Ms. Manal Said, MSW, ICPS, CPC-R, Coordinator, Substance Abuse Prevention Program

msaid@accesscommunity.org

Dr. Hakeem Lumumba, Ph.D., CAADC, CCS-M, LPC, LMSW, Behavioral Health Director

hlumumba@accesscommunity.org

Arab Community Center for Economic & Social Services (ACCESS)

Community Health and Research Center

SUBSTANCE USE DISORDERS PREVENTION & TREATMENT;

THE ARAB AMERICAN COMMUNITY

12TH ANNUAL SUDS CONFERENCE

Maslow Hierarchy of Needs•P

lease see handouts

Erickson’s Human Development•P

lease see the handouts

The Arab American Community…•A

rabs and Chaldeans Defined

Who are Arabs?

•US Citizens

•Permanent residents

•Middle-Eastern ancestry

•Shared cultural heritage

Arab Ancestry in Michigan

Who Are Chaldeans?

• The history of Chaldeans can be traced to at least the 13th centuries B.C.E. in what is now known as the first Mesopotamia civilization. Mentioned in the Hebrew Bible.• A prominent city of the Chaldeans, called Ur, is the historic homeland of the prophet Abraham• Chaldeans belong to the Chaldean Catholic Church which in the 15th century aligned with the Roman Catholic Church. However, they have their own Patriarch and the Eucharist (ordinance) differs.

Chaldean Americans

•Chaldean Americans are descendants of the northern Tigris-Euphrates Valley, located in Iraq. Not all Chaldeans are Iraqis and not all Christian Iraqis are Chaldeans.• In Iraq, there are multiple ethnicities.• In Iraq, Chaldeans are not well known or identified.•Chaldeans are believed to have immigrated to the United States as early as 1880•The majority live in Detroit, Michigan. It is estimated that there may be as many as 150,000 Chaldeans in the metropolitan area.•Mostly reside in Macomb and Oakland counties.•Chaldeans prefer being called Chaldean Americans.

Chaldeans cont.

Assyrians

•Indigenous to Iraq, Syria & Iran

Kurds

•Indigenous to Iraq, Syria, Turkey & Iran

Berbers

•Indigenous to Morocco, Algeria, Tunisia & Libya

Arab Countries

Different waves of immigration to the U.S., dating back to the late 1800’s

Recent waves include refugees from violence

Highly concentrated in metropolitan areas

Waves of Arab Immigration• First Wave (1880s-1920s)•Mostly single, Christian men from Greater Syria• Came looking for jobs• Second Wave (1950s-1960s)• “Brain-drain phenomenon”• 1948 and 1967- Palestinians emigrated because of political conflict

• Third Wave (1970s-Present)•War and political conflict

1975- Lebanese Civil War 1970s/1980s- Palestinian/Israeli wars 1980- Iran/Iraq War 1991- Gulf War 2003- War in Iraq

Some Demographics

•In all 50 States

•2/3 in ten States

•1/3 live in Michigan, California & New York

•94% live in Metropolitan areas

•California has largest Arab population

•Michigan has largest concentration of Arabs

Language عربي• Arabic• Several dialects• Official language of 21 of 22 Arab countries• Spoken by 92% of the population

• English• French• Aramaic• Kurdish• Berber• Armenian

Second Language at Home 2003

Religion•M

ost Arabs are Christians• Varies by region

•Islam• Sunni• Shi’a• Belief in Allah• 5 pillars of Islam

•Judaism

•Druze

Arab Religion 2003

Family

Culture

•Customs

•Clothing

•Food

Terminology

•Arab, Arabic or Arabian

•Arab American or American Arab

•Muslim or Moslem

•Middle East vs. the Arab World

Stereotypes

• Islam as violent or unfair religion• Arabs/Muslims are terrorists• Eye charm used as witchcraft

(hamsa) {WORN FOR PROTECTION}

• Arab women subservient to men• Arabs are oil rich• All Arabs are Muslim• Arabs don’t speak English & uneducated

Arabs/Chaldeans: Acculturation

•Gender differences women more vulnerable

•Religious differences

•Loss of the family unit & role reversal

•Discrimination

•Racial profiling post 9/11

•Generational gaps 1st, 2nd & 3rd

•Marginalization

Prevalence of Substance Abuse

Smoking rates among Arab American Adolescents (14 -18 yrs)

0%

20%

40%

60%

80%

100%

Tried smoking Smoked in past 30 days

Smoked Daily

Cigarette

Arghile

Binge Drinking Indicate Need for Culturally-specific Interventions

Michigan BRFS, 2007-2009

*

* p<.05

Arab Americans entering substance abuse treatment over time, Michigan

0

0.1

0.2

0.3

0.4

0.5

2000 2001 2002 2003 2004 2005 2006 2007

Numbers of admissions by Arab Americans noted above the bars.

59

138

168 187 201222

246 223

% o

f tot

al a

dmis

sion

s

FY 2007 had 62% increase over FY 2001

Ethnicity of Arab/Chaldean

Race of Arab American

Fiscal years

Social Consequences•P

erspectives• Legal• School• Religious• Family

Arab American Youth

Immigration & Acculturation• Immigration involves psychological stress &

loss • Acculturation

1. 1st generation – grieve losses while adjusting to new country and environment

2. 2nd generation – emotional turmoil & family conflict due to difference in parent-child assimilation levels

3. Since 9/11, 3rd and 4th generation Arabs reconnect to Arab culture & ancestry and preservation of cultural identity

Arab American Youth

Trauma & Arab American Youth•Immigration as a result of war & displacement

•Possibility for self-medicating through drugs or alcohol

•Parental Trauma makes parents emotionally unavailable to their children → negatively impacts the youth and creates instability

StigmaCultural stereotypes and family honor Mental illness sometimes seen as sign of punishment from God Mental illness considered by some as possession by Jin (devil) Belief that the mentally ill are dangerous, unpredictable and untreatable Hard to communicate or work with and hopeless

Effects of stigma•R

esearch shows that stigma of mental illness, can be as harmful as the illness itself.

•It may aggravate or increase symptoms.

•It diminishes social and work functioning.

•It depletes support networks and increase isolation in the community.

•It reduces chances of marriage or healthy relationships. May even cause divorce or family destruction.

•It reduces chances of getting jobs.

•Shunned by community.

Prevention MethodsACCESS Substance Abuse Prevention Program•Environmental and Community Based Strategies• Advocacy and policy change- legislator education• Vendor education and compliance checks• Provide bilingual educational community & school presentations and technical

assistance• Life skills curriculum• Bilingual printed informational material

ACCESS Community Substance Abuse Coalition (ACSAC)•Coalition capacity building•Provides forum for community stakeholders to share resources and information

Primary focus on Hookah and Tobacco Prevention•Second-hand smoke exposure• Smoking cessation

Goals•Increase awareness, change community norms and reduce accessibility

HOOKAH ARGILEH

•Hookah aka, Argileh or Shisha, is a single or multi-stemmed (often glass-based) water pipe for smoking flavored tobacco.

•It has a long hose attached to the pipe from which the smoke is drawn. The charcoal is used to heat and smoke the tobacco. When the smoke passes through the water it cools smoke of tobacco.

Flavored moist Hookah tobacco

Some Concerns…•M

isperception that carcinogens are filtered during the smoking process

•Many do not consider themselves as smokers if they only smoke hookah

•Many view it as a social activity, non addictive and not as harmful.

•Hookah is normally shared and poses sanitation hazards i.e. TB, H1N1, Herpes exposure

•Social acceptance of smoking hookah is high.

•Able to resist smoking for longer periods of time when they are in an environment where smoking is not allowed

•Family and guests smoking in the home and offered as sign of hospitality contribute significantly to the smoking behavior

Current hookah smoker by gender among Arab & Chaldean compared to non Arab Americans

41.6%

24.7%

33.6%

3.2% 1.9% 2.5%

0%

10%

20%

30%

40%

50%

60%

Male Female Total

A&C Americans

Comparison group

DSM-IV Definition of Substance Abuse and Chemical Dependency

•Substance Abuse-A Maladaptive Pattern of Substance Use Leading to Clinically Significant Impairment or distress as manifested by one or more of the following within a 12 month period, poor performances at work, with family and school, high risk behaviors (driving under the influence), legal encounters, and the inability to stop despite negative outcomes

•Substance Dependence-Maladaptive Pattern of Substance Use, Leading to Clinically Significant Impairment or distress, as manifested by either tolerance, withdrawals, abuse, inability to control use, or preoccupation to obtain substance(s) (APA, 2000)

DSM-IV Co-Occurring Disorders among Arab Americans and Chaldean

Americans•B

esides Opiate Addiction, Cocaine Addiction, Sedative Addiction, Marijuana Addiction, and Tobacco Dependency, many members of this group also suffer from Bi-Polar I and II Disorders, Anxiety Disorders (PTSD, Panic Attacks), Major Depressive Disorders, and Adjustment Disorders with Mixed Anxiety and Depression

DSM-IV Co-Occurring Disorders among Arab Americans and Chaldean

Americans•S

exual Abuse, Paranoid Personality Disorder, Paranoid Type of Schizophrenia, and Bereavement.

Treatment Methods•E

ngagement Techniques-There needs to be a sensitivity to the client’s need to feel safe. The Arab American and Chaldean American Communities are very closed knitted community and the concern for strict confidentiality is of the utmost importance.

•Language Barriers-There is a preference for the health care provider to be bilingual (English and Arabic), depending upon if the client is a member of the first, second, or third generation.

•Family/Couple Therapy-is important, however, it maybe difficult to include the husband. Many men in the Arab American and Chaldean Communities are entrepreneurs and may not be available. In addition, depending upon certain Arab Americans, the man is viewed as the ultimate authority. Therefore, it is essential to keep the father or male guardian in loop of the therapy

Treatment Methods continue•P

sycho-Education-There needs to be an emphasis on educating the client on the purpose of therapy. Many Arab Americans and Chaldean Americans have never engaged in therapy, so therefore, there maybe a high level of apprehensiveness. In addition, the client may need to be educated on the difference between a Psychiatrist, Psychologist, Social Worker, and Counselor.

Theoretical Models•A

ffective Intervention Model-This model stresses the importance of feelings, more importantly the sorting out of feelings.

•Cognitive Intervention Model-This model stresses the importance of the thought process and the client’s belief system.

Theoretical Model continue•B

ehavioral Intervention Model-This model stresses the importance of assisting the client with identifying their maladaptive behaviors as well as their adaptive behaviors. In addition, this model stresses identifying the enforcer of certain behaviors. Ultimately, this model emphasizes helping the client change their behaviors.

Theoretical Model continue•S

ystemic Intervention Model-Stresses the influence of the client’s systems. This includes their culture, gender, spirituality, and social environment. Systemic clinicians hypothesize that the client’s problems are rooted in their system. Most often this is due to either miscommunication or lack of communication. In addition to a difference in values and moral among members of the system.

Clinicians CharacteristicsB

ilingual (Arabic/English) PreferredG

ood Working Knowledge of the Arab and Chaldean cultureW

arm DispositionS

trong Rapport Building SkillsS

trong Listing SkillsS

ensitivity to Non-Verbal CuesR

esourcefulR

espectful of Client’s UniquenessP

atience

Clinicians Characteristics continue

•Some Arab Americans and Chaldean Americans have a preference for clinicians of their own race and culture.

•Some clients actually have a preference for clinicians of their own race. For example, a Lebanese client may have preference for a Lebanese clinician. However, in some cases, there is a preference for a clinician of the same race but from a different culture. For example, an Iraqi client may request an Arab American clinician but stipulate that the clinician be non-Iraqi.

Arab Community Center for Economic Social Services (ACCESS)

•Historical Aspects

•Services-See Handouts

ACCESS Ambulatory Chemical Dependency Program•A

im and purpose is to provide individual therapy to substance abuse and substance dependence clients as part of their continuing care treatment.

•Clients will receive comprehensive screening, psychiatric care on an as needed basis, medical care on an as needed basis, breathalyzer and random urine drug screens. Clients will be admitted based on the ASAM Admission Criteria. Clients will be treated by Certified Addiction Counselors and they will be required to attend a minimum of 3 documented Alcoholics Anonymous and Narcotics Anonymous meetings per week.

Resources•A

rab Community Center for Economic and Social Services (ACCESS) Accesscommunity.org

•National Institute on Drug Abuse (NIDA) nih.gov

•National Institute on Alcohol Abuse and Alcoholism nih.gov

•Substance Abuse and Mental Health Services Administration (SAMHSA) samhsa.gov

•Community Anti-Drug Coalitions of America (CADCA) www.cadca.org

•Tobacco Free Michigan (TFM) www.tobaccoofreemichigan.org

•Michigan Dept. of Community Health Tobacco Section www.michigan.gov/tobacco

•Southeast Michigan Community Alliance (SEMCA) www.semca.org

•Partnership for Drug Free America www.drugfree.org

•American Cancer Society (ACS) www.cancer.org/Healthy/StayAwayfromTobacco

•The Knopf Co. www.mi-pte.org

•Macomb County Office of Substance Abuse CMH www.mcosa.net

•Ingham County Tobacco Information www.hd.ingham.org/Home/OtherServices/TobaccoInformation

•Brighton Addiction Treatment Hospital www.brightonhospital.org

•Prosecuting Attorneys Association of Michigan www.paamtrafficsafety.com

•Michigan Multicultural Network (MCN) www.michiganmulticulturalnetwork.org

•Centers for Disease Control (CDC) www.cdc.gov/tobacco

•Addiction Technology Transfer Center Network (ATTC) www.attcnetwork.org

•Bureau of Substance Abuse and Addiction Services (BSAAS) www.michigan.gov/mdch-bsaas

Reference page•B

eck, A. T. (1976). Cognitive therapy and emotional disorders. New York: International Universities Press.

•Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson.

•Foley, V. D. (1989). Family Therapy. In R.J. Corsini & D. Wedding (Eds.), Current psychology therapies (4th ed.). Itasca, IL: F.E. Peacock.

•Hackney, H and Cormier, S (2005). The professional counselor a process guide to helping (5th ed.). Boston: MA.

•Lazarus, A. A. (1989). The Practice of Multimodal Therapy. Baltimore: Johns Hopkins

• University Press.

•Wolpe, J. (1990). The practice of behavior therapy (4th ed.). New York: Pergamon.

Final Thoughts…

• Each consumer is unique• Different ethnicity/race has different beliefs•Watch for consumer cues/body language/facial expressions and respond appropriately• Be patient and honest• Appreciate and respect differences• Build trust and rapport overtime• Provide culturally competent and bilingual services when appropriate• Always ask if you’re not sure and include the consumers input, they know themselves best

Acknowledgements

•Southeast Michigan Community Alliance (SEMCA)

•MDCH Tobacco Section

•Dr. Cynthia Arfken, WSU

THANK YOU