WAYS IN WHICH CULTURE SHAPES PEOPLE’S ATTITUDES TOWARDS

ADDICTION.

There have been numerous definitions of culture. Dwight Heath offers a simple
definition: "It [culture] is a system of patterns of belief and behavior that shape the
worldview of the member of a society. As such, it serves as a guide for action, a
cognitive map, and a grammar for behavior."

Substance abuse refers to the abuse of alcohol and other drugs, primarily illicit drugs,
but what is considered "illicit" is often culturally determined and can vary between
social groups. Most culturally distinct groups have used and abused alcohol and other
drugs throughout the ages, and they have established codes of behavior in their
approach to drugs and alcohol.

Addiction is a chronic relapsing disease that we must treat as we do other such

diseases. We do not expect the hearts of patients with heart failure to behave
normally — we understand that their function has been altered by disease. Why, then,
do we expect the brains of substances abusers to behave normally, since we know that
their function has also been altered by disease?

It is important to consider a person's cultural background when assessing for

substance abuse or dependence. The publication of DSM-IV was an important turning
point in the application of cultural psychiatry principles because it provided an outline
for cultural formulation including: a discussion of the cultural variations in
currently recognized DSM disorders; a glossary of culture-bound syndromes and
an outline for a culturally relevant case formulation based on 5 major areas:
cultural identity, cultural explanation of the illness, cultural factors related to
psychosocial environment and levels of functioning, cultural elements of the
relationship between the individual and the clinician, and overall cultural
assessment for diagnosis and care.
Culture plays an important role in every facet of our lives, including substance use.
Practicing cultural humility is crucial for effective treatment for everyone. Culture can
be defined as a shared set of beliefs, values, experiences, and more. It affects
everyone, no matter who you are or where you live. Our culture plays a role in how
we think, behave, and communicate. Substance use is no different. Culture affects
our substance and alcohol use, as well as the beliefs and views we hold about it.

Considering cultural contexts when assessing for and treating substance use disorder
is crucial.

Cultures around the world have used psychoactive substances medicinally, spiritually,
and socially since ancient times. For example, a psychedelic mushroom known
as Amanita Muscaria has been used ceremonially in Asia for 4,000 years or more,
according to research from 2022.

Mead, the first drink containing alcohol, has been used since 6000 BCE. The
substance of choice for Europeans was alcohol, according to research from 2007.
Early American colonizers consumed 7.5 million gallons of rum a year.

Humans have often used these substances to achieve certain mental and physical
states, whether it was having a glass of mead during a social occasion or using peyote
for a spiritual ceremony. While alcohol and psychoactive substances such as opium
were widely used in the Americas, the wave of Protestantism that started in the late
1900s started to change that.

Christian moralists began to view alcohol and some substances in a negative light.
They spread the idea that these substances could corrupt a person’s spirituality and
nature. The negative view of certain substances, and the laws that were created to
defend this view, were also influenced by xenophobia and racism.

By learning more about the historical origins of substance and alcohol use (and the
laws that were created to regulate it), it becomes clear that culture has had a large
impact on how we, as a society, view and define substance use.
Culture greatly affects how different groups use substances and view substance use.
To be clear, “culture” goes beyond just ethnic or linguistic groups. For example, binge
drinking is common and often socially encouraged in many university settings.

The same could be said for other micro-communities such as people who like certain
types of music. In other words, “culture” can be defined in many different ways, and
it’s crucial to allow people to define their own cultures.

A key point to consider would be the the bonding experience especially among
contemporary youths. Many individuals struggle to relate to peers. The stress of
socializing can be a major reason why individuals turn to drugs or alcohol as a means
of curbing social anxiety.

Alcohol, sometimes called the “social lubricant,” has been used this way since wine
was first produced in the late Neolithic Period (circa 10,000 B.C.). It is now
commonplace for groups of friends to plan social gatherings around the presence of
alcohol, such as meeting for happy hour at a favorite bar.

Being under the influence of alcohol makes peer interaction much easier; people often
feel more confident, are quicker to crack jokes and speak up, feel less self-conscious,
and worry less about rejection.

There is, however, a downside to being so socially uninhibited. People who are
intoxicated can become loud and obnoxious, offensive, and are sometimes difficult to
handle.

Another key cultural factor is relief from stress. A common reason people
overindulge is for the sense of relief from the stresses of daily life. It is common to
hear someone say that their drug of choice is “an outlet” or their means of temporarily
“escaping reality”? This typical, yet harmful, justification of frequent intoxication is
common and frequently a precursor to full-blown addiction.
Those who feel overwhelmed by the amount of stress experienced on a day-to-day
basis can benefit from a plethora of healthy alternatives to manage stress. Meditation,
guided breathing exercises, and yoga are relaxing and teach awareness of the state of
your body and its processes, both physical and emotional.

Another very important factor to note is the sense of community. A social factor that
contributes to addiction is the tendency for drug and alcohol abuse to promote group
solidarity and feelings of community and belonging. In particular, the primary
contributor—by and large—for use of narcotics such as cocaine and heroin are peer
group characteristics, followed distantly by adverse familiar conditions and individual
social circumstances (such as homelessness).

Finally, the allure of rebelling is important as a key point in this. The abuse of
alcohol and drugs, by nature, creates the sense that one is rebelling against the norms
and expectations of society. Adolescents in particular will turn to substance abuse as a
way to “act out” against authority and the limitations imposed on them both at school
and at home.

One of the most effective treatments to satisfy the desire to rebel is called dialectical
behavior therapy (DBT). This form of therapy promotes what is called Alternate
Rebellion. The individual makes a list of activities that could be enjoyed for fun or
because they might break a social “rule,” then they choose activities, one by one, until
one is found that satisfies the urge to be naughty without being harmful.

In treatment of drug abuse from a cultural viewpoint,The Diagnostic and Statistical

Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) suggests that
treatment providers consider the following areas during the screening and assessment
process for any mental health condition, including substance use disorder: cultural
identity; cultural explanation of the illness (for example, if someone views their
addiction as a punishment from a god); cultural factors related to the person’s
environment and functioning; cultural factors between the treatment provider and the
client (for example, if the treatment provider is part of a cultural group that has
historically oppressed the client’s cultural group) and overall cultural assessment
Regardless of these important cultural considerations, substance use disorder doesn’t
discriminate based on culture.Anyone of any race, country, gender, and more can
develop a substance use disorder. But cultural identity and values can both protect and
worsen substance use problems in some cases.

Some experts recommend mental health professionals practice “cultural humility,”

which differs from cultural competence. Cultural humility understands that it’s
impossible to fully understand everything about a culture that you’re not a part of.
Instead, mental health professionals can ask questions and allow clients to teach them
about their cultural identities and values.

Cultural factors also come into play during the recovery process. Recovery may look
different for each cultural group. For example, a full recovery could mean not only
recovering from symptoms of substance use disorder but also reconnecting to their
cultural identity or recommitting to spiritual or religious practice.

For these reasons, culturally responsive substance use treatment is critical.

In conclusion, the intersection of culture and substance use is a complex one and can’t
be reduced down to probabilities and numbers. Culture is an interwoven checkerboard
of various identities that include — but aren’t limited to — race, gender, national
origin, profession, immigrant status, and more.

By committing to providing culturally responsive outreach and treatment services,

mental health professionals can ensure that people of all cultural groups receive
adequate care for substance use disorder.
REFERENCES

Heath DW. Cultures and substance abuse. Psychiatr Clin North Am. 2001;24:479-496

Marc-Antoine Crocq (2007) Historical and cultural aspects of man's relationship with
addictive drugs, Dialogues in Clinical Neuroscience, 9:4, 355-
361, DOI: 10.31887/DCNS.2007.9.4/macrocq

Hendry T, Lim RF. The assessment of culturally diverse individuals. In: Lim RF,
ed. Clinical Manual of Cultural Psychiatry. Arlington, Va: American Psychiatric
Publishing; 2006:3-31.

Appendix I. Outline for cultural formulation and glossary of culture-bound

syndromes. Diagnostic and Statistical Manual of Mental Disorders. 4th rev ed.
Arlington, Va: American Psychiatric Publishing; 2000: 897-903.

Substance Abuse and Mental Health Administration. (2006). Chapter 10: Addressing
Diverse Populations in Intensive Outpatient Treatment. Substance Abuse: Clinical
Issues in Intensive Outpatient Treatment.
https://www.ncbi.nlm.nih.gov/books/NBK64095/