How Culture Affects Substance Abuse

Culture and Substance Abuse: Impact of Culture Affects Approach to Treatment

cultureThere have been numerous definitions of culture. here is a simple definition: “It [culture] is a system of patterns of belief and behavior that shape the worldview of the member of a society. As such, it serves as a guide for action, a cognitive map, and a grammar for behavior.”

Substance abuse refers to the abuse of alcohol and other drugs, primarily illicit drugs, but what is considered “illicit” is often culturally determined and can vary between social groups. Most culturally distinct groups have used and abused alcohol and other drugs throughout the ages, and they have established codes of behavior in their approach to drugs and alcohol.

This article begins with a brief overview of the historical background and context for the use and abuse of substances. A review of the effect of culture on the initiation, use, and abuse of substances follows. Finally, some guidelines on culturally informed assessment and treatment are provided. Rather than being all-inclusive, this article focuses on North American cultural groups.

Historical roots, fruits, and plants

Alcohol and many other drugs have been used for thousands of years. Alcoholic beverages have been fermented from an array of plants and fruits since at least 4000 bc. Both wine and beer were first made at about the same time in what are now Iraq and Iran. Some of the earliest references to the use of alcohol are found in ancient Sumerian clay tablets that contain recipes for the use of wine as a solvent for medications. There is little mention of alcohol use in North America before the arrival of whites. However, there are some isolated reports of alcohol use by the Aztec in Mexico, by the Pima/Papago in the Southwest United States, and by the Aleuts from as far north as Alaska. Alcoholic beverages were introduced in larger quantities during colonial times. At about the same time that some groups were fermenting alcoholic beverages, the Sumerians were cultivating the opium poppy, which they named “hul gil,” the plant of joy. The opium poppy was used for its medicinal properties to relieve pain and diarrhea and for its mental properties to provide sedation and euphoria. Its presence in the United States, in the form of opium, was noted among early Chinese immigrants, and later heroin was introduced to urban minority groups, such as blacks and Hispanics.

Marijuana is thought to have its origins more than 4000 years ago in China and later in India. Before its psychoactive use, marijuana (hemp) was used as a fiber, and traces of its use for cloth date back more than 10,000 years in China. Hemp was grown by George Washington at Mount Vernon and was the second largest crop–after cotton–grown in the South before the US Civil War. After World War I, Mexican laborers introduced Americans to smoking marijuana for its psychoactive properties.

Most of the world’s psychoactive plants originated in the Americas–in all, more than 1500 compounds. Included among these mind-altering drugs are hallucinogens, stimulants (cocaine), and tobacco. Cocaine was produced in the Andes of South America and became a major drug of abuse in the United States in the past 30 years. Tobacco was used in the New World in approximately 5000 bc. When Christopher Columbus landed in the Caribbean, he discovered the natives using tobacco for a number of ailments. Within the next 150 years, the use of tobacco rapidly spread around the world. Peyote was used in religious ceremonies in northern Mexico and later spread to southwestern Native American tribes.

The role of culture in substance use and abuse

Sociocultural beliefs can shape the approach to and behavior regarding substance use and abuse. Culture plays a central role in forming the expectations of individuals about potential problems they may face with drug use. For many social groups, this may provide a protective factor. An example is the use of alcohol by the ancient Aztecs before any contact with white settlers. Their use of alcohol was heavily regulated and was only for ceremonial purposes. Non-ceremonial use of alcohol was strictly forbidden under penalty of death.Another example is the development of the peyote cult in northern Mexico. Peyote was used in a ceremonial setting to treat chronic alcohol addiction. This use later became a central part of the Native Amer- ican church, which provided important spiritual treatment for chronic alcoholism.

Initiation into excessive substance use may occur during periods of rapid social change, often among cultural groups who have had little exposure to a drug and have not developed protective normative behavior. Anomie, or loss of a healthy ethnic or cultural identity, may occur among native populations whose cultures have been devastated by the extensive and sudden influx of outside influence.

Because of its low availability, few North American Indians had any exposure to alcohol before the arrival of whites. On the western frontier, potent distilled alcoholic beverages became widely available, and the only model Native Americans had was the drunken comportment of the frontiersman.

Acculturation, the degree to which an individual identifies with his or her native culture, is thought to be related to substance use and abuse. Native American elders believe that many substance abuse problems are related to the loss of traditional culture. Higher rates of substance use have been found in persons who closely identify with non-Native American values and the lowest rates are found in bicultural individuals who are comfortable with both sets of cultural values.

A related situation is that of the immigrant who has moved from his homeland to a new country. Immigrants leave the protective environment of their family behind and are faced with a new set of cultural norms and values. This has been seen in Hispanics who have moved to the United States. Sensitivity to changes in the degree of acculturation has been described in Cuban American, Puerto Rican, and Mexican American women. These women may often assume the drinking behavior of the dominant society and, as a result, they increase their use of alcohol.

A recent study from Washington State demonstrated the accelerated abuse of alcohol and use of illegal drugs in acculturated Hispanics.15 Illegal drug use in the previous month and increased alcohol use were reported by 7.2% compared with less than 1% of nonacculturated Hispanics and 6.4% of whites. Nonacculturated Hispanics (recent immigrants) were more family oriented and had lower rates of drug and alcohol use. Apparently, indigenous cultural values have a protective effect.

August 4, 2015


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