(3) Leveraging Asian American & Pacific Islander Resilience in Substance Use Recovery

Background &

Introduction: Asian American and Pacific Islander (AAPI) communities, despite being the fastest-growing racial and ethnic group in the U.S., face unique cultural barriers to substance use disorder (SUD) treatment. Historical narratives like the "model minority" myth have fueled stereotypes that perpetuate underfunding and neglect in AAPI SUD research and treatment. These perceptions contribute to data aggregation that treats AAPIs as a monolithic group, masking significant health disparities, including rising rates of opioid overdoses and hospital admissions among AAPI communities. Previous research has focused on risk factors for SUD among AAPIs, with limited exploration of how cultural strengths can serve as facilitators to treatment. This study aims to explore the cultural nuances impacting access to and engagement with SUD treatment among AAPIs in recovery. By focusing on a strengths-based approach, this research addresses the gap in understanding how AAPI cultural values, family dynamics, and community interactions influence treatment outcomes. Findings are intended to inform culturally competent clinical practices and policies that can better support AAPI communities.

Methods: This qualitative study utilized semi-structured interviews to explore cultural barriers and facilitators to accessing SUD treatment among AAPI individuals in recovery. We recruited 20 participants through snowball sampling from clinical settings in Los Angeles County, California. Eligible participants self-identified as AAPI, had a history of SUD, and resided in Los Angeles County. Interviews were conducted via Zoom, recorded, and transcribed. A structured interview guide focused on themes related to the model minority myth, acculturation, family dynamics, and community influence. Data were analyzed using thematic analysis, with codes generated based on existing literature on SUD barriers and facilitators specific to AAPI populations. Four coders reviewed the transcripts to ensure inter-rater reliability, with constant comparative analysis employed to refine themes until theoretical saturation was reached.

Results: Three major themes emerged from the interviews: (1) addressing the model minority myth, (2) family dynamics, and (3) the AAPI community. Each theme was broken down into barriers and facilitators to SUD treatment.

Theme 1: Addressing the Model Minority Myth
Participants reported that societal and familial pressures related to the model minority stereotype influenced substance use and hindered treatment engagement. Stereotypes about academic success and economic stability led to guilt, shame, and a reluctance to seek help. However, recognizing the diversity within AAPI communities helped participants challenge these stereotypes and facilitated their treatment journeys.

Theme 2: Family Dynamics
Family dynamics played a dual role in participants' experiences with SUD treatment. Acculturative family distancing and parental pressures often acted as barriers, with participants describing feelings of alienation and shame. Many reported using substances as a coping mechanism for strained familial relationships. However, family members also played a crucial role in facilitating recovery when they became involved in culturally competent treatment programs, which helped both patients and their families better understand SUD and mental health.

Theme 3: AAPI Community
The AAPI community's general limited of awareness of SUDs contributed to stigma and delayed treatment. Participants described how silence around substance use, motivated by concerns about "saving face," often exacerbated their struggles. Nevertheless, culturally concordant treatment programs that incorporated AAPI community values and offered AAPI staff were significant facilitators in recovery. Participants shared that such programs provided a sense of belonging and understanding, which was critical in overcoming internalized shame and fostering a positive recovery environment.

Conclusion &

Discussion: This study highlights the importance of culturally competent SUD treatment for AAPI individuals. The MMM and cultural stigmas around mental health and substance use create significant barriers to treatment. Programs that acknowledge the diversity within AAPI communities and incorporate family members and cultural values into treatment can improve outcomes for AAPI communities. Clinicians should exercise culturally humility when reconciling differences in values and communication with patients and their families. Practitioners from Western individualistic cultural backgrounds should also nonjudgmentally consider Eastern collectivist perspectives, particularly when working with first or second generation AAPIs. Helping patients identify strengths within their own culture and mobilizing their family in the treatment plan can improve both patient and family self-efficacy in the recovery process. Future clinical practices and public health policies must emphasize the need for culturally tailored interventions that address these unique barriers and leverage the strengths of AAPI cultural values. Disaggregating AAPI SUD research to elucidate cultural dynamics within AAPI subgroups is needed to improve the quality of care in SUD treatment programs. Recognizing the nuances in AAPI family dynamics, community interactions, and individual experience is essential for improving SUD outcomes in this growing population.

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