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

332 IV. SPECIAL POPULATIONSAsian professionals. Migration since the 1970s has resulted in people with lesseducation, and fewer language and work skills immigrating to the United States(Varma & Siris, 1996). Many of them entered as refugees from war-ravagedcountries. Poverty, overcrowded domiciles, discrimination, and other socialproblems are present in the lives of Asian Americans; however, documentationof these problems is sparse. This notion of “model” immigrant may be hurtingthe Asian American community from outside and within. It also lends itself tothe denial within the community and amplifies the elements of shame andembarrassment felt by the family.Better documentation of the extent of drug and alcohol abuse in the AsianAmerican population would, ideally, enhance the funding for culturally sensitiveeducation and treatment. Education at the community level is needed tofoster awareness and acceptance, and assist in prevention. Treatment programsthat target Asian Americans might consider the insular and private style of theAsian American family. Also essential is recognition of the dominance of thefamily and community over the psychological and social needs of the individual.Acceptance of these differences would decrease conflict between the familiesand treatment providers. This show of respect for their values might facilitatethe families’ participation in the treatment. A treatment goal for allindividuals should be reintegration back into their family and community, if atall possible.NATIVE AMERICANSMore than 200 Native American tribes have a differential use of illicit substances.Studies show that Native American/Alaskan Native youth have twicethe prevalence of cigarette, alcohol, marijuana, and cocaine use as that of Hispanics,blacks, or whites. Alcohol abuse is recognized as a significant problemamong Native Americans (Shalala, Trujillo, Nolan, & D’Angelo, 1996). TheCAGE questionnaire, however, has not been particularly useful among NativeAmericans (Saremi et al., 2001). Conduct disorder has been found to be a significantrisk factor for alcohol dependence in Navajo Indians (Kunitz et al.,1999). In the past, arrest rates secondary to alcohol use for Native Americanswere reported to be 12 times the national average (Stewart, 1964). In a MichiganMonitoring the Future study, Native American adolescents had the highestlevels of tobacco, alcohol, and illicit drug use (Wallace et al., 2002). NativeAmerican/Alaskan Native youth may also participate in more risky behaviors(Frank & Lester, 2002). Although the alcohol mortality rate for Native Americanswas three to four times the national average, evidence indicates that therehas been a decrease in mortality since 1969 (Burns, 1995). This drop seems tobe in concert with the doubling of alcohol treatment services by the Indian