Barriers

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Barriers Challenges in Substance Abuse
Recovery Among Asian-Americans

• Ting-Fun May Lai LCSW CASAC
• Behavioral Health Services
• Hamilton-Madison House
• May 2, 2008
• Recovery Symposium, Philadelphia, PA

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Demographics

• Asian-Americans are not a homogeneous group, it
  consists of over 40 ethnic groups.
• The Asian-American population is a fast-growing
  population in the United States.(14,656,608 2006
  Census)
• Asian-Americans in US are concentrated in 10 to
  15 states.
• 9 US Asian-Americans live in NY state.
• With a high proportion of recent immigrants, more
  than 35 of Asians speak an Asian language at
  home.

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Within-group Diversity Issues

• Different languages dialects
• Different historical trauma background
• Different immigration histories
• Different living,clothing customs
• Different family structure, inter-personal
  relationships
• Different cultural values
• Different substance abuse preferences
• Different help seeking patterns

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Barriers to Treatment

• Underestimation of the extent of the problem
• Lack of dependable statistics research data
• Underutilization of treatment services (delaying
  or not seeking treatment) due to shame stigma
  lack of knowledge, health insurance other
  resources
• Lack of cultural language appropriate treatment
  programs
• Lack of evidence based practice

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Barriers from the Communities

• Strong stigma for substance abuse problems
• Communities hold moralistic attitude towards
  individuals with addiction problems
• Insufficient outreach prevention services
  because Asian Americans being seen as a Model
  Minority not in need of services
• Substance abuse treatment recovery not
  communities priority
• Lack of recovery support services organizations

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Services to Asian-Americans

• Mainstream providers often do not have bilingual
  staff.
• Major barrier to access treatment limited
  language culturally appropriate providers, not
  in all levels of care
• Community based providers often provide services
  but are not reimbursed
• Lacking language appropriate educational
  materials
• Lacking other recovery support services

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Attitude toward Alcohol Substance Abuse

• Not considering alcohol as harmful drug, using
  with herbal medicine cooking
• Moderate use of alcohol at social ceremonial
  occasions
• Outward drunken and acting out behavior not
  tolerated
• Some use of substance at some communities for
  special groups of people acceptable
• Alcohol drug problems, especially related to
  criminal activities considered extreme shame
  disgrace to family

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Alcohol Substance Abuse Patterns

• Insufficient credible research data small
  sample sizes making meaningful analysis
  impossible
• Generally drink less, Flush Syndrome high
  percentage of persons not drinking at all
• Use less of illicit drugs
• Drug treatment admissions among AAPI increased by
  37 (SAMHSA 2000) between 1994 and 1999
• Different pattern of use for different ethnic
  groups, American or foreign born, age groups

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Co-Occurring Problems

• Mental Health problems
• Close relations to addiction problems
• Strong stigma
• Long waiting list for MH services
• Gambling problems
• Asian-Americans have a long history of
• accepting gambling as a community and family
  
• recreation
• High prevalence of problem gambling
  pathological
• gambling
• Communities number one concern

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Recommendations for Clinicians

• Willing to work with client who are not ready for
  total abstinence need a longer time of
  engagement to start with, cut down use
• Avoid traditional reflective, non-directive
  approach
• Focus on external stresses in the early stage,
  offer crisis intervention tangible help
• Respect family secrets and confidentiality
• Accommodate clients work family responsibility
  when scheduling appointment

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Recommendations for Clinicians

• Proficient in clients language/dialect, using
  interpreter only as last resort
• Avoid extensive questioning, assessment
  evaluation clarify and explain all procedures
• Help client develop measurable and tangible
  short-term treatment goals
• Receptive to Somatic Approach Pharmacological
  Treatment

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Strategies to Overcome Barriers Underutilization

• Understanding the cultural and practical barriers
  that exist are the first step in reducing them
• Increase enhance language culturally
  appropriate community education, outreach,
  screenings interventions
• Increase language cultural appropriate
  treatment services in all levels of care
• Improve linkages within the providers networks
  and with community based organizations
• Address the workforce issues for the Asian
  American communities
• Create alternative self-help/support group that
  is less confrontational and more supportive
  educational
• Work with families separately, to reduce enabling
  and negative feelings
• Support research initiatives focusing on Asian
  Americans

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Resources from New York State

• www.oasas.state.ny.us
• go to Specialized Services
• go to Asian-American Services
• 1.Simple Screening Instruments (TIP 11)
• Bengali, Chinese, English, Farsi, Hindi,
• Japanese, Korean Vietnamese
  2. Government Performance Results Act
  
• Instruments (GPRA) Bengali, Chinese,
• English, Hindi Korean
• 3. Other resources such as Presentation etc.

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Questions Discussions

• Thank you!