Asked about the factors that might make addiction treatment services for the Asian-American/Pacific Islander (AAPI) population different from those for other groups, Alan Shinn, MSW, executive director of the Coalition for a Drug-Free Hawaii in Honolulu, replied, “Which of the 35 groups do you want to start with?”
Actually, Shinn understates the issue. According to the National Minority AIDS Education and Training Center, members of 28 Asian and 19 Pacific Islander groups live in the United States. About 70% of the total population in these groups live in four states: California, New York, Hawaii, and Texas.
The global geographic range covered by the AAPI designation is staggering. Ford Kuramoto, DSW, LCSW, national director of the National Asian Pacific American Families Against Substance Abuse (NAPAFASA) in Los Angeles, describes it as going from Pakistan up the globe into China, turning east to Korea, Japan, and parts of China, going south to Thailand, Indonesia, and Malaysia, and continuing into the Pacific to Guam and the six Pacific Island jurisdictions—American Samoa, the Federated States of Micronesia, Guam, the Marshall Islands, the Northern Mariana Islands, and Palau. The nearly 50 groups are reported to speak more than 100 languages and dialects. In addition, the Asian and Pacific Islander American Health Forum (APIAHF) states that about one in four AAPI households is considered linguistically isolated because no one in the home over the age of 14 speaks English well.
Furthermore, most of these nations do not share the West's concept of health and wellness, says Kuramoto: “I'm a third-generation Japanese-American, so for the most part I am familiar with and feel comfortable with Western-style medicine, but I also think that there are valuable things to learn from Eastern-style medicine, including acupuncture.”
Kuramoto says the book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman, offers a good case history of how health practitioners' ideas of proper treatment clash with some Asian families' traditional healing beliefs and rituals, and how chaos can ensue. The child profiled in the book had epilepsy, an illness common in the Hmong population. The elders' understanding of the illness was literally that the spirit catches you and you fall down. Of course, American doctors had quite a different interpretation.
“The same [confusion] presents itself when it comes to how people understand alcohol and drug problems and how they think about getting treatment, what kind of treatment, and whether they will benefit,” says Kuramoto. “There's a different mind-set, you know, [about healing]. A lot of emphasis on herbal medicines and the various non-Western medical healing practices, including massage and shiatsu and meditation, were originated in Asian countries. I think much of it is useful and helpful to our Western-style attitudes and beliefs about health and wellness.”
Know why they are here
At Asian Community Mental Health Services, an agency in Oakland, California, Executive Director Betty M. Hong, MPH, says understanding immigrants and why they have come to the United States matters a great deal in the therapeutic setting.
“Vietnamese had to deal with the Vietnam War and they came to this country distraught and fragmented and having PTSD, so they have a mental health and a trauma issue. They may use drugs and alcohol to mask those behavioral problems,” Hong says. “And [many from] the Cambodian community came here as asylum refugees from the Pol Pot regime, and had to deal with torture and huge atrocities.”
Treatment professionals need to consider that getting to know the client's history constitutes the first order of business, Shinn says. “The experience of an immigrant is not the same as that of a refugee who was forced to leave the country because of war or political situations.
“With native Hawaiians and other Pacific Islanders you have to think about the whole experience from colonialism, how they were once subjugated to another race, or another people,” Shinn continues. “You have to have some knowledge of those cultural remnants that can influence how the [client] may relate to you, especially if you are a white person coming in.”
Hong adds that the Western tendency to separate addictions and mental health in treatment makes serving the Asian population difficult. “What providers see first makes a difference in terms of the treatment,” she says.
Norms related to alcohol
The way in which alcohol is used in a client's native country may differ from that seen in the United States, says Kuramoto.
“In the U.S., the idea of bars and alcohol being served in many places creates a different kind of access to alcohol and tobacco than many people would have back in their native countries, especially the countries that are less modern,” he says. “If you compare Tokyo and Seoul and maybe even a place like Bangkok, they're fairly Westernized. But then you can go to places in Laos, in Vietnam, or in parts of China and they're Third World countries, literally. The access to alcohol and partying and things like that is much different, because people are so poor they basically are malnourished.”
Hong says young Korean males in particular exhibit a high incidence of alcohol bingeing. She says this results from the strict, often religiously influenced culture they have been accustomed to at home, which then is contrasted with the freedom and exposure to alcohol that they experience in this country.