Discrimination, immigration, treatment expectations, and family stigma are among barriers to Latinos seeking treatment

The following article was recently published on the research page of the Recovery Research Institute website. It explores a new study that indicates Latinos have the lowest treatment seeking rates compared to people of other racial and ethnic backgrounds.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

National studies have shown that individuals who identify as Latino are less likely to seek treatment for substance use disorder or complete treatment at specialty treatment facilities. Barriers to treatment engagement by race and ethnicity have been examined in only a few national studies and results are inconclusive. Identifying barriers to treatment is a foundational step that will allow for public health planning aimed at addressing barriers. The purpose of this in–depth qualitative study was to gain a better understanding of barriers to specialty treatment for substance use disorder that are more prominent among Latinos than other racial and ethnic groups.

HOW WAS THIS STUDY CONDUCTED?

From 2017-2018 the authors conducted a qualitative study which consisted of telephone interviews with participants from Riverside, Los Angeles, San Diego, and Oakland, CA; Brooklyn, NY; Chicago, IL; Miami, FL; and San Antonio, TX, recruited via craigslist (i.e., a web-based advertising platform) to compare barriers to treatment utilization among racial and ethnic groups.

WHAT DID THIS STUDY FIND?

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Figure 1. Source: Pinedo et al, 2018

Latinos reported attitudinal barriers to specialty treatment more than other racial and ethnic groups (i.e., cultural, perceived treatment efficacy, and non-abstinent recovery goals). Overall, Latinos commonly felt specialty treatment providers did not understand their unique needs and experience. Specifically, they perceived healthcare providers to be unfamiliar with cultural issues such as discrimination and immigration. Providers were, therefore, discussed in terms of not being able to relate to personal experiences associated with being Latino including alcohol or other drug use which was in turn associated with low treatment efficacy. Being able to have a recovery goal of moderated alcohol use, and not complete abstinence, emerged as a larger barrier for Latinos in seeking treatment at specialty facilities. Its is unclear if these barriers could vary according to generation, meaning, foreign versus native born Latinos.

Social norms barriers towards specialty treatment (i.e., stigma and lack of social support) were more pronounced among Latinos than their White and Black counterparts. Stigma for seeking treatment was strong across all groups but most frequently mentioned by Latinos. Lack of social support from family emerged because it was viewed as “confirming” they had a problem and may tarnish the family.

Control over specialty treatment specifically logistical barriers, such as lack of health insurance, cost of treatment, transportation, and long wait times were highlighted by all racial and ethnic groups during interviews, however, showed no considerable differences in number of times mentioned between groups.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

This study identified specific barriers that discourage individuals who identify as Latino with alcohol or other drug use disorders from seeking treatment, and compared these to other racial and ethnic groups. Barrier identification is important because Latinos seek treatment at about half the rate as their White counterparts although higher estimates have been reported. Latino expectations that providers do not understand cultural issues like discrimination and immigration was an attitude barrier for seeking treatment. Researchers have suggested acknowledging important social contexts such as immigration and discrimination experiences in the delivery of specialty treatment for substance use disorders may increase service use. Latinos low expectations around treatment efficacy where rooted providers having no lived experience with alcohol or other drug problems and therefore are unable able to relate. Treatment facilities may need to promote their use of, or integration with, peer services as a means of showing that lived experience can be a part of the treatment process. Clinicians should be prepared to work with patients whose recovery goals include an initial goal of moderate alcohol use given about half of people in the US who have resolved a problem with alcohol or other drugs are not completely abstinent.

Stigma was heavily endorsed by Latinos including concerns over being seen by colleagues at a specialty treatment facility. To address this barrier, treatment centers might offer telemedicine which is when treatment is delivered using telecommunications technology like Skype but specially designed for secure health care communication.  In fact, a National Recovery Study found that individuals who identify as Hispanic were over one a half times as likely than White individuals to use recovery-related online technology. So, this may be a way to engage more Latinos with substance use disorder in treatment.

LIMITATIONS

  1. Qualitative studies like this use smaller samples to obtain richer ideas and explanations. This study was on only on a total of 54 individuals, of whom only 20 were Latino, recruited by advertisement, so it’s unclear to what extent findings may generalize to Latinos with substance use disorder as a whole. Particularly given the participants were assessed in terms of meeting diagnostic criteria over a 5 year window instead of 12 months, which is more standard.
  2. The barriers to treatment seeking identified in this qualitative study should be further tested in larger samples, and ideally, in a national study to determine the US prevalence of these barriers among racial and ethnic groups.
  3. Latino alone is a large group and there may be generational issues to consider in these outcomes related to foreign versus native born Latinos.

BOTTOM LINE

  • For individuals & families seeking recovery: This study of barriers to treatment for substance use disorder found that expectations of low efficacy were common. This low perceived efficacy of treatment was related to  experiences with treatment providers who had no lived experience with substance use disorder, or providers who were perceived to not understand stressful cultural issues like immigration and discrimination and its association with the onset, clinical course, and remission of substance use disorder. Talk to a treatment provider about setting expectations around the likelihood of remission, their use or integration with peer services, and provider cultural competency.
  • For scientists: This qualitative study found that social norms around low family support and acceptability of seeking treatment may be a barrier among individuals who identify as Latino. Preventative interventions aimed at adolescents and emerging adults that seek to improve the acceptability of using professional services for substance use disorders may have lasting impacts on creating a future culture of support and reduced stigma, that extends to families and communities across generations. In addition, it is important to develop and test strategies that can help engage Latino individuals with services. For example, 12-step facilitation for Spanish speaking Latinos since they value lived experience.
  • For policy makers: This was a qualitative study that examined barriers to specialty treatment for substance use disorder by race and ethnicity. Latino treatment seeking may be improved (and treatment seeking in general) by promoting the use of peer services (i.e., persons with lived experience in recovery), training providers in “cultural humility” in order to increase education around immigration and discrimination and its effect on recovery, and increasing privacy options during treatment. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied.
  • For treatment professionals and treatment systems: This was a qualitative study that examined barriers to specialty treatment for substance use disorder among individuals who identify as White, Latino, and Black. Latino treatment seeking may be improved by (and treatment seeking in general) by accommodating non-abstinent recovery goals around alcohol use, promoting organizational integration with evidence-based peer services (i.e., persons with lived experience in recovery), training providers in cultural humility to increase education around immigration and discrimination and its effect on recovery, and increase privacy options during treatment seeking. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied. It may be important for clinicians to process and problem solve around Latinos’ mistrust in professional treatment and address the family and cultural barriers they may face if attending treatment (i.e., stigma or lack of social support).

CITATIONS

Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1-8.

Rx Take Back Day at The Council Nets 400 Pounds of Unused & Expired Prescription Drugs

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The Council’s drive-through Rx Take Back site made Rx med disposal quick & convenient
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DEA agents collected over 400 lbs. of unused & expired Rx prescriptions for disposal

The Council on Recovery was a busy collection site for the DEA’s 16th National Rx Take Back Day this past Saturday. Nearly 100 people stopped by The Council’s drive-in location on Jackson Hill Street to dispose of their unused and expired prescription medications. By the end of the four-hour collection period, DEA agents had collected more than 400 pounds of Rx drugs.

This is the first time The Council has participated in the DEA’s National Take Back Day. The national initiative was launched after Congress enacted the Disposal Act in 2014, which amended the Controlled Substances Act, that gave the DEA authority to collect unused pharmaceutical controlled substances for disposal in a safe and effective manner.

The Council views unused or expired prescription medications as a public safety issue that contributes to potential accidental poisoning, misuse, and overdose. Proper disposal of unused drugs saves lives and protects the environment. As a Rx Take Back Day collection site, The Council provided a secure, convenient, and anonymous way for its constituency to clear their homes of old or unneeded Rx medications in a responsible manner.

As one of nearly 350 collection sites across the state, The Council provided an easily accessible and central location for residents in the Heights, Rice Military, Montrose, River Oaks, Midtown, and near-Downtown areas to dispose of their medications. During the last Rx Take Back Day in October, over 67,000 pounds of Rx prescriptions were collected in Texas, according to the Drug Enforcement Administration Diversion Control Division. The Council on Recovery is pleased to contribute 400 pounds to this Spring’s total haul and plans to participate in future Rx Take Back events.

If you missed Rx Take Back Day at The Council, you can still dispose of unused or expired prescriptions at DEA authorized collection sites, many of which are located within national and local pharmacies. To search the DEA’s website for a collection site near you, click here.

Andrew McCarthy Captivates Supporters at The Council on Recovery’s 36th Waggoner’s Foundation Speaker Series Luncheon

Andrew McCarthy at Council Luncheon
Andrew McCarthy captivates The Council’s 2019 Spring Luncheon

The excited buzz among the crowd after The Council on Recovery’s Spring Luncheon confirmed it: Andrew McCarthy was one the best speakers The Council has ever had! Speaking on Friday, April 12th, the actor, director, producer, and an award winning travel writer opened up about his personal struggle with alcohol and drugs, as well as the many gifts of his 27 years of sobriety.

Andrew was preceded on the stage by Luncheon Co-chairs, Bob Candito and Amanda Polich, each of whom shared their own personal stories of hope and recovery. Their heartfelt remarks were followed by an exuberant introduction by Jerri Duddlesten-Moore, who spoke of Andrew McCarthy’s decades of achievement and fame. From his iconic films Pretty in Pink, St. Elmo’s Fire, and Less Than Zero to his work as an actor and director of some of today’s most popular and acclaimed television shows to his award-winning writing as a travel journalist, Andrew’s trajectory of success is of inspiration to all.

Bounding to the stage, Andrew immediately thanked and praised The Council, saying, “… it obviously does some amazing work for the community. The Council is such a solid, strong, dependable, in-the-fiber-of-the-community place, that it’s a real cornerstone. It’s impossible to measure actually what The Council does…or really know how many people The Council is really helping. But, it would be hard to imagine if it wasn’t.”

Andrew then proceeded to captivate the audience of 900+ people with an intimate and revelatory story of his experience with alcohol and drugs from the age of 17 until he became sober at age 29. He related the highs and lows of a life that was dominated by alcoholism until a defining moment in 1992 when he finally asked for help. At the time, he was directed to an organization in New York City that he likened to The Council.

“That’s why I say The Council being there is so great. Because when that moment comes, there has to be somewhere to catch us,” Andrew said, “otherwise we fall.”

In early recovery, Andrew said he did exactly what he was told, including going to support groups. Within a couple of years…”my life started to get better”, he said, “…95% of my seemingly unrelated problems had disappeared by simply showing up, doing what’s in front of me that day, and then going to bed. And waking up and then doing what’s in front of me the next day.”

“In sobriety,” Andrew said, “I was able to find out that if I do the next right thing in front of me, I can have the opportunity to be who I am.”

Andrew’s inspiring message of hope, experience, and strength received a standing ovation from the audience who were clearly touched by his invaluable words of grateful recovery.

Read more about the Waggoner’s Foundation Speaker Series here and scroll through the galaxy of celebrities who have spoken at The Council’s Luncheons.

When Detox Turns Deadly

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Detox, also known as detoxification or withdrawal, occurs when one abruptly stops or reduces heavy, long-term use of alcohol or drugs. Detox happens when toxic substances leave the body over hours, days, or weeks, and may include a variety of non-life-threatening symptoms, such as distress or discomfort. But, sometimes detox can turn deadly.

In the case of opioids, benzodiazapines, and alcohol, detox can cause serious complications and even death. Most people are not aware of the dangers of detoxing off off these addictive substances, nor the importance of seeking medical care during the withdrawal process. Here are the facts:

Continue reading “When Detox Turns Deadly” →

April is Alcohol Awareness Month

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Drinking too much alcohol increases people’s risk of injuries, violence, drowning, liver disease, and some types of cancer. This April, during Alcohol Awareness Month, The Council on Recovery encourages you to educate yourself and your loved ones about the dangers of drinking too much.

In Texas alone, there have been 1,024 drunk driving fatalities over the past year. Of these deaths, nearly half were fatalities to people other than the drunk driver, including passengers, pedestrians, and people in other vehicles. The devastating impact of driving under the influence spreads far beyond the driver alone.

During Alcohol Awareness Month, The Council on Recovery urges everyone to take a look at their own use of alcohol and what it means to drink responsibly. Especially, don’t drink and drive.

If you or a loved one are drinking too much, you can improve your health by cutting back or quitting. Here are some strategies to help you cut back or stop drinking:

  • Limit your drinking to no more than 1 drink a day for women or 2 drinks a day for men.
  • Keep track of how much you drink.
  • Choose a day each week when you will not drink.
  • Don’t drink when you are upset.
  • Limit the amount of alcohol you keep at home.
  • Avoid places where people drink a lot.
  • Make a list of reasons not to drink.

If you are concerned about someone else’s drinking, offer to help.

If you or a loved one wants to stop drinking, The Council on Recovery offers many effective outpatient treatment options, including intensive outpatient treatment (IOP), individual counseling, and group therapy. We also facilitate interventions and offer many prevention and education programs related to alcohol and substance use disorders.


For more information, call The Council on Recovery at 713-942-4100 or contact us online.