Adolescent substance abuse is
a serious public health concern, and in response to this problem, a number of
effective treatment approaches have been developed. Despite this, retaining and
engaging adolescents in treatment are two major challenges continuously faced
by practitioners and clinical researchers. Low retention and engagement rates
are especially salient for ethnic minority adolescents because they are at high
risk for underutilization of substance abuse treatment compared to their White
peers. Latino adolescents, in particular, are part of the fastest growing
ethnic minority group in the U.S. and experience high rates of substance use
disorders. Heretofore, the empirical examination of cultural factors that
influence treatment retention and engagement has been lacking in the
literature.
The goal of this study was to investigate the influence of the
cultural variables ethnic identity, familism and acculturation on the retention
and engagement of Latino adolescents participating in substance abuse treatment.
This study utilized data collected from a sample of Latino adolescent males (N=96), predominantly of Mexican descent, and largely recruited
from the juvenile justice system. Analysis was conducted using generalized
regression models for count variables.
Results indicated that higher levels of
exploration, a subfactor of ethnic identity, and familism were predictive of
attendance and engagement. In contrast, higher levels of Anglo orientation, a
subfactor of acculturation, were predictive of lower treatment attendance and
engagement.
Clinical implications for the variables of ethnic identity,
acculturation, and familism as well as suggestions for future research are
discussed.
… higher levels of affiliation to the dominant culture
(i.e., Anglo orientation) negatively influenced treatment retention and
engagement for adolescents in the study whereas affiliation to the Mexican
culture was unrelated to retention or engagement. These findings may suggest
that Mexican American adolescents with more affiliation toward the dominant
culture experience less connection and cohesion from participating in treatment
groups with their less acculturated peers. The level of cohesion is an important
element to consider in group treatment participation and outcomes (see Burlingame, McClendon, &
Alonso, 2011), and subsequently, less connection with peers could
lead to lower motivation to attend and engage in treatment. Based on the
combined ARSMA-II scores slightly more than 60% of the sample were in bicultural (48%) or highly acculturated (14%) categories compared to 39% in
the less
acculturated category.
These proportions suggest that, overall, the sample was more highly
acculturated which could help to explain the lack of findings for the Mexican
orientation scale.
Finally, we found that
higher baseline levels of substance use negatively influenced treatment engagement
for adolescents in the study. This finding is partially consistent with other
research (see Grella et al., 2001; Shane et al., 2003), and may suggest that
adolescents with severe pretreatment substance use problems require more
intensive engagement strategies than standard outpatient treatments typically
provide (see Ozechowski & Waldron, 2008).
This is important to consider with the fact that adolescents are most likely to
receive outpatient treatment for substance abuse problems (SAMHSA, 2009). We also found that
externalizing behavior did not predict either treatment retention or engagement
for adolescents. This may be due to the fact that the adolescents in our study
were not formally diagnosed with an externalizing disorder, and subsequently,
their externalizing behaviors may not have reached a threshold to influence
retention and engagement similar to other studies (Austin & Wagner, 2010; Grella et al., 2001; Shane et al., 2003).
Findings from the current
study suggest two important clinical implications that we encourage
practitioners to consider. First, we found that specific cultural variables do
indeed influence treatment retention and engagement for Latino adolescents.
Based on these findings, practitioners may want to consider measuring cultural
variables for Latino adolescents as part of a pretreatment assessment. For
example, scores on measures of cultural variables, such as ethnic identity and
acculturation, may assist practitioners in assigning adolescents to treatment
groups with peers who share similar cultural perspectives. Second, the study
findings suggest that placing adolescents together in groups who all share
common identity labels, such as Latino or Hispanic, may not always be the best
approach. This second implication underscores the point that differences in
perspective can exist even when adolescents share a common racial or ethnic
identity label. For example, a practitioner cannot assume that two adolescents
who both identify as Latino share the same perspective, orientation or
world-view toward their culture of origin or the host culture. It may be that
ethnic minority adolescents benefit more from being in treatment groups with
peers who share similar cultural perspectives rather than similar identity labels...
Department of
Educational Psychology University of Utah 1721 Campus Center Dr., Rm. 334 Salt
Lake City, UT 84112
Department of Educational Psychology
University of Utah 1721 Campus Center Dr., Rm. 334 Salt Lake City, UT 84112
