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SAMHSA News - May/June 2008, Volume 16, Number 3


Communities Join Together To Promote Behavioral Health

Preventing and Treating Substance Abuse

By Kristin Blank

Several summit workshops and discussions focused on preventing and treating substance abuse among Arab Americans and American Muslims. Presenters noted that 22 countries around the world are considered “Arab nations.”

“When it comes to treatment strategies being culturally appropriate, wide-ranging diversity can impose a challenge,” said H. Westley Clark, M.D., J.D., M.P.H., Director of SAMHSA’s Center for Substance Abuse Treatment (CSAT), who moderated a substance abuse treatment panel.

According to presenters, service providers need to learn about community values and cultural traditions—including the prohibition of alcohol under Islamic law, the tendency not to speak about problems outside the family, and the idea that substance abuse recovery is a matter of personal will.

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Barriers to Treatment

When clinicians reach out to people with Arab or Muslim backgrounds, they may encounter initial barriers.

Denial. Because Islamic law prohibits the consumption of alcohol, some Muslim Americans who need help may deny that they drink.

Alec Berry, L.M.S.W., a treatment provider and an Arab American Muslim, discussed how he felt when he discovered he was an alcoholic. “My first reaction was, tell me I have cancer, but don’t tell me I’m an alcoholic,” he said.

Eventually, Mr. Berry started a support group for other American Muslims who had problems with alcohol, creating a nonjudgmental, welcoming community.

Biases. Like many other populations, Arab Americans and American Muslims often care deeply about their reputations and public personas.

In Arabic, the term ayb connotes social and religious norms regarding behavior or communication that would be shameful—and talking about mental health problems often is considered a shameful act. “We have to be really sensitive to the cultural bias when treating Muslims,” Mr. Berry said.

Privacy. Traditionally, people of Arab and Muslim heritage rarely talk about personal issues outside the family, according to panelists.

In addition, people in the process of becoming U.S. citizens may be wary of revealing substance abuse issues, fearing it could affect their status, said clinical therapist Amy Amal Rahhal, M.S.W., L.L.M.S.W., CAAC.

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Treatment Methods

Panelists noted that certain treatment methods can go a long way in helping clients from these communities trust providers. Ms. Rahhal discussed how, in the past, substance abuse treatment often was confrontational in order to break down denial, defenses, or resistance.

In her experience, the best approach to help these populations employs motivational interviewing, a nonjudgmental, client-centered technique that helps clients develop intrinsic motivation to change addictive behaviors. “We want them to decide to change,” Ms. Rahhal said. “We don’t want to decide for them.”

Motivational interviewing comprises several stages.

Identification. The provider assesses the client’s level of addiction and readiness to change. “We meet them where they are,” Ms. Rahhal said.

Engagement. The objective of this stage is for clients to develop comfortable and trusting relationships. Clients are encouraged to help others, which can build their own confidence and self-esteem. They are not required to disclose personal experiences.

Acknowledgment. Eventually, clients confront their own problems. Ms. Rahhal noted that relapse is expected, and each person moves at a different pace.

Finally, substance abuse treatment and prevention should engage more than just individuals. “If we are going to move toward strategies that help Arab American and American Muslim communities, we need to involve the whole community,” Dr. Clark said.

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