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...addresses alternative approaches.
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There have been increasing arguments made over the past decade that substance abuse treatment facilities fail to take into account the specific concerns of women and members of ethnic minority groups. Many traditional treatment programs in the United States operate from a model that combines a disease approach to addiction with one that focuses on the character of the addict (i.e., addictive personality) and a spiritual approach to recovery (W. R. Miller & Hester, 1995). W. R. Miller and Hester pointed out that such a model is not as common outside of the United States as it is within the country. In developing their programming, many treatment facilities conceptualize addiction as a disease and draw heavily on the 12-step approach of Alcoholics Anonymous (AA) as a mechanism for recovery. AA itself is a program that was developed by Caucasian alcoholic men based on their own experiences of addiction. Thus, treatment programs that adopt this approach, which combines an understanding of addiction as a disease with a 12-step route to recovery, have been characterized as likewise representing a middle-class, Caucasian model (Berenson, 1991; Drabble, 1996; Rowe & Grills, 1993; Sandmaier, 1992; Saulnier, 1996; Smith, Buxton, Bilal, & Seymour, 1993). Although a clear improvement over earlier perspectives that considered addiction a problem of morality (W. R. Miller & Hester, 1995; Rhodes & Johnson, 1997), the blended model that has become popular nonetheless has its own problems.
There have been a number of criticisms raised regarding using such a "one-size-fits-all" approach to treatment, especially with respect to women and members of ethnic minority groups. One concern has been that the model focuses on individual pathology and fails to take into account social and political realities that may affect not only patterns of use but also the experiences of addiction and recovery (Covington & Surrey, 1997; Ramlow, White, Watson, & Leukefeld, 1997; Rhodes & Johnson, 1997; Rowe & Grills, 1993; Saulnier, 1996). Such a focus fails to take into account the distressing effect of sexism and racism on those who experience it (Rhodes & Johnson, 1997; Watson, 1990; Wright, 2001). In addition, it fails to recognize differences in life experiences that influence the patterns and impact of substance use. For instance, there is greater social stigma attached to drinking alcohol, especially problem drinking, for women than for men (e.g., Covington, 2000; Kline, 1996; Ramlow et al., 1997; Sandmaier, 1992; R. W. Wilsnack & Wilsnack, 1997). Research has found that a large number of women who abuse chemicals have histories of victimization, including childhood sexual abuse, rape and sexual assault, and domestic violence (e.g., Drabble, 1996; B. A. Miller, Wilsnack, & Cunradi, 2000; Rhodes & Johnson, 1997; Vogeltanz & Wilsnack, 1997; S. C. Wilsnack, 1996), and that women are likely to be influenced by a partner's use of chemicals (Vogeltanz & Wilsnack, 1997; S. C. Wilsnack, 1996). Although comorbid psychiatric diagnoses are common among substance abusers, women are more likely to experience concurrent depression and/or anxiety, whereas men are more likely to experience coexisting antisocial personality disorders (Vogeltanz & Wilsnack, 1997).
Likewise, racial and ethnic groups tend to vary a great deal with respect to attitudes toward use and abuse of chemicals (Gilbert & Collins, 1997; Straussner, 2001). These attitudes are also framed by historical influences such as the multiple interconnections between alcohol and the slave trade, the practice of slavery, and the abolition movement (Christmon, 1995; Wright, 2001). Furthermore, among Caucasian Americans with European ancestry, currently the dominant group in the United States, attitudes regarding the use of chemicals by members of ethnic minority groups are often intertwined with general myths and stereotypes about those groups (Caetano, Clark, & Tam, 1998; Wright, 2001). Such attitudes are often made worse by differences in patterns of use between Caucasians and members of ethnic minority groups. Straussner pointed out that whereas alcohol is more problematic for Whites, illegal substances are more problematic for members of many ethnic minority groups, and use of these illegal substances also has additional stigma and social ramifications connected to it. She also addressed the increased prevalence of HIV/AIDS from intravenous drug injection among African Americans and Latinos/as, especially among women. In addition to the medical and psychological issues associated with an HIV or AIDS diagnosis, there is, again, additional stigma for people who already experience oppression due to ethnicity, gender, and perhaps drug use.
Just as there are differences in the nature of psychiatric comorbidity between women and men, limited research has suggested that there are differences along racial lines as well (Cornelius et al., 1996; Pavkov, McGovern, Lyons, & Geffner, 1992). Even within the dominant White culture, there are variations in patterns and ramifications of use related to age and to socioeconocnic status. Researchers have found that the nature of the variations can vary depending on race/ethnicity (Castro, Proescholdbell, Abeita, & Rodriguez, 1999; Jones-Webb, Hsiao, & Hannan, 1995). Cultural beliefs and practices must also be...
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