Using developmentally and culturally appropriate interventions

Researchers and theorists involved in creating criteria for substance abuse in the revision to Diagnostic and Statistical Manual of Mental Disorders IV for version V are suggesting using language that implies substance abuse as a “developmental disorder.”  They believe that substance abuse is a disorder that onsets when we are youth evolving in chronicity the older we get.  Along with developmental foundations of the disorder, most see substance abuse evolving out of many cultural contexts which either promote permissiveness or increase healthier perceptions of substance use.  This is especially obvious for all of us that live and grew up in Wisconsin where rates of alcohol abuse are astronomical.

Thus to treat substance abuse, the leading research and best practices are promoting using both developmentally and culturally informed methods to treat substance abuse.  This has been so obvious to many that have attempted in the past to treat adolescent substance abuse using an adult model or people of color using a primarily Caucasian normed methodology – it just doesn’t work.  In fact, it does more than just not working it often times increases substance abuse and repel individuals and families from seeking help.  Ask anyone that grew up in the 70s, 80s and 90s and had to go through or be a professional in a substance abuse treatment program and they will tell you that it was an awful experience with generally horrible results.  A common response of professionals during this period was to blame the Teens for being untreatable or too reactive when in fact it was the model of treatment that was flawed and not the youth.  An adult model of treatment has substantially lower effectiveness rates with youth because it is developmentally inappropriate.  A very simple example of this that many treatment programs that are developmentally informed harness the natural forces of adolescent individualism to be used as part of the therapeutic process rather than miss labelling this resistance and trying "break" a teen of their defiance like many of the historic models attempt to do.

In the same vein, using Caucasian informed, normed, and researched methods while working with African Americans or Native Americans often results in the same perceptions by those seeking services or treatment professionals.  For example, a Caucasian defined treatment approach is usually very individualistic and can use disempowerment (i.e. confronting powerlessness) as a framework.  Both these concepts can be more culturally appropriate to white folks, but when working with many African Americans these concepts can create frustration, fear and discomfort especially for individuals that are strongly identify themselves within the black community.  Similarly with Native Americans, using a perspective that is not informed by culture and spiritual perceptions along with not addressing historic and present experiences of prejudice can lead to a non-empathetic experience which highly correlates with reduced effectiveness in treatment.

So to be effective in treating clients with substance abuse problems, it is extremely important to evaluate the concentric circles around an individual that inform and define them which include culture, developmental stage, gender, substance sub-culture (i.e. cannabis, heroin, alcohol) and sexuality to name a few.  With these lenses present in the therapeutic relationship, effectiveness of treatment increases and individuals seeking treatment feel empathically affirmed leading to less struggles, greater attendance rates, and higher rates of motivation.


Jeff Ryan, LPCIT, CSAC
Therapist
Get Connected Counseling, LLC
Appleton, WI
920-7506120