Ethnicity, Culture and Alcohol презентация

Ethnicity, Culture and Alcohol NIAAA Social Work Education Module 10H

Outline Background Alcohol consumption/drinking patterns Alcohol impacts Ethnic and cultural influences on drinking patterns Prevention and intervention

Background Race (physical aspects) Culture (socio-cultural structures aspects) Ethnicity (group identity aspects) Cultural Identification (degree of affiliation)

Background (continued) Ethnoculturally competent practice leads to better outcomes Requires: Self-awareness Knowledge Commitment Ability to appropriately adapt practices

Alcohol Patterns Typical study of “between group” differences: White/Caucasian Americans vs. African Americans vs. Hispanic/Latino Americans vs. Asian Americans/Pacific Islanders Aggregate data mask key “within group” differences

Alcohol Patterns (continued) National origin Immigration/ migration histories Region/geographic distribution Generational and cohort influences Group and religious affiliations

Alcohol Patterns (continued) Relative rates of alcohol dependence Sample average = 3.5%

Alcohol Patterns (continued) Importance of distinguishing aggregate versus disaggregate data Examples: Aggregate Native American data versus data on distinct tribal groups Reservation versus urban versus rural habitation Level of attachment to Native American community and family

Alcohol Impacts Differential consequences of alcohol consumption relate to: Differing (intrinsic, biological) vulnerability Differing (extrinsic, contextual) resiliency Service disparities (access to intervention and prevention resources)

Alcohol Impacts (continued) Differential consequences of alcohol consumption also relate to: Differential rates of alcohol-related medical problems (cirrhosis, esophageal cancer not reflective of drinking patterns) Differential rates of alcohol-related mortality Differential impacts may relate to “drink of choice” Differential impacts may relate to physiology (e.g., ALDH2 gene, ALDH2*2 allele and “flushing” response)

Alcohol Impacts (continued) Mental health and other social effects Alcohol-related problems of men and women continue to be strong predictors of interpersonal violence Historically, alcohol has been used to maintain and preserve an inequitable social order and to reinforce patterns of oppression Alcohol has been recognized by some Native American tribal leaders as a source of their increasing vulnerability, poverty, persecution, and loss of traditional social order and resources

Ethnic/Cultural Influences Drinking is influenced by: Social norms, customs, and traditions of ethnic/cultural context (False) stereotypes, over-estimates, and misperceptions that affect drinking patterns by “normalizing” drinking behavior

Ethnic/Cultural Influences (continued) Alcohol-related cultural norms/values affect: Drinking patterns, reasons Alcohol expectations and resiliency/cultural strengths Preferences, which affect access and relative exposure Drinking contexts, controls, linked behaviors Some consequences

Ethnic/Cultural Influences (continued) Socialization theory explains transmission of drinking norms, customs, and patterns

Ethnic/Cultural Influences (continued) Alcohol risk perceptions vary with cultural norms, may affect use of alcohol Culture affects help-seeking Culture/ethnicity interact with other factors to affect stress and responses

Ethnic/Cultural Influences (continued) Practice and research influence drinking by: Influencing perceptions about ethnic groups’ drinking patterns Inattention to underlying social conditions, inequities that encourage drinking “Problematizing” ethnic groups

Ethnic/Cultural Influences (continued) Ethnicity x Gender (e.g., Hispanic communities) Religion, spirituality (e.g., Asian and African- American communities) Sub-groups may have risk factors/absence of protective factors Norms may include drinking in moderation

Ethnic/Cultural Influences (continued)

Ethnic/Cultural Influences (continued) Alcohol access differs Neighborhoods differ in concentration of suppliers Targeted marketing exists Adolescents encounter differences in offers, have different refusal strategies

Prevention & Intervention Ethnocultural competence in prevention and intervention: Strategy #1 Adapting evidence-based approaches Strategy #2 Developing culturally-specific approaches

Prevention & Intervention (continued) Different cultural and ethnic group approaches to accessing treatment (rates, styles of approach) Models/approaches: Motivational Enhancement Therapy (MET) Motivational Interviewing (MI) Transtheoretical Stages of Change AOD Cultural Framework

Prevention & Intervention (continued) Screening, assessment, diagnosis needs differ: Avoiding “built in” bias of instruments & interview techniques Norming for different groups may be necessary (non-universal “cut” points) Intake success predicts outcomes

Prevention & Intervention (continued) Different “best practice” approaches may be more salient with different groups: For example, behavioral vs. insight orientation vs. AA Approaches must address differences in causality and relapse risk factors Approaches need to draw on different strength factors

Contribute to Alcohol Use Discrimination Racism Oppression Social injustice Ethnocentrism Economic instability

Prevention & Intervention (continued) Community practice addresses: Messages about risk/protective factors Change norms, values, policies Promote cohesiveness Support systems enhancement (including “natural” systems and traditions) Integrate existing services; involve accepted groups/organizations