Alcohol and other drug addiction have had a major impact on African-Americans, destroying far too many black families and communities. The short-term relief one achieves from the use of alcohol and other drugs seduces many African-Americans who are looking for a way out of the stress, frustration, pain, pressure, and sense of hopelessness associated with oppression and the absence of opportunity.
The fast money associated with the illegal drug trade, long seen as a way out of the poverty-stricken ghettos of our nation, has fueled the black-on-black, drug-related violence that is rampant in African-American communities across the nation. The gangster rap music so popular with our black youth further glamorizes drug use and the drug-dealing lifestyle—so much so that many young blacks are eager to make a career out of the drug business.1
The introduction of crack cocaine in the late 1980s and the ensuing hysteria surrounding the crack “epidemic” was particularly devastating to the African-American community, as we saw sharp increases in violence, prostitution, and child abuse/neglect. Although there was no empirical evidence to support the concept of the “crack baby,” the ongoing media campaign served to manufacture public support for a criminal approach to the War on Drugs.
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This public policy is directly responsible for an 800% increase since 1986 in the number of African-American women behind bars, disparate sentences for crack-related offenses, and more blacks being in jail for longer periods of time.2,3 One in nine black males ages 20 to 34 is incarcerated.4
It is no wonder, then, that substance abuse in the African-American community and its collateral consequences of homelessness, mental illness, HIV/AIDS, and soaring foster care costs represents one of the primary public health issues in this country.
Although there have been no large-scale empirical studies to examine the issue of cultural competency in substance use treatment for African-Americans, there are signs of progress. The California Department of Alcohol and Drug Programs has adopted the Institute of Medicine model for inclusion in the redesign of its service system, acknowledging the importance of the commitment to institutionalize appropriate practices to ensure inclusion and respect of diversity in the delivery of services.5,6
Treatment requires trust, honesty, and self-disclosure, and if the client is unwilling or unable to do these things the program will not succeed. Many African-American clients have problems becoming engaged in the treatment process and are not comfortable talking openly about their genuine issues because of cultural norms that forbid “putting your business in the street.” Also, due to a history of oppression, discrimination, and racism, persons of color tend to have a healthy mistrust of bureaucratic systems and services provided by persons viewed to be the oppressor.7
Therefore, African-Americans are either failing to complete programs successfully or are being discharged for noncompliance. This is especially important when we consider that most African-Americans gain access to treatment through the criminal justice and/or child welfare system, and failure to complete treatment often results in loss of parental rights, loss of livelihood, a felony conviction with a long stay behind bars, and/or a return to previous drug use.
While there are no concrete numbers on how many people who relapse never make it back for a second try at treatment, we do know that the disease of addiction is so insidious and deadly that for many people the next time they use could be the last time they use. At the very least, a relapse or a poor treatment experience can extinguish the desire to be clean and sober. We in the treatment industry need to ensure that the treatment we provide affords clients the best possible chance for success. We must continually strive to improve our ability to provide culturally competent services delivered by trained and compassionate staff.
In doing so, we must offer resources, technical assistance, and other training opportunities to our treatment teams. We must meet with decision-makers at administrative levels to ensure that policies and systems that allow African-American clients to feel welcomed, understood, safe, and cared for are developed and implemented.
In the development or evaluation of programs serving African-Americans, the issue areas described below should be considered significant components of a comprehensive, culturally competent treatment model.
The treatment environment should be welcoming to the African-American client. A program does not need to be located in a black neighborhood, but it should be easily accessible to the client (transportation is one of the top three reported barriers to treatment for women). It should aesthetically be made to feel inclusive to the client, with photos, literature, artwork, etc., that portray African-Americans in a healthy way.