Evaluating an Individual’s Treatment Needs
Addiction Among African Americans
The health concerns of African Americans reflect the needs and issues of a diverse, heterogeneous group. Although the term African American is generally applied to individuals in the United States who can trace their ancestry to Africa, the term is often used to encompass a broad range of people of color, including individuals from Brazil or the Caribbean. Africa itself is an enormous continent, and its immigrants represent numerous nations. Yet the major government-sponsored studies of substance abuse and mental illness in African American communities do not differentiate between these recent immigrants from countries like Ethiopia or Somalia versus African Americans whose ancestors were brought to the US as slaves many generations ago.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), African Americans represent approximately 14.2 percent of the population. The majority of these individuals are descended from Africans who were brought to the US as slaves, and the repercussions of slavery, sharecropping, and racial segregation continue to exert a negative influence on their socioeconomic and political status. However, when looking at a portrait of substance abuse and mental illness among African Americans, it is important to remember that this group includes many ethnic subgroups, with varying traditions, beliefs, and practices.
In addition, many individuals do not identify with a single racial category, but with two or more groups. A black American might identify as Hispanic as well as African American, for instance. Providing effective substance abuse treatment and mental health care requires cultural awareness and sensitivity to the individual’s unique origins.
An assessment of these issues in an African American individual or family should consider factors like the following:
- Geographic location (urban versus rural)
- Religious background
- Family history
- Cultural identification
Patterns of Substance Abuse
National surveys on drug and alcohol use in the US consistently show that substance abuse rates are similar among African Americans, whites, and Hispanics. SAMHSA reports that its 2014 National Survey on Drug Use and Health revealed the following patterns in drug and alcohol use:
- 3 percent of African American respondents reported that they had used alcohol in the past 30 days, compared with 22.8 percent of population as a whole
- 6 percent of African Americans age 12 and older reported binge drinking (consuming five or more drinks in one sitting), compared with a US average of 23 percent
- 5 percent of underage African Americans reported binge drinking in the past month, compared with 13.8 percent for the population as a whole
- 4 percent of African Americans age 12 and older reported using illicit drugs, compared with 10.2 percent of the nation as a whole
These statistics indicate that while rates of drinking and problem drinking among African Americans are lower than the national average, illegal drug use is slightly higher. Yet an article published in the Psychological Bulletin says that while protective factors in black culture, such as a disapproval of drinking to intoxication, may reduce rates of binge drinking, African Americans tend to suffer more serious health and psychosocial problems from alcohol consumption, including:
- Alcohol-related illnesses, such as liver disease, heart disease, esophageal cancer, and pancreatitis
- Alcohol-related accidents and injuries
- Exposure to violence
- Legal repercussions
- Exposure to communicable diseases, such as HIV/AIDS
In 2013, the reported rate of substance dependence and abuse was lower among African Americans (7.4 percent) than among whites (8.4 percent) or Hispanics (8.6 percent), according to the National Survey on Drug Use and Health. Yet these statistics apparently do not reflect the full impact of alcohol use or abuse among African Americans.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) states that while rates of alcohol dependence or alcoholism among African Americans are generally lower (8.4 percent) than among Hispanics (9.5 percent) or Caucasians (13.8 percent), African Americans are more likely to have ongoing problems with alcohol dependence once it occurs. The rate of recurrent alcoholism among blacks is 35.4 percent, NIAAA notes, versus 33 percent among Hispanics and 22.8 percent among whites. The persistence of alcoholism among African Americans may be partly responsible for the higher rates of liver disease and other alcohol-related illnesses that affect those individuals.
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Illegal Drug Use in the African American Community
The African American community has been plagued by problems with illegal drugs, some real and some the result of racial profiling and cultural stereotypes. Yet national statistics from 2013 show that the rates of illicit drug abuse were roughly the same among African Americans, whites, and Hispanics. The National Survey on Drug Use and Health from 2013 reports the following statistics on current illicit drug use:
- 5 percent of blacks
- 5 percent of whites
- 8 percent of Hispanics
- 3 percent of American Indians or Alaskan Natives
- 0 percent of Native Hawaiians or Pacific Islanders
African Americans, especially in urban areas, have been associated with higher rates of cocaine use and trafficking, but these trends are changing. According to the Treatment Episode Data Set (TEDS) Report of February 2013, the majority of African Americans admitted for treatment in 1999 reported that alcohol and cocaine were their primary drugs of abuse. In the year 2000, 55 percent of African Americans admitted for drug rehab had a cocaine problem, compared with 40 percent in 2010. While cocaine-related admissions among black Americans have gone down since the 1990s, blacks are still twice as likely as other racial groups to report having a cocaine problem on admission to treatment, notes the TEDS Report.
The snapshot of substance abuse created by statistics on drug use in African American communities contradicts many of the predominant stereotypes about blacks and drug addiction. According to these stereotypes, the rates of drug abuse and drug-related crime are much higher among blacks than among whites or Asians. However, the National Institute on Drug Abuse proposes that these impressions are based on outdated administrative practices and racial profiling that led to an overrepresentation of blacks in the criminal justice system. The negative stereotyping of African Americans as criminal offenders and drug dealers has been one of the greatest barriers to culturally competent substance abuse treatment.
Issues of Mental Health
Despite many years of fighting against racism and discrimination, African Americans are still faced with these obstacles in all areas of their lives, including the search for mental healthcare. Finding culturally sensitive rehab programs remains a challenge, especially in a society where the fields of psychiatry and addiction treatment are dominated by the needs of white Americans. According to the National Alliance on Mental Illness (NAMI), African Americans are about half as likely to use mental health services as Caucasian Americans. The National Healthcare Disparities Report states that in 2008, only 50.6 percent of blacks who had a major depressive episode sought treatment, compared with 57.4 percent of Hispanics and 70.4 percent of whites. NAMI confirms that African Americans are 20 percent more likely than the rest of the US population to experience severe forms of mental illness, such as major depression, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD), as well as higher rates of suicide among African American men.
When faced with a mental illness like depression or anxiety, African Americans may be more likely to turn to family members or spiritual leaders for support, rather than seeking mental healthcare from white practitioners. The relatively low number of black mental health practitioners, combined with a lack of cultural training among the predominantly white practitioners, contributes to distrust and a reluctance to seek care. Instead of getting help in the early stages of a mental illness, African Americans may wait until symptoms become more severe, requiring more aggressive treatment.
African American individuals also have higher rates of exposure to life events or conditions that can worsen mental illness or discourage treatment, such as the following:
- Racial discrimination
- Lack of healthcare coverage
Office of the Surgeon General, lack of insurance is one of the greatest barriers to mental health treatment, with nearly one-fourth of African Americans uninsured or underinsured. This barrier may be reduced by the Affordable Care Act, which makes mental health coverage and substance abuse treatment mandatory among most programs and increases the availability of care.
When mental illness is combined with substance abuse, the search for treatment may become even more challenging. SAMHSA estimates that in 2014, 3.8 percent of African Americans had some form of mental illness combined with drug or alcohol addiction, compared with the US average of 3.3 percent. Substance abuse can worsen the symptoms of mental illness and may make it more difficult for clinicians to diagnose serious psychiatric conditions like depression, anxiety, bipolar disorder, or schizophrenia. Mental illness combined with substance abuse, a condition known as a dual diagnosis or co-occurring disorders, must be addressed through an integrated treatment program that combines recovery services with intensive mental health treatment.
Treatment Needs among Black Clients
While rates of illegal drug use may be higher among African Americans, statistics show that more members of this group receive treatment at specialized facilities than Hispanics or whites. In 2013, the NSDUHreports that among those Americans who needed treatment for illicit drug use, 21.3 percent of blacks received treatment at a specialty facility, such as a clinic or rehab center, compared with 17.3 percent of the rest of the population. Similarly, more African Americans received treatment for alcohol abuse at a specialty facility than other groups (13.5 percent versus 7.6 percent).
Contrary to cultural assumptions about high rates of drug abuse among poor African Americans, the NSDUH indicates that African Americans with an income 100 percent below the Federal Poverty Level were actually less likely than other racial groups to need treatment for substance abuse. While African Americans with health insurance were less likely to need substance abuse treatment, 15.4 percent of those who did need treatment sought help, compared with 8.7 percent of other racial groups. However, a study of retention rates published in Psychiatric Services indicates that while admission rates for cocaine and alcohol abuse treatment are relatively high among African Americans, dropout rates and lack of compliance are also high.
In order to provide more effective, personalized substance abuse treatment and psychiatric care to African Americans, practitioners in this field must learn to address each client as an individual, considering all of the variables that affect his or her mental health. An article published in Minority Nurse points out that many clinicians do not consider the multiple sociocultural factors that can influence substance use or mental illness in African Americans when they assess and treat these patients. These variables include:
- Income level
- Cultural background
- Spiritual orientation
Spirituality, in particular, should be emphasized as a coping mechanism for African Americans, who have traditionally used their spiritual beliefs and religious practices as sources of strength and support in the face of adversity. Practitioners should also take into account the importance of the family and community in recovery, and the need to engage family members in the treatment process for African American clients.
A motivational approach to treatment may improve retention rates and encourage compliance with treatment among African Americans. Cultural Diversity & Ethnic Minority Psychology proposes that Motivational Interviewing (MI) may be an effective way to keep African American clients engaged in treatment and encourage them to adhere to their recovery program. MI is a client-centered clinical approach based on the principles of empathy and therapeutic collaboration.
The goals of this modality include:
- Helping the client overcome resistance to treatment
- Working with the client to identify personal motives for change
- Aiding the client in rebuilding self-esteem
- Helping the client develop self-efficacy, or the ability to cope with challenges effectively
Although research studies on the effectiveness of MI among African Americans in substance abuse treatment have not been conclusive, the preliminary results are promising. There is an urgent need in the fields of mental health and recovery services for an approach that reflects African American experiences and perspectives. Providing a supportive, culturally sensitive environment is the key to engaging these clients in treatment and helping them overcome the barriers to recovery.
- Black Girls Smile: This organization is dedicated to empowering young African American women to take charge of their mental and emotional health, and to make healthy decisions about their lives. Its website includes descriptions of the group’s programs, access to national helplines, and referrals to advocacy and support groups.
- Emory University: Suicide Prevention for African American Students: Emory University offers this website as a support service for its student body, but anyone interested in suicide prevention, signs of suicidal behavior, or the relationship between suicide and depression can benefit from this site. The site also includes links to a national suicide hotline and other support resources.
- Addressing Mental Health in African American Communities: This government-operated website discusses the specific challenges of African Americans seeking mental health treatment and also offers more general support services for individuals in need of help with mental illness.
- National Alliance on Mental Illness (NAMI): African American Mental Health: An overview of the major mental health concerns, challenges, and barriers to treatment among African Americans, including advice on how to find culturally competent mental health practitioners who understand the needs and issues of this community.
- National Institute on Drug Abuse: Drug Use Among Racial/Ethnic Minorities (Revised): A comprehensive government report that compiles statistics on substance abuse among the major racial groups in the United States.
- Substance Abuse and Mental Health Services Administration (SAMHSA): Behavioral Health Equity: Black or African American: SAMHSA, the federal agency that oversees mental health and substance abuse services in the US, provides this collection of behavioral health resources, survey reports, and news on federal initiatives that affect African Americans.