What do you think are the core issues of addiction?
I believe that the primary core issue of addiction, in more than 85% of substance abuse cases, can be traced to the unresolved and unaddressed issue of child sexual abuse. I have worked with clients who are addicted to substance abuse since 1974, beginning with my clinical internship at Northwestern University Medical School Hospital. I was the Executive Director of a substance abuse methadone maintenance clinic from 1980 to1984, and as an adjunct faculty member of Northwestern University's medical school, supervised the Chemical Dependence Staff and Students of their Psychiatric Institute from 1983 to 1994. During my career, nearly 100% of the women substance abusers I treated, regardless of color, had experienced some sort of sexual abuse as a child. Most often the abuse began in early childhood and sometimes extended into adolescence and beyond. In most instances, with the females, the perpetrator was a relative or close friend of the family, including the mother's boyfriends.
In some cases, child sexual abuse is multigenerational. Abused mothers often enter into relationships and/or situations that put their children at risk for sexual abuse; they are often unable psychologically to protect their children from the same type of abuse they suffered themselves. Rarely is the abuse reported to authorities, and if reported within the family, little may be done to stop the abuse or vindicate the child. Often times the occurrence is ignored or quietly dealt with and "pushed under the rug." The victim and those who protect them may guard the "secret" to avoid the stigma of being "soiled" by the abuse. The target of the stigmatism is the victim, and shame/blame and guilt push the victim and family into silence.
How does this link between sexual abuse and substance misuse play out within the African-American community?
Within the Black culture, you "don't air your dirty laundry." There is a practice of not revealing "family secrets" that would shame the family or expose the family to gossip and blame. Substance abuse by early adolescents is the most common mechanism for coping. Often, even if the physical abuse stops, the victim continues to be exposed to interaction with the perpetrator and to a cyclical environment where substance abuse is part of the family culture as a coping mechanism.
What are some barriers to treatment within the community?
The barriers to reaching out for treatment are both cultural and systemic. The first barrier is denial and not recognizing addiction as a problem but as an accepted part of the personality of the abuser; "Oh, that's Uncle Ben, he always gets drunk. He'll sleep it off tonight;" or, "You know Ellen's a drug addict, just watch your purse when she's around." The problem of addiction is viewed as something that the affected person cannot control or chooses not to control. The addicted behaviors are tolerated within the extended family; the primary/nuclear family is expected to deal with the addicted member on its own. Seeking treatment is sometimes not even a consideration.
Treatment within most Black communities is not available; access is often inconvenient or unattainable. When treatment is available within the community, a stigma is attached to seeking it, or going into the clinic. Identified substance abuse clinics within the community are unwanted by neighbors, and residents who are recognized as attending these clinics are labeled negatively.
What are some unique cultural traits of the African-American community?
Family pride is a strong trait within the African-American community — the family being able to "hold its head up." African Americans believe that education is a way out of poverty, so higher education is valued and respected. A child being smart and achieving high grades is highly valued and serves as an important reflection of family pride.
Another trait is a strong belief in God and that one's belief in God will carry a person through difficult times. The church is seen as the most central institution with the African-American community. However, in more recent times, with the saturation of drugs in the black community, especially in very poor communities, drug use and illicit drug trafficking as an avenue for quick and large sums of money is a fierce competitor to church involvement.
What is important for those outside of the African-American community to know, when working with African Americans in recovery from substance misuse?
The key to understanding the Black perspective is realizing that many African Americans are hyper-sensitive to the reality that racism is alive and well within the American culture. While the majority population may not experience or believe that racism is a strong barrier, it is a stark reality for people of color in this county. African Americans have the same hopes and dreams as any other group of people. They love and care about their children and want the better things in life for themselves and their families. Poverty is the primary factor that acts as a barrier to accessing systems leading to "success." The majority of African Americans and especially their children live in a country where they are surrounded by wealth, with an invisible, but very real barrier to their being able to access that wealth.
The frustrating situation is that because many of the barriers are invisible or "buried" in American culture through systemic and institutionalized practices, African Americans' response to these barriers is often viewed as defensive rather than appropriate. The socialization process is pervasive with unconscious messages that African Americans' lack of achievement to access is due to cultural and racial inabilities that are personal and thus, internalized.
Within most African-American communities, services are lacking or seriously substandard. Many services in rural communities are comparably worse than those in some third world countries. A community may not have the strong belief and willpower to acquire the same level and quality of life as more affluent communities in the United States. Often if clients do not feel the "respect" of the provider, they do not maintain their use of support services; or, maintain their use inconsistently, even sporadically during an acute episode. The most accepted community services are medical clinics for the young and for the elderly.
What is the key to positive change within the African-American community?
The issues surrounding substance abuse and recovery are not isolated, but intricately woven within the socio-economic fabric of the American society. Portions of the African-American community are very aware that, for the most part, they do not produce, market, or traffic illicit drugs. They are very aware that their communities are the distribution centers that are targeted as such because of the level and degree of poverty. They are aware that the wealth from the drug trade does not reside within their communities but with the drug cartels and the political forces that protect the cartels. They are aware that it is only the "lowest man on this totem pole" -- the street dealers and users -- that suffer the consequences of being caught and imprisoned. Yet, families will tolerate, and in some cases, condone or "turn their heads" to their family members, youth and adults, selling drugs because it may be the only guaranteed substantial income that is easily attainable. Young children may, in fact, bring home more money in a month than the parents bring home in a year. When a family is living in a society where they are constantly bombarded through the media by images of wealth while they are living in abject poverty -- barely able to make ends meet -- it is very difficult to say "no" to the opportunities that involvement in the drug market offers, as an accessible avenue to wealth.
The importance of hope and strong sense of belief is paramount within the community. The degree to which African Americans believe that they can obtain "The American Dream" and have access to real avenues of success is a mitigating factor against drug involvement. Likewise, for those in recovery, it important that they believe that they can overcome the stigma that addiction carries. Also, they can heal from the wounds that made them vulnerable to addiction to begin with.
Addiction is a symptom of a more pervasive problem, both personal and communal. Therefore, it must be addressed on both levels if sustained recovery is going to be possible. Addiction is a condition from which individuals can achieve permanent recovery. It requires uncovering the strength of the spirit, the understanding of the wounds, the healing of the soul and the realization that an individual can find a passage out of addiction. This way of thinking will help to free the individual to create a more successful lifestyle.
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