Bridges to Recovery: Addiction, Family Therapy, and Multicultural Treatment
By Jo-Ann Krestan
This chapter explores the connection between a family's ethnic background and its relationship to addiction. While no one factor has been found to cause the disease of addiction, research has revealed that attitudes toward drinking and socially sanctioned drinking practices are important considerations in the development of the disease. Field studies have found that demographic categories play an important role in alcoholism. Cahalan and Room (1974) identified youth, lower socioeconomic status, minority status (Black or Hispanic), and other conventional ethnic categories (Irish vs. Jewish or Italian) as predictors of drinking problems. Greeley and McCready (1980) identified "ethnic drinking subcultures" and found that they have withstood the otherwise apparent assimilation into mainstream American culture.
Cultural differences are critical factors in the recognition by family, friends, and coworkers that one's drinking has reached problematic proportions. "Tremendous variability persists-even in the wave of widespread publicity regarding the nature of alcoholism as a "disease"-in people's inclination to deny, ignore, adjust to, or confront the drinking patterns of those around them".
There are fifty-three categories differentiating families of European ethnicity in the United States. The largest groups are German, English, and Irish. Most of these families have been here for three generations or more and consider themselves American. Their struggles against discrimination have largely faded. A large percentage marry outside their ethnic background. These groups of European origin were some of the first immigrants to this country. Even when clinicians treat second- or third-generation family members, who consider themselves American, they can often detect the nuances and intricacies of European family life that link to a client's ethnic heritage. For example, issues about emotional closeness and distance or about group affiliation versus individual freedom are connected to ethnic background. This is particularly interesting to think about in the context of addiction. Issues about pride and shame are integral to understanding the addictive process. These issues are present for members of each ethnic group, whose own drama about immigration and acculturation affects their sense of ethnic pride. Although research and models for treatment are largely based on the population of European ethnicity, the impact of ethnicity on the addictive process for clients and their family is rarely addressed.
This chapter addresses the clinical needs of American families whose ancestors were of European origin. It provides the clinician with new questions to ask when thinking about addiction in these groups. Case studies are provided to help translate this thinking into action in the therapy room. My goal is to create a context for this discussion that is inclusive of the above-mentioned issues and to then move to more central issues about gender, power, and privilege, issues that have for so long been obscured in our conversations, thinking, and research on addiction. Genetic factors, as well as the cultural context in which the disease develops, are also central to this discussion. Since Alcoholics Anonymous (AA) is the dominant model of treatment for addiction, AA as a social construct will be examined in light of its fit with particular cultures.
Some of the questions about the impact of culture on addiction are not easily answered. For example, because European groups have largely assimilated and presently seek to identify themselves as American, it is difficult to tease out the differences in sociopolitical power between each group. In general terms, we know, for example, that the Irish, German, and Anglo populations have become more assimilated and subsequently have had more privilege than the descendants of Italian or Polish immigrants. At different points in U.S. history it has been more dangerous for some group-at some points Irish, at other times German, Polish, or Italian-to claim their heritage. This means that at such times members of that group had difficulty getting a job or were discriminated against in some other way. Yet they always had the option of disguising or relinquishing their ethnic background in ways that were and are not available to African American or other immigrants of color. The fact that these groups were White afforded them advantages not available to people of color.
Although the immigration experience did eventually translate to privilege for members of these European groups, they encountered discrimination at first in a variety of ways. An interesting theme that emerges in writings about these groups is the importance of stoicism in their lives. The ability to feel pain and not let it show was a survival tool for many immigrant groups. It was communicated in hushed tones in the early, crowded settlements, stops on the way to fulfillment of the American dream: "Don't let it show." "Don't show your weakness." No doubt this survival tool had a strong connection with the immigrants' relationship to alcohol, which could function either to inhibit or permit the expression of those painful feelings. This is most evident when the variable of gender is taken into account: a woman, not socialized to show anger, could do so under the influence of alcohol; likewise, a man, not socialized to be emotionally vulnerable, could do so after a few beers.