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Module 10F - Immigrants, Refugees, and Alcohol

PARTICIPANT HANDOUT

Introduction

For decades, large numbers of individuals have been prompted to move to the United States due to threatening or emergency circumstances in their countries of origin. Some of these events have induced vulnerability due to "ethnic cleansing" campaigns, political transformations, climatic disasters, female mutilations, and wars. Refugees are often forced to flee suddenly and may not have an opportunity to make preparations to leave their home country or to arrive in a new country. The Refugee Act of 1980 defines a refugee as a person who cannot return home because of a "well-founded fear of persecution on the basis of race, religion, nationality, membership in a particular social group, or political opinion."

American policy concerning immigrants and refugees has long been characterized by ambivalence and conflicting goals. From its earliest beginnings, the social work profession in the United States has responded to the needs of immigrant and refugee populations (Axinn & Levin, 1975). In the late 1800s, the Settlement House Movement began, in part, to help immigrants and refugees make the transition from their homelands to the United States. At Hull House, started in 1889 by Jane Addams in Chicago, an Immigrants Protective League was organized to help immigrants in their new country (Davis, 1977).

The experiences of immigrants and refugees have differed widely, due in part to their national origins, ages, locales, family and employment status, and the period of U.S. history in which they arrived. Today, issues of equity, fairness, exploitation, discrimination, stress, communication, cultural competence, and mental health still face immigrants and refugees. Present-day social workers can continue their rich tradition by responding to the needs of immigrants and refugees, including those with alcohol problems.

Learning Objectives

By the end of this module, learners should be able to:

A. Develop awareness of psychosocial issues relevant to immigrant and refugee populations
B. Recognize and understand conceptual models for alcohol use problems among immigrants and refugees
C. Analyze and apply the results of empirical studies on alcohol problems among immigrants and refugees
D. Recognize the implications for practice with immigrants and refugees who experience problems with alcohol use
E. Understand the ethics and values related to social work practice with immigrants and refugees

Background

Table 1: Immigration, 1981-1996

1. Mexico 3,304,682
2. Philippines 843,741
3. Vietnam 719,239
4. China 539,267
5. Dominican Republic 509,902
6. India 498,309
7. Korea 453,018
8. El Salvador 362,225
9. Jamaica 323,625
10. Cuba 254,193

The main countries of origin for individuals immigrating to the U.S. between 1981 and 1996 include five Latin American and Caribbean nations, as well as five Asian nations (see Table 1). Mexico was the single country with the highest number of immigrants (U.S. Immigration and Naturalization Service, 2000a).


Table 2: Refugees, 1981-1996

1. Vietnam 420,178
2. Soviet Union 413,862
3. Laos 147,530
4. Cambodia 109,914
5. Iran 41,276
6. Romania 38,567
7. Poland 37,996
8. Bosnia-Herzegovina 35,172
9. Ethiopia 34,138
10. Afghanistan 30,952

 

During that same period, refugees who entered the United States came primarily from Asia and East Europe, with the highest numbers coming from Vietnam and the Soviet Union (U.S. Immigration and Naturalization Service, 2000a; see Table 2).

 

 


Table 3: Estimated Undocumented Residents, 1996

1. Mexico 2,700,000
2. El Salvador 335,000
3. Guatemala 165,000
4. Canada 120,000
5. Haiti 105,000
6. Philippines 95,000
7. Honduras 90,000
8. Poland 70,000
9. Nicaragua 70,000
10. Bahamas 70,000
11. Other 1,180,000

Total 5,000,000

Over half (54%) of the estimated 5 million undocumented immigrants residing in the United States during 1996 came from Mexico (U.S. Immigration and Naturalization Service, 2000b; see Table 3). Four countries in close proximity to the United States (El Salvador, Guatemala, Canada, and Haiti) accounted for an additional 15% of the estimated number of undocumented immigrants. It is estimated that approximately 4,000 undocumented, "illegal" immigrants entered the U.S. daily prior to 9/11/01, and that this number has dropped by 50% since then.

A chart  of foreign-born people resided in the United States. Asia 17%, Latin America 13%, Other 13%

 

In 1999, 26.4 million foreign-born people resided in the United States, constituting 9.7% of the total U.S. population (Brittingham, 1999). Of these, 50.7% were born in Latin America, 27.1% in Asia, 16.1% in Europe, and 6.2% in other countries.

 

 

 

 

Table 4: Percent Population Estimates of Legal Permanent Residents and Undocumented Immigrants by Top 10 States of Residence, 1996

State Legal Permanent Residents Undocumented
1. California 35.3% 40%
2. New York 14.2% 11%
3. Texas 7.8% 14%
4. Florida 7.5% 7%
5. New Jersey 4.4% 3%
6. Illinois 4.3% 6%
7. Massachusetts 2.9% 2%
8. Virginia 1.7% 1%
9. Maryland 1.7% *
10. Washington 1.7% 1%
11. Arizona * 2%
* Not among the top ten states.

Two states, California and New York, together accounted for half of both legal permanent residents and undocumented immigrants in the United States in 1996 (U.S. Immigration and Naturalization Service, 1999 and 2000b; see Table 4). Legal permanent residents are able to live permanently in the United States but are not naturalized citizens. They cross borders with issued visas, often as highly skilled workers, students, or tourists. Either they have not applied for citizenship or do not meet the qualifications.


Psychosocial Issues of Immigrants and Refugees

The decision to migrate is most likely made by a family rather than an individual, after weighing their resources, opportunities, and risks (Sherraden & Martin, 1994). Sometimes an entire household migrates, but oftentimes migration involves only one or two family members. Other family members may subsequently follow. Or, the migrant may eventually return to the family's country of origin. Sometimes the migrant members start a new life in their new homeland, separate from their original families.

The process of migration can be understood as consisting of three phases:

  • Pre-migration/departure phase
  • Transit phase
  • Resettlement phase (Drachman & Halburstadt, 1992).

During the pre-migration/departure phase, immigrants experience a separation from their social networks and familiar environments. They may have lingering concerns about family members who are left behind. Many experience depression and grief as a result of multiple, serial or concurrent losses (e.g., they may have to sell off all of their personal assets and belongings to pay for the move).

During the transit phase, an immigrant may experience either uncomplicated travel or very dangerous, hazardous journeys and illegal border crossings. Many individuals are extremely vulnerable to exploitation during this phase of the immigration process.

In the resettlement phase, cultural issues become prominent as the immigrant begins to adjust to living in a new country. Conflicts may arise because of the numerous areas for potential cultural dissonance between the country of origin and the host country. Among the subsequent problems experienced by many immigrants are racism, discrimination, language barriers, and loss of valued social roles (Bernier, 1992; Johnson, 1996; Kelley, 1994). Others may experience problems with depression, suicide, parent/child conflict, Post Traumatic Stress Disorder (PTSD), and/or substance abuse (Bernier, 1992; Drachman & Halburstadt, 1992; Le-Doux & Stephens, 1992).

Immigrants who are also refugees suffer more problems than other immigrants. These include having experienced persecution because of political, religious, or other reasons; hardship and torture in their own countries; and a lack of choice or planning in leaving their countries (Kelley, 1994). They may have had to contend with extended stays in refugee camps (Drachman & Halburstadt, 1992). The need among refugees for social work services is particularly acute, as is the need for medical and disability services. A wide range of interventions may be necessary ranging from concrete assistance to meet economic, legal, social and other needs, to psychotherapeutic intervention to address the continuing trauma effects.

A special class of immigrants and refugees are those who are in the United States without proper documentation. Undocumented individuals have a unique set of problems that set them apart from other immigrants and refugees. They lack many of the legal protections afforded to citizens and legally documented immigrants. Undocumented immigrants and refugees always face the jeopardy of being deported, even after many years of residence in the United States. Deportation may follow a prolonged period of detention, as well. As a result, they are vulnerable to many forms of exploitation, including receiving below minimum wage salaries, not being reliably paid, and other unjust labor practices by unscrupulous employers. In addition, undocumented individuals do not qualify for many of the government assistance programs because they lack legal residency.

Problems suffered by immigrants:
- Racism
- Discrimination
- Language barriers
- Loss of valued social roles
- Depression
- Suicide
- Parent/child conflict
- PTSD
- Substance abuse

Additional problems suffered by refugees:
- Persecution
- Hardship or torture
- Refugee camps
- No medical/disability services

Additional problems suffered by undocumented individuals:
- Constant threat of deportation

- No legal protection
- Open to exploitation
- Not qualified for government assistance programs

The extent to which individual immigrants and refugees have social networks to help them adjust to their new surroundings varies. Some have family members, friends, and formal ethnic-oriented agencies or programs available to assist them on their arrival in the host country. Others have no such social networks. Additionally, individual immigrants and refugees vary in the extent to which they come with their own financial resources and economic potential. Obviously, the extent to which social networks and financial resources are available can help to facilitate transition to a new homeland.

Despite the stresses associated with the migration or refugee experience, for many immigrants and refugees there are positive aspects as well. These can take the form of greater opportunities for employment, higher wages, personal freedom, or a greater sense of safety and security in the host country (Sherraden & Martin, 1994). Additional information on the psychosocial issues related to immigrants and refugees can be found in the special issue of the Journal of Multicultural Social Work (vol. 2, issue 1, 1992) devoted to this topic and in Social Work Practice with Immigrants and Refugees (Balgopal, 2000).

Alcohol Use Among Immigrants And Refugees

Several different models have been developed to explain the use of alcohol and other substances by immigrants and refugees. The acculturative stress model states that alcohol and other drug use are resultant reactions to the immigration experience itself because of the stress from cultural conflict, and the lack of social and economic resources for coping (Johnson, 1996).

Alcohol Use Models
- Acculturative stress model
- Assimilation/ acculturation model
- Continued original patterns
- Intracultural diversity model


The assimilation (or acculturation) model states that, as newcomers adopt the customs of the host country, their patterns of alcohol and other drug use will also begin to reflect those of their new location (Johnson, 1996). However, it is also possible thatimmigrants continue the alcohol and other drug use patterns that they had in their countries of origin (D'Avanzo, 1997; Rebhun, 1998).

Another model, which may be called the intracultural diversity model, emphasizes the diversity of alcohol and other drug use patterns that exist within different immigrant and refugee groups (Gutmann, 1999). It is incorrect to think of a specific drinking pattern as typifying all members of a particular group, and necessary to recognize heterogeneity. Differences in alcohol consumption exist among individuals within a specific group.

Empirical Alcohol Studies of Immigrant/Refugee Groups

Research is limited on the alcohol consumption patterns of immigrant and refugee groups in the United States (D'Avanzo, 1997; Rebhun, 1998). Most research has focused on ethnic groups with long histories in the U.S., such as Mexican Americans, Japanese-Americans, Chinese-Americans, and Korean Americans. However, much of this research fails to examine the differences that exist within these groups (Caetano, Clark, & Tam, 1998). Brief examples of the research conducted on alcohol use among newer Latino and Southeast Asian immigrant and refugee groups follows. These two groups are highlighted because limited empirical research exists on the alcohol-use patterns of other more-recent immigrant and refugee groups.

Within Group Differences
National Differences
Between Group Differences
Mexican-Indians vs. non Mexican-Indians
Mexicans vs. Central Americans
U.S. born Mexican-Americans vs. immigrant Mexicans and Central Americans
  • Fresno, CA (n=3,012)
  • Mexicans (n= 391)
  • Central Americas (n=531)
    (El Salvador & Nicaragua
  • U.S. born (n=188)
  • Immigrants (n=264)
  • Mexican-Indians have higher rates of lifetime alcohol abuse and dependence than non-Mexican-Indian groups
  • Abstinence for past 30 days: 64% for Central Americans and 57% for Mexicans
  • U.S.-born men and women more likely to be heavy drinkers than immigrants
  • No significant differences after adjusting for socioeconomic status
  • Average drinks in past 30 days: 6 for Central Americans and 9 for Mexicans
  • U.S.-born women more likely to use alcohol as mood elevator, tension reducer, and social disinhibitor
  • Alderete et al., 2000
  • Marin & Posner, 1995
  • Cervantes et al, 1990-91
  • Dominicans vs. Guatemalans
  • Vietnamese Men vs. U.S. Men

  • New Jersey, Choice for alcohol treatment
  • California
  • Dominican immigrants opt for church-based programs
  • Percent of male Vietnamese drinkers comparable to men in general U.S. population
  • Guatemalan immigrants opt for Spanish-language AA groups
  • Binge drinking twice as common among Vietnamese men
  • Rebhun, 1998
    California, Asian Groups
  • Makimoto, 1998
  • Vietnamese and Chinese-Vietnamese have higher alcohol consumption levels than Japanese, Chinese, Korean, or Filipinos
  • Caetano et al., 1999

Intra-national Differences: Mexican Immigrants.
Mexican immigrants are an excellent example of the intracultural diversity model. This model recognizes differences in alcohol consumption among individuals within a specific group. Although individuals of Mexican descent have a long history of living in the U.S., the immigration of Mexican Indians is a relatively new phenomenon (Alderete, Vega, Kolody, & Aguilar-Gaxiola, 2000). Mixtecos, Zapotecos, Mixes, Tarahumaras, and other Mexican Indians constitute 10% of the estimated one million persons in California's farm labor force. Alderete et al. (2000) note that immigrant Mexican Indians are often included with other Mexicans, despite the fact that these very different groups have minimal social contact with each other, either in Mexico or in the U.S. In a study of 3,012 Mexican-origin, Spanish- or English-speaking individuals in Fresno County (California), Mexican Indians were found to have higher rates of lifetime alcohol abuse and dependence than non-Indian Mexicans-5.1% versus 3.3% for alcohol abuse and 17.4% versus 10.7% for alcohol dependence (Alderete et al., 2000). However, there was no significant difference in lifetime rates for abuse or dependence between these groups after adjusting for sociodemographic factors.

Differences Between National Groups: Central America.
In a study of 531 immigrants from Central America (primarily El Salvador and Nicaragua), and 391 from Mexico, 64.4% of the Central Americans reported not drinking alcohol in the previous 30 days compared to 56.8% of the Mexicans (Marin & Posner, 1995). The number of days the Central Americans reported drinking in the previous 30 days (M = 4.5 days) was lower than that reported by the Mexicans (M = 7.4 days). The Central Americans consumed fewer drinks in the previous 30 days (M = 5.9 drinks) than the Mexicans (M = 9.2 drinks).

In a study comparing Dominican and Guatemalan immigrants in New Jersey, differences in the locations chosen for obtaining alcohol treatment were found between the two groups (Rebhun, 1998). Dominicans were most likely to seek help for their problem drinking from charismatic groups affiliated with the Catholic Church. In contrast, Guatemalans were more likely to seek help from Spanish-language Alcoholics Anonymous (AA) groups. Neither the Guatemalan nor the Dominican immigrants tended to go to clinics for alcohol problems.

Among Asian groups in California, Vietnamese and Chinese-Vietnamese have been found to report higher alcohol consumption levels in comparison to Japanese, Chinese, Koreans, and Filipinos (Caetano, Clark & Tam, 1999).

Differences Between Immigrant and U.S.-Born Groups.
In a study of 264 young adult immigrants, primarily from Mexico, El Salvador, Nicaragua, and Honduras (mean age 23 years) compared to 188 U.S.-born Mexican Americans, the U.S.-born men and women were found to be heavier drinkers than the immigrants (Cervantes, Gilbert, Salgado de Snyder, & Padilla, 1990-1991). Approximately 18.3% of the U.S.-born men and 4.2% of U.S.-born women were found to be in the highest drinking category (drinking at least once a week and drinking six or more drinks per usual occasion), in comparison to 9.4% of the immigrant men and 1.0% of the immigrant women. Additionally, U.S.-born women were significantly more likely than their immigrant counterparts to describe alcohol as having social disinhibiting effects, being a mood elevator and tension reducer, and enhancing sociability. No differences were found between the immigrant and U.S.-born males on their beliefs concerning alcohol.

In a study of Vietnamese men living in California, the percentage of drinkers was found to be the same as among men in the general U.S. population (Makimoto, 1998). However, binge drinking was twice as common among the Vietnamese men.

Acculturation Differences
One factor that accounts for some differences in alcohol use patterns within specific groups is acculturation. In Alderete et al.'s study of Mexican Indians and non-Indians, both Indian and non-Indian Mexicans who chose to do the interview in English had a statistically significant increased risk for alcohol abuse or dependence compared to those who did the interview in Spanish (Alderete et al., 2000). This was interpreted as suggesting that acculturation was a risk factor for both populations of Mexican immigrants.

In Marin and Posner's (1995) study of immigrants from Central America and Mexico, greater acculturation was significantly associated with less abstention in the previous 30 days (37.5% for Central Americans, 40.7% for Mexicans) in contrast to individuals who measured lower in acculturation (57.1% for the Central Americans and 68.7% among the Mexicans). The less acculturated Central Americans tended to drink significantly less often in the previous 30 days (M=3.9 days) than did their more acculturated counterparts (M=5.9 days). A similar pattern occurred among the Mexicans, although it was not statistically significant. The more acculturated Mexicans drank greater than twice the number of drinks in the previous 30 days (M=13.6 drinks) than did less acculturated Mexicans (M=6.1 drinks). Among the Central Americans, the more acculturated consumed more during the previous 30 days (M=8.1 drinks) compared to the less acculturated (M=5.2 drinks), but the difference was not statistically significant.

Gender Differences

Vietnamese in California

  • Santa Clara County, California
  • Women more likely to abstain than men (51% vs. 6%)
  • Men more likely to be moderate or heavy drinkers than women (39% vs. 6%)
  • Padilla et al., 1993

Mexicans vs. Central Americans

  • Mexicans (n= 391)
  • Cent Amer (n=531)
  • Women more likely to abstain than men
  • Men drank more often during previous 30 days
  • Men consumed more during previous 30 days
  • Marin & Posner, 1995

U.S.-born vs. immigrant Mexicans and Central Americans

  • U.S.-born (n=188)
  • Immigrant (n=264)
  • Abstention higher in both immigrant and U.S.-born women
  • Both immigrant and U.S.-born women less likely to be heavy drinkers
  • In both immigrant and U.S.-born men, depression is positively associated with drinking level
  • Cervantes et al, 90-91

Southeast Asians

  • Vietnamese in U.S. for less than 6 mos
  • Men more likely to report any alcohol use than women
  • Nelson et al., 1997

In a study of young adult immigrants from Mexico, El Salvador, Nicaragua, and Honduras, women had higher rates of abstention than males (59.4% vs. 28.1%) (Cervantes et al., 1990-1991). In the same study, U.S.-born Mexican American women also had higher rates of abstention than males (31.6% vs. 21.1%). Both immigrant and U.S.-born women were significantly less likely to be heavy drinkers than men. The immigrant women were also significantly less likely to endorse the belief that alcohol consumption enhances social acceptance, after-work relaxation, freedom from inhibition, global mood elevation, sexual pleasure, tension reduction, social pleasure, and social assertiveness. No association was found between depression and drinking level for either group of women, however, depression was positively associated with alcohol drinking level for both immigrant and U.S.-born men.

Marin and Posner's (1995) study of Central American and Mexican residents found similar gender differences. A lower proportion of men from Central America, compared to women, reported being abstainers in the previous 30 days (51.9% versus 73.0%, respectively). This finding was replicated among the Mexican men and women (37.7% versus 72.6%, respectively). Men drank more often during the previous 30 days (M = 5.3 days among Central Americans, M=8.4 days among Mexicans) compared to women (M=3.6 days among the Central Americans and M =5.8 days among the Mexicans). Men also reported drinking more during the previous 30 days (M=10.4 drinks among Central Americans, M=15.6 drinks among Mexicans) as compared to the women (M =2.8 drinks, among the Central Americans and M = 4.0 among the Mexicans).

Gender differences in alcohol consumption have also been found among Southeast Asian groups. Nelson, Bui and Samet (1997) report that, among Vietnamese immigrants living in the United States for less than 6 months, men were significantly more likely than women to report any alcohol use. A study in Santa Clara County in California found that 51% of Vietnamese women abstained from alcohol in contrast to only 6% of the men (Padilla, Sung, & Nam, 1993). In addition, 39% of the men were moderate to heavy drinkers in contrast to only 6% of the women.

REASONS FOR DRINKING

Cambodian Refugee Women
Hmong
Southeast Asian Refugees
Southeast Asian Youth
Long Beach, CA, and Lowell, MA (n=120)
Alcohol used for self-treatment (insomnia, pain, stress)
45% reported alcohol problems
Recent immigrants
More of Massachusetts sample used alcohol to cope with stress, pain, etc.
D'Avanzo, 1997
Alcohol use acceptable to cope with stress
Use alcohol to forget their past
Men's drinking described as social; women's as self-treatment
Caetano et al., 1999
Makimoto, 1998
D'Avanzo et al., 1994

In a study of 120 Cambodian refugee women conducted in Long Beach, California and Lowell, Massachusetts, more of the East Coast sample reported using alcohol to cope with nervousness, stress, insomnia or pain (D'Avanzo, Frye, & Forman, 1994). Cambodian women also described men's drinking as social in contrast to women's drinking which was used to deal with emotional or physical pain. The increasing use of alcohol for the self-treatment of insomnia, pain, and emotional stress has also been reported among the Hmong (D'Avanzo, 1997).

Caetano et al. (1999) observe that, among a study of Southeast Asian refugees, 45% reported having problems with alcohol use, and a large proportion found it acceptable to use alcohol to cope with stressful situations. Similarly, in a study of young people of different ethnicities, the recent immigrant Southeast Asian youth reported drinking primarily to forget their pasts, in contrast to the youth of other ethnic groups who reported drinking mostly for social reasons (Makimoto, 1998).

Special training is required for social workers who are interacting with immigrants and refugees with alcohol problems. Social workers already recognize the need for greater cultural awareness and cultural sensitivity, but these are not enough (McInnis, 1986; Sherraden & Martin, 1994). Some knowledge of the immigrants' histories, former lives and experiences of immigrating to the United States is also necessary (Sherraden & Martin, 1994). This is especially the case when working with refugees who have experienced multiple losses due to uprooting and relocation (McInnis, 1986). An understanding of the backgrounds of particular refugee groups and the effects of the trauma that they may have endured is critical (Kelley, 1994). This makes the knowledge of how to work with individuals suffering from PTSD essential (Bernier, 1992). In addition, as noted previously, it is important to recognize that subgroup differences in drinking patterns exist within specific immigrant and refugee groups.

Special Training Needs:
Knowledge of immigrant/refugee
- Histories
- Former lives
- Immigration experiences

Knowledge of PTSD work
Knowledge of immigrant subgroup differences

 

Reaching out to immigrants and refugees with alcohol problems may require working through existing ethnic associations that already have access to these populations (Jenkins & Sauber, 1988). Such agencies, with their cultural ties to immigrant and refugee populations, already provide services to these groups. Working through these existing organizations could result in reaching individuals who may have some hesitancy in accessing non-ethnic organizations or services. It allows social work professionals to build on and extend pre-existing positive and trust relationships.

It may also be necessary to involve indigenous personnel or paraprofessionals in the development and provision of services (Drachman & Halburstadt, 1992; Ivry, 1992). In addition, working in tandem with other agencies to address additional life stressors (limited educational and job-related skills, etc.) that may contribute to alcohol misuse by immigrants and refugees may be necessary (D'Avanzo, 1997).

Given the closeness that many immigrant groups have with their families of origin, it may be beneficial to involve an immigrant's or refugee's family and other social support systems in the person's treatment (Kelley, 1994). This is especially necessary when an individual has limited or no experience in using formal services in their country of origin (Sherraden & Martin, 1994). It may also be appropriate to consider developing alcohol treatment programs specifically designed for immigrant or refugee groups (Epstein & Mohn, 1992). In this case, translators must be readily available. Many immigrants utilize their children as translators which may not be practical given the sensitivity of issues and concerns that arise in social work interactions.

Values and Ethics in Social Work Practice with Immigrants and Refugees

Social workers must be cognizant of the different sets of values that can influence their practice with immigrants or refugees who experience alcohol-related problems. These sets of values come from the social work profession, the practitioner's own value base, and the values of the client.

Professional social work's core values are expressed in the Code of Ethics of the National Association of Social Workers (NASW, 2001). Included among these are the values of providing service, promoting social justice, and respecting the dignity and worth of each immigrant or refugee client. Respecting human dignity is based on: 1) a belief in individuals' rights to self-determination, and 2) acknowledging their need to control their own destiny and make their own decisions (Hoffman & Sallee, 1994). However, these values may have limits in certain social work situations, such as working with a suicidal client (Hoffman & Sallee, 1994).

Issues of Social Work Values and Ethics:
- NASW Code of Ethics
- Awareness of own personal values
- Understanding immigrant's/refugee's personal values
- Awareness of own stereotypes

In addition to the profession's values, each social worker has personal values that impact on the professional relationship with a client. These originate from the social worker's own history, culture, religion, and other life influences. A practitioner's lack of awareness concerning these personal values can impede positive interactions with immigrants and refugees, and can result in deleterious activities such as power struggles or the social worker actively deciding what a client should or should not do (Dungee-Anderson & Beckett, 1995). One exercise that can promote greater self-awareness by a practitioner is the "Professional Self-Awareness Inventory" found in Social Work Practice: Bridges to Change (Hoffman & Sallee, 1994).

Each individual immigrant or refugee client also has a set of values reflective of his or her own cultural background and social class. Because the experiences of immigrants and refugees may be very different from those of a social worker, it is very important that the practitioner have some knowledge of the immigrant's or refugee's own beliefs and values. Not having this awareness can result in inappropriate interventions due to faulty interpretations on the practitioner's part of an individual's cultural material (Dungee-Anderson & Beckett, 1995). Models for increasing multicultural sensitivity among social workers are provided by Dungee-Anderson and Beckett (1995) and Christensen (1992).

Different sets of values may often coincide, and at other times they may be in conflict with one another. It is important for the individual practitioner to have some knowledge and awareness of these different sets of values and of how to address conflicts that might arise among them. Such knowledge will influence both how a social worker responds to a client as well as what is chosen as the actual content of an intervention with that person.

Finally, in working with particular immigrant or refugee groups, it is important to identify and avoid stereotypes (Dungee-Anderson & Beckett, 1995). For example, heavy drinking in the context of "machismo" is usually identified with Hispanic men (Ross & Chappel, 1998), as if somehow this association is more characteristic of, or stronger for, that population. However, when a measure of machismo was used in a study of White, Black, and Mexican-American men, machismo was related to alcohol use among men regardless of ethnicity and did not explain the higher drinking levels among Mexican-Americans in the United States (Neff, Prihoda & Hoppe, 1991). Thus, it is important for social workers to identify, address, and question the assumptions that they may have about the drinking patterns of certain groups, and to base their interventions on correct information rather than stereotypes.

Summary
Social workers can play a vital role in assisting immigrants and refugees who experience alcohol use disorders. This role can include assisting them to decrease alcohol abuse or dependence, to decrease alcohol-related problems, and to find healthier strategies for coping with the stress of migration and acculturation to the United States. Such practices follow the tradition of social workers who have been assisting such populations since the inception of the profession in the United States.

Credits
Appreciation is expressed to the National Institute on Alcohol Abuse and Alcoholism for their support of this research (1 U24 AA11899-04).

CLASSROOM EXERCISES

  1. Information on alcohol and other substance abuse treatment programs for use with immigrant and refugee groups can be obtained from the website of the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services (http://findtreatment.samhsa.gov/). Assign each student to visit this site and report on two important things that they learned there. (Note that not all immigrant and refugee groups are represented.)
  2. Assign each student responsibility for contacting and reporting on one immigrant/refugee specialist program. Some examples are:
    http://www.yorku.ca/crs/ (Canadian services, similar issues)
    http://ww2.mcgill.ca/psychiatry/transcultural/immig.html (Canadian services, similar issues)
    http://www.ins.usdoj.gov/
    http://www.refugeesusa.org/
    http://www.mentalhealth.org/CMHS/SpecialPopulations/refugmhnew.asp

    Hispanic/Latino:
    Pinal County Hispanic Council
    Substance Abuse Counseling
    712 North Main Street
    Eloy, AZ 85231
    (520) 466-7765

    California Hispanic Commission on
    Alcohol and Drug Abuse
    Casa Elena
    832 South Anaheim Blvd.
    Anaheim, CA 92805
    (714) 772-5580

    Latino Family Alcohol and Drug Abuse Center
    5801 East Beverly Blvd.
    Los Angeles, CA 90022
    (323) 722-4529

    Hispanic Alcohol and Substance Abuse Program
    80 Jefferson Street
    Hartford, CT 06106
    (860) 527-1124

    Andromeda Transcultural Hispanic Mental Health Center
    1400 Decatur Street NW
    Washington, DC 20011
    (202) 291-4707

    Alianza Dominicana, Inc.
    2410 Amsterdam Avenue, 4th floor
    New York, NY 10033
    (212) 740-1960, ext. 434

    Hispanic Counseling Center
    Alcoholism Outpatient Clinic
    175 Fulton Avenue, Suite 500
    Hempstead, NY 11550
    (516) 538-2613

    Russian:
    Break Free Russian Adolescent Project
    2020 Coney Island Avenue
    Brooklyn, NY 11223
    (718) 676 -4280
    http://www.jbfcs.org/wwa/Dprogram.htm

    Southeast Asian:
    Cambodian Association of America
    2501 Atlantic Avenue
    Long Beach, CA 90806
    (562) 426-6002

    Community University Health Care Center
    Southeast Asian Outpatient Program
    2001 Bloomington Avenue South
    Minneapolis, MN 55404
    (612) 627-4774
    http://www.ahc.umn.edu/cuhcc/

  3. Assign the exercise cited in the text above to promote greater self-awareness by a practitioner: the "Professional Self-Awareness Inventory" found in Social Work Practice: Bridges to Change (Hoffman & Sallee, 1994).
  4. Download, review, and discuss this module presented on refugee training for women (http://www.refugeesusa.org).
  5. Discuss whether or not alcohol treatment programs should be culturally specific or cross-cultural in design, and how this relates to culturally competent social work practic

Recommended Reading for Discussion

  1. The entire special issue on social work with immigrants and refugees in the Journal of Multicultural Social Work, 2(1), 1992.
  2. Balgopal, P. R. (2000). Social Work Practice with Immigrants and Refugees. New York: Columbia University Press.
  3. Kelley, P. (1994). Integrating systemic and postsystemic approaches to social work practice with refugee families. Families in Society: The Journal of Contemporary Human Services. 75, 541-549.
  4. McInnis, K. M. (1986). Working with political refugees: new challenges to international social work. International Social Work, 29, 215-226.
  5. Sherraden, M. S. & Martin, J. J. (1994). Social work with immigrants: international issues in service delivery. International Social Work, 37, 369-384.

References

Alderete, E., Vega, W. A., Kolody, B., and Aguilar-Gaxiola, S. (2000). Effects of time in the United States and Indian ethnicity on DSM-III-R psychiatric disorders among Mexican Americans in California. The Journal of Nervous and Mental Disease, 188, 90-100.

Axinn, J., & Levin, H. (1975). Social welfare: A history of the American response to need. Hagerstown, PA: Harper & Row.

Balgopal, P.R. (ed). (2000). Social work practice with immigrants and refugees. New York: Columbia University Press.

Bernier, D. (1992). The Indochinese refugees: a perspective from various stress theories. Journal of Multicultural Social Work, 2, 15-30.

Brittingham, A. (1999). The foreign-born population in the United States. Washington, D.C.: U.S. Bureau of the Census, 2000. Current Population Reports, Population Characteristics, March 1999. (CPR P-20, no. 519)

Caetano, R., Clark, C .L., & Tam, T. (1999). Alcohol consumption among ethnic minorities: theory and research. Alcohol Health and Research World, 22, 233-241.

Cervantes, R. C., Gilbert, M. J., Salgado de Snyder, N., & Padilla, A. M. (1990-1991). Psychosocial and cognitive correlates of alcohol use in younger adult immigrant and U.S.-born Hispanics. International Journal of Addictions, 25, 687-708.

Christensen, C. P. (1992). Training for cross-cultural social work with immigrants, refugees, and minorities: a course model. Journal of Multicultural Social Work, 2, 79-97, 1992.

D'Avanzo, C. E., Frye, B., & Forman, R. (1994). Culture, stress and substance use in Cambodian refugee women. Journal of Studies on Alcohol, 55, 420-426.

D'Avanzo, C. E. (1997). Southeast Asians: Asian-Pacific Americans at risk for substance misuse. Substance Use and Misuse, 32, 829-848.

Davis, A. F. (1977). Settlements: History. In J. B. Turner (Ed.). Encyclopedia of social work, 17th ed, vol 2. Washington, D.C.: National Association of Social Workers.

Drachman, D., & Halburstadt, A. (1992). A stage of migration framework as applied to recent Soviet émigrés. In A. S. Ryan (Ed.). Social work with immigrants and refugees (pp. 63-78). Binghampton, NY: Haworth Press.

Dungee-Anderson, D., & Beckett, J. O. (1995). A Process Model for Multicultural Social Work Practice. Families in Society- The Journal of Contemporary Human Services, 76, 459-468.

Epstein, M., & Mohn, S.L. (1992). Planning for pluralism: a report on a Chicago agency's efforts on behalf of immigrants and refugees. Journal of Multicultural Social Work, 2, 119-123.

Gutmann, M.C. (1999). Ethnicity, alcohol, and acculturation. Social Science and Medicine, 48, 173-184.

Hoffman, K. S., & Sallee, A. L. (1994). Social work practice: Bridges to change. Boston: Allyn & Bacon.

Ivry, J. (1992). Paraprofessionals in refugee resettlement. Journal of Multicultural Social Work, 2, 99-117.

Jenkins, S., & Sauber, M. (1988). Ethnic associations in New York and services to immigrants. In S. Jenkins (Ed.). Ethnic associations and the welfare state: services to immigrants in five countries, (pp. 21-105). New York: Columbia University Press.

Johnson, T. P. (1996). Alcohol and drug use among displaced persons: an overview. Substance Use and Misuse, 31, 853-1889.

Kelley, P. (1992). The application of family systems theory to mental health services for Southeast Asian refugees. Journal of Multicultural Social Work, 2, 1-13.

Kelley, P. (1994). Integrating systemic and postsystemic approaches to social work practice with refugee families. Families in Society- The Journal of Contemporary Human Services, 75, 541-549.

Le-Doux, C., & Stephens, K. S. (1992). Refugee and immigrant social service delivery: critical management issues. Journal of Multicultural Social Work, 2, 31-45.

Makimoto, K. (1998). Drinking patterns and drinking problems among Asian-Americans and Pacific Islanders. Alcohol Health and Research World, 22, 271-275.

Marin, G., & Posner, S. F. (1995). The role of gender and acculturation on determining the consumption of alcoholic beverages among Mexican-Americans and Central Americans in the United States. International Journal of the Addictions,30, 779-794.

McInnis, K. M. (1986). Working with political refugees: new challenges to international social work. International Social Work, 29, 215-226.

National Association of Social Workers (2001). NASW Code of Ethics (electronic file). Available: http://www.naswdc.org/pubs/code/default.asp

Neff, J. A., Prihoda, T. J., & Hoppe, S. K. (1991). Machismo, self-esteem, education and high maximum drinking among anglo, black and Mexican-American male drinkers. Journal of Studies on Alcohol, 52, 458-463.

Nelson, K. R., Bui, H., & Samet, J. H. (1997). Screening in special populations: a case study of recent Vietnamese immigrants. The American Journal of Medicine, 102, 435-440.

Padilla, A. M., Sung, H., & Nam, T. V. (1993). Attitudes toward alcohol and drinking practices in two Vietnamese samples in Santa Clara County. Horizons of Vietnamese Thought and Expression, 2, 53-71.

Rebhun, L. A. (1998). Substance use among immigrants to the United States. In S. Loue, S (Ed.). Handbook of immigrant health, (pp. 493-519). New York: Plenum Press.

Ross, S. M., & Chappel, J. N. (1998). Substance use disorders: Difficulties in diagnoses. The Psychiatric Clinics of North America, 21, 803-828.

Sherraden, M. S., & Martin, J. J. (1994). Social work with immigrants: international issues in service delivery. International Social Work, 37, 369-384.

U. S. Immigration and Naturalization Service. (1999). State population estimates: legal permanent residents and aliens eligible to apply for naturalization, November 20, 1996. Washington, D.C.: INS, U. S. Department of Justice.

U. S. Immigration and Naturalization Service. (2000a). Statistics. Country of origin. Washington, D.C.: INS, U. S. Department of Justice.

U. S. Immigration and Naturalization Service. (2000b). Illegal alien resident population. December 20, 2000. Washington, D.C.: INS, U. S. Department of Justice.

Updated: March 2005