Acciones preliminares de julio a diciembre de 2009

Advocates of a hedge-your-bets strategy acknowledge, for example, that following both prescribed medication and ethnic spiritual therapy may be the best hope for securing adherence. This model also encourages a more honest discussion of the other therapies being tried and their interaction from the reading of sacred texts to the possible infliction of physical harm.

Two potent instruments of change are commonly recognized in the cross-cultural treatment literature. The significance of the family as the conduit of cultural norms and values is recognized in most ethnically sensitive programs. Supporting the family foundation and home stability are cherished goals in

communities originating from cultures with a strong extended-family network and threatened by the reduced family mosaic in our societies. A sensitive family assessment will encompass the individual roles of all members and respect their potential utilization toward a positive outcome (Delgado 1995).

Religious affiliation and religious beliefs also play a major positive role in the development of prevention networks for recovery and treatment compliance in many ethnic groups (Galanter 2006). The

adaptation of 12-step programs to many cultures in various parts of the world is an example of a common value placed on spiritual growth as an ingredient of recovery.

Cultural recovery may involve regaining a viable ethnic identity and developing a healthy affiliation with an individual's ethnic group, as well as reacquiring a functional social network, a religious or spiritual commitment, a rebuilt social status in the recovering as well as the cultural community, and

reestablished vocational and recreational activities. Cultural recovery starts after physical and

psychological recovery begins and often takes years (Westermeyer et al. 2006). Unreasonable cultural expectations, as well as cultural cues to resume the addictive behavior, may delay recovery, whereas cultural abstinence-based programs may facilitate recovery.

CONCLUSION

The goal of this chapter is to advance knowledge of how to provide optimal clinical care to individuals from cultures different than our own. The impact of ethnicity is moderated by a number of risk and protective factors. Sometimes everything is attributed to ethnicity or culture, whereas at other times the existence of cultural impact is completely denied. Concentration on cultural differences may lead to missed important diagnostic signs. Cultural sensitivity is not a fixation on culture and it should not be a ready explanation for the unexplained. Currently, the methodological differences used in various studies lead us to caution about the validity and reliability of the results. Many conclusions range from the

subjective to the speculative.

A better understanding of the patient can be gained through systematic cultural formulation, which includes the cultural aspects of the clinician–patient relationship. Minority groups underutilize our treatment and social services. Making these services more user friendly should be a first-order concern in our multicultural societies when the subject of alternate models of care is addressed.

KEY POINTS

Culturally sensitive clinical care is required for individuals from different cultures. The impact of ethnicity is moderated by both risk and protective factors.

A cultural assessment provides a better understanding of the patient's subjective views. Nosological classifications are influenced by culture.

Culturally sensitive care can be delivered either through separated services, a consultation model, or a sensitized melting pot approach.

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Print Close Window Shelly F. Greenfield, Grace Hennessy: Chapter 5. Assessment of the Patient, in The American Psychiatric Publishing Textbook of Substance Abuse Treatment. Edited by Marc Galanter, Herbert D. Kleber. Copyright ©2011 American Psychiatric Publishing, Inc. DOI: 10.1176/appi.books.9781585623440.349209. Printed 10/7/2011 from www.psychiatryonline.com

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