Introduction, Part 2

Bridges to Recovery
by Jo-Ann Krestan

(Page 2 of 5)

Part Two: Ethnic Ecologies

Part Two of this book integrates what we know about ecological contexts, addiction, and family systems in ways that are immediately useful for clinicians.

Most of the contributors struggled with the need for a dialectical process between an ethnic-focus approach and Falicov's multidimensional comparative approach (Falicov, 1995). Ellias-Frankel, Oberman, and Ward quote an old joke: "Two Jews meet and there are three opinions." Rather than holding three opinions, they speak in terms of "ethnic themes" that do not "determine a particular response but rather [pose] an overt or covert question to which members of the group may have dissimilar responses." Dispelling the myth that Jews don't drink or have other addiction problems, they insist, "The most important fact to grasp about Jewish addiction is that it exists and is significantly underdiagnosed and undertreated."

Chang explores major commonalities among Asian Americans and Pacific Islanders while integrating highly particular and useful information about a wide range of groups. The compassionate depth of his work is reflected in discussions of the Asian historical background, especially migration and loss, and his analysis of families, relationships, gender roles, communication, harmony, and addictions. His clinical explications are extremely specific and practical. His thoughtful explorations of values and the poignancy of his depiction of the migrant's experiences of loneliness and loss stayed with me from my first reading of his first draft.

Hudak uses an ethnic-focus approach to groups of European origin. It is interesting that when I decided to treat European groups as an ethnic category, we found that there was more anthropological than clinical literature available. This presents new questions about assumptions inherent in a dominant discourse that was largely formed by the early settlers from European countries (see chapter 1). The richness of Hudak's case studies teaches us much about treatment and compensates for the lack of literature. The anthropological information that is available suggests that these individual groups do in fact have significant ecological differences that impact on addiction patterns and treatment.

Reid, a social worker, trained family therapist, pastoral counselor, and Baptist preacher, writes on African Americans with an immediacy that joins expression with commitment. According to Knox (1985), "the organized church is by far the most profound instrument available to Blacks when it comes to coping with the multiplicity of problems that beset their lives" (p. 35), and, as Harrison Pipes (1997) says, "undoubtedly, the old-time Black preacher is the Black leader today; it is to him that the great majority of Blacks in this country look for guidance" (p. 64).

Reid's chapter, which reflects her pastoral calling, is consistent with Pipes' formulation of old-time religion: it uses words familiar to her audience; a narrative voice meant for listening more than reading; a figurative style with heavy use of metaphor, often drawn from the Bible; and rhythmical, sometimes elliptical, sentences. It appeals to emotion as much as to reason.

In the chapter by Hernandez and in the one by Bibb and Casimir, our attention is directed to how U.S. foreign policy and the international drug trade closely affect addiction among Puerto Rican and West Indian immigrants, respectively. Since I do not believe we ever speak apart from context, I have no difficulty with material that some readers may consider highly politicized. As Almeida, Woods, Messineo, and Font (1998) point out, family theory has too frequently considered the systems in the "interior" of family life while neglecting the larger social systems. Even feminist theory, while introducing an analysis of power inequities, has paid insufficient attention to multiple levels of oppression. Hernandez' approach directly deconstructs addiction in the Puerto Rican population as a multilevel systemic phenomenon that is often rooted in racism, classism, and oppression. I believe that there is a place in clinical work for the acceptance and encouragement of linear rage, as well as for systemic responsibility.

Clinically, Hernandez, true to the creativity that first struck me, applies Stivers' (1976) idea of a group adopting a dominant group's stereotype when he writes, "The central theme I try to discuss is how by losing control and becoming addicted the client has fallen into the trap of acting out the stereotyped view that the dominant group has about Puerto Ricans. I tell my clients that every time they lose control, they become another number in the statistics that proves to 'them' that Puerto Ricans are 'spiks who don't do nothing but get high'. Talking about the impact that poverty, migration, and ethnic minority reality have on our lives is done to contextualize addiction within a sociopolitical context."

Bibb and Casimir state in the opening to their chapter, "Holding individuals personally accountable must be balanced with knowledge of the powerful social, geographic, and economic forces that created and now maintain the flow of alcohol and drugs abroad and in North America. It is important to attend not only to the psychological and clinical dilemmas that substance abusers face but also to their social and community context. Addiction is extremely personal and yet extremely global." Their discussion of addiction and West Indians includes specific clinical issues, suggestions for needed research agendas, and comments on the international drug trade.

Baron meets the challenge of writing about the enormous complexity of our largest immigrant group, the Mexican Americans. This group is burdened by heavy substance abuse. Baron focuses on a way of assessing a particular family at a particular moment in time. He synthesizes several models (notably those of Falicov, Sue and Sue, and Jones) in a methodology that pays particular attention to acculturation, ethnic identity development, and worldview. He also offers an extremely comprehensive review of the literature. Of the enigmatic character of the Mexican, the late Octavio Paz (1985) wrote, "It is revealing that our intimacy never flowers in a natural way, only when incited by fiestas, alcohol or death" (p. 70) and "There is nothing so joyous as a Mexican fiesta, but there is also nothing so sorrowful. Fiesta night is also a night of mourning" (p. 53).

"Mitakuye Oyasin" (Lakota for "All Our Relations")

Don Coyhis, director of White Bison, is a man I wanted to connect with for several years. I knew that Don, following a vision quest, had exchanged his corporate life for a path of bringing substance abuse recovery to his own people. In a series of "coincidences" involving a stranger in Las Cruces, New Mexico, I finally did track Don down. After much discussion he and his staff, notably Richard Simonelli, shared a series of Don's talks, originally given in the oral tradition of Don's people and transcribed by Richard. The addiction recovery program for Native Americans described in chapter 3 represents a unique blend of the wisdom of the medicine wheel and a twelve-step approach to sobriety. One of the beauties of White Bison's approach to the "red road of sobriety" is its ability to transcend the heterogeneity of Indian nations and traditions by synthesizing symbols and rituals that are common to all.

Future Directions

Several ecological contexts deserve more exploration in relationship to addiction recovery in the twenty-first century:

1. The Role of Gender
It is a consistent finding across every group that the most prevalent risk factor for addiction, other than having an alcoholic parent, is gender — that is, being male. The Ninth Special Report to the U.S. Congress on Alcohol and Health (1997) concludes, "Studies confirm that women drink less and report fewer alcohol-related problems than men do" (p. 27). Heath (1995), an anthropologist, concurs: "One measure of status that is recognized everywhere is gender (what many consider to be the sociocultural implications of the biological category of sex differentiation)... men drink more, and more often, than do women. (This is almost a cultural universal with only two peculiar instances — both small migrant groups in novel settings — known where the opposite holds)" (p. 337). The Ninth Special Report also concludes that future research on women and alcohol use should pay particular attention to "childhood and adult violent victimizations, depression, sexual experience, and the influence of husbands' or partners' drinking" (p. 28). It seems significant that these factors, which are predictors of women's drinking, have as much to do with the women's relationship to men as to the women themselves.

2. The Role of Spiritual/Religious Belief Systems
It is a consistent finding that religious belief systems are often predictors of drinking behavior, and yet little attention has been paid to religion as a demographic variable since Cahalan, Cisisn, and Crossley did the original research in 1969. Alcoholism is often considered a disease of the mind, body, and spirit; Chappel (1997) and Royce (1995) consider it a spiritual disease. There appears to be considerable cultural resistance to this idea. Relatively little research has been done on the relationship between alcoholism recovery and spirituality despite studies that identify spiritual healing as a major contributor to the overall health of individuals (Benson, 1976; Borysenko, 1988; Michaud, 1998; Ornish, 1995).

3. Adolescence
Adolescence in different groups (particularly Latino), with its potential for engendering cross-generational conflict, its heavily researched risk factors, and its vulnerability both to addiction and to early intervention deserves a book of its own. The literature on risk and protection factors in adolescence is extensive. As a start I recommend Jose Szapocznik's work on prevention of alcohol and drug abuse among Latino youth, particularly his work on multicultural effectiveness training.

4. The Rural Context
An excellent resource, published by the National Institute of Drug Abuse, is Rural Substance Abuse: State of Knowledge and Issues (1997), which decisively dispels the myth of rural insulation from drug problems. Although one quarter of Americans live in rural areas and although among some groups (for example, African Americans) there seems to be increasing migration to rural areas from urban areas, rural America has rarely been the focus of concern about substance use and abuse. The tremendous economic downturns in rural areas create special vulnerabilities to psychosocial problems and addiction, and since the agricultural community is moving more toward hiring single, male migrant workers, instead of families, we might expect alcohol and drug use within the migrant populations to escalate.

5. Groups of European Origin
We have not talked about Franco-American concentrations in New England, the legacy of high suicide rates in the Nordic countries and their relationship to alcoholism in Nordic populations in the upper Midwest, the role of vodka as a medium of exchange in a crumbling Russian economy and our increasing population of Russian immigrants.

As Lippard (1990) says, "We have not yet developed a theory of multiplicity that is neither assimilative nor separative — one that is, above all, relational" (p. 21).

What we have done is to begin.

Copyright © 2000 by Jo-Ann Krestan

About the Author

Jo-Ann Krestan is a leading marriage and family therapist and addiction counselor who has appeared on such shows as Oprah and 20/20 and is co-author of The Responsibility Trap: A Blueprint for Treating the Alcoholic Family. Her other books include Singing at the Top of Our Lungs and Too Good for Her Own Good. She lives in Surry, Maine, and Castle Valley, Utah.