From Silence to Trust

N A D C P MAY 2 9, 2 0 1 4 From Silence to Trust Serving Asian-American Families in Drug Court Honorable Erica Yew Jorge Wong, PhD Akiko Kitazumi

Panel Introductions Honorable Erica Yew (Santa Clara, CA) Jorge Wong, PhD (San Jose, CA) Akiko Kitazumi (Los Angeles, CA) Moderator: Russ Bermejo, MSW (Lake Forest, CA)

From silence to trust Honorable Erica Yew, Santa Clara Superior Court, California

The AAPI Mosaic Is Rich With Diversity TOP AAPI SUBGROUPS COUNTRY OF ORIGIN OR BIRTH (including Pakistani, Cambodian, Hmong, Thai, Laotian, Taiwanese, Bangladeshi, Burmese, Indonesian, Nepalese, Sri Lankan, Malaysian, and Bhutanese) Japanese 6% Korean 9% Other 18% Vietnamese 10% Mosaic Indian 16% Chinese (not Taiwanese) 22% Filipino 19% Fact: AAPI includes at least 20 different ethnic subgroups

U.S. Asian-American Population, 2011 18,205,898 TOTAL U.S. ASIAN-AMERICANS THEY MAKE UP 5.8% OF TOTAL U.S. POPULATION FASTEST-GROWING RACE OR ETHNIC GROUP Between 2000 and 2010, the AAPI population grew by over 43%, while the total population grew by 9.7%. Source: Pew Social Trends

Counties with the highest AAPI Population AMONG PEOPLE REPORTING ONLY ONE RACE, 2000 AND 2010 CENSUS 618K Santa Clara County, CA Queens County, NY 553K 1.5 mil Los Angeles County, CA 598K Orange County, CA 591K Honolulu County, HI Source: White House Initiative on Asian Americans and Pacific Islanders

AAPI Immigration Approximately 60% of Asian-Americans are foreign-born, the highest proportion of any racial group nationwide (vs 38% of Latinos, 8% of African Americans, and 4% of non-hispanic Whites were born outside the US) U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement, 2010

AAPIs & Drug Use Is it a Problem? Why have AAPIs been thought to have lower than expected rates of substance use disorders? Stereotypes Data

AAPI Model Minority Stereotype? Tables from www.pewsocialtrends.org

Model Minority Myths & Stereotypes AAPIs first characterized as model minority during 1960s at the height of the Civil Rights movement Outcomes educational, employment, economic, physical, mental health, criminal justice Used to pit AAPIs against other minorities Statistics based on pooled AAPI statistics, obscuring socioeconomic diversity (and even polarization) among subpopulations of AAPIs Sources: Uba, (1994), Tran & Birman, 2010)

AAPIs & Drug Use Drug Scholarship Epidemiological studies of AAPI drug use have often lacked sufficient numbers of cases to examine patterns of drug use among young people who were not members of the three largest racial and ethnic groups (whites, African Americans, and Hispanic Americans) (Wallace et al., 2002). Most national studies either omit mention of AAPIs entirely, or lump Asian-Americans into a broader (and generally unstudied) category of other The two major national studies of drug use Monitoring the Future (MTF) and the National Household Survey on Drug Abuse (NHSDA) still do not provide detailed information about AAPI drug use due to small sample sizes.

Identifying the Need Although AAPIs, as a single group, have low rates of alcohol and drug abuse disorders, this generalized data does not mean the clinical significance or impact on the community is negligent. AAPIs with addictive disorders suffer the same consequences as non-aapis Impact of addiction are often hidden away from family and community until they are so serious that intervention is often forced onto them (arrest, hospitalization, homelessness) Source: Price RK, Risk NK, Wong MM, Klingle RS, 2002

Less Likely To Need, To Receive, To Recognize AAPIs were less likely than persons of other racial or ethnic groups to need substance use treatment. Among those who needed substance use treatment, AAPIs were less likely than persons of other racial or ethnic groups to receive substance use treatment. AAPIs who need but do not receive treatment are less likely to recognize their need for treatment and less likely to make an effort to receive specialty treatment. Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2003 to 2005, 2006 to 2010 (revised March 2012), and 2011.

Percentage Need for and Receipt of Treatment At a Specialty Facility for Substance Use in the Past Year among AAPI Compared with Persons of Other Racial and Ethnic Groups (*Aged 12 or Older, 2003 to 2011) 12 10 8 9.5 10.4 6 4 2 4.9 5.3 0 Needed SATx AAPI Received SATx who needed Tx Other Racial/Ethnic Groups *Difference between Asian-Americans or Pacific Islanders and persons of other racial and ethnic groups is significant at the.05 level. Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys on Drug Use and Health (NSDUHs), 2003 to 2005, 2006 to 2010 (revised March 2012), and 2011.

Minorities & Justice System People of color are hesitant to call law enforcement or to become involved with the justice system because of their community s or personal experiences with the system Feel they betray their people when they notify law enforcement and other system professionals Lack of language access issues amongst law enforcement can impact trust Source: Colorado Bar Association

DV and Gambling as Co-Occurring Issues 41-61% of Asian women report experiencing intimate partner violence (IPV) during their lifetime (AAPI Institute on Domestic Violence Fact Sheet, 2012) Problem/pathological gambling is associated with cooccurring substance use disorders, mood disorders, personality disorders, suicidality, and IPV (Fong, et al, 2009) Anecdotally, San Francisco AAPI social workers estimate that: (a) 25-33% of divorce and DV cases have their roots in pathological gambling; (b) close to 20% of the cases of child neglect in Santa Clara, CA have been linked to pathological gambling (Fong, et al, 2009)

What Judges and Drug Courts Can Do Collect data Become trauma-informed to show respect, build trust Be non-blaming Provide language access Promote diversity on the bench and in legal field Education for court staff Community outreach and education to normalize the issue; provide context and lexicon

From silence to trust Jorge Wong, PhD Direction of Clinical and Regulatory Affairs Asian Americans for Community Involvement

Acculturation and Substance Use A one-way process from less to more acculturated The longer the time and exposure in U.S., the greater their propensity to engage in a variety of risky behaviors (Rumbaut, 2004) Those who had been in the U.S. for 10 years or longer reported drug use that was not significantly different from that of the U.S.-born population (SAMHSA, 2004).

AAPIs & Drug Use Three Narratives (Social Construction) 1. Acculturative Stress substance use as a response to difficulties arising from their Asian-American identities, the experience of culture clash and stresses associated with acculturation and Americanization 2. Acculturation Leading to Substance Use saw drug consumption as unusual among AAPIs and saw their drug use as indicative of the degree to which they've grown apart from AAPI culture and toward white/american culture 3. Normalized Consumption saw drug use as a normal, accepted, mundane part of their leisure time, not something they viewed as problematic, shameful, or unusual Source: Asian American Identity and Drug Consumptions: From Acculturation to Normalization (Moloney, Hunt, and Evans 2008).

Treatment Barriers for AAPIs Cultural barriers - Shame in asking for help - Stigma - Prejudice and discrimination - Lack of identification - Familial insulation Practical barriers - Limited access - Lack of culturally competent services - Lack of evidence-based programs for AAPIs Source: Asian-Americans, Addictions, and Barriers to Treatment, (Fong & Tsuang, 2007)

Treatment Solutions for AAPIs Address importance of ethnic heritage and assess the level of acculturation Incorporate drug and alcohol education in order to reduce the stigma Approach treatment from the vantage point of promoting overall health Honor the importance of family as the focal point Focus on problem-solving, goal-oriented, and symptomreduction strategies Explore the history of trauma and PTSD Source: SAMHSA, Treatment Improvement Protocol (TIP) Series, No. 51., 2009

Engaging Families to Support Recovery Reporting substance abuse problems can be a significant source of shame for women and their family, and can also be perceived as hurtful to their family The importance of otherness and relevance of community and family in perception of self-identity as a woman Family is central, along with maintenance of family obligations Individuals with socially stigmatized behaviors, such as drug abuse, may experience significant consequences from their family and community Source: SAMHSA, Treatment Improvement Protocol (TIP) Series, No. 51., 2009

Don ts When Serving AAPIs Do not assume all individuals from a similar heritage hold similar values Do not assume all trauma and PTSD symptoms are manifested in behavioral health settings Do not forget family relationships Do not forget to assess impact of acculturation on gender roles Do not forget to assess for other addictive behaviors Do not forget about role of spirituality and diversity of religious views amongst AAPIs Do not think that one hat fits all

From silence to trust Akiko Kitazumi Drug Court Graduate My Story

My Past

March 22, 2013

My Family

Past, Present, Future

Asian-American Drug Abuse Program Established in 1972 One of only two programs in the nation with a mission to target and design services for AAPIs with drug abuse problems AADAP is treatment provider for the Inglewood Drug Court, (total 12 Drug Courts in Los Angeles County) Out-patient drug rehab, day treatment, and residential programs Current treatment capacity is about 45 Target population is first time non-violent offenders Armenian, Cambodian, Hmong, Japanese, Korean, Samoan, Vietnamnese, Tamil, Spanish, and Tagalog For more information, visit: www.aadapinc.org

From silence to trust Q&A and Discussion

Resources Asian Americans for Community Involvement www.aaci.org Asian American Drug Abuse Program www.aadap.org Asian-Americans, Addictions, and Barriers to Treatment, (Fong & Tsuang, 2007) http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2860518/pdf/pe_4_11_51.pdf Characteristics of Asian and Pacific Islanders admitted to U.S. drug treatment programs in 2005. Wong W; Barnett PG. Public Health Rep; 125(2): 250-7, 2010 Mar-Apr. http://bvsalud.org/portal/resource/en/mdl-20297752 THE NSDUH REPORT: Need for and Receipt of Substance Use Treatment among Asian Americans and Pacific Islanders (May 2013) http://www.samhsa.gov/data/2k13/nsduh125/sr125-aapi-tx.pdf

Contact Information Honorable Erica Yew Santa Clara County Superior Court Department 11 191 N. First Street San Jose, CA 95113 (408) 882-2220 Jorge Wong, Ph. D., CCEP, CHC Licensed Psychologist, PSY# 21180 Director of Clinical and Regulatory Affairs Asian Americans for Community Involvement 2400 Moorpark Ave., Suite 300 San Jose, CA 95128-2680 (408) 975-2730 x230 Jorge.wong@aaci.org Asian American Drug Abuse Program 2900 S. Crenshaw Office Los Angeles, CA 90016 (323) 293-6284 www.aadapinc.org