How can cultural congruency help treatment providers develop programs for drug and alcohol abuse?
"Congruency" mean that there is an accord, a harmony, an agreement between parts. In the case of cultural congruency with health treatment of any kind, "congruency" means an agreement or a similarity or a unity between the cultural background of the practitioner and the patient.
congruence or congruency
the quality or state of corresponding, agreeing, or being congruent [congruent adj.: agreeing; accordant from 1375 < Latin congruent] (Collins English Dictionary)
Studies have shown that differences exist between ethnic and cultural groups in their drug and alcohol use and abuse patterns. There are similarly ethnic and cultural patterns in predisposing patterns that precede use and abuse and that predict response to treatment. Research on cultural congruency and public health interventions suggests that cultural congruency (the agreement between the ethnic, cultural and gender background) between counselor and patient improves the outcome of interventions and treatment. Drug use and abuse programs share the same dynamic of improved outcome when cultural congruency is present. When careful attention is given to considering the variants of a population's or individual's cultural framework, then recidivism is decreased while treatment efficacy is increased (recidivism: noun repeated or habitual relapse into harmful activity or practice). Tailored culturally congruent intervention/treatment approaches begin with an examination of the cultural variants and values of the target individual or community population, i.e., what cultural variants are significant to and define the individual/population? Some questions to ask, as pointed out by Amodeo et al. (1997) and identified by Smith and Seymour (2001) are these:
- At what point is the use of alcohol or other drugs considered a problem in this culture?
- At what point is a user deemed to require treatment?
- Who is perceived as owning this problem (e.g., the individual, the family, the community)?
- To what extent is any stigma attached to the problem?
- Are certain individuals more stigmatized (e.g., women)? ("Ethnic Issues And Cultural Relevance In Treatment." Encyclopedia of Drugs, Alcohol, and Addictive Behavior on Gale Cengage)
A broad example of variants in cultural frameworks is the difference between American and European conceptualization of addiction problems. Two distinct differences are that, in general terms, (1) European physicians dealing with chemical dependency, such as the toxicomanes of France, reject twelve-step programs as ineffective and invest heavily in psychoanalytical treatments while (2) they also reject the idea that all psychoactive drugs must be avoided by the recovering addict making a particular case that wine is a food therefore not correctly added to a list of "drugs" to be strictly avoided by addicts. Thus, while it may be true that twelve-step programs may offer a credible bridge between active addiction and active recovery for white Euro-American cultures, it may be less true to assert these programs as a credible bridge for non-white, non-Euro-American cultures.
While the prototype of the twelve-step program, Alcoholics Anonymous (AA), founded by Bill W. and Doctor Bob, had its beginnings in the Christian Oxford Movement (begun at Oxford in 1833 and devoted to fundamental doctrinal truths in the wake of a waning of confidence in the Church as a result of scientific discovery), there were earlier historical antecedents to an approach to addiction that focused on the development of spiritual maturity within the environment of a supportive, like-minded community, examples of which are the Buddhist Four Noble Truths and Eightfold Path, the Hindu Vedas, and the Zen Oxherding Panels. In terms of the subject of cultural congruency, in order for a Buddhist to participate in a Euro-American twelve-step program to addiction recovery, careful attention would need to be paid to the cultural variant between the Christian based "higher power" concept and the Buddhist "faith as a philosophy and a way of life" concept. While the specifically Christian components of twelve step programs are not indispensable, it is necessary that the idea of a "power outside oneself that is capable of bringing one to sanity in terms of one's addiction is necessary" (Smith and Seymour, Gale Cengage).
From a recovery standpoint, addiction can be seen as a disease of self-centered fear that depends on isolation and deeply held convictions regarding the nature and effects of the addicts' drugs of choice; that isolation renders the addict incapable of understanding the disease and its personal effects, which is the basis of denial. So long as the addict attempts to fight the addiction through personal willpower alone, he or she is fighting a losing battle, trapped in emotional gridlock in a state of "white knuckle sobriety," where increasing anxiety from the stress will inevitably result in relapse. The reason for this is that the convictions about use are buried within the individual's spiritual belief system, where they can be reached only if the addict is willing to accept that there is something outside his or her own immediate being that can lead him or her to sanity power higher than oneself. (Smith and Seymour, Gale Cengage)
While the "higher power" concept, with its variants in cultural frameworks, is necessary in spiritual approaches to addiction treatment, the concept of "surrender" is equally needed with equally significant cultural variations. For example, African Americans who have a scarred background in which surrender and subjugation are etched may find the concept of surrender in a white Euro-American culture understandably threatening. Native Americans may find surrender in opposition to their cultural ideal of stoicism and self-reliance. Adolescents may find surrender in an adult-operated program of twelve educationally imposed steps a renunciation of the desire for independence and individuality. Contrastingly, since the word "Islam" literally means "submission to God's will," Muslims may find the least cultural incongruity within twelve-step programs.
An example of a successfully culturally congruent addiction intervention and treatment program is African-American Extended Family Program. The success of the program is founded upon careful observance of the cultural variant within the Africa American community framework that values collectivism or communalism and that finds the restrictive effects of addiction reminiscent of and similar to the effects of slavery as they think of drug and alcohol addictions in terms of drug slavery.
The HAIGHT ASHBURY FREE CLINICS, Inc. (HAFCI)/Glide Memorial Methodist Church African-American Extended Family Program (AAEFP), described in detail in Reverend Cecil William's book, No Hiding Place, represents an important collaboration that has made possible an effective intervention in the inner-city crisis of CRACK-cocaine use. (Smith and Seymour, Gale Cengage)
Some of the cultural variants for African Americans identified as significant in cultural congruency programs are:
- Low self-esteem
- Late introduction into recovery
- Focus on short-term abstinence rather than long-term recovery
- Dialect of African-Americans
- Institutionalized racism
- Internalized racism (HAFCI, 1990; Jackson, 1995; Longshore et al., 1998 and 2000 on Gale Cengage)
Another example taken from American society is that of Asian Americans. Generally taken as a homogenous cultural group of the ideal or "model minority," Japanese Americans, Filipinos, Vietnamese Americans, and Chinese Americans all have very different cultural variants within their cultural frameworks. However, one similarity amongst them all is the social and cultural stigma (stigma: mark of disgrace and rejection) attached to drug addiction and drug users. The great fear of this stigma will be a critical element of cultural congruency in any intervention or treatment program within the Asian American cultural framework.
Source: Encyclopedia of Drugs, Alcohol, and Addictive Behavior, Gale Cengage 2001.
To the extent that drug abuse is a product of environmental factors, then cultural sensitivity, or congruency, can be very important in treating the underlying cause of that abuse. Cultural congruency simply refers to the practice or policy of taking into account unique cultural factors and influences that contribute to the problem and the understanding of which is essential for rectifying the problem. By treating patients with sensitivity to the cultures from which they originated, psychologists and others involved in treatment can better communicate with the patients and have a better chance of successfully treating them. Understanding the variables unique to specific patients or groups of patients, for example, customs and traditions associated with certain ethnicities or religions, as well as environmental factors like socioeconomic status and neighborhood idiosyncrasies like the presence of gangs and other sources of social pressure can contribute considerably to developing a constructive relationship with the patients in question, which, in turn, makes the prospects of successful treatment better.