CULTURAL-ASPECTS OF SUBSTANCE-ABUSE AND ALCOHOLISM - ASSESSMENT AND MANAGEMENT

Clinical care for substance abuse and alcoholism requires knowledge of the patient's culture. Thorough assessment should include prescriptio ns for substance use, proscriptions against substance use, and knowled ge of permitted-but-not-required substances in the patient's culture. Clinicians should be aware of the differing patterns of pathogenic use among diverse cultures. Poor enculturation during childhood or leavin g one's cultural origins can increase the risk of substance disorders. Skill in taking a cultural history aids in identifying these premorbi d factors as well as in planning successful treatment. Cultural affili ation can influence access to and availability of treatment. Patients should have culturally consistent role models during treatment. Some t reatment approaches merely need to be applied in a culturally sensitiv e manner; others may be thought of as ''culture bound,'' relevant for one group but not for another. Clinicians should guide patients in cho osing appropriate ''cultures of recovery.'' From a group perspective, cultural groups should consider the potential pathogenicity to cultura lly prescribed practices of substance use, should adapt models of reco gnition and intervention that are culturally consistent, and should be beware of using a particular substance as a counterculture symbol.