Chapter 45. Minorities

Joseph Westermeyer, M.D., Ph.D.; Dan Dickerson, D.O., M.P.H.
DOI: 10.1176/appi.books.9781585623440.357974



The term minority refers here to groups within the population who differ from others in their cultural or ethnic characteristics and may be liable to different—often inferior—policy or procedure. Culture refers to the sum total of a group's ways of living, including the group's material culture, worldview, social organization, symbols, status, child-raising methods, language, technology, and citizenship. The term ethnicity, as used in multiethnic societies, applies to peoples from diverse cultural backgrounds who share a common national culture. Distinctive characteristics include identity with a national origin, religious practice, language besides English spoken in the home or neighborhood, dress, diet, nonnational holidays or ceremonial events, traditional family rituals, and use of disposable income and free time (Keyes 1976). Subculture refers to groups within a culture that have distinctive group characteristics but that cannot exist independently of the population at large. Substance use, abuse, or commerce can foster highly cohesive and distinctive subcultures, such as "bottle gangs," tavern culture, cocktail lounge culture, opium den culture, and crack house culture (Bourgois 1989; Dumont 1967; Weibel-Orlando 1985; Westermeyer 1974a). Cross-cultural can refer to the comparison of psychosocial characteristics across two or more cultural groups or, in the medical context, to treatment in which the clinician and the patient belong to different cultures (Comas-Diaz and Griffith 1988). Comparisons across cultures are often termed etic, whereas noncomparable, culture-specific elements or patterns are termed emic (Lefley and Pedersen 1986).

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TABLE 45–1. Continental origins of psychoactive substances (pre-1500 a.d.)
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TABLE 45–2. Epidemiological changes in substance use post-1500 a.d.
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TABLE 45–3. Social means to impede substance use epidemics
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Knowledge about the evolution of alcohol and drug use among various cultures and ethnic groups can contribute to an understanding of substance-related problems among minorities today. The substances used and their routes of administration changed slowly and regionally until around 1500 a.d., when rapid changes resulted in the first substance-related epidemics. These changes have affected all minority groups, although in differing ways and to varying degrees.

Evolving patterns of alcohol and drug use and medical comorbidities have affected cultural and ethnic groups in both similar and divergent ways. Awareness of historical and cultural factors can prove crucial in preventing or ameliorating such problems. For minority ethnic groups, the relationship with the majority society as well as internal dynamics within the group can affect how substances and their use and abuse are perceived and how related problems are addressed.

Prevention and treatment involve not only medical and public health measures but also possible changes in minority community attitudes and mores, laws and law enforcement, education, the mass media, technology, and other aspects of our current ever-changing culture and its ethnic groups.

Perceived barriers to care within a minority group can impede treatment seeking, even when services are available. These barriers may involve the type of service provided but also may involve the clinicians providing these services, the potential patients themselves, and the patients' families and communities.


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A major social construct around substance abuse in minority communities is community-level retail distribution of illicit substances. Which of the following characteristics of this arrangement is false?
Regarding specific risk for substance abuse in minority groups, several cultural risk factors have been described. The loss of a positive ethnic identity among traditional peoples whose technological culture had been rapidly undermined by foreign influences is described as. . .
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