Asian American Recovery Services celebrated its 25th anniversary last month in San Francisco. Dr Inaba was honored with the AARS Nelson Hall Founders Award for his work with helping to create culturally appropriate treatment for Asians and Pacific Islanders. He is one of the founding members of the organization. We discuss AARS history and culturally consistent treatment.
Transcript (edited):
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions. I am Howard LaMere here with Dr. Darryl Inaba and today Im going to talk about you, Darryl. A couple of decades ago, around 85 or so, you were one of the primary founders of the the Asian American Recovery Services in the San Francisco Bay Area. And just recently they had a major awards ceremony and gave you a whole passel of awards. Congratulations!
DARRYL: Thank you, Howard. I feel like I should have given them an award because its probably one of the most meaningful things and meaningful periods of my life – I was working on trying to establish culturally relevant services for Asian Americans and Pacific Islanders in the city in San Francisco, which has a very large population of Asian and Pacific Islanders. In the 70s, there were no programs that targeted that community because the funders and the people in power in San Francisco falsely believed that Asians didnt have drug problems. Even when the community was saying, hey we have drug problems – we need funding to help us establish a program that will be affective in addressing, attracting and holding these clients into treatment. So, we had to fight pretty hard – but we had a vision. We developed a vision for what we wanted for that community and with that vision, we developed a focus and purpose. The people that held the purse strings kept denying us and caused obstacles preventing us from moving forward which got us more enraged and more excited about doing something – it was like the 60s again. We were meeting every week. We were scheming and strategizing and we were dealing with the obstacles and barriers. First was the empirical research. We were amazed to learn that as of the 1980s there wasnt a single funded study done by the United States on Asian substance abuse issues. Every other community had studies to determine the extent of the problem and possible ways to intervene, but zero studies addressed the Asian population and that was used against us. If there is no data, no documentation.
HOWARD: So obviously you dont have a problem!
DARRYL: Right! The lack of interest was the problem, but nothing documented a problem so we didnt have one. So what we did actually we had good researchers on our task force .was start the San Francisco Asian American Substance Abuse Task Force. We had Dr. Davis Ja, Dr. Herb Leung, and a guy named Jerome Beck from U.C. Berkeley, social department, and we actually did empirical research to show there was a significant problem in this community, that wasnt being addressed the Asians who had drug problems didnt even know it was a treatable condition. They bought into the moral weakness thing and the disgrace thing. Less than 5% of the people we interviewed believed this was a treatable condition. And very few had ever received treatment. And the other thing that was very curious was the fact that we were being compared with the African American community, the Latino community, and the Anglo community in San Francisco. We found that unlike those communities, which were getting all the press and the headlines because of the evolution of crack cocaine, heroin and things like that, the Asian youngsters who were abusing drugs were into prescription drugs. They were diverting drugs like Quaalude – at that time it was thought to be non-addictive – and were developing a tremendous addiction. So we knew one of the interventions that had to be done was to develop Quaalude treatment. In San Francisco you could find heroin treatment, cocaine treatment, meth treatment, alcohol treatment, even PCP treatment, but there was no awareness that a Quaalude addiction could and should be treated.
So we went forward with our research and after we got that established, the funders and the county government said youve got a problem alright, but you lack the expertise. There arent any Asian substance abuse experts who are culturally adept enough to clinically move forward with a program. We didnt realize at the time that we were actually being insulted! I mean, here we were professionals who had identified the need and had treatment experience and were told the expertise is missing. So – we did a national search. We tried to find Asians with the right credentials and background to move to San Francisco to head this thing up. And then we sat down one Friday night said, Wait a minute! Were all treating people. We all have expertise, and credentials. So we logged all of this and realized we compared favorably with every other drug treatment program in San Francisco in terms of expertise, experience, and credentials. When we presented this were were told well, thats all well and good, but you have no infrastructure you are not a 501C3 you have no facility.
HOWARD: Sounds like theyre picking on you!
DARRYL: They were just stalling. They had too many sacred cows to fund and didnt want another program. We did need to become a nonprofit, we did need a facility and to go through the rigorous licensing, the regulations, the hearings, all the permit process to deliver services. But luckily, a member of our task force, Jeffrey Morey, who is the current CEO of the Asian American Recovery Services, was connected to West Side Community Mental Health Services and they had a facility that was open and vacant. They had 501C3 status and were well respected in the city. They invited us in and we went back to the city and they had to open our program. Today – 25 years later, the program is in 3 counties is the largest Asian treatment program in the United States. It is doing very well and most gratifying and most wonderful thing that happened was, one of our early directors, David Mineta, this year was appointed by President Obama and brought to the Office of National Drug Control Policy as the deputy director under Gil Kerlikowske,. So he is the top person in the country to oversee treatment and prevention of substance abuse. And Im so proud of Dave and so proud of the organization that after 25 years I just thumb my nose at the city who said we had absolutely no expertise to run a program.
HOWARD: Again, congratulations on that astounding work! Can we talk a little bit about the difference in cultures and how thats relevant in treatment?
DARRYL: Every culture
and I certainly dont want to stimulate stereotypes – is a grouping of individuals who have a common entity. They might be a culture of Catholics or culture of Protestants, you might look at ethnicity, but even then there are differences within a culture. When we looked at Chinese Americans in terms of being part of our Asian American task force we were astounded to find over 340 different dialects of Chinese if you lived in a village 50 miles away from another village, you might not speak the same language, even though the e written language is the same. In addition to that, there are many variables in terms of belief systems, in terms of value systems and ethic systems, so once you define a group that share a common element – in this case we were all considered Asian and Pacific Americans you look for the key that crosses all the seams of those micro cultures, that sets it apart from say, African American or Latino cultures , which is what our research did. We did ethnographic research, immersing ourselves in the Asian drug taking communities of the San Francisco Bay area and we gathered field notes, we didnt translate or filter the information but tried to determine what they were talking about by doing the research and even the drug buys. If they mentioned ludes we wanted to make sure it wasnt PCP, so we actually bought some to analyze. We found differences in what the African American youths or Latino or Anglo youths were into. One of the most important cultural relevant things to do is the get the word out that we understand what that drug is, what it does and that its a treatable addiction. But Asians
and I dont really want to stereotype here have multi-generations living together a 4th generation, or 5th generation is totally different from a 1st or 2nd generation. We were mostly dealing with 2nd or 3rd generation Asians and they tend to refrain from overburdening people with their problems, they are not people who lay their problems on other people they hold them within. They were not into sharing, listened more than spoke, and would never insult anybody by putting words into peoples mouths. These are all great cultural values, but not so good if youre in treatment to recover from drugs and alcohol.
So we had to address those differences – we had to help Asians express themselves. I remember the first group, it was mainly male gang bangers and a a few women, and I waited
(because I was taught that silence is the best way , to get people talking)
whole hour and nobody said a damn thing! So, obviously I needed another technique
.
HOWARD: So youre actually training beyond drug treatment. Youre training in communication skills.
DARRYL: Exactly. You have to develop a whole different approach to deal with a culture who has different values. A drama student from San Francisco State was a member of our task force and he proposed expressive arts therapy because sometimes people find it easier to express themselves through role play. He created something called the I can do it now theater for Aisans who came into our residential program – and our was for 2 years where they took on different roles and the play was loosely built around their own lives. They could express their frustrations, their alienation, their detachment from the world around them, their feelings of ambivalence toward the parents they considered old fashioned relics who didnt belong in this society. And used all of the relevant issues they had and we made a play, they played the roles and performed before a couple hundred people. We had big galas and presented these plays and every individual would finally connect with what they were trying to do. So, that was I think another kind of intervention. The Asian American community contains either overbearing, over dominant parents and families that push kids to be successful – to overachieve or just the opposite. Two end of the stick – nothing in between. We were dealing with kids from families where both parents work and theyre latchkey kids. If they dont have positive relationships with their siblings and they are out on their own they develop extended families with gangs and other street people that is conducive to drug use. So we had to develop a family treatment system and get the nuclear family involved because parents believed that the drug problem was the fault of their kids. They didnt want to own any part of it so the kid has to take care of himself and get better – otherwise he is garbage and he doesnt exist to them. We had to address that with family education therapy and bring it about, if we were going to be successful – thank goodness we were successful with the families who participated. Family members did not respect former addicts if you were an ex-addict counselor or if you were from the street you had no value. They held the American belief that you have to be a doctor or have a PHD or be a nurse or something. So we had to play that game. In our book, Uppers, Downers, All Arounders the treatment section of cultural consistent treatment, outlines 15 key interventions that we had to address for Asian Pacific Islanders that were different than those used to address African Americans or Anglos. That is what culturally relevance is – bringing treatment to a community, sometimes in the language of that community, in the style of that community and the culture of that community. A Cal data study that found that every culturally specific program (compared to a generic program) showed a factoring or doubling in the success rate. So the more you identify and address a particular culture, the more success you have in treatment.
HOWARD: So the more specific the treatment is to the individual and to the particular group
DARRYL: I would say the more meaningful if it is meaningful for them and makes sense to them and they will participate more.
HOWARD: Well, its exciting that one of your colleagues is now in charge of the federal prevention aspect and hopefully well see the economy improve soon so the ability to provide more treatment becomes economically viable. I read a story about Floridas prescription addiction problem and the fact that even though treatment is available – no one can afford the horrendous expense.
DARRYL: Im hoping that with Davids involvement we will see a shift in the priorities of the Office of the National Drug Control Policy and theyll start spending more money on treatment and prevention and less money on intervention and on supply reduction. And I dont mean overall I just mean a shift.
HOWARD: It is certainly worth a try because obviously what weve been doing for 40 years hasnt been working too well.
DARRYL: Absolutely and Davids the right guy. Davids the right guy. Tom Mclellan is the right guy. I think Gils the right guy and Im hoping they can bridge the gap between both sides of the aisle in congress. Congress is becoming much more separatist with each party attacking the other. If one partys favors something – the other attacks it. But this team very well could bridge the gap and begin moving forward. We must move forward in terms of the war on drugs rather than investing so heavily in supply reduction and being so entrenched in only that strategy.
HOWARD: Lets hope that it turns a corner and we see some success. So, again, congratulations on those honors and we will talk again soon.
DARRYL: Thank you for flattering me by talking about my awards, thank you very much!
HOWARD: Please get in touch with any comments or questions and check back soon for the next in the series.