Treatment for alcohol-related problems: special populations: research opportunities.

UNLABELLED: For the subgroups indicated, a few questions/issues are relevant to all three (women, elderly, minorities): 1. Heterogeneity of the special populations, for example, Hispanic-Americans are from different countries with different cultures. Women and the elderly vary by age, education, income, social class, health status, etc., to say nothing of ethnicity/color/religion. 2. Of therapy modalities, professional and indigenous, which are more efficacious? 3. Are group-specific therapies needed, or will sensitivity to a particular group work as well? WOMEN: Stereotypes and myths have prevailed, for example, the long-standing belief that women have poorer prognoses than male alcoholics. When female and male alcoholics are compared, women report more positive family history, a later onset of drinking and problems, more marital disruption, more comorbidity, etc. The review of treatment outcomes (Vannicelli, 1986) showed few significant gender differences in outcomes. Research recommendations include biological and genetic studies, women's view of and use of therapeutic modalities, and outcome studies of different modalities, including all female facilities. ELDERLY: Medications are used more by older patients, and such patients are more likely to experience adverse drug reactions. In the moderate social use of alcohol, there are conflicting reports and the extent of elderly use awaits decisive study. The etiology of problem drinking by older persons is studied rarely. An attempt has been made to explain onset later in life (vs. earlier onset) based on the stresses of aging (loss, loneliness, health problems, etc.); research results have not been supportive. Consequences of older persons' heavy drinking seems to be most often alcohol-related medical disorders, although there are often familial and social consequences. Atkinson (1995) recommended the development of elder-specific outcome measures, study of the efficacy of different treatment modalities, and study of the efficacy of treatment for patients in elder-specific and mixed age groups, etc. MINORITIES: Each of the federally mandated minority groups in the United States is heterogeneous. The epidemiology of use and abuse of alcohol and other drugs is well studied, but treatment issues are not. AMERICAN INDIANS: There are more than 200 tribes; each has its own customs and culture. Some tribes are abstinent; others have big problems with abuse of alcohol, and other drugs. Orthodox treatment methods, used by professional counselors and therapists, have not worked very well.

RECOMMENDATION: study of traditional Indian forms of healing practices combined with other treatment; this would be a culture-sensitive model. BLACK AMERICANS: This includes not only African-Americans but people from the Caribbean, Central and South America, etc. Among African-Americans, there is a history of ambivalence toward alcohol: on the one hand, a tolerant "nightclub culture" and on the other, church beliefs in temperance and abstinence. There is "respectable drinking" and "problem drinking," most often defined as solitary or public drinking. The primary source of support is considered familial, so people tend to be distrustful of therapy from "strangers." They are anonymous in promoting sobriety and study of subcultural norms and the history of slavery. Earlier ethnographic works (Liebow, 1967) were of "street-corner men," slum dwellers, ghetto norms; recommended: studies of middle-class African-American life and drinking behaviors. ASIAN-AMERICANS: A study in Los Angeles reports differences among Chinese, Japanese, Filipinos, and Koreans in drinking beliefs and behavior. Of these groups, the Japanese in Japan and the Japanese-Americans report the largest number of heavy drinkers. It is, however, considered a private matter, even when associated with social problems. Interestingly, there is an organization called the All Nippon Sobriety Association (like Alcoholics Anonymous). RECOMMENDATIONs: studies of generational differences among Japanese-Americans in use and efficacy of treatment. For the Chinese-Americans, who are fairly permissive about older persons' drinking and share a belief in the health benefits of alcohol, a gender/gerontological study is recommended. HISPANIC-AMERICANS: As a total group, they drink more and present more alcohol-related problems than other immigrant minorities. Age, ethnicity, and gender patterns in permissiveness to drink need to be explored. Treatment sought is often in pentecostal churches and Centros for Espiritismo. Hispanics are not likely to seek help in formal clinical settings which emphasize alcohol consumption as the basic, core problem. They are more likely to seek out and be responsive to the perception of their drinking problem as sin and a rejection of Jesus. It is not that minorities do not recognize problems and seek out help. They are not likely to seek out the health profession's offering of outpatient clinics, residential treatments, etc.