Listening to Clients is the First Step in Mitigating Health Disparities
By Maurice Fisher, PhD, NASW Chair of ATOD Specialty Practice Section
June 23, 2008
Substance use disorders, in their many forms, have always been a more confounding social problem for people in minority groups than for others. Substance use/abuse treatment is complicated, owing to the many psychosocial, financial, health, mental health, and environmental challenges that clients face.
Several years ago, I was the clinical director of a large inner city residential substance abuse program where 98 percent of clients were racial and/or ethnic minorities. Seven out of ten of these patients happened to be men. There, I learned the complexities of substance abuse intervention through my lived work experience. No matter what I thought I had learned and what I thought I knew, my experience was taught by the clients themselves—through their stories and their experiences.
My minority clients taught me that there is an enormous difference between being “culturally aware” (i.e., recognizing that someone is different from you) and being “culturally sensitive” (i.e., actually using this awareness to intervene effectively). Moreover, I quite quickly learned that though minority clients may well be evaluated and diagnosed as having a substance use disorder, either abuse (e.g., a judgment and/or decision-making problem) or dependency (e.g., a physiological or psychological addiction), the vast majority were de facto self-medicating for extremely painful emotional and situational issues.
In 2006, the Central Registry of Drug Abuse noted that roughly 8 out of 10 people in minority groups diagnosed with a substance use disorder were men. This statistic speaks volumes about the needs for cultural competency and gender-specific interventions in social work practice with our clients. Let us begin the therapeutic process by first listening to what they are saying.
Stumble it!
3 Responses to “Listening to Clients is the First Step in Mitigating Health Disparities”
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Ann Sewell BSSW Says:
July 12th, 2008 at 4:40 amThis is sooo true and I am so glad to see someone with your education and respectability teaching us all the simple need to LISTEN. One thing I have found being Caucasian talking with Black men is that it can take a man from the inner city where so much trauma and abuse has been seen and experienced , a very long time to trust me or anyone else in a helping position. They feel and know that we don’t understand what they have been through. What gool does it do to talk to someone like me who has had priviledge and opportunity and peace in my neighborhood my whole life! I don’t have a clue what they have been through. It is true I don’t. But with the patience they have with me as I sincerely keep asking for self disclosure, I hear bits and pieces of their experience that like a puzzle , begins to help me to understand what their “american ” experience has been like. It begins to shed light on the overwhelming odds some face to overcome their socialization. It begins to she light on the tremendous courage some exercise to even try to overcome their past experiences and coping mechinisms that turned out to not work in the long run. Strength based treatment can start also by recognizing the amazing courage in our consumers, and admitting that no I don’t understand, but please help me to. One by one some of those who want to seek help will make a huge impact not just in their own lives but on those of us who have never experienced life in these united states the same way they have. We want liberty ans justice for all don’t we? Have you ever thought of yourself as a social worker as a promoter of democracy and freedom?? Maybe we are. If we begin with Listening. Thank you Dr Fisher.
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Barbara lee ruiz Says:
July 27th, 2008 at 5:37 pmLet’s face it; we certainly do not have enough individuals of colour going into the field of therapy–which we must try to encourage. I do not agree with either of you. I find that this generation of individuals, ages 21-31- regardless of ethnicity have no interest in becoming a better person- our nation has taken a nose dive with self respect. I agree with Senator Obama- and I think that the last Blogger needs to review her journalistic writing. Barbara Lee–LCSW-R
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Margorete Whitfield Says:
September 3rd, 2008 at 5:35 pmDrugs have been a problem since the beginning of time. It doesn’t matter the race, ethic, culture, etc. It will always be a problem until society get involved and help stamped out the problem.