One of the distinctive features of the recovery advocacy movement is its commitment to transcend the historical barriers that have separated people within the United States and across the world. I have been particularly moved by the growth of recovery community organizations around the globe. In the U.S., early RCOs within African American communities and within Indian Country were among the midwives of the new recovery advocacy movement. Since then, calls have increased to extend these efforts into Latino, Asian and other ethnic communities within the U.S. The following essay by Angelo Lagares and Gaynelle Gosselin is a reminder to us all of the import of such inclusiveness. I was very touched by their passion and their eloquence and wish to share their call to action with my readers. Bill
IMPROVING COMMUNITY RELATIONSHIPS THROUGH INCLUSION OF RACIAL AND ETHNIC MINORITIES IN RECOVERY ADVOCACY EFFORTS
Angelo Lagares, Founder, Latino Recovery Advocates
Gaynelle Gosselin, Parent Advocate
Language matters. It's a phrase often spoken among recovery advocates, and generally refers to shifting the way we speak about addiction and recovery so that we reduce the stigma surrounding substance use disorders. There is evidence behind the movement, with one study noting that even mental health professionals were more likely to favor punitive over therapeutic measures if a case history referred to a patient as a "substance abuser" instead of a "person with as substance use disorder."1 The conversation about "people first" language is an important dialogue to have, as stigmatizing words can foster an environment that is hostile to treatment and recovery.
It is vital that we shift the language so that shame ceases to be a barrier to those seeking help. Furthermore, we must ensure that recovery messaging is carried to ALL who need to hear it. Too often, minority populations are left out of the conversation.
Cultural Sensitivity Matters
If we are to build recovery ready communities, we must address the whole community, not just the majority population. To this end, there is a fundamental shift that must take place regarding recovery messaging. Not only must we eliminate stigmatizing language, but we must also ensure that everyone who needs to hear the message can understand and relate to it. We must take steps to reach across class, racial and ethnic divides in our endeavors to share life-saving information concerning overdose prevention, harm reduction, addiction treatment, and recovery support. Currently, recovery messaging is tailored almost exclusively for a non-Hispanic white, English-speaking audience. By failing to include diversity in our messaging and our messengers, we are leaving out racial and ethnic minorities. While it is doubtful that this is intentional, the outcome is the same. The recovery movement is exacerbating already existing disparities in treatment. This needs to change if we are to have a unified front in creating positive norms with regard to addiction, treatment, and recovery.
Diversity Matters
Recovery advocates are quick to note that addictive illness and overdose have no boundaries. Substance use disorders affect people of all races, all ethnicities, and all socio-economic classes. Addiction directly affects fully one in three Americans (either because they have a substance use disorder; they are in recovery from a substance use disorder, or they have a direct relative who has or is in recovery from a substance use disorder). Despite this, the recovery movement shows an astonishing lack of diversity. The white, non-Hispanic middle and upper classes have become the faces and voices of the recovery movement. Yet, a third of the population is not exclusively white and non-Hispanic. According to U.S. Census Data, nearly 18 percent of the population is Latino/Latina, and nearly 14 percent of the population is black or African-American. Include those who identify as bi-racial, and more than a third of the population is a member of a racial or ethnic minority. In some communities the percentage of racial and ethnic minorities is much higher.2 For instance, in Miami, Florida, nearly 68 percent of the population is Hispanic.3 We cannot have a robust recovery movement if we leave out these people.
Members of the Latino community and other minority communities are far more likely to receive punishment than treatment when it comes to drug offenses. This has less to do with stigmatizing language and more to do with existing racial, ethnic, and socioeconomic disparities. In 2015, The Drug Policy Alliance noted that although they constitute only 30% of the population, Latinos and Blacks represent 57% of people incarcerated in state prisons and 77% of those incarcerated in federal prisons.4
Furthermore, even when Latinos and African Americans are able to access treatment for substance use disorders, they are less likely to complete their treatment programs.5 In order for this to change, the advocacy community and the treatment industry must give more than lip service to diversity and cultural competence. If we wish for all people to have access to recovery, we must ensure that all really means all. Latinos and other minorities must be able to access and complete treatment, and they must be represented in the recovery movement. How can we have a unified movement when we leave out more than a third of the population.
Language Matters
Recovery messaging is almost exclusively delivered in English to a non-Hispanic audience. Not only is there a serious problem regarding the lack of diversity among the messengers, there is also a problem with the delivery of the message. How is one supposed to receive it, if one does not speak English.We know addiction is pervasive and universal, cutting across social, racial and ethnic divides. Desperation has no language. Overdose kills regardless of language. Naloxone saves lives regardless language. Recovery is real in every language. As we carry the message that overdose deaths are preventable, addiction is treatable, and recovery is possible, we must take care to translate our words so that all who need the message can get it.
Knowing that lives hang in the balance, how could we in good conscience deny information to non-English speakers. The obvious answer is we cannot; we must not.
Dismantling Cultural Barriers to Recovery Messaging
There are some readily apparent ways to begin addressing the issue of diversity and cultural competence in the recovery advocacy movement. First, and foremost, we must eliminate the language barrier. Information can be translated. Websites for major advocacy groups (Facing Addiction, Young People In Recovery, Shatterproof, etc.) can add links to make information available to non-English speakers. Documentaries produced by recovery advocates can include subtitles in Spanish. These are simple steps that can have immediate and profound effects when it comes to including the Latino population in the recovery movement.
Expanding the reach of the recovery message is critical to changing public perception about addiction, treatment, and recovery. The advocacy movement is already engaged in efforts to take the message of recovery out of confines of support group rooms and into the larger community. These outreach efforts must expand to include populations that are historically under-represented in the recovery community. This requires rethinking channels of delivery. It means reaching beyond treatment center alumni groups, support groups, and recovery community organizations. If the advocacy community is to reach racial and ethnic minorities, the message must be delivered through their existing social support networks, such as churches, fraternities, community centers, and cultural organizations. Only when we meet people where they are, hear their needs, and work together for meaningful change, can we build recovery support systems that serve the whole community.
Inclusivity Matters
A recovery movement that ignores the needs of a third of the population is unsustainable. We must work for inclusivity in advocacy efforts. If addiction affects all races, cultures, and classes, recovery should be universal. Our message and our messengers must reflect that. Together, we can make recovery a reality for ALL.
References
- Kelly, J. F., & Westerhoff, C. (2010). Does it matter how we refer to individuals with substance-related problems: A Randomized study with two commonly used terms. International Journal of Drug Policy, 21(3), 202-207.
- www.census.gov/topics/population/race.html
- www.census.gov/quickfacts/fact/table/miamidadecountyflorida/PST045216
- The Drug War, Mass Incarceration, and Race,.Drug Policy Alliance Fact Sheet, June 2015
- Saloner, B. and LeCook, B. (2013). Blacks and Hispanics are less likely to complete addiction treatment, largely due to socioeconomic factors,.Health Affairs, 32, 135-145.
Acknowledgement: A special thank you to Jorge Taveras for providing the following translation of this advocacy essay.
MINORIAS ETNICAS Y RACIALES EN LOS ESFUERZOS DE APOYO A LA RECUPERACION
El lenguaje importa. Es una frase que escuchamos a menudo entre los defensores de la recuperaci. y generalmente se refiere a alterar la forma en que hablamos sobre adicci. y recuperaci. para que podamos reducir el estigma que rodea los desordenes del uso de sustancias. Hay pruebas detr's del movimiento, con un estudio notando que incluso los profesionales de salud mental eran mas propensos a favorecer medidas severas en vez de terap.ticas si el historial del caso se refiere al paciente comoabusador de sustancias.en vez de una persona condesorden de uso de sustancias.a href="#_ftn1" name="_ftnref1">[1]. La conversaci. sobreprimero la persona.en el lenguaje es un di.ogo importante que debemos tener ya que palabras que fomenten el estigma crean y fomentan un ambiente hostil para el tratamiento y recuperaci.. Es vital que alteremos el lenguaje para que la verg.nza deje de ser una barrera para esos que buscan ayuda. Mas a., debemos asegurarnos que el mensaje de recuperaci. es llevado a TODO el que necesita escucharlo. Muy frecuentemente la poblaci. minoritaria no es tomada en cuenta.
La Sensibilidad Cultural Importa
Si hubi.amos de construir comunidades listas para la recuperaci. debemos dirigirnos a la comunidad en su totalidad no solo a la mayor parte de la poblaci.. Para estos fines hay un cambio fundamental que tiene que suceder respecto al mensaje de recuperaci.. No solo debemos eliminar el lenguaje que estigmatiza, tambi. debemos asegurarnos que todo el que necesite escuchar el mensaje pueda entenderlo y relacionarse con este. Debemos tomar medidas para trascender divisiones raciales ytnicas en nuestros esfuerzos de compartir informaci. que salva vidas relacionadas a prevenci. de sobredosis, reducci. de da.s, tratamiento de adicci. y soporte a la recuperaci.. Actualmente, el mensaje de recuperaci. esta adaptado casi exclusivamente a una poblaci. blanca, no hisp.ica que habla ingl.. Al no incluir diversidad en nuestro mensaje y nuestros mensajeros, estamos dejando fuera minor.stnicas y raciales. Aunque dudamos que esto sea intencional, el resultado es el mismo. El movimiento de recuperaci. esta empeorando diferencias que ya existen en el tratamiento. Esto debe cambiar para poder conseguir un frente unido al crear normas positivas en relaci. a la adicci., tratamiento y recuperaci..
La Diversidad Importa
Los que abogan por la recuperaci. son r pidos en notar que los des.denes de adicci. y las sobredosis no tienen fronteras. El desorden del uso de sustancias afectan a gente de toda raza, grupotnico y todas las clases socio-econMicas. La adicci. afecta directamente a uno de cada tres americanos (ya sea por que tengan un desorden de uso de sustancias, est. en recuperaci. de un desorden de este tipo o tienen un familiar directo que estuvo o est.en recuperaci. por un desorden de uso de sustancias). A pesar de esto, el movimiento de recuperaci. muestra un falta de diversidad sorprendente. La clase blanca no hisp.ica de media clase o alta se han convertido en las caras y voces del movimiento de recuperaci.. Sin embargo, un tercio de la poblaci. no es blanca y no hispana. De acuerdo a los datos del Censo de Estados Unidos cerca del 18% de la poblaci. es latino/latina y cerca del 14% es negro o afro americano. Si incluimos esos que se llaman Bi-raciales mas de un terci.de la poblaci. pertenece a una minor.tnica o racial.[2] En algunas comunidades el porcentaje de minor.s raciales otnicas escucho mayor. Por ejemplo, en Miami, Florida, cerca del 68% de la poblaci. es hispana.[3] No podremos tener un movimiento de recuperaci. robusto si dejamos fuera estas personas.
Miembros de la comunidad latina y otras comunidades minoritarias son mas propensos a recibir castigos en vez de tratamiento cuando se refiere a ofensas de drogas. Esto tiene poca relaci. con el lenguaje y mas con las diferencias raciales,tnicas y socio econMicas que ya existen. En el a. 2015 la Alianza De Pol.icas de Droga not.que aunque constituyen solo el 30% de la poblaci., latinos y negros representan el 57% de personas encarceladas en prisiones estatales y 77% de los encarcelados en prisiones federales.[4]Adem., a. cuando latinos y afro americanos son capaces de tener acceso a tratamiento para el desorden del uso de sustancias, son menos propensos a completar los programas de tratamiento.[5] Para que esto cambie la comunidad y la industria de tratamiento deben hacer mucho mas que declaraciones hip.ritas por la diversidad y la aptitud cultural. Si queremos que todas las personas tengan acceso a la recuperaci., debemos asegurarnos que todos quiere decir todos. Latinos y otras minor.s deben tener acceso y completar los tratamientos y deben estar representados en el movimiento de recuperaci.. CMo podemos tener un movimiento unido si dejamos fuera a mas de un tercio de la poblaci../p>
El Lenguaje Importa
El mensaje de la recuperaci. se difunde casi exclusivamente a un p.lico blanco no hisp.ico. No solo hay un problema serio concerniente a la falta de diversidad de los mensajeros, tambi. hay problemas con la presentaci. del mensaje. CMo uno puede recibir el mensaje si uno no habla ingl.. Sabemos que la adicci. es penetrante y universal cortando divisiones raciales, sociales ytnicas. La desesperaci. no tiene lenguaje. Las sobredosis matan no importa la lengua. Naloxone salva vidas no importa el idioma. La Recuperaci. es real en todos los idiomas. De manera que llevemos un mensaje de que las muertes por sobredosis se pueden prevenir, que la adicci. es tratable y que la recuperaci. es posible debemos tener cuidado de traducir nuestras palabras para que todo el que necesite el mensaje lo reciba. A sabiendas de que hay vidas en peligro,CMo en buen juicio podemos negarle la informaci. a los que no hablan ingl.. La respuesta obvia es que No Podemos; NO Debemos.
Desmantelando las Barreras Culturales a la Difusi. del Mensaje de Recuperaci.
Hay maneras que est. listas y son aparentes para empezar a resolver el asunto de diversidad y aptitud cultural en el movimiento de recuperaci.. Primero y mas importante, debemos eliminar la barrera del lenguaje. La informaci. puede ser traducida. Las p.inas web de los grupos de abogac. mas importantes (Facing Addiction, Young People in Recovery, Shaterproof, etc.) pueden agregar enlaces que hagan la informaci. disponible a personas que no hablen ingles. Los documentales producidos por los que abogan por la recuperaci. pueden incluir subt.ulos en espa.l. Estas son medidas sencillas que pueden tener un efecto profundo en la inclusi. de la poblaci. latina en el movimiento de recuperaci..
Expandir el alcance del mensaje de recuperaci. es clave para cambiar la percepci. p.lica sobre adicci., tratamiento y recuperaci.. El movimiento de apoyo est.comprometido a sacar el mensaje de recuperaci. de los confines de un grupo de soporte y llevarlo a comunidades mas grandes. Estos esfuerzos de superaci. deben ser expandidos para incluir poblaciones que han sido hist.icamente poco representadas en la comunidad de recuperaci.. Esto requiere replantearse los canales de distribuci.. Eso significa alcanzar mas all.de los grupos de centros de tratamiento, grupos de soporte y organizaciones comunitarias de recuperaci.. Para que el movimiento de soporte a la recuperaci. alcance a minor.stnicas y raciales el mensaje debe ser distribuido a trav's de sus organismos de enlace y soporte social como son iglesias, fraternidades, centros comunitarios y organizaciones culturales. Cuando no encontramos con las personas en donde est., escuchamos sus necesidades y trabajamos juntos para un cambio significativo, solo as.podremos construir sistemas de soporte a la recuperaci. que sirvan a la comunidad entera.
La Inclusion Importa
Un movimiento de recuperaci. que ignore a un tercio de la poblaci. no es sostenible. Debemos trabajar por la inclusion en los esfuerzos de soporte. Si la adicci. afecta todas las razas, culturas y clases, la recuperaci. debe ser universal. Nuestro mensaje y nuestros mensajeros deben reflejar eso. Juntos podemos hacer la recuperaci. una realidad para TODOS.
[1] Kelly, John F. and Westeroff Cassandra,Does It Matter How We Refer to Individuals with
Substance-Related ConditionsA Randomized Study of Two Commonly Used Terms./p>
International Journal of Drug Policy, May 2010, Volume 21, pp. 202-207
[2] http://www.census.gov/topics/population/race.html
[3] http://www.census.gov/quickfacts/fact/table/miamidadecountyflorida/PST
[4]The Drug War, Mass Incarceration, and Race,.Drug Policy Alliance Fact Sheet, June 2015
[5] Saloner, Brendan and LeCook, Benjamin,Blacks and Hispanics Are Less Likely to Complete
Addiction Treatment, Largey Due to Socioeconomic Factors,.Health Affairs 32, pp. 135-145