Special Populations and Conditions

Despite being considered a medical condition, addiction remains a stigmatized disease. This is particularly pertinent for already underserved populations and for people with multiple diseases, such as HIV and AIDS. This unit examines the unique treatment needs of special populations.
The complexities surrounding drug addiction make it a challenging health issue for researchers, treatment providers, public health officials, and others. Research shows that addiction is a disease and should be treated as such. But unlike other diseases, the majority of substance abuse and addiction situations are the result of illegal activity. Another factor that makes drug addiction unique is its stigma within society. People with substance abuse issues are stereotyped as weak individuals who do not have the moral strength to fight their destructive habits. As a result, those seeking better prevention, treatment strategies, and policies surrounding drug abuse issues must also take into account both societal and law enforcement factors.
The societal stigma of drug abuse and addiction has led to several misperceptions, particularly for racial and ethnic minority populations. For example, a common perception is that African Americans and Latino Americans use illicit drugs more than Caucasians do—although this is not necessarily true. Still, the stigma regarding drug abuse and addiction among minority communities persists, and it can affect the prevention and treatment options being offered to that community. In addition, racial and ethnic minorities can experience different consequences of substance abuse than the Caucasian population. Thus, addiction treatment professionals must take into account the special needs of minority populations, when proposing drug prevention and treatment services within these communities. Beyond racial and ethnic lines, gender can also play a role in drug addiction.
All of these factors can play a role in substance abuse among women and can require unique treatment and prevention strategies. Other populations with special needs include:
• Children and adolescents.
• Homeless people.
• Senior citizens.
• Gay, lesbian, bisexual, and transgender people.
• People with mental illnesses.
• People with infectious diseases, such as HIV, AIDS, tuberculosis, and hepatitis.
Many individuals addicted to drugs like heroin or cocaine are at increased risk for diseases. For these individuals and the community at large, drug addiction treatment is disease prevention (National Institute on Drug Abuse, 1999). For example, the risks associated with continued injection drug abuse escalate dramatically due to exposure to hepatitis C and HIV through the reusing and sharing of needles. Those who do not enter treatment and continue involvement with treatment activities are six times more likely to become infected (National Institute on Drug Abuse, 1999).
Treatment for diverse populations presents unique challenges to the addictions-treatment professional. While a comprehensive review of factors associated with multiculturalism and substance abuse is beyond the scope of this course, it is essential that examples be reviewed to highlight the importance of this variable. Assumptions about high rates of alcoholism in some cultural groups are often not supported by research. For example, among Native American tribes, alcohol and other substance abuse behaviors take a drastic toll on the health and well-being of users (Peregoy and Tait, 2001). At the same time, the use patterns vary widely from locale and within age groups. In addition, significant risks are associated with any cultural group in which women abuse alcohol while pregnant, particularly in the form of fetal alcohol syndrome. There is some suggestion that use and abuse patterns for alcohol and drugs is somewhat less intense for Asian Americans (Zane and Kim, 1994). Cultural val ues—filial piety, shame as behavioral control, and fatalism—may play a role in determining whether substance abuse patterns develop (Peregoy and Tait, 2001).
Treating special populations requires the addictions-treatment professional to be sensitive to a wide variety of qualities and characteristics of the client populations receiving therapeutic services. If the client is female, poor, and from a culture other than that of the helping professional, additional care is needed to ensure that treatment is designed to address these characteristics. Such sensitivity must be extended to clients who are members of any diversity group.
National Institute on Drug Abuse. (1999, October). Principles of drug addiction treatment: A research-based guide (NIH Publication No. 99-4180). Retrieved March 18, 2009, from http://www.nida.nih.gov/PDF/PODAT/PODAT.pdf
Peregoy, J. J., & Tait, C. S. (2001). Issues in prevention and intervention: Working with diverse cultures. In P. Stevens & R. L. Smith, Substance abuse counseling: Theory and practice (2nd ed., pp. 251–276). Upper Saddle River, NJ: Merrill Prentice Hall.
Zane, N., & Kim, J. H. (1994). Substance use and abuse. In N. W. S. Zane, D. T. Takeuchi, & K. N. L. Young (Eds.), Confronting critical health issues of Asian and Pacific Islander Americans (pp.316–343). Thousand Oaks, CA: Sage.
• To successfully complete this learning unit, you will be expected to:
1. Recognize the unique substance abuse treatment needs of special populations.
2. Describe the role of substance abuse treatment in the prevention and treatment of HIV and other infectious diseases.
3. Develop new strategies to enhance the delivery of substance abuse treatment services for underserved populations.

Learning Activities Studies
Use your Concepts of Chemical Dependency text, the library, and your coursepack to complete the following:
• Read Chapter 18, “Gender and Substance Use Disorders,” pages 252–264. This chapter discusses the influence of gender on substance abuse.
• Read Chapter 19, “Hidden Faces of Substance Use Disorders,” pages 265–278. This chapter discusses substance abuse in older people and among people with disabilities, along with other populations.
• Read Chapter 20, “Substance Use and Abuse by Children and Adolescents,” pages 279–307. This chapter discusses the scope of the problem and possible diagnostic criteria.
• Read Volkow and Montaner’s 2011 article, “The Urgency of Providing Comprehensive and Integrated Treatment for Substance Abusers With HIV,” from Health Affairs, volume 30, issue 8, pages 1411–1419.
• From your coursepack, read the Seale and Muramoto article, “Substance Abuse Among Minority Populations.”
In Concepts of Chemical Dependency, review Chapter 24, “The Dual-Diagnosis Client: Substance Use Disorders and Mental Illness,” pages 339–358.
College Drinking Research
Read the report What Colleges Need to Know Now: An Update on College Drinking Research from the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA’s) Task Force on College Drinking, which has posed statistically relevant challenges. The bulletin will provide the most current statistics, challenges, and ideas for early intervention with this young population. This is a relevant Web resource to supplement scholarly articles you will generate, if you choose to work with this population for your project
Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Client Needs
• Based on the assigned readings, identify and discuss two unique needs experienced by two different clients in one of the following populations:
• Women.
• Homeless people.
• Senior citizens.
• Gay, lesbian, bisexual, and transgender people.
• People with mental illnesses.
• Children and adolescents.
• College students.
• People with HIV and AIDS.
• People with viral hepatitis.

Discussion 2: 1 page needed with minimum of 250 words and 2 references.
Ideal System
• Rarely can one agency provide all the services needed to meet the multitude of problems experienced by clients. Follow these steps to participate in this discussion:
1. Use the population you chose in the previous discussion to construct an “ideal system of integrated care” to adequately address the unique and multiple needs of this population in your own community.
2. Choose a traditional AA model, traditional cognitive behavioral, or a solution-focused or motivational model and develop a treatment approach. (Generate an outside peer-reviewed journal article for cognitive behavioral therapy with substance abusers, if you choose this approach.)
3. Identify what local resource agencies (for example, Health Care for the Homeless or a local AIDS resource organization) would be important to incorporate into this integrated model.


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