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					Cultural Elements in Treating
    Hispanic Populations
   Maria del Mar Garcia, MSW, MHS

  22nd Annual Multicultural Symposium
           June 8-9, 2006
CBHATTC Headquarters

             St. Thomas

 • 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.
 • 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
 • Discuss helping strategies to treat Latinos
   drug users
   • Hispanics/Latinos (H/L) now comprise the
     largest minority group in the United States

   • 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
 • 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
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 1992-2002
Percent distribution

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
Distribution Map by ATTC Region

     Hispanic Population
     Providers serving Hispanic   < 5%   5-10% > 10%
What is culture?
 • Is the conceptual system that structures
   the way we view the world
   – Beliefs
   – Norms
   – Values

 • 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

 • 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
 • 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

           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
      • 2-Culture Change
Familism in the Latino Culture
 • Strong commitment to family life that
   values collective goals over individual well-
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

 • 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
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
 • 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
 • 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

   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
 • 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