Discrimination, immigration, treatment expectations, and family stigma are among barriers to Latinos seeking treatment

The following article was recently published on the research page of the Recovery Research Institute website. It explores a new study that indicates Latinos have the lowest treatment seeking rates compared to people of other racial and ethnic backgrounds.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

National studies have shown that individuals who identify as Latino are less likely to seek treatment for substance use disorder or complete treatment at specialty treatment facilities. Barriers to treatment engagement by race and ethnicity have been examined in only a few national studies and results are inconclusive. Identifying barriers to treatment is a foundational step that will allow for public health planning aimed at addressing barriers. The purpose of this in–depth qualitative study was to gain a better understanding of barriers to specialty treatment for substance use disorder that are more prominent among Latinos than other racial and ethnic groups.

HOW WAS THIS STUDY CONDUCTED?

From 2017-2018 the authors conducted a qualitative study which consisted of telephone interviews with participants from Riverside, Los Angeles, San Diego, and Oakland, CA; Brooklyn, NY; Chicago, IL; Miami, FL; and San Antonio, TX, recruited via craigslist (i.e., a web-based advertising platform) to compare barriers to treatment utilization among racial and ethnic groups.

WHAT DID THIS STUDY FIND?

Pinedo fig1

Figure 1. Source: Pinedo et al, 2018

Latinos reported attitudinal barriers to specialty treatment more than other racial and ethnic groups (i.e., cultural, perceived treatment efficacy, and non-abstinent recovery goals). Overall, Latinos commonly felt specialty treatment providers did not understand their unique needs and experience. Specifically, they perceived healthcare providers to be unfamiliar with cultural issues such as discrimination and immigration. Providers were, therefore, discussed in terms of not being able to relate to personal experiences associated with being Latino including alcohol or other drug use which was in turn associated with low treatment efficacy. Being able to have a recovery goal of moderated alcohol use, and not complete abstinence, emerged as a larger barrier for Latinos in seeking treatment at specialty facilities. Its is unclear if these barriers could vary according to generation, meaning, foreign versus native born Latinos.

Social norms barriers towards specialty treatment (i.e., stigma and lack of social support) were more pronounced among Latinos than their White and Black counterparts. Stigma for seeking treatment was strong across all groups but most frequently mentioned by Latinos. Lack of social support from family emerged because it was viewed as “confirming” they had a problem and may tarnish the family.

Control over specialty treatment specifically logistical barriers, such as lack of health insurance, cost of treatment, transportation, and long wait times were highlighted by all racial and ethnic groups during interviews, however, showed no considerable differences in number of times mentioned between groups.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

This study identified specific barriers that discourage individuals who identify as Latino with alcohol or other drug use disorders from seeking treatment, and compared these to other racial and ethnic groups. Barrier identification is important because Latinos seek treatment at about half the rate as their White counterparts although higher estimates have been reported. Latino expectations that providers do not understand cultural issues like discrimination and immigration was an attitude barrier for seeking treatment. Researchers have suggested acknowledging important social contexts such as immigration and discrimination experiences in the delivery of specialty treatment for substance use disorders may increase service use. Latinos low expectations around treatment efficacy where rooted providers having no lived experience with alcohol or other drug problems and therefore are unable able to relate. Treatment facilities may need to promote their use of, or integration with, peer services as a means of showing that lived experience can be a part of the treatment process. Clinicians should be prepared to work with patients whose recovery goals include an initial goal of moderate alcohol use given about half of people in the US who have resolved a problem with alcohol or other drugs are not completely abstinent.

Stigma was heavily endorsed by Latinos including concerns over being seen by colleagues at a specialty treatment facility. To address this barrier, treatment centers might offer telemedicine which is when treatment is delivered using telecommunications technology like Skype but specially designed for secure health care communication.  In fact, a National Recovery Study found that individuals who identify as Hispanic were over one a half times as likely than White individuals to use recovery-related online technology. So, this may be a way to engage more Latinos with substance use disorder in treatment.

LIMITATIONS

  1. Qualitative studies like this use smaller samples to obtain richer ideas and explanations. This study was on only on a total of 54 individuals, of whom only 20 were Latino, recruited by advertisement, so it’s unclear to what extent findings may generalize to Latinos with substance use disorder as a whole. Particularly given the participants were assessed in terms of meeting diagnostic criteria over a 5 year window instead of 12 months, which is more standard.
  2. The barriers to treatment seeking identified in this qualitative study should be further tested in larger samples, and ideally, in a national study to determine the US prevalence of these barriers among racial and ethnic groups.
  3. Latino alone is a large group and there may be generational issues to consider in these outcomes related to foreign versus native born Latinos.

BOTTOM LINE

  • For individuals & families seeking recovery: This study of barriers to treatment for substance use disorder found that expectations of low efficacy were common. This low perceived efficacy of treatment was related to  experiences with treatment providers who had no lived experience with substance use disorder, or providers who were perceived to not understand stressful cultural issues like immigration and discrimination and its association with the onset, clinical course, and remission of substance use disorder. Talk to a treatment provider about setting expectations around the likelihood of remission, their use or integration with peer services, and provider cultural competency.
  • For scientists: This qualitative study found that social norms around low family support and acceptability of seeking treatment may be a barrier among individuals who identify as Latino. Preventative interventions aimed at adolescents and emerging adults that seek to improve the acceptability of using professional services for substance use disorders may have lasting impacts on creating a future culture of support and reduced stigma, that extends to families and communities across generations. In addition, it is important to develop and test strategies that can help engage Latino individuals with services. For example, 12-step facilitation for Spanish speaking Latinos since they value lived experience.
  • For policy makers: This was a qualitative study that examined barriers to specialty treatment for substance use disorder by race and ethnicity. Latino treatment seeking may be improved (and treatment seeking in general) by promoting the use of peer services (i.e., persons with lived experience in recovery), training providers in “cultural humility” in order to increase education around immigration and discrimination and its effect on recovery, and increasing privacy options during treatment. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied.
  • For treatment professionals and treatment systems: This was a qualitative study that examined barriers to specialty treatment for substance use disorder among individuals who identify as White, Latino, and Black. Latino treatment seeking may be improved by (and treatment seeking in general) by accommodating non-abstinent recovery goals around alcohol use, promoting organizational integration with evidence-based peer services (i.e., persons with lived experience in recovery), training providers in cultural humility to increase education around immigration and discrimination and its effect on recovery, and increase privacy options during treatment seeking. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied. It may be important for clinicians to process and problem solve around Latinos’ mistrust in professional treatment and address the family and cultural barriers they may face if attending treatment (i.e., stigma or lack of social support).

CITATIONS

Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1-8.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 54

Guest Blogger and long-time Council friend, Bob W. presents Part 54 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

Jane Austen is recognized as the premier author of the Regency Period in England, the historical period that preceded the Victorian Era.  Her various works adroitly characterize the highly structured yet anxiety riddled social structure of the upper classes of British society. Perhaps her best such rendition is the story Emma, about a privileged, headstrong society girl in a small fictitious town in England.  Early in adulthood, Emma begins to manipulate her peers in her social structure to pursue the lives she believes they should, according to their standing, whether or not they agree with her or whether it is the right thing for them to do.   

Her penchant for such machinations develops to such increasing levels of bad maneuvers that she is ruining various lives irreparably.  Emma remains unconscionable is her efforts until George Knightly, a friend who is her one constant critic, finally convinces her of the extent of the damage she is doing and provokes a change in her behavior.

Emma’s descent into the behavior that so ruins other lives is similar to that of many of us as we descended into the final throes of our disease. We heaped abuse on others as if it was our right to destroy lives; we believed that relationships meant we could treat others as prisoners.  For many of us, it was only in the shock and final realization of such destruction that we could begin to pursue relief and reconstruction.

Think about how we behaved with loved ones at the height of our disease, the abuse and bad behavior that was so destructive and cruel without our even being aware of what we were doing.  And think how we pushed those same loved ones into behavior patterns to protect themselves, even though such patterns set them up for Al-Anon like pathologies. The repair of both sets of behaviors required almost lifelong efforts of recovery for both.

In a late scene in Austen’s book, there is an exchange between Emma and Knightly in which Knightly castigates her for a particularly mean and outrageous series of comments towards a garrulous societal friend. He says: “How could you be so unfeeling? […] How could you be so insolent in your wit to a woman of her character, age, and situation?” 

Emma tries to explain away her affront by diminishing the target, but Knightly will have none of it.  He adroitly points out that, despite Emma’s innermost self being of much higher quality, her penchant to put down and abuse others is destroying who she really is.  This exchange causes a dramatic change in Emma’s consciousness and the beginning of an ultimate resolution of the story…one that is highly enjoyable and uplifting.

For all of us in Recovery, how much like this has it been that a friend, or group thereof, has finally gotten through to our innermost selves, occasions that finally triggered the Journey that ultimately saved our lives and the lives of those around us.

The Council Receives LegitScript Certification

LegitScript Certification

The Council on Recovery is pleased to announce that it has received LegitScript certification. LegitScript is the certification service for drug and alcohol addiction treatment providers that is relied upon by Google, Bing, and Facebook to vet advertisers for eligibility. The certification is a key requirement for advertising on Google.

The Council’s certification from LegitScript will allow it to fully utilize the
Google Ad Grants that The Council was awarded in 2017. The Google Ad Grants program supports registered nonprofit organizations that share Google’s philosophy of community service. It is an in-kind advertising program that awards free online advertising to nonprofits via Google Ads. The Grant provides The Council with up to $10, 000 per month in online advertising in the Google Ads program .

LegitScript, an independent certification organization, has been by Google since 2018 and is a requirement for addiction treatment facilities to be able to advertise with Google. Both Facebook and the search engine Bing rely upon the seal of certification to assure legitimacy of advertisers.

The LegitScript seal of certification posted on web pages helps differentiate the services of legitimate facilities (like The Council) from those engaged in illegitimate practices or illicit activities. Being LegitScript certified is intended to build trust with prospective patients and clients by letting them know the advertised facility operates safely and legally.

Andrew McCarthy Captivates Supporters at The Council on Recovery’s 36th Waggoner’s Foundation Speaker Series Luncheon

Andrew McCarthy at Council Luncheon
Andrew McCarthy captivates The Council’s 2019 Spring Luncheon

The excited buzz among the crowd after The Council on Recovery’s Spring Luncheon confirmed it: Andrew McCarthy was one the best speakers The Council has ever had! Speaking on Friday, April 12th, the actor, director, producer, and an award winning travel writer opened up about his personal struggle with alcohol and drugs, as well as the many gifts of his 27 years of sobriety.

Andrew was preceded on the stage by Luncheon Co-chairs, Bob Candito and Amanda Polich, each of whom shared their own personal stories of hope and recovery. Their heartfelt remarks were followed by an exuberant introduction by Jerri Duddlesten-Moore, who spoke of Andrew McCarthy’s decades of achievement and fame. From his iconic films Pretty in Pink, St. Elmo’s Fire, and Less Than Zero to his work as an actor and director of some of today’s most popular and acclaimed television shows to his award-winning writing as a travel journalist, Andrew’s trajectory of success is of inspiration to all.

Bounding to the stage, Andrew immediately thanked and praised The Council, saying, “… it obviously does some amazing work for the community. The Council is such a solid, strong, dependable, in-the-fiber-of-the-community place, that it’s a real cornerstone. It’s impossible to measure actually what The Council does…or really know how many people The Council is really helping. But, it would be hard to imagine if it wasn’t.”

Andrew then proceeded to captivate the audience of 900+ people with an intimate and revelatory story of his experience with alcohol and drugs from the age of 17 until he became sober at age 29. He related the highs and lows of a life that was dominated by alcoholism until a defining moment in 1992 when he finally asked for help. At the time, he was directed to an organization in New York City that he likened to The Council.

“That’s why I say The Council being there is so great. Because when that moment comes, there has to be somewhere to catch us,” Andrew said, “otherwise we fall.”

In early recovery, Andrew said he did exactly what he was told, including going to support groups. Within a couple of years…”my life started to get better”, he said, “…95% of my seemingly unrelated problems had disappeared by simply showing up, doing what’s in front of me that day, and then going to bed. And waking up and then doing what’s in front of me the next day.”

“In sobriety,” Andrew said, “I was able to find out that if I do the next right thing in front of me, I can have the opportunity to be who I am.”

Andrew’s inspiring message of hope, experience, and strength received a standing ovation from the audience who were clearly touched by his invaluable words of grateful recovery.

Read more about the Waggoner’s Foundation Speaker Series here and scroll through the galaxy of celebrities who have spoken at The Council’s Luncheons.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 52

Guest Blogger and long-time Council friend, Bob W. presents Part 52 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

The ultimate tragedy of alcohol and drug addiction is that some sufferers never achieve long-term, committed sobriety.  The end for most of them is catastrophe, an ugly, untimely demise occasioned by incidents of devastation for friends and family alike.

In the multi-season cable TV series, Breaking Bad, Walter White is a highly qualified, timid high school chemistry teacher in Albuquerque, New Mexico. His knowledge of physics, chemistry and the related sciences is extraordinary. But missteps and fear in his earlier life kept him from achieving wealth and fame in the high-tech business world, a series of conditions for which he harbored deep resentments against his peers who were successful.

Early in the series, Walter is diagnosed with inoperable lung cancer. Over subsequent episodes this triggers a massive mind shift; occasioned by a surge of hopelessness and fear for his family, he develops a hard aggressive edge.  Meeting a former student, Jesse Pinkman, who is a drug dealer, he decides to use his chemistry expertise to manufacture an extremely pure and highly popular form of crystal methamphetamine.  With Jesse, he builds a successful illicit drug business, accumulates massive amounts of cash, and eventually becomes a person of some renown for his skill and ruthlessness throughout the Southwestern United States. This all happens over many episodes with fascinating subplots of death and devastation to people both closely, and remotely, connected to Walter. 

Another interesting element is that he remains anonymous through most of these episodes, even to his brother-in-law who is a senior DEA agent.  His street name becomes Heisenberg, recalling the German scientist who ran the Nazi attempts to build a nuclear bomb, the individual whose existence in the waning years of WWII created a fear that drove the Manhattan A-Bomb Project for the United States.

The process of Walter’s descent into such depravity, through so many episodes, seems a spectacular characterization of the descent of many of us into the deep dark terrors of alcoholism and drug addiction.  In truth, we became our own Heisenbergs within our families and the circles of our associates and friends.

On a few occasions, Walter attempts to remove himself from the business, but his success and renown, and the sense of power that it gives him, pulls him back.  He has become addicted to that sense of power and is unable to resist its pull. The addictive element of that sense is unmanageable…precisely as the addiction to alcohol and drugs became unmanageable to all of us in our disease.  This same addiction, this addiction to power, is also one that many of us felt in our earlier alcoholic lives; it may have even accelerated our own descents into the abyss.

But, tragically, Walter does not recover.  By the end of the series, he has destroyed all of those whom he believed wronged him in his life…and, more severely, he has destroyed everything and everyone that he ever held dear. It all becomes a grim reminder for all of us as to what could have happened if we didn’t get sober when we did.

Infographic: 11 Myths About Narcotics Anonymous (NA)

Here are some of the popular misconceptions about NA that contribute to a lack of attention to the organization as a recovery support resource:

11 NA Myths pdf
[Source: Recovery Research Institute]

The Council on Recovery believes that Twelve-Step programs, patterned after Alcoholics Anonymous (AA), play a vital role in the recovery process. We strongly recommend attendance of Twelve-Step meetings to our clients. However, the meetings and groups themselves are entirely autonomous and are not affiliated with The Council beyond our provision of space for them to hold their meetings.

For a complete listing of Twelve-Step meetings held each week at The Council, including Narcotics Anonymous, click here:

If you or a loved one has an alcohol or drug problem, and need help, call The Council on Recovery at 713-942-4100 or contact us online.