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Addiction & Demographics: Evaluating an Individual’s Treatment Needs

Addiction is a disease that crosses all boundaries. Statistics show that this chronic, progressive condition affects individuals from all walks of life, regardless of their gender, age, race, socioeconomic status, or occupation. Yet within these demographic groups, it is possible to discover patterns of substance use and abuse that affect the lives and health of these individuals. In the admission stage of rehab, and throughout the rehab process, an evaluation of the client’s needs can make the difference between effective, individualized care and a cookie-cutter approach to rehab.

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What Makes Addiction Universal?

The compulsive actions and thoughts associated with addiction vary from one individual to another, yet there are neurological and behavioral patterns that make this disease truly universal. No matter what the individual’s background may be, addiction has the following characteristics:

  • It is compulsive. Unlike recreational drug use or social drinking, which users can at least partially control, addiction is unmanageable. Drinking or drug use feels mandatory, not optional, and once individuals start using, they are rarely able to stop. Powerful cravings make it difficult to concentrate on work, family relationships, or activities that people used to enjoy.
  • It is progressive.Unless a user makes a conscious effort to stop using a drug, with help from professionals, it is likely that the disease will continue to get worse, or progress, until the user becomes seriously ill and debilitated. Addiction can ultimately end in death, either by an accidental or deliberate overdose, or by a physical illness caused by the disease.
  • It is repetitive.Users struggling with addiction repeat the same destructive behaviors over and over again, in spite of the harm they do to their bodies, their relationships, their finances, and their jobs. When people do try to quit, they will almost always go back to using, or relapse, without the help of a strong support system. Although individuals may feel torn apart by guilt or remorse over their behavior, these feelings alone are rarely enough to make them stop.
  • It is obsessive.Once users cross over from chemical abuse to addiction, their thoughts are consumed by the drug. Addicted people become preoccupied with all aspects of using the substance of choice, regardless of the consequences to health.

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According to the American Society of Addiction Medicine, addiction affects the areas of the brain responsible for executive functioning, or judgment and reasoning. Those struggling with addiction lose the ability to think clearly about their behavior and its impact on their own lives, or the lives of their loved ones. They may take dangerous risks that affect their health and safety without considering how those risks could change their future. In other words, addiction distorts the boundaries between right and wrong.

Addiction is universal because it affects neurological patterns that are common to all humans. The brain has a built-in reward system that reinforces healthy, life-sustaining behaviors, such as the pursuit of food, warmth, sexual activity, and physical intimacy. This reward system is based on the release of brain chemicals called neurotransmitters, which generate feelings of contentment or happiness in response to healthy behaviors. The primary neurotransmitters involved in the reward process are dopamine and serotonin. Norepinephrine is also involved in the production of energy and excitement.

Dopamine, which creates the powerful feelings of euphoria and happiness associated with substance abuse or high-risk behaviors, is not just a “feel-good” chemical. Samantha Smithstein, PsyD, states in Psychology Today that “[dopamine] tells the brain what is important and what to pay attention to in order to survive.” The dopamine rush may also explain why people who work in uninspiring jobs, have few social relationships, or live in impoverished conditions are drawn to drugs and alcohol: “… those that have fewer salient things in their lives that capture their attention are more vulnerable to those things that may give them a rush and alert the brain in a powerful way,” Smithstein adds.

Unfortunately, these same neurotransmitters can be triggered by the use of alcohol or drugs. Once the reward system has been activated by compulsive substance use, the user will eventually be driven to repeat the behavior in order to recreate those feelings of happiness and euphoria. If the user attempts to stop using the drug or to cut back, the brain responds by creating physical and emotional withdrawal symptoms to compel the user to take more of the drug. The withdrawal experience is so uncomfortable and unpleasant that it very often overcomes the user’s willpower, self-discipline, and desire to lead a sober life.

But addiction is not just a matter of compulsively seeking pleasure. Psychology Today notes that compulsive behaviors like drinking, using drugs, or gambling are also learned responses to stress — a phenomenon that affects all members of society, no matter what their gender, race, or socioeconomic background might be. Once individuals learn that performing a certain behavior will help relieve emotional pain, fear, anxiety, or other uncomfortable feelings, they are likely to repeat that behavior, even if it ultimately has a destructive effect. In recovery, clients must learn new ways to cope with mental stress, traumatic memories, and emotional pain without turning to a substance or destructive behavior.

Addiction by the Numbers: How Demographic Groups Compare

Statistics from the 2013 National Survey of Drug Use and Health, a nationwide report that tracks substance abuse and treatment across all the major demographic groups, provide an image of addiction in the US today:

About 9.4 percent of Americans age 12 and older (24.6 million) had used illicit drugs within the 30 days before the survey. Out of those who used illicit drugs, 22.7 million had a problem severe enough to require treatment.

Asian Americans had the lowest level of illicit drug use, with 3.1 percent reporting the use of illegal substances. Among Hispanic Americans, 8.8 percent used illicit drugs, compared with 9.5 percent of Caucasians, 10.5 percent of African Americans, and 12.3 percent of Native Americans and Alaska Natives.

More American males used illicit drugs than females (11.5 percent versus 7.3 percent), and more males abused multiple drugs, including marijuana, cocaine, meth, and hallucinogenic drugs, than females.

Approximately 57 percent of American males age 12 and older were current users of alcohol, compared with 47.5 percent of females.

Males were nearly twice as likely to binge drink, or consume five or more alcoholic beverages in one session, as females, with 30.7 percent of males admitting to binge drinking versus 14.7 percent of females.

White Americans were more likely to report that they were current consumers of alcohol (57.7%) than African Americans (43.6%), Hispanics (43%), Asian Americans (34.5%), or Native Americans (37.3%).

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There are many more variables that influence an individual’s substance use patterns but aren’t necessarily reflected in national statistics, such as an individual’s ethnicity, profession, religious affiliation, family background, and history of personal trauma or abuse. In the assessment stage of rehab, clinicians must discover these variables when they evaluate a client, so treatment can be tailored to the client’s needs.

Assessing Unique Treatment Needs

If addiction is a disease that transcends the boundaries among demographic groups, why is it so important to consider the needs of a specific client in treating this disorder? To some degree, addictive behaviors can be addressed as universal, but when it comes to resolving the problems that affect the individual, then the factors that contribute to addiction must be addressed. Otherwise, the client is more likely to feel alienated, isolated, or lonely in treatment — and more likely to drop out early.

Professionals in the fields of mental health and substance abuse treatment have become more aware of the need for personalized, culturally sensitive care that reflects the needs of the individual. With this trend comes a new emphasis on the importance of personalized assessment and evaluation at the beginning of the treatment process, and at various stages throughout rehab and recovery. Listed below are some of the demographic categories that should be taken into consideration when evaluating a client.

Men

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Gender plays a key role in the outcome of addiction treatment. In general, substance abuse is more prevalent in men than in women, and there are more males enrolled in rehab programs than females, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). American men face the pressure to live up to an image of strength, competence, and self-sufficiency, yet in rehab, they may be forced to confront their own weaknesses and vulnerabilities as they face the consequences of addiction. In fact, stereotypes of masculinity can lead to denial of substance abuse and create barriers to recovery. Men often feel uncomfortable admitting that they need help or that they need to rely on others for support in recovery, even if they have a profound need for support. Rehab for male clients often focuses on the following issues:

  • Building stronger intimate relationships
  • Communicating effectively with others
  • Managing strong emotions (anger, grief, resentment, and frustration)
  • Addressing the problem of domestic abuse

Because males are socialized to complete specific goals and take action to solve problems, men tend to respond well to action-oriented treatment plans that allow them to complete specific tasks on the course of recovery.

Women

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Like men, women are subject to gender socialization, and treatment must acknowledge these culturally created roles. While men are expected to be strong and independent, many women with substance abuse issues feel the need to nurture and care for others, either in the role of mother, wife, or girlfriend.

Women seek help for substance abuse at much lower rates than men. According to the TEDS Report, only approximately 33 percent of the individuals admitted for treatment in 2011 were female, while 67 percent were male. This discrepancy, in part, reflects higher rates of substance abuse among men than women; however, it also reflects a reluctance among women to admit the need for help or to believe that they deserve recovery services. Women may also refuse treatment because of childcare responsibilities, a lack of financial resources to pay for treatment, or a lack of adequate transportation.

Because women are often better at recognizing and addressing the needs of others than identifying their own needs, therapeutic services must focus on self-care techniques. Building self-esteem, setting boundaries with partners and children, managing stress, and improving communication skills are also important in helping females recover from drug or alcohol abuse.

Pregnant Women

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According to the NSDUH of 2013, pregnant women abuse illicit drugs at about half the rate of non-pregnant women (5.4 percent versus 11.4 percent). Alcohol use was much lower among pregnant females (9.4 percent) than among non-pregnant women (55.4 percent).

Drug and alcohol abuse are more common in the first trimester of pregnancy, possibly because a certain percentage of women continue to abuse substances before they realize that they are pregnant. Unfortunately, substance abuse during the first and second trimesters poses a high risk of causing birth defects and complications with pregnancy. Methadone and buprenorphine have proven to be highly effective at helping pregnant women overcome opioid addiction and preventing neonatal abstinence syndrome (NAS), or drug withdrawal symptoms in newborns.

One of the greatest obstacles to treatment for pregnant women struggling with addiction is the fear of being judged, criticized, or even legally prosecuted for abusing substances during pregnancy. Pregnant women need to be offered a full range of recovery services, as well as information about childcare, affordable housing, transportation, and other social resources, without fearing legal complications.

Parents in Need of Rehab

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Parents who are challenged by addiction often face guilt and regret over the effects of their disease on their children. Substance abuse has a profoundly negative impact on families, creating emotional strife and breaking bonds of trust. According to a report from CASAColumbia, drug and alcohol use among parents is responsible for up to 70 percent of child abuse cases in the US. In addition to increasing the risk of abuse and domestic violence, substance abuse can affect parenting in a number of important ways:

  • By leaving children vulnerable and unsafe
  • By creating a chaotic home environment
  • By interfering with parent-child relationships
  • By causing developmental and behavioral problems in children
  • By increasing the risk that children will develop substance abuse problems of their own

Substance abuse is both caused and worsened by a lack of coping skills to handle emotional stress. In recovery, parents need help not only with their own stressors, but also with the problems inherent in the family. In households where one or more people abuse drugs or alcohol, family members often have problems with communication, trust, and setting boundaries. Intensive family therapy, both with individual parents and with the family as a whole, is a critical component of a successful treatment program for parents. Parents can also benefit from participation in support groups or 12-Step fellowships, where they can gain hope and strength from the experiences of other mothers and fathers like themselves who are challenged by addiction.

Students

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The 2014 Monitoring the Future survey, which tracks drug and alcohol use among American adolescents in junior high and high school, indicates that a significant number of teens are abusing illegal or legal substances:

  • Alcohol: 37.4 percent of 12th graders, 23.5 percent of 10th graders, and 9 percent of 8th graders used alcohol in the past month
  • Illegal drugs: 23.7 percent of 12th graders, 18.5 percent of 10th graders, and 8.3 percent of 8th graders used illegal drugs in the past month
  • Marijuana: 64 percent of 12th graders believe that marijuana use is relatively safe

Marijuana, prescription medications, and over-the-counter drugs were the most widely abused drugs among high-school seniors.

Teens are at a vulnerable stage in their neurological development. The prefrontal cortex, or the area of the brain responsible for judgment and impulse control, is not yet mature, which makes teens more likely to engage in high-risk, thrill-seeking behavior. In rehab, teenagers must learn new strategies to cope with the powerful emotions and impulses that drive their actions. This can be accomplished through therapies like Cognitive Behavioral Therapy (CBT), which teaches young clients how to transform destructive thoughts and impulses into more positive thoughts and behaviors. Many teens respond well to experiential therapies, such as art therapy, music therapy, or equine therapy, which allow them to practice new coping skills and acquire a sense of responsibility and accountability.

Family therapy, continuing education or tutoring, and peer support groups are crucial components of a rehab program for teens. Group therapy sessions, in particular, can teach teens how to establish healthy friendships and replace negative peer pressure for positive social reinforcement. Family therapy can strengthen ties with parents and help teenagers learn how to respect boundaries and communicate effectively with family members.

Older Adults

As the baby boomer generation ages, the number of Americans age 65 and older is increasing rapidly. With that population change comes a growing problem of substance abuse among older adults. Estimates published in Today’s Geriatric Medicine indicate that up to 15 percent of seniors living in the community have a problem with alcohol, around 20 percent misuse prescription drugs, and approximately 1.7 percent use illegal drugs like marijuana.

Because older people metabolize drugs and alcohol more slowly, smaller amounts of these substances can lead to chemical dependence and addiction. Alcohol and drug addiction often go unnoticed or untreated in the elderly population, however, for the following reasons:

  • Healthcare providers have inadequate training in the identification of substance abuse in elderly patients.
  • Due to cultural stereotypes about aging, younger Americans often assume that the elderly are not vulnerable to addiction.
  • Older adults may feel ashamed or guilty about substance abuse, considering it a moral failing rather than a disease.
  • Healthcare providers frequently overprescribe medications or prescribe multiple medications to older patients, leading to potentially dangerous drug interactions or chemical dependence.
  • Older people may misuse prescription medications, such as painkillers or tranquilizers, without being aware of the health consequences.

Recovery services for seniors must address the social and emotional problems that these individuals face, such as isolation, chronic disease, loss of partners or other family members, and financial stress. In retirement, many older people find themselves struggling with a loss of social connections and personal identity, as well as a reduction in income. Addiction treatment must focus on helping older clients rediscover sources of self-worth and purpose, as well as providing education on the health risks of alcohol and drug abuse.

Codependent Relationships

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In codependent relationships, one person feels an excessive sense of responsibility for the other, leading to a mutually destructive bond. In codependency, one of the parties involved — often a romantic partner, spouse, or parent — takes control over the other person’s addiction, unconsciously enabling the addict to continue the destructive behavior. The codependent will attempt to “help” the addict by covering up the signs of substance abuse, so that the person can continue to drink or use without being held accountable. Some of the typical codependent behaviors include:

  • Lying to the addict’s boss or colleagues when the person is too intoxicated or hungover to work
  • Making excuses for the person’s behavior to friends or family members
  • Paying the person’s bills when money is an issue
  • Accepting abusive treatment or even violence because the person “can’t help it”

Perhaps the greatest barrier to recovery is the codependent’s denial that help is needed or deserved. Codependents frequently suppress their own needs, refusing to believe that they need support just as much as their partners. “Not only do codependents deny their own addiction — whether to a drug, activity, or person — they deny their feelings, and especially their needs, particularly emotional needs for nurturing and real intimacy,” writes Darlene Lancer, JD, MFT, in Psych Central.

In rehab, codependency must be treated as a disease that is just as destructive as addiction itself, and codependent partners must go through their own form of recovery. Marriage and family counseling, education programs, and membership in 12-Step groups like Al-Anon or Co-Dependents Anonymous can help both of the partners in a codependent relationship restore their accountability and recover from the disease of addiction.

First Time in Rehab

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Rehab is an intense experience for anyone who commits to recovery, but it can be especially intimidating for an individual going through treatment for the first time. These individuals need careful assessment, orientation to their treatment program, and additional support in order to achieve the best outcome. A client who feels overwhelmed or unsupported is likely to drop out before finishing the program. Joseph A. Califano Jr., founder of the National Center on Addiction and Substance Abuse, was quoted in TIME as stating that “The therapeutic community claims a 30% success rate, but they only count people who complete the program. Seventy to eighty percent [of clients] drop out in three to six months.”

In order to engage new clients in treatment and motivate them to continue, they must have a personalized treatment plan that reflects their needs, along with the support of a multidisciplinary treatment team. In the assessment stage, clinicians must be able to identify the variables that could affect clients’ chances of recovery, such as the presence of a co-occurring mental illness. A comprehensive aftercare program, including participation in community-based support groups and transitional housing in a sober living environment, can significantly improve a new client’s chances of long-term abstinence.

Chronic Relapse

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For many people who abuse drugs or alcohol, relapsing after a period of sobriety is emotionally devastating. They may feel that they have failed themselves and their loved ones by going back to the behaviors that motivated them to go to rehab in the first place. But relapse is one of the primary symptoms of addiction, and the majority of individuals who go through treatment will do so more than once.

The National Institute on Drug Abuse states that although addiction is a treatable disease, relapse rates among substance abusers are similar to relapse rates among individuals who suffer from other chronic health conditions, such as diabetes, asthma, or high blood pressure. In spite of their best intentions, most people who have been through detox and rehab will return to their dysfunctional coping mechanisms (i.e., drugs or alcohol) and require one or more repeated courses of treatment.

For an individual who has relapsed multiple times, long-term residential treatment lasting six months or more may be the most effective solution. Many of these clients suffer from the long-term psychological effects of drug or alcohol withdrawal, such as depression, anxiety, or anhedonia (the loss of the ability to experience pleasure in everyday life).

“Post-acute withdrawal syndrome (PAWS) is very significant in chronic relapsers and frequently interferes considerably with an individual’s ability to understand recovery principles in early sobriety,” states Heidi Voet Smith, LPC, in Addiction Professional. Many of these individuals have recovered physically from the effects of addiction, but have not yet experienced the deeper, more personal benefits of leading a sober life.

For the chronically relapsing client, there must be a high level of accountability, as well as an intensive focus on the spiritual and emotional side of recovery. Partners and family members must be actively involved in the treatment process in order to address problems of codependency or resistance that may be interfering with the individual’s abstinence.

Co-Occurring Disorders

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Substance abuse is often accompanied by, or exacerbated by, an underlying mental illness, a condition known as co-occurring disorders, or a dual diagnosis. The National Alliance on Mental Illness (NAMI) notes that approximately 30 percent of individuals who have some form of mental illness also experience substance abuse, while as many as 50 percent of those who have a severe mental illness, such as major depression, bipolar disorder, or schizophrenia, also abuse alcohol or drugs. Mood disorders, anxiety disorders, and post-traumatic stress disorders commonly co-occur with alcohol or drug abuse, which may be used as a form of self-medication for individuals trying to manage their own symptoms. Substance abuse can also mask the symptoms of a psychiatric disorder, and vice versa, making it difficult for clinicians to identify each condition.

In treating co-occurring disorders, it is very important that treatment for the client’s psychiatric disorder be integrated with treatment for the substance use disorder. Otherwise, the chances that the client will experience a return of addictive behavior or psychiatric symptoms after treatment is very high.

Integrated treatment means that mental health care and recovery services are provided at the same facility, by staff members who have been trained in both fields, and that the client’s treatment plan be customized to reflect specific mental health needs. Clients with co-occurring disorders often suffer from low levels of motivation, anxiety about working with others, or the inability to focus on recovery activities. They may require additional support and specialized therapeutic approaches to engage them in treatment and motivate them to advance through the stages of recovery.

Comorbid Medical Conditions

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Substance abuse often goes hand in hand with health problems. The effects of heavy drug and alcohol use can set the stage for serious chronic medical conditions, such as high blood pressure, liver disease, diabetes, pancreatitis, stomach problems, cancers of the digestive tract or respiratory system, as well as communicable diseases like hepatitis and HIV/AIDS.

Individuals with comorbid medical conditions — or physical illness combined with substance abuse — require more intensive monitoring in rehab, especially during the detox stage. Round-the-clock observation by doctors, nurses or health technicians ensures that these clients remain stable as the drugs and alcohol clear their bodies.

In addition to monitoring and medical care in the detox stage, clients with comorbid conditions may need support services and education to help them maintain their health during and after treatment. They may require medication adjustments or nonpharmaceutical pain management interventions in order to reduce their need for habit-forming narcotics. Nutritional counseling, recreational therapy, and fitness programs can help these individuals achieve greater overall health as they advance through the process of recovery.

Rehab Needs by Profession

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The National Survey on Drug Use and Health shows that substance abuse is a serious problem in the American workplace. Between 2008 and 2012, 18.7 percent of Americans who were working fulltime reported heavy use of alcohol, while 8.6 percent abused illicit drugs. Nearly 10 percent (9.5) of employed Americans age 18-64 were chemically dependent on drugs or alcohol during that time. Given the loss of work time, the effect on job performance, and the risk of injuries or accidents caused by substance abuse, these figures have a sobering impact for employers and employees alike.

A person’s occupation plays a significant role in lifestyle choices, stress levels, and emotional health. All of these factors can contribute to an individual’s use of drugs or alcohol, as well as the barriers that might stand in the way of treatment. For instance, members of the medical profession are exposed to high levels of emotional stress, as well as exposure to health hazards; at the same time, they often have easy access to prescription narcotics. Yet they may be reluctant to seek treatment because they fear losing their jobs and their licenses to practice medicine. Construction workers are required to have the physical strength and mental acuity to perform demanding and complex labor, yet they are exposed to job instability and hazardous work environments.

The stressors and triggers associated with a client’s profession must be taken into account when developing an individualized treatment plan. Some rehab programs are customized to meet the needs of certain groups of professionals, such as corporate employees, attorneys, healthcare professionals, construction and industrial workers, and military members/first responders. These plans, often supported by Employee Assistance Programs (EAPs), provide a safe, supportive environment where clients can learn new coping strategies to deal with the stress of their particular profession.

Socioeconomic Considerations

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Even in an egalitarian society that has no official class system, socioeconomic status is one of the most important factors in determining our opportunities and challenges. Individuals who live in poverty face a different set of stressors and obstacles than those who are members of the wealthy or working classes.

When it comes to rehab, Americans with stable jobs are more likely to have health insurance coverage than those who are chronically unemployed, which may make it easier for them to find affordable treatment. The lack of medical insurance or other financial resources is the top reason that individuals who needed substance abuse treatment did not receive it, with 37.3 percent claiming that they could not afford rehab in 2013, according to the National Survey on Drug Use and Health. Another 8 percent stated that they did not have adequate transportation, and 6.6 percent said that they feared losing their job if they went to rehab.

Even though publicly funded rehab programs and sliding-scale payment options are available for individuals with low income levels, poverty can still be a significant barrier to treatment. In addition to lacking the means to pay for rehab, people living in poverty may lack access to reliable transportation or childcare, both of which are necessary to participate in certain programs. If they are employed at a low-wage job, they may fear losing that source of income, however small, if they take time off to go to rehab. A comprehensive rehab program must address these needs in order to give these individuals the opportunity to overcome addiction.

Victims of Trauma and Domestic Abuse

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Many individuals who have had traumatic experiences, or who have been abused by a relative or partner, have firsthand experience with substance abuse, as well. Drug and alcohol abuse often occur as a result of suppressed memories of life-threatening experiences, or as a way to cope with the pain and fear of domestic violence. The National Resource Center on Domestic Violence presents disturbing statistics on the relationship between addiction and domestic abuse:

  • Between 25 and 50 percent of women who seek help for domestic violence also abuse drugs or alcohol.
  • Between 55 and 99 percent of women with drug or alcohol use disorders have been the victims of violence or trauma at some time in their lives.
  • As many as 80 percent of women in substance abuse treatment programs have been the victims of domestic violence.
  • Up to half of men in substance abuse treatment programs have battered their intimate partners, and they are up to 11 times more likely to commit violence when they are under the influence of alcohol.

In addition to domestic violence, trauma may include exposure to natural disaster, war, sexual assault, homicide, motor vehicle accidents, or any other event that threatened the individual’s safety or the safety of others. Out of the individuals who witness or experience traumatic events, nearly 7 percent will develop post-traumatic stress disorder, or PTSD, according to the National Center for PTSD. Substance abuse often co-occurs with PTSD, a condition that results in intrusive memories, nightmares, panic attacks, unresolved feelings of fear or anger, and a sense of helplessness or powerlessness.

Rehab programs that target the victims of abuse or trauma must incorporate trauma therapies that can help these individuals resolve their unprocessed emotions and cope with their memories without resorting to drugs or alcohol. Victims of domestic violence, either past or present, need a secure, confidential environment, where they can undergo intensive therapy to recover from the effects of physical and psychological abuse.

Handicaps and Disabilities

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According to the 2010 U.S. Census, around 19 percent of the country’s population, or about 56.7 million people, are living with disabilities, and around half of these disabilities could be considered severe. People with disabilities face multiple challenges in their daily lives, including the search for accessible and affordable rehab services.

The Americans with Disabilities Act of 1990, which guaranteed equal opportunities for handicapped individuals, helped to remove some of the obstacles that prevent disabled individuals from taking part in the activities that the general population takes for granted. However, a handicap or disability can be an obstacle to substance abuse treatment, especially if the individual does not have a strong support network. Disabled individuals face several challenges in their search for substance abuse treatment, including:

  • A shortage of facilities that accommodate the specific disability
  • A lack of access to reliable transportation
  • Inadequate healthcare coverage to pay for substance abuse treatment
  • Limited support services to cover living expenses while in treatment

Recovery services for the disabled must take into account the physical effects of the client’s disability, as well as the psychological and emotional impact of living with a condition that restricts one’s activities. In order to be effective, a rehab program must accommodate the client’s impairment, whether it be a loss of hearing, vision, the inability to walk, the inability to lift or grasp objects, or other limitations. Therapeutic recovery services should empower the disabled client to maximize physical potential by building self-esteem and providing new coping strategies to deal with the tasks of daily life.

Homelessness

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The relationship between homelessness and substance abuse is a complex and destructive one. Substance abuse can be both a cause of homelessness and an outcome of the poverty, despair, and deprivation that homeless people experience.

The National Coalition for the Homeless estimates that as many as 38 percent of homeless people abuse alcohol, and that 26 percent abuse drugs. In addition, over 26 percent of homeless adults suffer from a severe mental illness, such as major depression, bipolar disorder, or schizophrenia, according to the Substance Abuse and Mental Health Services Administration.

Drug or alcohol use can make the search for mental health care more complicated by concealing the symptoms of mental illness, or by altering those symptoms so they are more difficult to detect. Many homeless adults struggle with fear, anxiety, and paranoia as a result of their exposure to the environment and constant threats to their safety. For these individuals, placing trust in a recovery program can be difficult, if not impossible. Additionally, healthcare and recovery services may seem out of reach for homeless people due to their lack of health insurance or financial resources to pay for treatment.

The social stigma against substance abuse and negative stereotypes about the homeless are also barriers to recovery for this population. Rehab services for the homeless must take a compassionate, nonjudgmental approach to treatment in order to motivate these clients to choose sobriety over addiction.

Rehab Needs by Race

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The need for culturally sensitive treatment has become more apparent with the growing racial diversity of the United States. Individuals admitted for rehab at specialized facilities around the country represent a full range of racial groups, including Caucasians, African Americans, Native Americans, Pacific Islanders, Hispanics, and Asian Americans. Because cultural and racial backgrounds can have a strong influence on an individual’s drug or alcohol use, recovery services must acknowledge the effects of a client’s race and culture when developing a personalized treatment plan. A culturally competent rehab program aims to achieve the following goals:

  • Increasing client participation in rehab and motivation to recover
  • Building the client’s self-respect and self-esteem
  • Decreasing the dropout rate among members of racial minority groups
  • Applying treatment strategies that effectively target the client’s needs and values

Cultural sensitivity creates a supportive, empathetic environment that respects the individual’s heritage while taking into account the challenges and obstacles faced during the course of treatment.

African Americans

In spite of social advances and efforts to combat racist stereotypes, African Americans still feel the repercussions of slavery, segregation, and racial profiling. Members of this group — which include Americans who can trace their heritage to Africa — generally are exposed to higher rates of poverty and violence, combined with fewer opportunities for education and professional advancement.

Contrary to cultural misconceptions about drug and alcohol use among African Americans, substance abuse rates in this racial group are similar to rates of drug and alcohol abuse among Caucasians or Hispanics. However, the impact of substance abuse on the physical health and socioeconomic status of African Americans is greater than that of other groups.

Tamika C.B. Zapolski, PhD, proposes in Psychological Bulletin that low-income African American men, in particular, experience the negative effects of substance abuse, including alcoholism and alcohol-related crime and disease, at a disproportionately high rate: “We theorize that this effect is due to the complex interaction of residential discrimination, racism, age of drinking, and lack of available standard life reinforcers (e.g., stable employment and financial stability).”

Culturally competent treatment for African American clients reflects the values and experiences of this group. Family engagement is important in rehab, as are spiritual development, education on relapse prevention, and strong aftercare programs to help these clients successfully transition back to the community after rehab.

Hispanic/Latino Americans

The Hispanic/Latino population now represents 17.4 percent of the US population, or approximately 54 million people, according to the U.S. Census. This group includes immigrants and their descendants from numerous Spanish-speaking countries in Mexico, Central America, South America, Spain, and other regions. The most rapidly growing Hispanic subgroups are from Puerto Rico, El Salvador, Cuba, the Dominican Republic, and Guatemala, notes the Centers for Disease Control and Prevention.

The cultural and linguistic diversity of these subgroups makes it difficult to generalize about the substance abuse treatment needs of Hispanic/Latino Americans. However, there are certain values and perspectives that these groups have in common, such as a strong emphasis on the importance of family and the role of religion and spirituality in issues affecting health. When faced with a substance abuse problem, Hispanic Americans may be more likely to seek help from a family member or close friend, or to consult a spiritual leader than to enroll in a rehab program.

Although Latinos generally have lower rates of substance abuse than other racial groups, those who do enter treatment generally have poorer outcomes, according to the Journal of Ethnicity and Substance Abuse. Treatment can be made more effective by accommodating Hispanic cultural values, by providing bilingual services, and by taking into account the ethnic and cultural differences that exist among the many Hispanic subgroups.

Asian Americans

Among the major racial groups that make up the melting pot of the US, Asian Americans have the lowest rates of drug and alcohol abuse. The 2013 NSDUH reports that 3.1 percent of Asian Americans — a group that includes people of Chinese, Japanese, Vietnamese, Korean, Cambodian, and Laotian descent, among others — were current users of illicit drugs, and that 34.5 percent were current users of alcohol.

However, drug use is increasing among younger generations of Asian Americans, who are more likely to experiment with hallucinogenic drugs, marijuana, and stimulants as part of the club scene. According to the Journal of Drug Education, substance abuse is increasing among Asian American adolescents and has been associated with depression and low self-esteem, especially among females. Similarly, the rates of mental illness and emotional disorders appear to be increasing among younger generations of Asian Americans, possibly as a result of their efforts to assimilate into mainstream American culture, according to the American Psychological Association.

Like other racial minorities, Asian Americans tend to consider substance abuse a private matter to be kept within the family. When Asian Americans experience substance abuse, depression, or anxiety, they are more likely to share these concerns with close relatives or seek out traditional Asian healers rather than consulting a therapist or entering rehab. By the time they feel the need to seek help, symptoms have often become severe. First-generation Asian immigrants, in particular, may not seek professional help because of language barriers, cultural stigma against substance abuse and mental illness, and a lack of awareness of available resources.

Treatment programs tailored to the needs of Asian Americans must focus on the importance of familial bonds and traditional cultural practices, as well as the personal experiences of Asian immigrants and their exposure to violence or trauma. In particular, refugees from Southeast Asia may require specialized therapy for post-traumatic stress disorder (PTSD) because of their experiences with war and political persecution.

Native Americans

Rates of substance abuse are highest among Native Americans and Alaska Natives, with 12.3 percent of American Indian/Alaska Natives reporting illicit drug use, and 23.5 percent reporting episodes of binge drinking, according to the NSDUH. Drug and alcohol use is particularly high among residents of tribal lands or Indian reservations, where substandard living conditions and lack of health services lead to increased rates of disease, mental illness, and substance abuse. A history of problem drinking among American Indians has led to negative stereotypes that portray all Native Americans as alcoholics, even though a large percentage of these individuals do not drink or use drugs at all.

When Native Americans do drink alcohol, they suffer more severe consequences than other racial groups. According to the National Institute on Alcohol Abuse and Alcoholism, Native Americans experience higher rates of the following alcohol-related conditions:

  • Liver disease and cirrhosis
  • Drunk driving and alcohol-related accidents
  • Alcohol-related suicide
  • Alcohol-related homicide

Access to affordable mental health care and substance abuse treatment has been a barrier to recovery among Native Americans, both on and off the tribal lands. Outreach efforts, preventive education, and increased access to recovery services can help to correct the disparities in substance abuse and mental illness that have plagued American Indians for generations.

Help for All Demographics

Substance abuse and addiction touches all population demographics in the US and around the world. Thankfully, specialized help is available for all individuals who wish to leave substance abuse in the past and move to a healthier future. When choosing an addiction treatment facility, it’s important to ensure that the staff has the capacity to effectively address any particular considerations, including physical, mental health, cultural, socioeconomic, or financial issues.

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