Since 1975, the Institute for Social Research at the University of Michigan, in conjunction with the National Institute on Drug Abuse, has produced the Monitoring the Future (MTF) survey, which reports the substance use rates of 12th grade American youth. The MTF results in 1979 revealed annual prevalence of use rates for alcohol and marijuana at 88.1% and 50.8%, respectively, with both figures being the highest for each substance over the life of the survey. Forty-one years later, it is this general cohort that often enters addiction treatment with the most chronic and severe forms of alcohol dependence. And for many of these patients, obtaining the care they have needed has meant confronting societal stigma around accessing treatment.
A key component of treatment for mental and substance use disorders is therapy. For minorities, stigma associated with entering treatment can be compounded by discrimination. And while similar cultural roots don’t guarantee a better bond, competence in learning about differences and being mindful of verbal and non-verbal cues are critical. Yet nationally, minorities comprise less than 3-in-10 master’s level social workers. Thus, for many minorities, seeking therapy can be both intimidating and humiliating, as the staff may neither reflect minority backgrounds, nor be trained in cultural competency. We can’t effectively advance access to care without addressing stigma and the promotion of cultural competency. In plain language, we must get to know and understand each other better.
Possibly the most significant work that has been done to reduce stigma is the recovery movement. The goals of the movement are to put a face on recovery, reduce stigma and discrimination, and to provide a supportive environment for mentoring people in recovery. SAMHSA awarded the first round of Recovery Community Services Program grants in 1998, and in 2005, the Detroit Recovery Project – which has become a national model – launched under the direction of Andre Johnson. Programs such as this developed the ability to assist newly recovering individuals via other individuals from the same community who possessed long-term recovery success. Having said this, supporting people in recovery is not fundamentally about the “community we come from,” but rather the willingness to go to others and meet fundamental human needs. This movement has shown that full recovery from mental and substance use disorders is possible. It has also shown that recovery is a process, throughout which individuals can live a life full of meaning – even in the face of residual effects of these conditions. For additional resources on reducing stigma, go here.
May our efforts today be seen 40 years from now by the 2019 MTF cohort as key to reducing the impacts of chronic and severe substance use disorders. It starts with cross-cultural understanding and communication. It starts with you, and it starts with me.
Raymond Waller is hospital administrator at Ascension Brighton Center for Recovery in Brighton, Mich., and 2020 chair of AHA's Behavioral Health Council. The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.