Communities Join Together To Promote
Behavioral Health
Preventing and Treating Substance
Abuse
By Kristin Blank
Several summit workshops and discussions
focused on preventing and treating
substance abuse among Arab Americans
and American Muslims. Presenters noted
that 22 countries around the world
are considered “Arab
nations.”
“When it comes to treatment
strategies being culturally appropriate,
wide-ranging diversity
can impose a challenge,” said
H. Westley Clark, M.D., J.D., M.P.H.,
Director of SAMHSA’s Center for
Substance Abuse Treatment (CSAT), who
moderated a substance abuse treatment
panel.
According to presenters, service providers
need to learn about community values
and cultural traditions—including the prohibition
of alcohol under Islamic law, the tendency
not to speak about problems outside
the family, and the idea that substance
abuse recovery is a matter of personal
will.
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Barriers to Treatment
When clinicians reach out to people
with Arab or Muslim backgrounds, they
may encounter initial barriers.
Denial. Because Islamic law prohibits
the consumption of alcohol, some Muslim
Americans who need help may deny that
they drink.
Alec Berry, L.M.S.W., a treatment
provider and an Arab American Muslim,
discussed how he felt when he discovered
he was an alcoholic. “My first
reaction was, tell me I have cancer,
but don’t tell me I’m an
alcoholic,” he said.
Eventually, Mr. Berry started a support
group for other American Muslims
who had problems with alcohol, creating
a nonjudgmental, welcoming community.
Biases. Like
many other populations, Arab Americans
and American Muslims often care deeply
about their reputations and public
personas.
In Arabic, the term ayb connotes social
and religious norms regarding behavior
or communication that would be shameful—and
talking about mental health problems
often is considered a shameful act. “We
have to be really sensitive to the
cultural bias when treating Muslims,” Mr. Berry said.
Privacy. Traditionally,
people of Arab and Muslim heritage
rarely talk about personal issues outside
the family, according to panelists.
In addition, people in the process
of becoming U.S. citizens may be wary
of revealing substance abuse issues,
fearing it could affect their status,
said clinical therapist Amy Amal Rahhal,
M.S.W., L.L.M.S.W., CAAC.
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Treatment Methods
Panelists noted that certain treatment
methods can go a long way in helping
clients from these communities trust
providers. Ms. Rahhal discussed how,
in the past, substance abuse treatment
often was confrontational in order
to break down denial, defenses, or
resistance.
In her experience, the best approach
to help these populations employs motivational
interviewing, a nonjudgmental, client-centered
technique that helps clients develop
intrinsic motivation to change addictive
behaviors. “We want them to
decide to change,” Ms. Rahhal
said. “We don’t want to
decide for them.”
Motivational interviewing comprises
several stages.
Identification. The provider assesses
the client’s level of addiction
and readiness to change. “We
meet them where they are,” Ms.
Rahhal said.
Engagement. The objective of this
stage is for clients to develop comfortable
and trusting relationships. Clients
are encouraged to help others, which
can build their own confidence and
self-esteem. They are not required
to disclose personal experiences.
Acknowledgment. Eventually,
clients confront their own problems.
Ms. Rahhal noted that relapse is expected,
and each person moves at a different
pace.
Finally, substance abuse treatment
and prevention should engage more than
just individuals. “If we are
going to move toward strategies that
help Arab American and American
Muslim communities, we need to involve
the whole community,” Dr. Clark said. 
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