PAC 120 Module 1 Culture, Identity and Addiction Example

Three Clients, Three Histories: How Culture, Identity and Discrimination Shape Substance Use and the Road Into Treatment

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 120: Multicultural Advocacy

Instructor Name

Month Day, Year

Three Clients, Three Histories: How Culture, Identity and Discrimination Shape Substance Use and the Road Into Treatment

Northside Community Recovery, an invented outpatient program in Milwaukee, serves a city of many cultures, and this month three of its clients made the point clearly. Dale, fifty-two, a member of an Ojibwe nation in northern Wisconsin, has been sober for four months and wants to keep attending the sobriety circle at his reservation's community center on weekends; he says it means more to him than the program's groups. Terrence, thirty-four, a Black father of two who was referred by a drug court, told his counselor that the program feels like another arm of the courts that have been watching him since he was sixteen. Rafael, twenty-nine, a Mexican American man, has been attending for six weeks and has not told anyone at Northside that he is gay or that most of his drinking happens in a community where he feels he can be himself only when drunk. This paper examines how culture, identity and discrimination shape substance use and help-seeking for clients like these. The program and all three clients are composites written for teaching; the research is real.

Why Culture Matters in Addiction Work

Culture shapes what substances are used, what use means, whether it is seen as a problem and where people turn for help. It also shapes the counseling relationship itself, since clients bring their experiences with institutions into every session. But culture is not destiny, and every group contains enormous diversity. The task for counselors is to understand how culture and experiences of discrimination may be shaping a particular client's life without assuming that group patterns describe any individual.

Historical Trauma and Community Strength

Gone and Trimble (2012) reviewed research on the mental health of American Indian and Alaska Native peoples. They described serious disparities, including high rates of alcohol-related deaths, suicide and posttraumatic stress in many communities, and they connected these disparities to the history of colonization: the loss of land, forced removal, boarding schools that separated children from families and suppressed languages and ceremonies, and continuing poverty. They also emphasized diversity, since there are hundreds of tribal nations with different histories, and they noted that abstinence from alcohol is common in many communities. They argued that culturally grounded approaches, including traditional healing and community ceremonies, deserve serious attention alongside conventional treatment, and that Native communities' own perspectives should guide mental health services.

Minority Stress

Meyer (2003) proposed the minority stress model to explain why lesbian, gay and bisexual people have higher rates of some mental health problems. He argued that sexual minorities face stress beyond the ordinary, stemming from their stigmatized status. Distal stressors include experiences of prejudice, rejection and violence. Proximal stressors include expecting rejection, concealing one's identity and internalizing negative attitudes about oneself. Meyer's review found higher prevalence of mental disorders among lesbian, gay and bisexual people than among heterosexual people, consistent with the model, and he also described coping resources, such as connection to a supportive community, that can buffer stress. Rafael's concealment, at Northside and in parts of his family life, and his sense that he can be himself only when drinking fit the proximal stressors Meyer described.

Discrimination and Substance Use

Gibbons et al. (2004) followed African American parents and their children in Iowa and Georgia over several years. Parents and children who reported more experiences of racial discrimination reported more substance use, and children's reports of discrimination predicted increases in their substance use over time. The researchers found that the link appeared to work partly through psychological distress, such as anger and anxiety, which discrimination produced and which substance use was used to relieve. Supportive parenting reduced the effect for children. Terrence's description of being watched by the courts since adolescence suggests a long experience of institutional surveillance that may shape both his stress and his trust in the program.

Barriers to Treatment

Guerrero et al. (2013) reviewed research on substance use and treatment among Latinos in the United States. They found that rates of substance use differ across Latino groups and by generation, with some measures rising among those born in the United States. Latinos were less likely than non-Latino whites to receive and complete treatment, and they faced barriers including lack of insurance, limited availability of Spanish-speaking providers and services that did not reflect cultural values such as the central role of family. The authors argued for culturally adapted, evidence-based interventions and for expanding access through health care reform.

Implications for Northside

The research points to several changes. At intake, counselors should ask about cultural identity, community and spiritual practice in open terms, and should ask every client, not only those they assume may be gay, about sexual orientation and gender identity in a way that signals safety. For Dale, the program could treat the sobriety circle as part of his treatment plan and build a relationship with the tribal community's health services. For Terrence, his counselor could acknowledge his experience with the courts openly and clarify what the program shares with the court and what it does not. For Rafael, the program could offer referrals to affirming community groups and sober social events where he can be himself without drinking. Across the program, Northside should review its staffing, language access and partnerships with community organizations.

Limits of This Analysis

Three clients cannot represent the communities they belong to, and the research describes patterns across groups, not the lives of individuals. A Black client may trust the program completely, and a Native client may want nothing to do with traditional healing. The research tells counselors what to ask about, not what they will find.

Conclusion

Dale, Terrence and Rafael show how culture, identity and discrimination shape substance use and the road into treatment. Gone and Trimble connect disparities to history and community strength, Meyer explains minority stress, Gibbons and colleagues link discrimination to substance use and Guerrero and colleagues document barriers to treatment. For a community program, the lesson is to ask, to listen and to build services that each client can trust.

References

Gibbons, F. X., Gerrard, M., Cleveland, M. J., Wills, T. A., & Brody, G. (2004). Perceived discrimination and substance use in African American parents and their children: A panel study. Journal of Personality and Social Psychology, 86(4), 517-529. https://doi.org/10.1037/0022-3514.86.4.517

Gone, J. P., & Trimble, J. E. (2012). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 8, 131-160. https://doi.org/10.1146/annurev-clinpsy-032511-143127

Guerrero, E. G., Marsh, J. C., Khachikian, T., Amaro, H., & Vega, W. A. (2013). Disparities in Latino substance use, service use, and treatment: Implications for culturally and evidence-based interventions under health care reform. Drug and Alcohol Dependence, 133(3), 805-813. https://doi.org/10.1016/j.drugalcdep.2013.07.027

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697. https://doi.org/10.1037/0033-2909.129.5.674