Historically, the field of substance use treatment focuses on cultures based on language, ethnicity, race, and national origin, with little or no attention to an individual’s drug culture. In turn, this neglect has affected not only the duration of a person’s substance use pattern, but also contributes to years of multiple relapses. Within the drug culture, individuals often share similar ways of socialization patterns, language, and style of communication. Generally, people who experiment with drugs usually do so in highly marginalized social settings, which can contribute to the development of substance use disorders. When people who abuse substances are marginalized, they tend not to seek access to mainstream institutions that typically provide sociocultural support. This isolation can result in even stronger bonding with a drug culture. A person’s identification with a drug culture enables its members to view substance use disorders as usual or even as status symbols. The confusion becomes a source of pride, and people may celebrate their drug-related identity with other members of that culture. Stigma, when coupled with other discrimination, can increase denial, projection, and rationalization, which facilitates an individual’s attempts to substance use. The immorality that mainstream society attaches to substance use/abuse can unintentionally serve to strengthen an individuals’ ties to a drug culture. Thereby, decreasing the likelihood that they will seek treatment.
Drug-seeking behaviors have a reinforcing effect beyond that of the actual substance. For example, rituals of use can provide a focus for those who use drugs and help them shift attention away from problems in living they might otherwise need to face. Drug cultures serve as a sustaining force for substance use and abuse. The drug culture provides a way for people new to substance use to learn what to expect and how to appreciate the experience of getting high. As White (1996) notes, “the drug culture teaches the new user how to recognize and enjoy drug effects”. In some communities, participation in the drug trade is one of the few economic opportunities that gain the admiration and respect of peers. Some adolescents and young adults find drug cultures particularly appealing. Feelings of alienation from society and a firm rejection of authority can cause youth to look outside the traditional cultural institutions, allowing youth to seek acceptance in a drug culture. As a person progresses from experimentation to abuse and dependence, he or she develops a more intense need to “seek for supports to sustain the drug relationship”. In addition to gaining social sanction for their substance use, participants in the drug culture learn many skills that can help them avoid the pitfalls of the substance-abusing lifestyle and thus continue their use. The more an individual’s needs are met within drug culture, the harder it will be to leave that culture behind and find recovery.
The Culture of Recovery
The main barriers to the implementation of a culture of recovery continue to be: (1) the influence of the drug culture and (2) the existing infrastructure of a medically driven behavioral health service system. The current system of care reinforces stigmatization, medicalization, and criminalization of individuals with alcohol and drug challenges. To combat the above two issues, a significant transformational movement from drug culture to a culture of recovery must reaffirm the reality of long-term community recovery. This long term recovery is accomplished by celebrating multiple pathways of healing, that support a “recovery-oriented systems of care”. The current treatment system, with its historical acute care focus, needs to increasingly expand its focus to incorporate a population health model that gives equal justice and attention to the social determinants of health. Therapeutic healing can be accomplished in addressing those social determinants that influence many lifestyle choices.
White (1996) in articulating a culture of recovery, indicates that a “recovery-oriented system of care” must:
• Teach clients about the existence of drug cultures and their potential influence in clients’ lives.
• Teach clients about cultures of recovery and discussing how aspects of a culture of improvement can replace elements of the drug culture.
• Establish clear boundaries for appropriate behavior in the program that consistently corrects actions that violate boundaries.
• Work to shape a peer culture in which clients can socialize new
behaviors to a culture of recovery.
• Have regular assessments of clients and the entire program in which staff members and clients determine areas where work is needed to minimize cultural attitudes that can undermine treatment.
Active behavioral health recovery must be: (1) traditional, in that it involves a shared common welfare, a support network of other people in recovery; (2) progressive in creating personal conditions conducive to transformative insights, and (3) proactive by identifying, engaging, and ensuring service access at the earliest possible stage in an individual’s recovery.
The realization that the old entrenched methods of behavioral health care delivery are not working has moved a medically driven care approach to a system of care that provides lifetime recovery supports while recognizing the many pathways to health.
References Provided Upon Request
Pascal Scoles, DSW, LCSW is Professor, Behavioral Health/Human Services and Director, Office of Collegiate Recovery, Student Life, Community College of Philadelphia, 1700 Spring Garden St, Philadelphia, PA 19103 https://sites.google.com/site/pascalscolesccp/
