15. A multicultural approach to drug and alcohol-related issues and problems

The greatest barrier for people of non-English speaking backgrounds is language. The information available is often insensitive to language, levels of education and cultural differences, and therefore may be an ineffective education tool. Often the printed information given is distributed to people according to their country of birth rather than by preferred language, and therefore may be irrelevant or inadequate. As a result, many people from non-English speaking backgrounds are largely uninformed about drugs and their effects, the problems that can be experienced, or the drug and alcohol support services available, and thus are oblivious to telltale signs of problems arising from intoxication and dependency. Language barriers, and the insensitivity of mainstream drug and alcohol services to cultural differences, may discourage people from non-English speaking backgrounds from accessing available services.

While many people from non-English speaking backgrounds would prefer to consult a professional or knowledgable member in their own community about a drug- or alcohol-related problem, in many cases this may not be an option. These people are therefore faced with the prospect of accessing the mainstream agencies, often with little understanding of the services, where they exist, or the concepts upon which they are modelled.

As a general practitioner or health worker, there are a number of issues you may like to consider when consulting people from non-English speaking backgrounds.

• Where a language barrier exists seek assistance with interpretation. This may include:
  • Telephone Translating and Interpreting Service
    
  • assistance from a bilingual family or community member
    
  • a health worker of the same language background.
    
• Bilingual interpretation is essential. It will assist in:
  • identification of needs
    
  • a description of the current situation
    
  • the perceived role of drugs or alcohol in the user's life
    
  • establishing the extent of drug use
    
  • the treatment options available
    
  • accurate information regarding administration of any prescribed medications
    
  • information about existing resources and supports important to the patient.
    
• Be aware that what constitutes a 'drug' differs between cultures (eg many European and Indo-Chinese cultures may not regard caffeine, alcohol or prescribed pharmaceuticals as drugs). Similarly the use of some substances may be acceptable in one culture but unacceptable in others.
• Recognise that drug use or non-use can be a gender and cultural issue.
  
• When determining the extent of drug use take into consideration the cultural patterns of drug choice and use, and where possible compare pre-immigration and post-immigration levels of use.
• Acquaint yourself with differing aspects of the cultural groups you may have contact with. Learn to recognise particular cultural features, including:
  
  • language, dialect and parochial dialogue
    
  • socialisation patterns
    
  • beliefs regarding health, illness and the significance of folk medicine in preventing and treating illnesses
    
  • values, ideals and roles of members in the community
    
  • the perceived role of drugs and alcohol in the community
    
  • the role of the family unit in the community (including matriarchy and patriarchy)
    
  • the cultural and interpersonal conflicts which may exacerbate drug or alcohol use among people of non-English speaking backgrounds
    
  • the generational differences regarding drug use, drug choice and broader issues which may exacerbate or influence the behaviour.
    
• Where appropriate, contact a significant member of the cultural community and discuss the most appropriate ways to increase information in that community and the most effective and accepted modes of communication and intervention.
• A respect of people's choice is essential. What is an acceptable form of treatment for one person may not be culturally or personally acceptable for another.
  
• The development of culturally sensitive approaches and interventions will result in more effective services and greater adherence to prescribed regimens. The most effective interventions will be those based upon the values of the community being dealt with.
• Familiarise yourself with the ethno-specific workers and agencies available in your area, and the services they offer. Networking with these agencies may enhance the distribution of information to members of particular communities who may be uninformed about drug-related issues and the relevant services available.

There is evidence to suggest that people from some cultural backgrounds may be at greater risk of developing a drug- or alcohol-related problem:

• those with little or no family support
• unemployed migrants
  
• individuals who have suffered severe trauma during wars, dispossession or displacement
• recent migrants or refugees
  
• victims of torture and rape
• those facing cultural and interpersonal conflicts
  
• those living alone
• the aged
  
• those who are grieving
• some Aboriginal and Torres Strait Islander peoples.