Addictive disorders vary widely across nations and cultural groups. For example, unusually high rates of alcohol abuse and dependence occur among some countries of Eastern Europe and North America where some ethnic groups in Asia have high rates of opium abuse. Why is this and what factors might be to blame? Are Cultural Norms to Blame? In my case specifically, sociocultural interventions had a profound effect on me while in treatment and to a large degree are responsible for me becoming culturally competent again. In on of my many given cases, the entrance into a new sober environment occur had widespread affects on me spiritually and psychologically. One area was in my religious orientations. In residential facilities as well as my halfway houses their was a centralized theme, purpose and belief to which I was aware and competent. This type of similar knowledge, skills set and belief system was most reinforcing and comfortable to me. My background and belief set worked well in the similar environment I have always felt most accustomed to from childhood through adulthood. I found this assimilation and continued enculturation to be helpful in my recovery in more ways than not. The philosophies of habitation fit well into my belief system wheelhouse and presented a common thread and protective blank for me to focus on my rehabilitation and individualized treatment plan. This environment emphasized similar thematics in the modalities to which I adhered and which sped up my process of recovery. It connected me in the active participations found in ethnic-specific religious groups, meetings and sessions where I felt most comfortable and most productive. I do believe the culturally sensitive and competent environment has benefited me like other numerous people afflicted with addictive disorders. In the case of religion and the higher power belief, this ideology is more often seen and heard of in recovery institutions when talking about twelve step programs. This worked form me, but what about those without this spiritually founded ideology wher a higher power theme that underlines its purpose. Some people may dislike the concept of a “higher power” emphasized in Alcoholic Anonymous. For some it may work but for other it may prove counterproductive and counterintuitive. Shouldnt the person in recovery have a choice? Shouldnt they decide for themselves? I am happy to report that this is in fact the case and there are choices from all lines of spiritual and nonspiritual identities alike. In one such case, clinicians might refer the patient to Rational Recovery. Some culture-related groups may not specifically address addiction, but can nonetheless support recovery. For example, some Buddhist communal experiences can be extremely useful in these selected cases (49). Why is this? It is logical for us as humans to want, need and seek those environment we are most accustomed to and familiar in our historical frameworks. As in my case and millions of other cases, it is important to have the frameworks in place for culture specific treatments. Therapies specific to particular cultures, ethnic groups, nationalities, and religions can contribute to recovery from substance use disorders. Participation in these programs can and will aid the recovering person in several ways: provision of a stable and sober environment, engagement in meaningful and productive work, availability of emotional support from other members, and establishing a new social identity as a recovering person. There are a few ways in which to provide culture specific treatment. In one such way, a social interventions may be used and in another pharmacotherapy may play crucial roles in the recovery process. Pharmacotherapies also played pharmacocultural roles during my rehabilitation. My associated clinicians provided me with the proper medicines to stabilize my situation immediately and in the short term duration of my inpatient treatment. Certain drugs were used and had profound effects on me and the speed in which I was able to stabilize and ultimately integrating into my long term recovery. Another cultural specific treatment arm as was in the referral process of my treatment plan. A referral to outside treatment physician was helpful in combining my cultural or ethnic values within my expectation of long term recovery. I found it introduced introduces a healthier beliefs in addiction medicine and was most productive. It was never counterproductive or counterintuitive. I think it is important to have the proper training as well as concomitant cross training when faced with conflicting issues such as behavioral and medical recommendations in substance use treatment. In our class readings one paper provided a teaching model I found to be most useful, The Self and Other Awareness Project (SOAP) model of instruction. It has also been developed as an instrument for training in cultural competence (Colvin-Burque et al.,2007). Recognizing self-awareness as a vital component of cultural competence, the SOAP model goes into more depth to identify various teaching strategies in fostering self-exploration. Through the use of large and small group activities, journal assignments, videos, guest speakers, and self-evaluations, this model has demonstrated potential to enhance student self-awareness (Colvin-Burque et al., 2007). Each of these models contributes greatly towards the development of pedagogical frameworks that allow for the selection of teaching materials that will instigate student self-awareness. However, there is a gap in literature that outlines specific teaching exercises to build cultural self-awareness and continued cultural self assessment within these frameworks. I found some recommendations a therapist or program might want to reflect on this framework on maybe what one should do and maybe why. This might play an important role in the outcomes of patients deep within the therapeutic model. Specifically, when cultural norms conflict with behavioral and medical recommendations for addressing substance use disorders it can be counterproductive if not taken into account as well as properly approached. Some recommendations might be, to support the concept of self awareness so that cultural competence is developed. It is shown this is in fact a developmental process which evolves over an extended period. When individuals are at various levels of awareness and cultural knowledge along the cultural competence continuum, the probability of successful treatment is much lower. Cultural competency in more important to the successful recovery process than previous thought years ago and any deflated and unincorporated capacity to engage in a continued self-assessment will prove to be futile. In practice, a self-assessment may help to: • gauge the degree to which you are effectively addressing the needs and preferences of culturally and linguistically diverse groups • establish relationships and diverse partnerships that will meaningfully involve patients their families and key community influences • improve family-patient access to and utilization of services when enabling support groups • increase family-patient satisfaction with all services received from intake to follow up • strategically plan for the systematic incorporation of ALL culturally and linguistically competent policies, structures and practices • allocate personnel, training programs and fiscal resources to enhance the delivery of services • enabling supports that are culturally and linguistically competent at all times personally and professionally to provide continuity • determine each and ever individual for collective strengths and areas for growth There are numerous benefits to self-assessment. Such processes can lead to the development of a strategic successful organizational plan with clearly defined short-term and long-term goals where there will be more measurable objectives, identified fiscal resources as well as enhanced consumer and community partnerships. Self-assessment can also provide a vehicle to measure outcomes for personnel, organizations, population groups and the community at large as presented by the NCCC viewpoint and perspectives. I to believe that self-assessment as an ongoing process, not a one-time occurrence where it offers us the opportunity to assess individual and collective progress over time. Disparity between ideal and behavioral norms results in substance abuse that is costly to many individuals as well as the society or culture at large. Substance use is much too important in most cultures to be left to individual judgments and decisions especially across history of the cultural group norms which have fostered culturally specific norms with regard to substance use. These self awareness assessments will have a most profound effect and affect on us as future providers. Healthcare providers and other addiction specialists will need to appreciate the interaction of cultural entities with addiction in hopes of enhancing their clinical effectiveness. Additionally, cultural factors can and will increase the risk of high failure rates in addiction therapies not to mention undermining their patients' beliefs and backgrounds. Similarly, an appreciation of cultural factors in a patients history may influence the physicians power to help their patients and while increasing their social networks which have been found to enhance treatment outcomes. Additionally, while assessing cultural factors is in a patients culture-ethnicity history will elucidate the patient's current cultural and ethnic affiliations which is paramount in developing proper clinician patient relationship and successful individualized treatment plan. As presented, clinicians and counselors can increase their effectiveness by understanding the cultural elements that the patient brings to the clinic. This task begins immediately on intake when doing the work up and history which will include information do gain a better understanding of the patient's enculturation from childhood to young adulthood and any possible subsequent acculturation experiences. Additionally, any current and past cultural affiliations might prove to be helpful in devising a successful recovery plan as well. This assessment in the patient's intimate social network is a critical first step in this plan as presented in many papers. It is important to remember that cultural factors contributed to the onset of a persons' substance abuse in all substance-abusing patients and subsequently, these same cultural influences provide effective resources to serve clinicians and patients in the challenging process of recovery. We have an obligation and oath to take when taking on the responsibility of helping those with addiction. I to take their recommended motto for future counselors and trainees with regard to the developmental tasks of self exploration and awareness about one’s own cultural heritage and understanding the valuing differences of others. Trainees are affected personally and professionally through a self reflexive orientation with the interactions of their clients who all of which will be multiculturally different. I find we as providers and future therapists will in fact relate better when they are introspective about our own and their own culture-based backgrounds and cultural differences. The Negi and Bender Paper on Self Awareness is quoted in saying, “Therapist, Know Thy Cultural Self” which resonates to me the same to me as, “To Thine Own Self Be True” which I learned in recovery. How fitting and how true! References: Principles of Addiction Medicine, Chapter 14 Principles of Addiction Medicine, Chapter 24 Negi and Bower, Enhancing Self Awareness Study Instrument for training in cultural competence (Colvin-Burque et al.,2007
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