In American society, Asian Americans have been viewed as a “model minority,” assimilating easily into the mainstream with their strong work ethic, solid family structures, and high levels of motivation. But this model minority image, while it may reflect positively on Asian American immigrants, can hide the very real cultural conflicts and personal problems that members of this group experience.
Statistics show that Asian Americans have lower rates of substance abuse, in general, than other major racial groups in the US. The National Institute on Alcohol Abuse and Alcoholism reports that the rate of alcohol use among Asian Americans is 38 percent, compared to 59.8 percent for Caucasians and 43.8 percent for African Americans. Within the Asian American subgroups, the highest substance abuse rates exist among Japanese Americans, states Public Health Reports. Yet statistics do not reflect the devastating effects that addiction and mental illness have on thousands of Asian American individuals and their loved ones.
The Asian American community represents one of the largest and most influential ethnic groups in the United States. According to data from the 2010 U.S. Census, over 15 million Americans identified their race as Asian and nearly 675,000 identified as Native Hawaiian or Pacific Islander.
The diversity of this community makes it difficult to generalize about the causes, risk factors, and consequences of substance abuse for Asian Americans. However, it is possible to identify common behavioral patterns, cultural beliefs, and social barriers that affect the way Asian Americans respond to addiction and mental illness, and to use these themes to determine the most culturally appropriate plans of treatment.
The Asian American/Pacific Islander group encompasses over 20 subpopulations representing numerous languages, religions, and cultures:
Risk Factors for Substance Abuse
Like other immigrant groups, Asian Americans have experienced internal tension and interpersonal conflicts when trying to integrate into the surrounding community. The process of acculturation can cause a great deal of stress, as the individual tries to adjust to meet the demands of learning a new language, earning a living, or going to school. The Journal of Ethnicity in Substance Abuse points out that substance abuse rates are higher in US-born Asian Americans than in first-generation immigrants, indicating that the pressures of acculturation contribute to an increased risk of drug or alcohol addiction.
Racial discrimination, social injustice, and a history of personal or family trauma can also play a part in substance abuse for Asian Americans, many of whom have experienced personal violence or persecution at some point in their journey to US citizenship. The Substance Abuse and Mental Health Services Administration reports that although drug abuse, binge drinking, and alcoholism are lower among Asian Americans than any other racial group, Southeast Asian refugees are at high risk for post-traumatic stress disorder due to violence experienced before their emigration to the US. Post-traumatic stress disorder is associated with an increased risk of depression, suicidal ideation, and drug and alcohol abuse.
Drugs of Abuse and Addictive Behaviors
Among recent Asian immigrants, alcohol and drug abuse rates are typically lower than average. However, through the process of acculturation, the subsequent generations are more likely to experiment with various substances as they assimilate into American society. In recent years, club drugs like ecstasy, LSD, meth, and ketamine have become popular among younger Asian Americans in urban areas like San Francisco and New York. A survey of 206 young adults of Asian descent who participated actively in the club scene found that many of these individuals took drug and alcohol use for granted and considered it to be a normal part of their social lives.
Statistics from this study, published in the Journal of Ethnicity and Substance Abuse, revealed that:
- 80 percent had drunk beer in the previous 30 days
- Two-thirds had smoked marijuana in the previous 30 days
- 28 percent had used ecstasy in the previous 30 days
- 67 percent had tried hallucinogenic mushrooms in the previous 30 days
- 55 percent had tried five or more drugs in their lifetimes
For some of these respondents, drug use was simply an accepted part of the social scene. For others, it was a way to self-medicate for the loneliness, anxiety, and depression of trying to assimilate into a foreign culture. Regardless of their reported reasons for using drugs and alcohol, most of the survey respondents felt that drug use was normal and that illicit drugs were relatively easy to obtain.
Substance abuse is not the only form of addiction found in Asian American cultures. Compulsive gambling is an addictive behavior that affects many Asians, particularly of Vietnamese, Chinese, and Korean descent. According to the organization National Asian and Pacific American Families Against Substance Abuse (NAPAFASA), problem gambling has had a destructive effect on many Asian American communities, and the gambling industry has worked actively to capitalize on this community’s interest in wagering and betting. For Vietnamese, Chinese, and Koreans, casino games like black jack, roulette, and Pai Gaw poker are especially alluring, while other groups favor video lotto, slot machines, sports betting, or traditional Asian games like mahjong.
Compulsive gambling, which can have a devastating effect on an individual’s financial status as well as one’s psychological and physical health, has become so problematic in certain Asian communities that the Massachusetts Council on Problem Gambling started a multilingual helpline to assist Asian Americans who are trying to cope with the consequences of this addiction. NAPAFASA points out that there may be a link between pathological gambling and post-traumatic stress disorder among Asian Americans, as one study showed that up to 60 percent of refugees and asylum seekers from Laos, Vietnam, and Cambodia met the criteria for gambling addiction. Other motives for compulsive gambling include a need to overcome a sense of isolation and loss, and a need to relieve the stress associated with immigration and acculturation.
Still other Asian Americans say that gambling is a way to gain recognition in a community that values performance and achievement. To win a game in front of one’s peers brings a certain status, as well as the potential to earn money. Gambling is a social activity as well as a form of recreation, and winning provides the opportunity to be respected and admired by other members of the community. Unfortunately, losing bets or wagers can have the opposite effect, with many individuals losing thousands of dollars in the span of a single night.
Myths and Misconceptions Affecting This Community
Stereotypes and myths about Asian Americans often mask the growing need for treatment of substance use disorders and mental illness in this population. Asian Americans are commonly viewed as healthy, hardworking, and self-supporting, with little need for social or interpersonal support. They are also frequently viewed as reclusive, secretive, and reluctant to merge with mainstream American culture. Publicly funded rehab programs may overlook the needs of Asian Americans during outreach efforts, failing to provide the information that these individuals need to take advantage of recovery services.
Research on substance abuse among Asian Americans has often focused on the metabolic effects of alcohol rather than substance abuse patterns in this community. Because of a phenomenon known as flushing syndrome that affects some Asian Americans when they consume alcohol, the medical community often mistakenly assumes that this group is less vulnerable to alcohol abuse. Flushing syndrome is caused by a deficiency of the enzyme aldehyde dehydrogenase, which facilitates the metabolism of alcohol. In individuals with flushing syndrome, consuming alcohol causes uncomfortable and even dangerous symptoms, including facial redness, nausea, and a rapid heart rate. PLOS Medicine states that approximately 36 percent of people of East Asian descent suffer from flushing syndrome. It is often believed that the side effects of this metabolic condition discourage Asians from drinking; however, this assumption draws public attention away from the fact that many Asian Americans do need help with substance use disorders, notes the Journal of Psychoactive Drugs.
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Co-occurring Mental Illness among Asian Americans
At first glance, statistics on mental illness among Asian Americans seem to indicate they suffer from fewer psychiatric disorders than other major racial groups. The American Journal of Public Health states that according to national statistics, 17.3 percent of Asian Americans will experience some form of mental illness during their lifetime, yet only 8.6 percent seek professional help, compared with 18 percent of the general population. As with substance abuse, there is a strong negative stigma associated with mental illness in Asian cultures. As a result, many Asian Americans choose to bear the pain and stress of mental illness alone or deal with the problem within the immediate family rather than risking public exposure.
The pressures of acculturation can contribute to depression and anxiety in Asian American immigrants and their descendants. The American Psychological Association notes that many Asian Americans experience serious identity conflicts as they struggle to fit in with their surrounding culture. Young adults and teenagers often feel compelled to meet family expectations and uphold the same social, moral, or religious values as their parents, while trying to gain acceptance with their American peers.
Post-traumatic stress disorder (PTSD), an anxiety disorder caused by exposure to shocking or life-threatening events, is more common in Southeast Asian immigrants than in the general population, according to J. Chu and S. Sue. In an article published in Online Readings in Psychology and Culture, the authors report that the rate of major depression and PTSD in Cambodian refugees is as high as 62 percent. In spite of the severity of their psychiatric symptoms, Asians with serious mental illness may be hesitant to use available mental health services because of language barriers, negative cultural perceptions of mental illness, and fear of social discrimination, the authors add.
Cultural Barriers to Treatment
Although the rates of mental illness among Asian Americans are similar to those of the general US population, Asian Americans are significantly less likely to use professional mental health services or to delay treatment until their symptoms have become unmanageable. Within the Asian American community, conditions affecting the individual’s mental health and substance use are often not openly discussed, and rehab services are often underutilized. The Journal of Substance Abuse notes that although Asian Americans are the most rapidly growing ethnic minority in major urban areas like New York City, they are less likely to use addiction treatment services than other racial groups.
Some of the reasons for this underutilization include:
- Language barriers
- Social taboos against addiction
- Lack of education about available resources
- Lack of cultural or familial support for rehab
Mental illness and substance abuse are often viewed as a source of shame or disgrace in Asian American groups, and they are either addressed privately or denied altogether. Family pressures to maintain a successful image and racial discrimination against Asian minorities are two of the other most common obstacles to seeking help. When translation services and culturally sensitive treatment services are available, however, participation in recovery programs tends to increase, according to the article referenced above.
When Asian Americans do reach out for help, they are more likely to turn to their immediate relatives or to close friends from their own community than to consult a mental health professional. They may prefer to use self-help services or to seek assistance from holistic practitioners of Asian medicine before they turn to Western psychiatric specialists. When they do consult a psychiatrist or therapist, symptoms have usually become severe. Approximately a third of Asian American patients drop out of treatment before completing a course of therapy, according to the Journal of Consulting and Clinical Psychology.
Treatment Needs and Solutions
Providing effective treatment for substance abuse and mental illness in Asian Americans starts with culturally appropriate screening tools and assessment measures. Asian Americans express emotional distress differently than Caucasians, Hispanics, or African Americans, and mental illness is more likely to manifest itself through physical symptoms than psychological changes, according to Online Readings in Psychology and Culture. Asian Americans may not reveal signs of depression, substance abuse, or suicidal ideation in standard screening tests, and they may prefer to disclose their symptoms directly to interviewing therapists or psychologists who are trained in culturally sensitive assessment.
Within nearly all Asian American subgroups, family is one of the most influential factors in determining personal choices and behaviors. Individuals seeking treatment for drug or alcohol abuse need the support and affirmation of their parents, siblings, and other close relatives in order to feel validated in their search for recovery and to achieve the greatest possible benefits from treatment. For this reason, family involvement should be considered one of the top priorities for substance abuse treatment in culturally sensitive rehab programs for Asian Americans, according to the Journal of Ethnicity in Substance Abuse.
In addition to acknowledging the role of the family in recovery, rehab providers must include bilingual programs in order to make these services widely available. Treatment should acknowledge the cognitive patterns, cultural practices, and religious beliefs of the client’s native ethnic group, such as the need for strong family engagement and the involvement of traditional Asian healers. Finally, substance abuse treatment must be integrated with mental health care and psychosocial services in order to address any underlying mental illness or unmet social needs that might interfere with the course of rehab and recovery.