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Article Excerpt
This article introduces a combination of approaches based on multicultural interventions and sociopolitical themes that provide interventions for working with Latinos with substance abuse problems.
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Thirty-six percent of the U.S. population has used illegal drugs (National Institute on Drug Abuse, 1998). People between the ages of 18 and 25 have the highest percentage of illegal drug use, with 15.6% of them admitting use during the past month and 82.6% admitting using alcohol. Latinos have the third highest percentage of illicit drug use and the second highest percentage of alcohol use of the total U.S. population (Cherpitel, 1999; National Institute on Drug Abuse, 1998). Poverty, unemployment, low educational attainment, acculturation stresses, economic marginalization, and other environmental factors are well-known contributors associated with risk for drug and alcohol abuse (Alvarez & Ruiz, 2001; Bourgeois, 1995; Cherpitel, 1999; Medina, 2001; Ramirez, 1999; Rothe & Ruiz, 2001).
The term Latino is preferred in this article because Latino is an inclusive term that has been used by people of Latin/Hispanic descent in the United States to allow themselves to be empowered in political arenas, humanities, and literature and thus allows Latinos to name themselves (Moore, 1990; Oboler, 1995; Shorris, 1992; Torres-Rivera, Wilbur, Roberts-Wilbur, & Phan, 1999). In addition, for simplicity and to avoid confusion, the word Latino is an inclusive term that refers to males and females according to language guidelines provided by the Royal Academy of Spanish Language (Real Academia Espanola, 2001). Latinos in the United States, on average, are younger than the general population (U.S. Bureau of the Census, 2000). More than 75% of all Latinos are 39 years old or younger, in contrast to 60% of the total U.S. population who are 39 years old or younger. Socioeconomically, 21% of all Latino households are under the poverty level. More than 87% of all Latinos are employed in service-, support-, or labor-related jobs. Although there are an equal number of Latino men and women in the United States, the unemployment rate for men is 12.2% versus 9.8% for women and 5.4% for non-Latino men. The unemployment figures for Latinos are even higher in inner cities because of the lack of reporting by Latinos to Census Bureau officials for fear of penalty by the government (Bourgeois, 1995; Garcia & Zea, 1997). The problem of underreporting has long been supported by other social researchers working with Latinos since the late 1950s (Lewis, 1968; Marin & VanOss Marin, 1990; Steward et al., 1972; Torres-Rivera, 1995; Winddance Twine & Warren, 2000).
In addition, more than 14.9% of all incarcerated individuals in the United States are Latinos. Twenty-three percent of these Latinos are in prison because of drug offenses. Approximately 50% of Latino inmates will be on probation within 2 years of their sentence (U.S. Department of Justice, Bureau of Justice Statistics, 2000). Thus, it is a safe assumption that counselors working with Latino clients will likely find some kind of drug use problem among some of their clients or their clients' families. Consequently, Latino clients and their families are among those needing greater understanding from counselors about Latinos' substance abuse problems and the dynamics that come with these problems (Torres-Rivera, Wilbur, & Roberts-Wilbur, 1998). It is therefore essential to understand the culture-specific counseling needs of Latinos, especially when dealing with the complexity of the dynamics of drug use in the counseling process.
However, very little can be found in the literature about the counseling of Latinos with drug use problems that is culture specific and uses multicultural competencies (Alvarez & Ruiz, 2001; Delgado, 1997; Medina, 2001; National Institute on Drug Abuse, 1998; Rothe & Ruiz, 2001; Substance Abuse and Mental Health Services Administration, Center for Substance Abuse, 1998). Textbooks are usually broad and general, with little information about effectively counseling Latinos with substance abuse problems (Beshoff & Janikoski, 2000; Buelow & Buelow, 1998; Doweiko, 1999; Fisher & Harrison, 2000; Klutschkowsi & Troth, 1995; Stevens & Smith, 2001). Furthermore, the information that is presented about the counseling of Latinos is often inadequate and misleading. Adding to this problem is the lack of accurate research about effective counseling and about the way that many Latinos who have experienced problems with substance abuse have managed to quit by their own means without attending formal counseling programs or self-help groups (Bourgeois, 1995; Cherpitel, 1999; Mirande, 1997; Pico, 1994; Ramirez, 1999; Torres-Rivera et al., 1998).
The purpose of the present article is to view multimodal interventions, multicultural approaches, and humanistic counseling from a genetic perspective. It is hoped this view will help avoid the singular myopic approach of so many professionals in substance abuse counseling when working with Latinos. Training programs based on the traditional disease concept and Euro American traditional approaches (e.g., moral model genetic model, system theory, solution focus theory, behavioral theory, sociocultural theory, biopsychosocial theory) to substance abuse counseling at the expense and exclusion of multicultural approaches (Erickson, 2001; Leshner, 2001; Whittinghill, Rudenga Whittinghill, & Loesh, 2000) may prove too narrow for use with members of ethnic minorities who have problems related to drug use. For instance, numerous substance abuse counseling approaches concentrate on the individual and disregard the power of the Latino family, particularly mothers, during the recovery process (Alvarez & Ruiz, 2001; Pico, 1994).
In this article, the following four points are emphasized:
1. Substance abuse problems among Latinos are a multidimensional, complex problem that requires a multimodal/multicultural approach.
2. Substance abuse problems among Latinos may be redefined as lifestyle or problems in living that are associated with individuals' emotions and behaviors.
3. Substance abuse problems among Latinos and problems in living are associated with issues of the sociopolitical history rooted in racism and discrimination against Latinos in the United States.
4. The honest expression of emotion represents a psychological necessity or force (Blanton, 1996), whereas substance abuse and dishonesty are symptomatic coping behaviors.
Multimodal Approaches
When working with Latino clients, it is essential for mental health professionals to understand that human beings are culturally bound. For counseling interventions to be effective, they must reflect the culture of the client (Torres-Rivera et al., 1998). Conventional Euro American approaches to counseling, and particularly substance abuse counseling, often miss the cultural aspects of different minority groups. For example, some counseling approaches assume that clients' problems are a product of their intrapsychic disorganization or dysfunction without considering external variables (Sue, Ivey, & Pedersen, 1996). Another example is that 12-step programs could clash directly with machismo (which is related to male superiority and the ability to achieve sexual conquest and is also a combination of virtue, courage, romanticism, and fearlessness) and some religious beliefs (Alvarez & Ruiz, 2001; Harwood, 1987). Such approaches devalue individual differences, experiences, behaviors, and choices to change oneself or one's life conditions (Torres-Rivera, 1996). On the other hand, multicultural, bilingual, bicultural, family-oriented perspectives allow a multidimensional definition of substance abuse problems and multimodal counseling approaches with a culture-specific method (Alvarez & Ruiz, 2001; Delgado, 1997; Medina, 2001; Peregoy & Tait, 2001; Rothe & Ruiz, 2001).
Research on working with Latinos indicates that no one counseling approach is more effective than others (Martinez, 1994). Nevertheless, when working with substance abuse, Delgado (1997) indicated that family, bilingual, bicultural, and group-oriented...
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