great Spirit/ Higher Power awakens the healing wisdom within us when we open ourselves to that power. 4.) We examine our beliefs, addictions, and dependent behavior in the context of living in a hierarchical, patriarchal culture.
The Thirteen Circles Of Recovery: 1.) We believe that we are not responsible for creating the oppression that permeates our society. 2.) We believe that a power outside ourselves and deep within us can restore our balance and give us wholeness. 3.) We make a decision to ask for help from the Goddess and others who understand. 4.) We acknowledge our beauty, strengths and weaknesses and look at the ways we have been taught to hate ourselves.
Sobriety Through The Sacred Pipe-Cannupa Wakan: 1. We admit that we are powerless over alcohol, and that our Indian way of life had become unmanageable. 2. We come to believe that the power of the Sacred Pipe- Cannupa Wakan is greater than ourselves, and can restore us to our culture and heritage. 4. We make a searching and fearless moral inventory of who we are, and understand the symbolic meaning of each of the four directions.
Nation of Islam "6 Steps": 1. Admit you are a drug addict., 2. Understand that Black Drug use in America is an attempt to escape or blunt the hurt of racism.
Peter Bell, (A national consultant on addictions in the Black community
to Presidents Reagan and Bush and founder of the Minneapolis based Institute
on Black Chemical Abuse) and once said, that in terms of sheer numbers
the most effective treatment program for Black American's were not 12 step
based programs, but the Nation of Islam. The Nation of Islam incorporates
characteristics of culturally relevant treatment that to date most 12 step
based treatment centers ignore.
Some characteristics of culturally relevant treatment include to:
assist participants develop a "realistic" perception of the "American
Dream" and develop notions of self-worth not tied to the possession or
consumption of material goods.
assisting participants in identifying their links with the larger social
group that they belong to, i.e. race, class, community, and other sectors
of society.
Develop problem solving skills rather than problem denial and problem
avoidance skills;
To engage people beyond their addictive patterns we must engage the whole person outside of the dominant cultural paradigm and recreate or innovate healthier traditions.
The Koan of Culture is this:
Culture Causes, Cures
Violence, Sickness, Deaths, Dis-Ease
All Must Find Their P(I)E(A)CE
Culturally speaking, prevention is the practice of that which makes us strong.
Shta Yoo - Stay Strong
- (Choctaw)
Bio section:
Mark Harris M.A. is a doctoral student in Public Health. He is the
Substance Abuse Prevention Coordinator / Multicultural Substance Abuse
Prevention Program at Lane Community College in Eugene Or.
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URL http://www.lanecc.edu/stuser/koancult.htm
Revised: 3/19/99 (tlb)
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