Cultural and Linguistic Factors

As stated by Burns, Coleman-Cowger and Breen (2016), uncontrolled alcohol and drug usage has been reported to yield physiological and societal implications in the form of liver damage, increased automobile accidents and mortality, domestic and public violence lead to disruption of domestic as well as familial harmony.

The emerging rate of illicit drug and alcohol abuse amongst culturally and linguistically diverse (CALD) populations continue to plague the Australian community, as stated by the National Drug Strategy (Rowe et al., 2018). The following paragraphs of the essay shed light on the case study of Massimo, an Italian immigrant inflicted with illicit substance and alcohol abuse. The essay discusses extensively the various cultural and linguistic factors prior to provision of treatment, the effective assessment and screening tools, potential challenges, intervention strategies, the required substance counseling model and the ethical issues which must be considered prior to his treatment.

Massimo is an Italian immigrant and the counselor must consider providing a cultural competent treatment. As stated by the National Drug Strategy of Australia, the prevalence of substance and alcohol abuse along with illicit drug usage is alarmingly high amongst culturally and linguistically diverse groups. The presence of more liberal practices of alcohol consumption in Australia, often puts culturally diverse immigrants at a disadvantage due to the absence of prevalent alcohol usage in their respective countries (Horyniak, Lim & Higgs, 2016). According to Roche et al., (2015), such groups continue to face continued discrimination from native Australians, in terms of employment opportunities, resulting in financial constraints and associated implications on mental health exhibited in the form of anxiety, depression and distress. Such conditions often subject such groups to greater alcohol and substance abuse usage, which may be prevalent in the case of Massimo. Massimo required an interpreter meaning that he may be at a disadvantage during reception of treatment due to the prevalence of an English speaking background in his surroundings (Gainsbury, 2017).

The counselor first consider Massimo’s cultural diversity along with his needs, preferences and opinion which may be unique to his culture. The counselor must consider his unique linguistic identity and hence, must provide a non-English speaking environment which will facilitate communication (Posselt et al., 2014). Hence, the above cultural and linguistic factors unique to Massimo’s culture, along with the possible presence of inequitable provision of resources due to this immigrant identity, must be considered by his respective counselor for the provision of culturally competent treatment.

The key screening tools chosen for assessing Massimo’s condition prior to his treatment, will aim to evaluate his alcohol as well as cannabis usage behaviors.

For the purpose of screening alcohol consumption, the AUDIT or Alcohol Use Disorders Identification Test may be used. This screening tool is formulated by the World Health Organization for the purpose of assessment of consumption of alcohol, conductance of behaviors associated with drinking as well as evaluation of additional problems which may be associated with alcohol ingestion. The AUDIT screening tool has been documented to be suitable across all sexes, and even across a variety of ethnic and culturally diverse groups, hence making it appropriate for screening the condition of Massimo (Ludin et al., 2015).

Screening Tools

The second screening tool is the Cannabis Use Disorder Identification Test- Revised (CUDIT), which consists of 8 questions aiming to assess behaviors associated with cannabis usage and attempts at quitting by the concerned patient. The counselor must aim to administer these screening tools in the form of languages highlighting Massimo’s ethnicity, which  will not only be easy for Massimo to comprehend but will also form a successful step towards provision of culturally competent treatment (López-Pelayo et al., 2015).

Massimo, a 56 year old Italian social worker, was recently admitted to the local hospital upon sustaining a head injury as a resultant of a fall. Despite the absence of any previous medical complications, the patient engages in extensive marijuana usage.

A pain screening in the form of a PQRST pain assessment tool was conducted which included a comprehensive evaluation of palliation or provocation (P), quantity or quality (Q), radiation or region (R), scale of severity and the timing of this head pain (Fink & Brant, 2018). A comprehensive medical assessment was conducted concerning his medication usage, musculoskeletal functioning and medical history (Traub et al., 2015). A psychosocial assessment was also conducted considering his culturally unique identity, which aimed to assess his opinions, belief and coping mechanisms (Singla et al., 2015). Lastly, considering his excessive alcohol and marijuana usage, an Alcoholic Use Disorders Identification Test and Cannabis Use Identification Disorder Test was conducted which revealed alarmingly high levels of substance and alcohol abuse (Harris, Louis-Jacques & Knight, 2014)

The client’s culturally and linguistically diverse background will serve as major challenges due to the prevalent discrimination, inequitable share of resources, lack of employment opportunities and the resultant financial constraints which minority migrant groups are subjected to, from native citizens. The client is also lacks fluency in English which can be a major determinant for initiating communication and understanding the individual needs of the client, due to the majority prevalence of English speaking professionals (Patternote et al., 2015). The client also denies his engagement in detrimental alcoholic and substance abuse behaviors, which is a major challenge prior to the administration of treatment (Williams, Olfson & Galanter, 2015).

The key supports which can help the client in his treatment are multicultural and culturally diverse self help and peers support groups, who engage in the provision of culturally competent treatment practices. Peer groups and self help groups comprise of individuals who suffer from common social issues and problems and hence engage in the dissemination of mutual support for each other. Further, multicultural support groups consist of culturally diverse members who share a common understanding of the issues faced by minority groups and hence, yield beneficial outcomes through social interaction of shared experiences (Maura & Weisman de Mamani, 2018).

As stated by Pereira, Figueiredo-Braga and Carvalho (2016), one of the key intervention strategies which must be considered by the counselor is the usage of a patient-oriented support, which comprises of involving the client in the decision-making procedure, to be performed during the formulation of an appropriate treatment plan. Further, considering the diverse cultural and linguistic background of Massimo, the counselor must consider additional three intervention strategies during the first meeting. These will include: Awareness, Acceptance and Asking.

Assessment and Case Formulation

According to Hsieh and Bean (2014), one of the key intervention strategy outlines the presence of awareness of the counselor considering one’s own beliefs as well as those of the client belonging to a culturally diverse background. Possessing adequate self awareness concerning one’s own cultural beliefs, will aid the counselor in the identification of potential judgment and biases which must be removed. Possessing awareness of the unique cultural identity of the client aids in the recognition of beliefs, preferences and opinions which are intrinsic to the patient and must be considered for the purpose of successful culturally competent treatment.

As stated by Guerrero et al., (2018), the second intervention strategy of acceptance will require the counselor to accept that the culturally diverse client, in this case, Massimo’s Italian origins, will possess unique beliefs and opinions, which must be empathetically attended to during the first meeting and hence, will lead to client empowerment resulting in positive health outcomes.

Lastly, as researched by Thom, Black and Pene (2018), appropriate enquiry or ‘asking’ must be used as an intervention strategy which will require the counselor to communicate and show interest concerning the culturally unique views, needs and preferences possessed by the client. This will further help the counselor to gain awareness of the client’s diverse needs, resulting in successful patient-centered intervention strategies.

The substance abuse counseling model will comprise of Gestalt Therapy, Cognitive Behavioral Therapy and Didactic Therapy.

Fritz and Laura Perls were the formulators of Gestalt Therapy, which is a type of psychotherapy concentrating on humanistic principles. This type of treatment focuses on encouraging clients to express without inhibition, their reasons and justifications for engagement in detrimental behaviors, resulting in an increased level of self-acceptance, accountability and responsibility of the client. A popular gestalt therapy model which will be used in the treatment of Massimo is the empty chair technique, where he will be required to sit and communicate facing an empty chair, representative of a near and dear one Through role playing, Massimo will be required to freely express his reasons of substance abuse and alcohol engagement further allowing him to express issues which he may not have been able to communicate in reality. The rationale behind this technique is Massimo’s constant denial of his engagement in detrimental behaviors, and hence, this method will compel him to come to terms with his shortcomings paving the way for effective treatment (Narkiss-Guez et al., 2015).

The psychotherapeutic principles of cognitive behavioral therapy, focus on the behavioral paradigm underlying detrimental mental health and harmful activities in the client. Cognitive behavioral therapy focuses on modification of harmful behaviors associated with specific stimuli. Massimo’s drinking and cannabis usage can be a resultant of underlying social or emotional factors which may act as stimulus resulting in conductance of harmful behaviors – hence, forming the rationale behind the usage of cognitive behavioral therapy. Hence, through the usage of this technique, the counselor can identify the key stimulating factors which compel Massimo to adhere to detrimental thoughts of denial and engagement in substance and alcohol abuse, which can be further treated for modification (Carroll et al., 2014).

Massimo is part of  a culturally diverse minority group and may find it difficult to communicate his unique cultural needs and preferences to the native population. Hence, the conductance of group therapy sessions consisting of multicultural team of individuals belonging to various cultures form the rationale behind usage of didactic therapy, which is characterized by providing psychological educational and demonstrative or experiment-oriented treatment in the form of groups or teams (Zafar & Khalily, 2015).

Additional referral services which can be used as referral for Massimo, would include multicultural or culturally diverse self help groups or non-profit organizations. The availability of  diverse cultural and linguistic task force in such self help groups forms the rationale behind referral selection since they will be sensitive to the unique cultural needs of Massimo. Examples include: Australian Mosaic, Villaggio Italiano Limited: Extended Respite Care Service and the Carers ACT: CALD Carers Program Support Groups prevalent in ten diverse linguistic characteristics (Liamputtong et al., 2015).

Despite the usage of effective treatment programs, clients suffering from substance or alcohol abuse can suffer from relapse. The key strategies for preventing relapse would involve ensuring that Massimo engages in full completion of his treatment course along with usage of effective medication treatments which can target mood alterations, reduce substance cravings and regulate withdrawal symptoms (Witkiewitz et al., 2014). According to Linke and Ussher (2015), additional relapse preventive strategies would involve adoption of multidisciplinary holistic treatments, such as exercise and adequate nutrition. Supervised physical activity has been documented to improve sleep and enhance transmission of impulses in substance abuse and alcoholic patients. Extensive alcohol and drug usage also results in essential nutrient depletion, which may still not be met despite avoidance of such substances. Hence, consumption of a balanced diet through intervention by a nutritionist compensates for the nutrient loss and also enhances physiological and psychological functioning in such patients.

For optimum ethical consideration of Massimo’s case study, the counselor must adhere to the Psychology and Counseling Federation of Australia (PACFA) Code of Ethics. One of the key ethical issues is the Massimo’s diverse cultural background which may be different that the opinions of the counselor. As stated by the fourth ethical standard of PACFA, the counselor must respect the diversity of Massimo, exhibit awareness concerning his culturally unique background, engage in  culturally sensitive communication and avoid any form of discrimination in terms of his cultural diversity. In accordance to the PACFA Code of Ethics, the counselor must put the client firsts and conduct a patient centered approach, engage in a trustworthy relationship, and most importantly, respective the privacy and confidentiality of the case details of Massimo (Bolton, 2017).

Conclusion:

For the provision of optimum treatment services to the client, the counselor must engage in the conductance of culturally competent activities. Prior to Massimo’s treatment, the counselor must consider his cultural background along with engagement in patient-centered approach and usage of appropriate ‘asking’, ‘acceptance’ and ‘awareness’ intervention strategies. A substance abuse model outlining psychotherapeutic principles of gestalt therapy, cognitive behavioral therapy and didactic therapy have been utilized, concerning Massimo’s culturally diverse background, prevalence of possible discrimination and constant denial. Referral services in the form of multicultural self help groups have been recommended due to the presence of like-minded, culturally diverse principles. Relapse prevention techniques such as medication, adequate exercise and proper nutrition have been considered for the deliverance of holistic treatment. Lastly, to conclude, adequate ethical standards have been considered in accordance to code of ethics, for the provision of culturally competent treatment.

References:

Bolton, J. (2017). The Ethical Issues which must be addressed in online counselling. Australian Counselling Research Journal, 11(1), 1-15.

Burns, L., Coleman-Cowger, V. H., & Breen, C. (2016). Managing maternal substance use in the perinatal period: current concerns and treatment approaches in the United States and Australia. Substance abuse: research and treatment, 10, SART-S34558.

Carroll, K. M., Kiluk, B. D., Nich, C., Gordon, M. A., Portnoy, G. A., Marino, D. R., & Ball, S. A. (2014). Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. American journal of Psychiatry, 171(4), 436-444.

Fink, R. M., & Brant, J. M. (2018). Complex Cancer Pain Assessment. Hematology/oncology clinics of North America, 32(3), 353-369.

Gainsbury, S. M. (2017). Cultural competence in the treatment of addictions: Theory, practice and evidence. Clinical psychology & psychotherapy, 24(4), 987-1001.

Guerrero, E. G., Song, A., Henwood, B., Kong, Y., & Kim, T. (2018). Response to culturally competent drug treatment among homeless persons with different living arrangements. Evaluation and program planning, 66, 63-69.

Harris, S. K., Louis-Jacques, J., & Knight, J. R. (2014). Screening and brief intervention for alcohol and other abuse. Adolescent medicine: state of the art reviews, 25(1), 126-156.

Horyniak, D., Lim, M. S., & Higgs, P. (2016). News media reporting on substance use among people of African ethnicity in three Australian states, 2003-2013. Australasian Review of African Studies, The, 37(2), 56.

Hsieh, A. L., & Bean, R. A. (2014). Understanding familial/cultural factors in adolescent depression: A culturally-competent treatment for working with Chinese American families. The American Journal of Family Therapy, 42(5), 398-412.

Liamputtong, P., Koh, L., Wollersheim, D., & Walker, R. (2015). Peer support groups, mobile phones and refugee women in Melbourne. Health promotion international, 31(3), 715-724.

Linke, S. E., & Ussher, M. (2015). Exercise-based treatments for substance use disorders: evidence, theory, and practicality. The American journal of drug and alcohol abuse, 41(1), 7-15.

López-Pelayo, H., Batalla, A., Balcells, M. M., Colom, J., & Gual, A. (2015). Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments. Psychological medicine, 45(6), 1121-1133.

Lundin, A., Hallgren, M., Balliu, N., & Forsell, Y. (2015). The use of alcohol use disorders identification test (AUDIT) in detecting alcohol use disorder and risk drinking in the general population: validation of AUDIT using schedules for clinical assessment in neuropsychiatry. Alcoholism: clinical and experimental research, 39(1), 158-165.

Maura, J., & Weisman de Mamani, A. (2018). The feasibility of a culturally informed group therapy for patients with schizophrenia and their family members. Psychotherapy, 55(1), 27.

Narkiss-Guez, T., Enav Zichor, Y., Guez, J., & Diamond, G. M. (2015). Intensifying attachment-related sadness and decreasing anger intensity among individuals suffering from unresolved anger: The role of relational reframe followed by empty-chair interventions. Counselling Psychology Quarterly, 28(1), 44-56.

Paternotte, E., van Dulmen, S., van der Lee, N., Scherpbier, A. J., & Scheele, F. (2015). Factors influencing intercultural doctor–patient communication: A realist review. Patient education and counseling, 98(4), 420-445.

Pereira, L., Figueiredo-Braga, M., & Carvalho, I. P. (2016). Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes. Patient education and counseling, 99(5), 733-738.

Posselt, M., Galletly, C., de Crespigny, C., & Procter, N. (2014). Mental health and drug and alcohol comorbidity in young people of refugee background: a review of the literature. Mental Health and Substance Use, 7(1), 19-30.

Roche, A., Kostadinov, V., Fischer, J., Nicholas, R., O’Rourke, K., Pidd, K., & Trifonoff, A. (2015). Addressing inequities in alcohol consumption and related harms. Health promotion international, 30(suppl_2), ii20-ii35.

Rowe, R., Gavriel Ansara, Y., Jaworski, A., Higgs, P., & Clare, P. J. (2018). What is the alcohol, tobacco, and other drug prevalence among culturally and linguistically diverse groups in the Australian population? A national study of prevalence, harms, and attitudes. Journal of ethnicity in substance abuse, 1-18.

Singla, M., Jones, M., Edwards, I., & Kumar, S. (2015). Physiotherapists’ assessment of patients’ psychosocial status: are we standing on thin ice? A qualitative descriptive study. Manual therapy, 20(2), 328-334.

Thom, K., Black, S., & Pene, R. (2018). Crafting a Culturally Competent Therapeutic Model in Drug Courts: A Case Study of Te Whare Whakapiki/the Alcohol and Other Drug Treatment Court in Aotearoa New Zealand. Int’l J. Therapeutic Juris., 3, 117.

Traub, S. J., Wood, J. P., Kelley, J., Nestler, D. M., Chang, Y. H., Saghafian, S., & Lipinski, C. A. (2015). Emergency department rapid medical assessment: overall effect and mechanistic considerations. The Journal of emergency medicine, 48(5), 620-627.

Williams, A. R., Olfson, M., & Galanter, M. (2015). Assessing and improving clinical insight among patients “in denial”. JAMA psychiatry, 72(4), 303-304.

Witkiewitz, K., Warner, K., Sully, B., Barricks, A., Stauffer, C., Thompson, B. L., & Luoma, J. B. (2014). Randomized trial comparing mindfulness-based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Substance Use & Misuse, 49(5), 536-546.

Zafar, H., & Khalily, M. T. (2015). Didactic therapy for management of stress and co-morbid symptoms of depression and anxiety in Pakistani adolescents. Pakistan Journal of Psychological Research, 30(1), 131-149.