Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

328 IV. SPECIAL POPULATIONStrol and compulsivity that make a drug abuser or alcoholic are not dissimilarbetween ethnic groups. However, as we continue to tailor treatment to individuals,racial and cultural factors have to be addressed.Should programs in primarily African American communities be especiallydesigned to promote cultural sensitivity? In some sense this goes on naturally.The feel, look, and language of an Alcohol Anonymous (AA) meeting in anAfrican American community is different from that in a white self-help group.AA had its beginnings in the Oxford movement and was initially white andmiddle class. However, given that the church and spiritual dimensions of blacklife are an integral aspect of black culture, it is not surprising that AA has beensuccessfully transplanted to the black community. There have been attempts todevelop and describe culturally sensitive mental health facilities (Deitch &Solit, 1993; Rowe & Grills, 1993). These attempts often are trapped in a quagmireof definitions of culture, race, and what is crucial to a culturally relevantprogram. Culturally relevant programs might promote positive racial and culturalidentity, enhance self-esteem, increase self-determination, and appreciatetraditional African American values. Afrocentric values stress relationships,verbal fluidity, emotional expressiveness, and spirituality. A study of substanceabuse programs, using the National Drug Abuse Treatment System Survey, suggeststhat culturally competent treatment is holistic and emphasizes employment,spiritual strength, and physical health (Howard, 2003a). Programs thathire staff that mirror patients’ ethnic background may minimize racial bias. Inaddition, possessing knowledge of African American history and culture is acomponent of a culturally competent program (Howard, 2003b).Research questions related to primary hypotheses that especially addressethnic concerns are needed. There may be dimensions to an all-black treatmentprogram that go beyond variables currently thought to be important. Ethnicbiological differences, if any exist, of African Americans need further work. Differencesin health outcome and possibly medication responses need furtherconsideration. The issue of matching or nonmatching of therapist or patientalong racial and ethnic dimensions has been a subject of considerable discussionin mental health and has a role in the substance abuse field. Matching ofracial and cultural attributes between therapist and client may enhance empathyor in some cases result in therapist overidentification with the client.Empathy and respect of others’ cultural norms are an essential components toany discussion of cultural sensitivity.HISPANIC AMERICANSHispanics comprise a heterogeneous group, including Mexican Americans,Puerto Ricans, Cuban Americans, and others. As with other ethnic groups, agreater number of Hispanic men drink alcohol and use drugs than do Hispanic