PS508 Unit 8 Culture and Spirituality Paper Example

A Rosary, a Court Order and Two Kinds of Fit: A PS508 Unit 8 Paper on Culture and Spirituality in Ethical Addictions Treatment

[Student Name]

Purdue University Global

PS508: Ethics for Addictions Professionals

Unit 8 Culture and Spirituality in Treatment Paper

[Instructor Name]

[Date]

The writer, the program, the clients and every detail of the cases are composite and illustrative; the sources cited are real.

Two Clients

Marites is 41, a line supervisor at a seafood plant and a member of the island's large Filipino community, many of whose families came to work in the canneries. Marites entered our program for alcohol use after her doctor raised concerns about her liver. At intake she said that she sends money to relatives in the Philippines, cares for her mother and feels shame about drinking because "in my family, you don't bring problems outside." She asked whether there was a counselor who was Filipino or at least Catholic. Our four counselors include no one who is Filipino.

Jonah is 52, a longline fisherman and, in his words, "a lifelong atheist." After a conviction for driving under the influence, a judge ordered Jonah to complete treatment and attend three Alcoholics Anonymous meetings a week. Jonah told me he finds the references to a higher power insulting and asked whether he could do something else.

Does Cultural Matching Matter?

Flicker et al. (2008) studied 86 highly acculturated Hispanic and Anglo adolescents receiving functional family therapy for substance use. Hispanic adolescents whose therapists were also Hispanic showed greater decreases in substance use than Hispanic adolescents seen by Anglo therapists. For Anglo adolescents, whether the therapist matched made no difference. The authors concluded that the findings point to the need for more ethnic diversity among therapists and better cultural competence training for therapists from the majority group.

The study cannot be applied to Marites directly. It involved adolescents, Hispanic families and family therapy in another state. Its broader lesson is that cultural fit can affect outcomes for clients from minority groups, and that when matching is not possible, counselors from the majority group have work to do.

What Ethics Requires for Marites

The NAADAC code asks addiction professionals to practice with cultural humility, to learn about the cultures of the clients they serve and to recognize how their own backgrounds shape their work (NAADAC, 2021). It also asks them to refer clients when they cannot provide competent services. For Marites, three options were possible: refer her to a counselor in Anchorage who is Filipino American and offers telehealth sessions, assign her to our counselor who shares her Catholic faith or work with her myself and build cultural competence with consultation.

I discussed the options with Marites. She chose to stay with our program, partly because she wanted in-person sessions and partly because the telehealth counselor's hours conflicted with her shifts. She asked to work with our Catholic counselor, Ana, which the director arranged. Ana and I consulted with a Filipino American social worker at the island's health clinic, who helped us understand how family obligation and shame might shape treatment, including the importance of involving Marites's sister if Marites wished.

Matching was one way to offer cultural fit; when it was not possible, the ethical duty shifted to building fit through consultation and choice.

Religion and Attitudes Toward Addiction

A scoping review pulled together 36 quantitative studies on how religion and spirituality relate to attitudes toward addiction and its treatment (Grant Weinandy & Grubbs, 2021). Higher religiosity was associated with stronger belief in the disease model of addiction among providers, more negative attitudes toward addiction and stronger support for spiritually based treatments. Results varied by measure, and many relationships were not significant.

Two points from the review applied to Jonah's case. First, attitudes toward spiritually based treatment differ with the beliefs of the person holding them, so a recommendation that seems natural to a religious counselor or judge may feel coercive to a nonbeliever. Second, providers' own religiosity can shape their views, which means a counselor should notice whether a recommendation reflects the evidence or the counselor's beliefs.

What Ethics Requires for Jonah

Requiring a nonbeliever to attend a program built around a higher power raises a real ethical concern about respect for a client's autonomy and beliefs. The NAADAC code asks addiction professionals to respect clients' values and to avoid imposing their own (NAADAC, 2021). At the same time, the court order was a legal requirement our program did not create.

I took two steps. First, I explained to Jonah that I could not change the court order but could ask the court to accept an alternative. Second, with Jonah's written consent, I sent the probation officer a letter explaining that Jonah objected to AA on grounds of belief and asking whether the court would accept attendance at secular mutual help meetings, such as SMART Recovery, which runs online meetings that Jonah could join from the boat when in port. The court agreed. Jonah attends two online SMART meetings and one in-person meeting a week and has not missed one.

Comparing the Cases

The two cases look like opposites: Marites wanted more of her culture and faith in treatment, and Jonah wanted less religion. The ethical principle was the same in both. Clients' cultural and spiritual identities should shape their treatment in the ways they choose, and counselors should neither impose their own beliefs nor ignore the client's.

Both cases also exposed a gap in our program. Our intake form asked about religion with a single checkbox and said nothing about family roles, language or community. After these cases, the team added three open questions: what role faith or spirituality plays in the client's life, if any; who in the family should or should not be involved in treatment; and whether the client would prefer a counselor of a particular background, along with a note that the program will explain honestly what it can offer. These questions do not solve the shortage of counselors from the island's communities, but they make sure the issue is raised by the program rather than left for clients to bring up.

Limits

Neither study was designed for clients like Marites or Jonah. The matching study involved adolescents in family therapy, and the review summarized attitudes rather than outcomes. Both were used here to guide reasoning, not to predict how these clients will do.

Conclusion

Ethical addictions treatment takes culture and spirituality seriously in both directions. Flicker and colleagues' study suggests that cultural fit matters for some clients, and when a match is not available the counselor must build fit through consultation and the client's choices. The scoping review shows that attitudes toward spiritual treatment vary with belief, which supports offering secular options to clients who object. In both cases the NAADAC code's emphasis on respect and cultural humility guided the decision.

References

Flicker, S. M., Waldron, H. B., Turner, C. W., Brody, J. L., & Hops, H. (2008). Ethnic matching and treatment outcome with Hispanic and Anglo substance-abusing adolescents in family therapy. Journal of Family Psychology, 22(3), 439-447. https://doi.org/10.1037/0893-3200.22.3.439

Grant Weinandy, J. T., & Grubbs, J. B. (2021). Religious and spiritual beliefs and attitudes towards addiction and addiction treatment: A scoping review. Addictive Behaviors Reports, 14, Article 100393. https://doi.org/10.1016/j.abrep.2021.100393

NAADAC. (2021). NAADAC code of ethics. NAADAC, the Association for Addiction Professionals. https://www.naadac.org/code-of-ethics