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Unread October 3rd, 2005, 09:59 PM
James Pretzer James Pretzer is offline
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Default Cultural/ethnic/racial issues in CBT

The September 2005 issue of the Behavior Therapist features a special series of articles on treating co-morbid addictive behaviors in "Indigenous, African, Hispanic, and Asian American Groups." Each short article starts with a list of "Top Ten Recommendations" which I'll recap below:

American Indians and Alasks Natives (Blume, 2005)
  1. One size will not fit all.
  2. Traditional medicine practices may be preferred.
  3. Respectful noncompliance.
  4. Language.
  5. Fatalism.
  6. Sickness: a symptom of something else.
  7. The cultural meaning of the behavior.
  8. Spirit world and dreams.
  9. Soul wounds.
  10. Walking in beauty and peace.

African Americans (McNair, 2005)
  1. Actively integrate the client's experiences of race, ethnicity, and culture into therapy.
  2. Directly address racism and discrimination in the client's life.
  3. Conceptualize racisim and discrimination as "triggers" for addictive behavior as well as relapse.
  4. Evaluate the role of racism as a mediator between the client's comorbid disorder and substance abuse.
  5. Address culturally-relevant factors related to initiation of substance use.
  6. Assess the cultural context of substance use.
  7. Assess the cultural context of the comorbid disorder.
  8. Examine the client's engagement in therapy in order to enhance completion of therapy.
  9. Consider the role of gender and race interactions, e.g., women with PTSD related to sexual trauma who also engage in addictive behaviors.
  10. Address potential HIV risk, particularly in women who use cocaine and alcohol.

Asian Americans (Hall, 2005)
  1. One size doesn't fit all.
  2. Only penguins look alike.
  3. Some Asian Americans believe in a genetic etiology of problems.
  4. Some Asian Americans believe in a psychosocial etiology of problems.
  5. There are limited data on comorbidity in Asian Americans.
  6. Treatment is a form of acculturation.
  7. Acculturation in treatment can be coercive.
  8. Matching treatment with client etiological beliefs may be effective.
  9. Clients having genetic etiological beliefs may benefit from a medical solution.
  10. Clients having psychosocial etiological beliefs may benefit from a psychosocial solution.

Hispanics (Castro, 2005)
  • Assess the duration, severity, and type of psychiatric and substance abuse disorders.
  • Consider within-group heterogeniety as related to levels of acculturation.
  • Examine cultural orientations, personal identities, and ethnic pride.
  • Consider traditionalism in cultural life views.
  • Examine cultural and other forms of personal identity.
  • Assess feelings of discrimination and victimization.
  • Consider motivations for recovery and risk of relapse.
  • Examine family connectedness and social support or its absence.
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