Member Q&A | Cultural Sensitivity and Addiction Psychiatry with Evans Rochaste, NP
The therapeutic alliance, or the provider-client relationship, is the strongest mediator of positive and effective mental health care. For clients with marginalized identities, working with a culturally sensitive and inclusive provider is particularly important. We asked Alma member Evans Rochaste, NP, about the importance of cultural sensitivity in addiction psychiatry.
Below, find his thoughts on the root causes of addiction, the importance of recognizing and confronting misconceptions and bias, and the risk of perpetuating trauma or stigma that comes from not understanding a client’s sociocultural identity.
Evans Rochaste is a psychiatric nurse practitioner who provides holistic mental health and wellness care tailored to the needs of adult and adolescent clients. He specializes in the care of clients who are concerned with addiction and substance use. He also works as a consultant in the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center.
Q: What is the relationship between addiction and mental health?
Mental health and addiction go hand in hand. Many times, those who struggle with a mental health disorder experience symptoms — like emotional pain, physical pain, or both — that can be temporarily eased or taken away with the use of a substance. As long as the underlying pain is there, medicating may feel necessary and addiction may follow. Pain can be extremely difficult to cope with, especially if it feels like there is no other way to handle it. Unfortunately, substance abuse and addiction have devastating consequences over time.
Although the initial cause of substance abuse may be to help ease symptoms of mental illness, addiction can lead to further symptoms that affect mental health and cause even more pain and/or discomfort. This can create a dual diagnosis for someone over time and deepen their original issues. This happens because the brain changes when substances are used, and these changes occur in some of the same brain areas that are disrupted in mental disorders such as depression and anxiety. An example of this could be someone struggling with a mood disorder and a substance use disorder simultaneously. To add to this, it is proven that those suffering from mood or anxiety disorders are twice as likely to suffer from an addiction use disorder. However, it’s important to know that one does not necessarily cause the other, and understanding each unique case is vital to helping someone on their path to recovery.
Addiction and mental health are also tied together in terms of factors that can potentially lead to issues with both. Substance use disorders and other mental illnesses can be caused by overlapping factors like genetic vulnerabilities and early exposure to stress or trauma. The stress that is caused by these factors can result in mental health issues such as depression and/or anxiety, adding to the likelihood of substance use and addiction. An example of this would be someone who has a genetic predisposition to mental health issues and who witnesses trauma while growing up, then develops chronic anxiety, then develops an alcohol addiction to ease the symptoms of their anxiety.
It is also important to note that although addiction can happen at any time, adolescents are most at risk due to the rate at which their brands are changing brains. Adolescents are most at risk for developing mental illness and/or addiction disorders and because of the rate their brains are changing, there can be long term consequences on brain development.
Overall, addiction and mental health can co-exist in many complex ways. Along with this, addiction and mental health can both be socially stigmatized. Having a better understanding of how they relate to one another is vital to help those who are struggling achieve holistic healing.
Q: What role does cultural sensitivity play in addiction psychiatry?
It’s important to understand a client’s perspectives and beliefs about addiction psychiatry and medication management from the onset. Diagnosis, medication, and therapy can be stigmatized or considered unacceptable within some cultures and communities. Being sensitive to this allows the client to feel seen, safe, and understood. Because of this, my goal is to do my due diligence in uncovering sociocultural issues that would affect acceptance, retention, and treatment outcomes for my clients.
Cultural sensitivity is important specifically for people of color who have been and continue to be negatively affected by prejudice and discrimination in the healthcare system across the United States. Misdiagnoses, misconceptions, and both conscious and unconscious bias often lead to inadequate treatment. A lack of cultural competence among health professionals causes distrust and repeated traumatic exposure, which subsequently prevents many people of color from seeking or staying in treatment. As a result, people of color often bear a disproportionately high burden of disability resulting from mental health disorders.
Within communities of color, there is often a misconception that a mental health condition is a personal weakness or punishment at the behest of a higher religious or spiritual power. Practicing faith can be grounding and protective, but it shouldn’t be the sole, end-all-be-all path for mental health.
It’s equally important to recognize that faith communities can be a source of stigma and distress. Some religious communities can alienate individuals who identify in a particular fashion or who experience specific symptoms, leading to increased symptom burden. Men of color, at times, may experience an additional layer of stigma. Society portrays men as individuals who are supposed to be reliable, unbreakable, and emotionally stoic from a very young age. This model of masculinity can be toxic, especially for men of color. Society has begun to open the dialogue surrounding mental health and wellness, which is encouraging. As we normalize our experiences, we can lessen the stigma.
Q: Is there anything else we should know about treating addiction through a culturally sensitive lens?
As mental health care professionals, we can continue to educate ourselves in terms of cultural competency and be honest about any of our own biases toward certain groups. For many of us, we can stigmatize certain cultures or issues and if they go unchecked and we can add further harm to those we’re trying to help. Be willing to offer a safe and judgment-free space where empathy is in high supply. We need to learn and understand how identification with one or more cultural groups influences each client’s worldview, beliefs, and traditions surrounding the initiation of substance use, healing, and treatment.
Along with this, it’s important to understand that there can be multiple “drug cultures” that influence clients’ substance use or abuse and the behaviors they engage in to manage mental disorders. This usually has a strong correlation with the desire for belonging and acceptance. Someone who gains acceptance from a group, even if mainstream society discriminates against them because of substance use or mental illness, will many times choose to engage and accept that group’s behavior and beliefs. Prejudice from mainstream society can make ties with the drug culture even stronger and the client may feel as if there is no other place to turn for social and cultural support.
Alma is a network of mental health care providers dedicated to simplifying access to high-quality, affordable mental health care. To learn more, visit helloalma.com.
