10 - Issues in specific populations

Abstract

The terms subpopulation and special population refer to various subdivisions of drug and alcohol-abusing groups. Misunderstanding or lack of consideration of variables such as gender, race, psychiatric comorbidity, culture, age, or occupation, and other differences may create or support barriers to the identification and treatment of substance abuser. Awareness of ethnocultural issues is a significant facet of client–treatment matching. This chapter reviews several subpopulations and the issues relevant to psychoactive substance use disorders of each group. Given the important influence of culture on substance use, it is no surprise that awareness and inclusion of cultural values in treatment improves program effectiveness with minority populations. It is important to note that even within a given subgroup there is significant heterogeneity so that no single best approach exists; rather, a general sensitivity and flexibility about incorporation of cultural beliefs and concepts fosters recovery. The inclusion of culture-specific values in treatment enhances credibility and relevance, increases pride and self-esteem, and reduces acculturation stress. Cultural and ethnic traditions also exert some influence on the use of substances. Most cultures endorse rules about the use or control of substances. When movement occurs from one culture to another (e.g., through migration, occupation, or marriage) the original rules or constraints may be lost or in conflict with the norms of the dominant culture. Weak acculturation can also result in inadequate internalization of values, norms, and customs about the control of substance use.