Asian Americans and Pacific Islanders generally have lower rates of substance use disorders than other cultural groups, which has contributed to a stereotype of them as a “model minority.”2 This view discounts the impact these problems have on the community.
Asian Americans are also less likely than other cultural groups to seek help when they have a problem.1 They may feel ashamed about having an addiction or not have access to culturally competent treatment providers. They may benefit from understanding their unique risks and how they can find an affordable treatment program.
What Are Some Common Addictions Among Asian American/Pacific Islanders?
Asian American and Pacific Islanders may suffer from a variety of addictions:
- Alcohol. Many Asian Americans experience a negative reaction when they drink due to the inactivity of an enzyme that helps metabolize alcohol. 8 These people experience flushing and itching of the skin, increased heart rate, and nausea when they drink.2 Despite this, some Asian Americans do develop alcoholism and suffer consequences due to their use. Those who are born in the United States are also more likely to abuse alcohol than Asian American immigrants.2
- Methamphetamine. Although Asian Americans tend to have lower rates of cocaine and heroin use, some subgroups show alarming rates of methamphetamine use.2 Meth was one of the most commonly reported illicit drugs among people in this group who entered addiction treatment between 2000 and 2010.1 This drug is especially problematic among Asian Americans in Hawaii and on the West Coast, where it is more available.
- Marijuana. Throughout history, some Southeast Asian groups used marijuana for medicinal purposes and viewed it as a healing drug.1 The acceptance of marijuana for its perceived healing properties may lead to use among some Asian Americans. Marijuana and methamphetamine were the two most frequently cited illicit drugs among Asian Americans who entered addiction treatment between 2000 and 2010.1
- Tobacco. Asian Americans who recently immigrated to the United States are at higher risk of using tobacco. Lung cancer is currently the leading cause of cancer deaths among this group.2
- Gambling. For some Asian Americans, gambling is a recreational activity that allows family and community members to bond.2 But gambling may transition from a recreational activity to a serious problem. Symptoms of gambling addiction include a need to gamble with larger amounts of money, feeling restless or irritable when trying to cut back, and jeopardizing important relationships or responsibilities because of gambling.3
Are There Differences in Substance Use Among Subgroups?
In the past, research on addiction among Asian Americans and Pacific Islanders focused on the group as a whole, rather than distinguishing between different subgroups. This practice led to the false assumption that all Asian Americans have the same rates of drug and alcohol use. More recent research has examined substance use among different subgroups of Asian Americans and found that:1,5
- Korean American college students drink greater amounts of alcohol than Chinese American college students and are more likely to view drinking as socially acceptable. They are also more likely to have family histories of alcoholism.
- Vietnamese Americans have higher rates of alcohol use than other Southeast Asian Americans, while Cambodian Americans have higher rates of illicit drug use.
- Filipino Americans are at higher risk of using and injecting illicit drugs compared to other Asian Americans. Compared to Chinese Americans, Filipino Americans are more than two times as likely to be diagnosed with a substance use disorder.
- Japanese American adolescents have higher rates of alcohol, marijuana, inhalant, and other illicit drug use compared to Vietnamese, Chinese, Korean, and Filipino Americans.
- Mixed-heritage Chinese and Vietnamese Americans, meaning people whose families originate from more than one cultural group, are up to four times more likely to use drugs and alcohol compared to non-mixed-heritage Chinese and Vietnamese Americans.
Why Do People in This Group Abuse Drugs and Alcohol?
The causes of addiction can vary significantly from person to person, even among members of the same cultural group. Asian Americans may be vulnerable to addiction for a number of reasons:
- Mental illness. Asian Americans are just as likely as other cultural groups to experience mental illnesses. But they may be more likely to have somatic complaints, such as stomach aches or headaches, rather than express their distress verbally.1 In some cases, people with mental illness may also suffer from addiction, a situation referred to as co-occurring disorders. Some people with mental illness may use drugs and alcohol as a coping mechanism, while others may develop the signs and symptoms of mental illness in conjunction with their substance abuse. Mental health problems, such as depression, may also lead to substance use among Asian American youth.4
- History of trauma. Asian Americans may have been exposed to multiple traumas in their countries of origin, including war, torture, and death of or separation from loved ones.1,5 Moving from a person’s homeland to the United States can also be traumatic. Trauma can lead to posttraumatic stress disorder, a condition that involves intrusive memories, nightmares, and flashbacks to a traumatic event.3 Asian Americans who have suffered traumatic experiences may use drugs and alcohol to cope.
- Acculturation. Acculturation is the process of gradually adopting the attitudes and behaviors – including language, values, and beliefs – of a new culture.6 Acculturation can be stressful because the person is shifting from the ways of their home culture to the new one. The process may contribute to tobacco and alcohol use and problematic gambling.2
- Intergenerational tension. Asian American family members may differ in their levels of acculturation.1,6 For example, older generations may hold onto customs and traditions, while younger generations may try to adopt the customs and traditions of the new culture. The older and younger generations may clash, causing tension and distress. Asian American youth may also feel that their parents are putting pressure on them to meet high academic standards, and this increased stress may contribute to substance use.
- Racism and discrimination. Asian Americans may be victims of racism. Asian Americans who suffer from alcohol addiction are five times more likely to have experienced racism at some point in their lives.1
- Financial stress. Asian American families may experience poverty or financial stress due to difficulty finding employment in the United States, poor education in their home country, and limited job opportunities. Families faced with financial stress may experience high rates of tension between parents and children, which can lead adolescents to experiment with drugs and alcohol.4
- Separation from family members. Parents play an important role when it comes to whether or not their children will experiment with drugs and alcohol. Asian American youth whose parents disapprove of drug and alcohol use and communicate these concerns are less likely to use drugs and alcohol.4 Children who are separated from their parents due to immigration, trauma, or divorce may be at risk for substance use.
What Are the Signs and Symptoms of Addiction?
Asian Americans who use drugs and alcohol may develop a substance use disorder, which is the clinical term for an addiction. The signs of a substance use disorder include:3
- Using a drug in larger amounts or more frequently over time.
- Unsuccessfully trying to cut back on drug use.
- Spending a great deal of time seeking, using, or recovering from a drug.
- Having cravings to use more of a drug.
- Being unable to take care of responsibilities at home, work, or school because of drug use.
- Continuing to use a drug despite relationship problems.
- Giving up important activities.
- Using a drug in dangerous situations.
- Continuing to use a drug despite physical or mental health problems caused or made worse by drug use.
- Tolerance, a condition that involves a need for more of a drug to get the same effects.
- Withdrawal, a condition that involves physical and mental symptoms that develop when stopping or reducing drug use.
What Are Some Barriers to Treatment in This Population?
Asian Americans addicted to drugs and alcohol face barriers to treatment that may prevent them from getting the help that they need. Without the proper help, their addictions may become more severe over time.
Barriers faced by this group include:
- Feelings of shame. Some members of this group may associate alcoholism and drug problems with moral weakness and a lack of self-control. As a result, they may feel that acknowledging an addiction problem would cause them and their family members shame.1,7
- Language. Asian Americans may avoid seeking treatment if services are not available in their language.7 They may be more likely to seek help when bilingual services are available.
- Cost. Inability to afford treatment can deter Asian Americans from seeking help.2
- Lack of awareness of the signs and symptoms of addiction. Asian Americans may be unsure of the signs of addiction or experience them as physical symptoms.2 They may seek medical help, rather than addiction treatment.
- Lack of services. In some cases, treatment that meets a person’s needs is simply not available.2 This can include treatment that is local, affordable, and accessible. Asian Americans who recently immigrated, do not have health insurance, and do not speak English may have an especially hard time finding help.
- Lack of awareness of available services. Asian Americans, particularly those who recently immigrated to the United States, may not be aware of the treatment services available in their communities.2
- Lack of culturally competent providers. Many providers may be unfamiliar with Asian Americans’ beliefs, values, and views on addiction.2 Also, available treatment programs may not offer approaches that are effective at treating Asian Americans. As a result, Asian Americans may feel more comfortable seeking help from family and friends or using non-Western approaches, such as Chinese herbal medicine or religious healers.
What Other Issues Does This Group Need Help With in Treatment?
Asian Americans who are seeking treatment may have unique issues, including unemployment, family problems, acculturation issues, and co-occurring disorders. Asian Americans may therefore benefit from additional services during treatment, such as:
- Employment services. For people who recently immigrated to the United States, finding a job that matches their skill set may be difficult. Asian Americans may benefit from job training and assistance finding a job.
- Citizenship assistance. Asian Americans may benefit from information and assistance on how to become a legal resident or citizen.
- Help for families. The stress of acculturation combined with having a family member suffer from addiction can put strain on families. For many Asian Americans, involving family members in treatment can improve the chances of a successful recovery.1 Family members may participate in family therapy, educational groups on addiction, and recovery meetings for family members of people addicted to drugs and alcohol, such as Al-Anon and Nar-Anon.
- Medical treatment. Users may need treatment for physical health issues that may arise from drug and alcohol abuse, such as liver disease, hepatitis, and infections.
- Mental health treatment. Asian Americans seeking addiction treatment may also suffer from psychiatric problems related to immigration and acculturation, family tension, past trauma, and other issues. Co-occurring treatment provides help for both addiction problems and mental illness.
Where Can This Population Get Help?
Addiction is a serious condition that affects many areas of a person’s life and can have negative consequences on a person’s physical and emotional health, relationships, and well-being. Asian Americans suffering from addiction can benefit from the treatment programs available, which include the following:
Government-funded treatment programs may cost less than private programs.
- Detoxification allows people to withdraw from drugs and alcohol in a safe and controlled environment. Detoxification centers are staffed with medical professionals who closely monitor symptoms and provide treatment and support to reduce the likelihood of a dangerous withdrawal.
- Inpatient treatment programs offer help and support 24 hours per day for people in the early stages of recovery. These programs provide drug-free housing and intensive therapy sessions. Some programs also offer recovery meetings, such as Alcoholics Anonymous, and other amenities, such as yoga, exercise, and equine therapy.
- Outpatient treatment programs offer one or more group and individual therapy sessions each week. They are less intensive than inpatient programs, since they do not include drug-free housing and 24-hour help. They are a helpful option for people who have completed an inpatient treatment program and would like to continue to receive support.
- Government-funded treatment programs may cost less than private programs. These programs may offer detox, inpatient, and outpatient treatment for little or no cost.
- Nonprofit treatment programs also offer free or lower-cost treatment for people who cannot afford private programs. The Salvation Army Harbor Light Centers offer a six-month program that includes detox, residential, and outpatient treatment, along with therapy, education, anger and grief management, housing, and job training. Catholic Charities is a nonprofit agency with over 160 locations throughout the United States. Local agencies offer addiction counseling and help with relapse prevention.
- Twelve-step programs incorporate the principles and philosophy of Alcoholics Anonymous (AA) into treatment. AA helps members recover by encouraging them to recognize their powerlessness over their addiction, develop a connection with a higher power, make amends for past wrongs, and develop a support system of other sober people. Many inpatient and outpatient, private, government-funded, and nonprofit treatment programs offer 12-step treatment.
How Do You Find a Culturally Competent Program?
Asian Americans may benefit from programs that provide culturally competent treatment. This type of treatment involves an understanding of how culture impacts a person’s experience of addiction and ability to recover. Culturally competent treatment programs use approaches proven to be effective with different cultural groups, tailor treatment to each unique person, and train staff members on cultural competence.1
To determine whether a program provides culturally competent treatment, look at its website and read reviews. You can also ask the admissions staff directly about their cultural competence. Questions to consider include:
- Does your program work with individuals from my cultural background?
- How will your program incorporate cultural competence into my treatment?
- What kind of training does your staff receive on cultural competence?
What Options Are Available to Help Pay for Treatment?
The cost of addiction treatment can range significantly from program to program. Many people do not get the proper help for their addictions because they assume that they cannot afford it. Fortunately, there are several options to help reduce the costs of addiction treatment.
The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Behavioral Health Treatment Services Locator offers an online search tool for finding free and low-cost treatment programs in your area. You can also find a program by calling SAMHSA’s National Helpline at 1-800-662-HELP (4357).
Health insurance can help cover all or some of the costs of treatment. If you do not have health insurance, you can sign up through the Affordable Care Act by going to the Healthcare.gov website. You may sign up anytime during the open enrollment period. If it is outside of the enrollment period, you may still qualify if you have experienced certain life events. You can find out whether you are eligible for coverage by entering your zip code and answering some questions on the government’s public health insurance website.
Some rehab programs also offer assistance to people who have difficulty paying for treatment:
- Treatment centers may use a sliding scale to lower the fee for treatment. Sliding scales consider a person’s annual household income and household size to determine an affordable fee.
- Payment programs allow you to pay for treatment over an extended period of time, rather than all at once.
- Rehab scholarships can cover all or some of the costs for people who cannot afford treatment and are highly motivated.
- The Asian Community Mental Health Services (ACMHS) is a California-based organization that conducts research and provides education and culturally competent treatment in several different languages. It seeks to help members of the Asian American and Pacific Island communities to lead healthy and productive lives.
- The Asian Counseling and Referral Services (ACRS) is a Seattle-based organization that provides free and low-cost mental health and addiction treatment, citizenship and immigration assistance, and job training for Asian American children, teens, adults, and older adults.
- The National Asian Pacific American Families Against Substance Abuse (NAPAFASA) is a nonprofit organization that seeks to prevent and reduce drug, alcohol, tobacco, and gambling addiction among the Asian American community. Through research, advocacy, and education, the NAPAFASA promotes health and social justice.
- The National Alliance on Mental Illness (NAMI) offers education on living with mental illness, discussion groups, and information on finding a culturally competent provider. NAMI also offers face-to-face meetings for individuals and family members of loved ones suffering from mental illness across the United States. You can contact NAMI’s helpline at 1-800-950-NAMI (6264).
- The Asian American Health Initiative offers a pamphlet, “Mental Health: Understanding is the First Step,” which explains the signs and symptoms of mental illness among Asian Americans, types of mental health providers, and how to get help.
- Substance Abuse and Mental Health Services Administration. (2014). Improving cultural competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Fong, T. W., & Tsuang, J. (2007). Asian-Americans, addictions, and barriers to treatment. Psychiatry (Edgmont), 4(11), 51-59.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.
- Hong, J. S., Huang, H., Sabri, B., & Kim, J. S. (2011). Substance abuse among Asian American youth: An ecological review of the literature. Children and Youth Services Review, 33(5), 669-677.
- Price, R. K., Risk, N. K., Wong, M. M., & Klingle, R. S. (2002). Substance use and abuse by Asian Americans and Pacific Islanders: Preliminary results from four national epidemiologic studies. Public Health Reports, 117(Suppl 1), S39-S50.
- Hahm, H. C., Lahiff, M., & Guterman, N. B. (2003). Acculturation and parental attachment in Asian-American adolescents’ alcohol use. Journal of Adolescent Health, 33(2), 119-129.
- Yu, J., Clark, L. P., Chandra, L., Dias, A., & Lai, T. F. M. (2009). Reducing cultural barriers to substance abuse treatment among Asian Americans: A case study in New York City. Journal of Substance Abuse Treatment, 37(4), 398-406.
- National Asian Pacific American Families Against Substance Abuse. (2005). Fact Sheet: Asian American and Pacific Islander (AAPI) Alcohol Use.