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Substance abuse is one of the most harmful phenomena of a society. It can also be considered as substance-related disorder, and is related to abuse of drugs, tobacco, and/or alcohol that can lead to harmful outcomes. Estimates show that over 8 million children in the U.S. have one of the parents having substance-related disorder. Substance abuse can result in significant problems in a family as, for example; it can lead to separation of partners, problems in raising the children, employment problems, and severe levels of conflict in the society (Donohue et al., 2014).
It has been reported that 50% to 70% of those children are maltreated and neglected, whose mothers are substance abusers. Nearly 38% of children with parents having cocaine abuse face maltreatment in the 1st year of their life. Parents who use methamphetamine represent families that face dirty housing, unchanged diapers, and being without formula or food for children. Nearly 42% of 3 to 7 years old children born to parents having heroin-related abuse may suffer some form of mental problem or severe kind of emotional problems. Even though marijuana is less harmful as compared to many other hard drugs, negative health consequences and poor supervision have been reported in children with parents of marijuana-related abuse (Donohue et al., 2014).
Most of the studies have considered the alcohol abuse in Hispanics or Latinas. In those minorities, men are found to have more alcohol related abuse as compared to women. Moreover, illicit drug use has also been found in those minorities, especially in the families with acculturation. Opiates are most commonly used by Hispanic/Latina women, though they also use cocaine, marijuana, and metamphetamine. On the other hand, substance abuse in African Americans is declining as shown by reports. Moreover, illicit drug use is comparatively lower in Asian and Pacific-American women as compared with other ethnic and racial groups (Finkelstein, 2009).
Lower level of socioeconomic status or poverty in childhood has been found to be among the most important risk factor in substance abuse in adolescence. Importance of income in the onset of substance abuse treatment in underserved or minorites has been considered on the basis of two findings; according to one finding people from families having low income have more chances of going for substance abuse treatment, and according to the second finding, Latinos and blacks have more chances of belonging to those impoverished groups (Lê Cook & Alegría, 2015). However, it is also important to note that familial genetic risk factors could also contribute to the development of substance abuse. Therefore, it is important for health care providers to consider not only the parental income in but also other familial risk factors such as family dissolution, parent-child relationship, and parental criminality (Sariaslan, Larsson, D’Onofrio, Långström, & Lichtenstein, 2014).
Pain has also been found to be an important cause in the development of substance abuse. Most of the patients visit doctors due to the presence of pain. Studies show that undertreated pain is common in minority communities especially due to decreased level of patient-physician communication, stereotyping, and physician bias. Moreover, undertreated pain could lead to disturbed function and decreased quality of life. Several medications can be used to decrease the pain, but some of those medications such as morphine and codeine that can treat severe type of pain could lead not only to the treatment of pain but also their abuse. Therefore, healthcare providers have to work not only on the analgesic effects of medications but they have also to consider the potential ill effects as well as drug abuse. Health care providers can work on “the four As” including analgesia, activities of daily life, adverse effects, and aberrant behaviors while giving opioids having abusive potential. Moreover, they have also to consider the patients showing abuse potential for opioids. In this regard, health care providers may consider opioids having lower potential for substance abuse; prescribe lower doses and smaller quantities of opioids; keep on checking urine toxicology, and schedule frequent visits during renewal of prescriptions (Primm et al., 2004).
Acculturation, the process of adjusting and adapting to a new environment while maintaining some cultural identity, is considered to be among the key factors in substance abuse in Hispanics and Latinas. Sometimes alcohol and drug abuse start as a result of environmental and acculturation stress such as new roles and expectations. These findings show that acculturation must also be considered in the development of treatment strategies especially in Hispanics and Latinas (Finkelstein, 2009).
In the development of effective therapeutic interventions for substance abuse in underserved or minority population, it is important to consider the values, language, and backgrounds of the families and their cultures. Moreover, staff training to improve the knowledge and cultural awareness is also critical for effective services. For example, substance abuse therapeutic intervention could consider a therapeutic environment that gives respect to the cultural heritage as well as incorporates values such as family relations and cohesiveness. In the development of therapeutic intervention in African Americans, resiliency factors in their families can be considered. Those factors include a high level of spiritual or religious orientation; a perception of racial pride; unity of family including family pride and sense of cohesiveness; a high level of commitment to the family, and an adaptability of family roles. In the Asian and Pacific-American families, certain indigenous therapeutic modalities such as acupuncture, massage, meditation, and tai-chi could also be considered (Finkelstein, 2009). It has also been found that enrollment of underserved population in public insurance programs could improve the substance abuse treatment as those insurance programs significantly change the black-white differences in receiving the substance abuse treatment (Lê Cook & Alegría, 2015).
In order to deal with families experiencing substance abuse, behavioral therapies could be started that have shown improved outcomes. In the child neglect treatment, SafeCare has been studied more often. In this therapeutic strategy, home visitors help in learning home safety, positive interaction between parent and child or infant, and child health. In the SafeCare method, problem solving skills are developed that are helpful in dealing with child neglect. Another method of dealing with the problems of substance abuse includes Multisystemic Therapy, which is a multi-component family based intervention. This intervention could help the families in global psychiatric functioning as well as overall stress. Moreover, it is helpful in improving parent-child interaction. On the other hand, parent training could significantly help in reducing social problems such as conflicts with neighbors, children’s problems in schools, and unemployment. Another therapeutic intervention is Parent Child Interaction Therapy that could decrease children physical abuse. However, experts are of opinion that continued intervention development is essential for the families experiencing substance abuse (Donohue et al., 2014).
Donohue, B., Azrin, N. H., Bradshaw, K., Van Hasselt, V. B., Cross, C. L., Urgelles, J., . . . Allen, D. N. (2014). A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse. Journal of consulting and clinical psychology, 82(4), 706-720.
Finkelstein, N. B. (2009). Substance Abuse Treatment: Addressing the Specific Needs of Women: DIANE Publishing.
Lê Cook, B., & Alegría, M. (2015). Racial-ethnic disparities in substance abuse treatment: the role of criminal history and socioeconomic status. Psychiatric Services.
Primm, B. J., Perez, L., Dennis, G. C., Benjamin, L., Clark, W., Keough, K., . . . Sullivan, L. W. (2004). Managing pain: The Challenge in Underserved Populations: Appropriate Use Versus Abuse and Diversion. Journal of the National Medical Association, 96(9), 1152.
Sariaslan, A., Larsson, H., D’Onofrio, B., Långström, N., & Lichtenstein, P. (2014). Childhood family income, adolescent violent criminality and substance misuse: quasi-experimental total population study. The British Journal of Psychiatry, 205(4), 286-290.