💰 Asian-Americans, Addictions, and Barriers to Treatment

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They are fixtures in Chinese newspapers: promotions for the Mohegan Sun, Foxwoods and Bally's casinos. And they list the bus departures.


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Minimal research has investigated the stigma associated with problem gambling, despite its major hindrance to help-seeking and recovery.


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When a US woman started a Reddit thread about how 'rude' Chinese tourists are, Chinese users responded.


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gambling consequences. Gambler resulted in more miscellaneous words (e.g., casino, money). Conclusions: Stereotype content was not entirely inaccurate and​.


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Some people think that racism toward Asians diminished because Asians “​proved themselves” through their actions. But that is only a sliver of the.


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Horch and Hodgins () identified a range of negative stereotypes associated with 'problem gambler' and 'gambling addict', with some variations for each label.


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suicide risk, offering brief interventions, where necessary, for this vulnerable population. Keywords: alcohol misuse, clinical, pathological gambling, Singapore​.


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When a US woman started a Reddit thread about how 'rude' Chinese tourists are, Chinese users responded.


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Some people think that racism toward Asians diminished because Asians “​proved themselves” through their actions. But that is only a sliver of the.


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suicide risk, offering brief interventions, where necessary, for this vulnerable population. Keywords: alcohol misuse, clinical, pathological gambling, Singapore​.


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This implicates the need to involve family members in treatment from the very beginning, which is a different concept than that seen in the themes of self-reliance and personal responsibility among Western cultures. As an example, most addiction treatment programs will utilize step support groups.{/INSERTKEYS}{/PARAGRAPH} Furthermore, while there was no significant difference in pathological gambling between AAPI and non-AAPI casino patrons, approximately 30 percent of the AAPI casino patrons surveyed met criteria for pathological gambling. In general, recent reports have indicated that AAPI have poor access to care for medical care and mental healthcare, making it likely that access to substance abuse care is also lacking. There are some unique biopsychosocial aspects of addictive disorders that impact the AAPI population. Another critical systems issue is the lack of culturally competent services tailored to specific AAPI language, cultural beliefs, and values. First, there is the general stigma from society of seeking help for an addictive disorder; this would be true for any member of any ethnicity. These cultural trends do have implications to public health; for instance, according to Department of Justice data from Los Angeles County, driving under the influence DUI are the most common reasons for why Korean-Americans are arrested. One behavioral addiction gaining more attention among AAPI is pathological gambling. Another risk factor that is described for this population is availability, untreated mental health disorders, and lack of structured activities for the disenfranchised community. Explanations for this are unclear but are possibly related to the interplay between gender and impact of acculturated values on behavior. These barriers include cultural values, individual factors, and practical issues. Levels of awareness and understanding about the signs and symptoms of addictive disorders, particularly in AAPI communities, can be quite low. The shame in asking for help represents a failure of the family to solve the situation, and AAPI place significant emphasis on appearances of normal functioning. In contrast, there are some subgroups of AAPI that still demonstrate high alcohol use despite the absence of this alcohol-metabolizing enzyme. In regards to specific data, the most appears to be available in the area of alcohol and much less is available in regards to drugs of abuse. In terms of treatment data, most of the major clinical trials on nicotine dependence did not include AAPI, thus limiting the generalizability of those trials to clinical practice. Together, these studies provide examples that within smaller ethnic subgroups or within specific populations, AAPI do in fact have significant levels of alcohol and substance use disorders. AAPI have a holistic view of health and oftentimes view mental and addictive disorders as a medical problem, a sign of weakness, or a lack of willpower over Western temptations. Specifically, the following factors are associated with increased likelihood of smoking: not being able to speak English, recently immigrating to the US, being from a Southeast Asian Heritage, and being an adolescent AAPI. These ethnic group differences would not have been sorted out unless data on specific ethnicities were available. In terms of incidence and prevalence rates of substance use disorders among AAPI, there tends to be lower rates overall for all AAPI for stimulants, marijuana, and heroin dependence. Transportation and access to insurance are also examples of access-to-care issues. In community surveys, however, the rates of substance use disorders do not necessarily reflect that of national surveys. Some researchers have suggested that the reduced smoking rate may be due to the selection of Asian immigrants who are more educated and have higher incomes. For instance, many traditional Asian medicines are alcohol-based or are taken for an energy boost e. Despite this low number, recent data suggest that more AAPI are presenting to treatment for the first time and over the last 10 years there has been an increase in the number of AAPI that enter treatment. Second, AAPI have to face the stigma of seeking help for psychiatric and behavioral problems. Recent community surveys have shown that pathological gambling rates among AAPI vary but can be strikingly high. This will likely lead to higher dropout and less chance of engagement in treatment in the first place. These factors may account for the higher rates of problem gambling and for the severity of the consequences that result from problem gambling. The explanation surrounding this finding is still unclear but it is thought to be due to genetic and psychological differences seen only in the mixed-heritage groups. Although the stereotype is that AAPI do not present or come to treatment, the reality is that there are several significant and unique barriers to accessing care. AAPI have varying levels of risk and vulnerability to addictive disorders and appreciating the differences between ethnic subgroups is critical for screening and early intervention. The most recognized one is the issue of shame in asking for help for an addictive disorder. Understanding the different population subgroups and the dynamics of growth are important because AAPI are a heterogeneous group at least 20 different ethnic subgroups with individualized cultures and heritages. Many immigrant families live in isolation due to language and cultural barriers. Most studies indicate that the more acculturated AAPI are, the more likely they are to consume more alcohol. Tobacco use in Asian countries is quite substantial as noted that China is the largest producer and consumers of tobacco in the world. One example of how this might be important comes with data from the tobacco helpline in California. Further evidence shows that admissions for methamphetamine have increased four-fold in the last several years. So, in reality, this low number presenting to treatment probably represents the larger healthcare disparity that exists between those that need treatment and those that actually present to treatment. Recognizing these specific factors is important to identifying AAPI populations who are most vulnerable to developing these addictive disorders. Recent data demonstrated that this conception is not true for all AAPI subgroups. This behavior is not denial, which is an overt disavowing of an illness, but rather a misattribution of what is causing the problem. AAPI women who are more acculturated to the US are more likely to smoke as compared to recent immigrants; in men, the reverse relationship is true. For instance, psychological maladjustment, low self esteem, and low self confidence are related to increased alcohol use among Chinese and Filipino adolescents. One indicator that at first glance suggests a lower overall rate of substance use disorders among AAPI is the number of AAPI that present to alcohol a drug abuse treatment. Because of the wide range of AAPI subgroups, understanding epidemiological patterns of substance use disorders among specific AAPI population has been difficult. For the purpose of clarity, treatment barriers for AAPI can be divided into cultural and practical barriers. This stigma is often accentuated by AAPI past experience with addiction treatments in their native countries whereupon such treatments are often equated with incarceration, banishment, or long-term institutionalization. The traditional AAPI response to crises is either denial or attempting to handle problems within the family itself. As an example, Southeast Asians report a distrust of Western medicine because by the time AAPI presented to treatment, the conditions are severe enough that outcomes will be poor but patients are left wondering why Western treatment always seems to result in poor outcomes. AAPI that do smoke habitually have been shown to smoke more cigarettes per day than any other ethnic group, with an average of close to 17 cigarettes per day close to one and a half packs per day. Separate from cultural issues there are specific barriers to the delivery of psychiatric and addiction care to AAPI population. Kumi-Price recently reviewed four national epidemiological studies to understand prevalence rates of substance use disorders among subgroups of AAPI. For AAPI, psychological and social factors, denial, guilt, or shame, coping strategies, acculturation issues, language barriers, and help-seeking behaviors all exacerbate the impact of problem gambling on the gambler, family, and community. Barriers to care will significantly impact the ability of AAPI to accept or receive care for addictive disorders. One of the first issues is limited access to care because of cost, awareness that care exists, or because there is lack of actual services that can be accessed. Furthermore, the impact of addictive disorders on AAPI populations are often hidden away from family members and friends until they are so serious that intervention is often forced onto them arrest, hospitalization, homelessness. Japanese-Americans, though, were found to have substance use and abuse rates similar to those of Caucasians, while Vietnamese-Americans reported the lowest level of substance use and abuse. The reality is that although generalized national data may reflect lower rates of substance use disorders, it does not mean the clinical significance or impact on the community is negligent. Another clear factor is the role of acculturation on alcohol intake. As a whole, AAPI are greatly underrepresented in addictions treatment across the different settings, from residential to outpatient to hospital-based admissions. This article will review current epidemiological rates of addictive disorders among AAPI, will describe the current treatment barriers that face this population, and will provide practical solutions to breaking down these barriers. Although many of these barriers are similar to what are experienced by non-AAPI population, there are several that are specific. A working definition of acculturation is the number of generations residing in the US. Despite the growing body of evidence that shows that addictive disorders in AAPI are significant and are not absent, there remain many barriers to treatment. Because of the high penetrance into AAPI, this was thought to play a role in reducing rates of alcohol dependence. Since this time, national surveys focusing only on AAPI substance abuse have not been conducted; instead, AAPI have been included as a category in recent national surveys. One particularly concerning trend though is the evidence showing elevated rates of methamphetamine abuse and dependence among Hawaiians and Pacific Islanders. Stigma for Asians suffering from addictive disorders is another significant barrier and can emerge in several different forms. An interesting trend is revealed in that, overall, AAPI had higher rates of abstaining from alcohol and illicit drugs but in the subgroup of AAPI who were not abstainers, this group demonstrated equal rates of substance dependence as compared to Caucasians. For non-pharmacological treatment studies, such as behavioral counseling or the use of telephone helplines, there have been only a few studies looking at the impact of culturally specific services. The end result of most forms of stigma is to isolate, alienate, avoid, and to create ambivalence about seeking help, which in turn will lead to a delay in the time to seeking treatment, which means that often, AAPI who present to treatment are further along in their addiction. Cultural barriers. Data on this topic suggests that AAPI who are likely to not have access to care include recent immigrants, the uninsured, and those who do not speak English. Contributing to the barriers of shame and stigma are the concepts of prejudice and discrimination. Specifically, most cities lack trained health and social service providers that are familiar with AAPI beliefs and values, health-seeking behaviors, and culturally relevant treatment strategies. In terms of gender differences, AAPI men are more likely to smoke as compared to AAPI women, and this is thought to relate to the acculturation process. Practical barriers. As an example, rates of alcohol use disorders remain close to that of non-AAPI populations, even among AAPI that experience the flushing syndrome thought to protect from alcoholism. While there may be individual biological and psychological factors that play a role in the development of problem gambling, there are cultural and social factors that may encourage these problem gambling behaviors in specific ethnic groups. AAPI have had a long history of accepting gambling as a community and family recreational activity. Close to 40 percent of the Asian callers to the tobacco helpline were friends or family members compared to six percent of the calls for non-AAPI. One unexplored area is understanding exactly how significant the role of psychological and environmental influences are on the rates of alcohol dependence among AAPI. {PARAGRAPH}{INSERTKEYS}Due to model minority stereotypes and a lack of empirical data, AAPI have been thought to have lower than expected rates of substance use disorders and behavioral addictions. These data indicate there are stronger cultural and environmental influences to drinking other than the contribution of the mutated alcohol-metabolizing enzyme. Most studies have shown that the presence of this polymorphism does indeed lower the risk of AAPI but it doesn't eliminate it, nor is it the only factor contributing to the lower risk. These are, primarily, cultural factors that will lead to either a delay in or not seeking treatment. Various estimates suggests that up to 60 percent of adult males in China and Korea smoke. Recent national prevalence surveys of the general population have shown rates of pathological gambling to be around 1 to 2 percent. Familial insulation can be another significant barrier. Furthermore, AAPI of mixed-heritage reported much higher rates of substance use and abuse as compared to unmixed racial groups. Along these same lines, some ethnic subgroups of AAPI are unfamiliar with Western medicine and techniques and persist in thinking that diagnostic equipment such as x-rays can be curative. These rates have been shown to be as high as nine percent in some studies. Even though national data may show reduced rates of smoking, community surveys have found elevated rates of nicotine dependence in certain vulnerable groups. Lack of recognition or identification of an addiction problem is another important barrier to accessing care. Treatment will then be more difficult because of the increased negative emotions seen, anger, denial, resentment, frustration, and desperation.