“We Want What’s Best for Us!” Understanding Cultural Competence in Global Recovery: Michael Hooper

When I was working outreach in Cleveland, Ohio, I heard a story from some friends at The LGBT Center in Gordon Square. It was about a community activist group, which ran out of a local church some years ago, before I arrived in Ohio. The goal was to offer the local youth of the surrounding community free after-school services such as study space, athletic activities, arts & crafts and home-economic skills. All of these services were offered on church grounds as an alternative to the criminal temptations that harrowed so many young people in that area of Cleveland. The only prerequisite was that the adolescents would have to attend a thirty-minute sermon to receive The “Lord’s Message” prior to these services. These services were provided through a  state charity grant that the church had applied for and had been awarded for that year. 

Now, even for a non-religious young person, it doesn’t seem like a big ask right? I mean, sit in a pew, doze off while some geezer reads a verse or two. In half an hour, you’re back playing three on three. Well, what if I were to tell you that in this community, many of the adolescents were part of the LGBTQIA community and had previously or were still suffering from religious trauma? The thought of participating in anything to do with religion on a recreational basis was simply ludicrous. This program eventually failed because of lack of attendance. Take a moment to think about that. It didn’t fail because it was unpopular. It failed because the organizers did not do their due diligence concerning the population they were attempting to serve.  In the end, their need to serve their own self-interests caused the continuing suffering of a declining neighborhood. This population could have benefited from funding and resources a grant like the one this church was awarded could have provided. This brings me to the topic I want to share with you today, understanding the importance of cultural competence on a global scale when it comes to the art of behavioral health & addiction recovery provided by treatment organizations or mutual support groups. 

I am a person who identifies as being in recovery, who has the honor of being employed by the world’s largest nonprofit, evidence-based recovery organization in the world, SMART Recovery Global. Today I want to talk to you about what cultural competence is and what that means to the world of recovery. It is my intention that my perspective as an addiction counselor, a recoveree and as a Man of Color can motivate the readers to the gravity of the importance of this crucial concept and how to notice some of the warning signs that some of our peers have missed in the past.

Let us start by clarifying what cultural competency is. I think we can all agree that the word culture embodies the customs, traditions, daily habits, colloquial norms, and societal commonalities that we all recognize as commonplace within our regions of the planet.  Not only do we enjoy ethnic diversity, but our sentient individuality has allowed us to evolve our collectives into gems of dazzling, unique patterns of life that can be similar but never identical. To be culturally competent while treating individuals in recovery, is to understand that these nuances in lifestyles play a significant role in the outcome of progressive treatment in addiction and mental health. (I deliberately hesitate in using words such as “successful” when describing treatment in mental & behavioral healthcare. For more on why, please see SMART Recovery’s work on Word Exchange and Dr. Richard Saitz, M.D. Presentation at our 2019 United States’ Annual Conference on Changing Language within the Recovery Community)

But herein lies the dilemma when treating issues such as addiction or mental health. For too long modern science has treated addiction and mental health recovery with the same approach as other diseases that attack the body; develop a treatment, duplicate it, send it out to the masses. If there is a medication available for said diseases, incorporate that into said treatment. This creates the well-known colloquial phrase “cookie cutter” effect of addiction treatment many of us have heard many times before. Sure, there are medications that can be effective for many symptoms of both addiction and mental health disorder or MHD, but we have learned that there are many factors that affect the outcome of each disorder, such as social, environmental, even seasonal aspects that can modify the results of treatment techniques. For this article, we are focusing on the importance of the social, in this case, cultural impacts, that can be game changers in either direction, depending on the treatment providers’ attention to detail. 

Let’s look at some examples. There is always a big module on any social service network training program’s syllabus on communication. Usually, during the course of this training they will go over what Princeton University Experts refer to as the Four Main Styles of Verbal Communication. These are Passive, Aggressive, Assertive, and Passive Aggressive. Now, it’s usually taken in many Western Cultures that a blend of all four is a good strategy to have as it is believed to give you a good baseline for many types of social interactions. However, certain types of communication can be misunderstood depending on your culture, environment and life experiences. For instance, some cultures can misinterpret a passive style as insulting; misjudging this as a sign of communicating in a childlike manner because you perceive them as intellectually inferior. I have personally seen this mistake made by inexperienced undergraduates in substance abuse intensive outpatient program (or “SAIOP”) sessions for mandated probation attendees. This was largely due to the counselor who had recently graduated from their university and was inexperienced, not understanding the culture of the criminal element they were tasked to instruct. 

Oh wait, did I just catch some of you off-guard?! Culture can have nothing to do with an ethnic group, regional birthrights or nationalities. It can simply be a way of life. Professions, Religious Sects, Fraternities, Cults, for example, all can be considered cultures in their own rights, and all should be treated with the same respect when approached for recovery treatment, especially on a global scale. This will make the task particularly daunting if you are a foreign instructor to one of these groups in a land you are not native to, so be particularly wary of both the customs of the region you are in, and the disciplines your clients follow.

Which brings me to my next point which is equally crucial when taking cultural competence into account for our calling. Be wary of tunnel vision of your recovery model and your client’s person-centered goals based on their cultural lifestyle. Many articles you will read focus on the client’s culture as the focal point to be most wary of when dealing with treatment parameters, but this is only one side of the coin. For instance, if you were trained in a faith-based recovery model, but have begun to treat clients whose culture is primarily atheist or follow a spiritual path that does not resemble your methodologies, does your model have enough flexibility to be effective for those clients or will you attempt conversion? If your answer is the latter, you are attempting an age-old tradition of proven failure, that a study conducted by Harmony Ridge Recovery Center in April of 2023 on Forced Recovery (Mandatory Rehabilitation), produced data regarding this method of treatment. Their piece and many others like it show that while such approaches may produce short term success in creating abstinence during the course of the lock down of the program, the chance of self-harm, trauma, and relapse of the client skyrocket upon release. 

It is much more beneficial during the intake phase to have an honest and transparent conversation about your program, its assets, as well as its limitations. 

Flexibility is a necessity if you plan to be vital to the global recovery community. For instance, many western European and African nations thrive on the spiritual and familial aspects of the recovery process being incorporated into the client’s process of healing, while some cultures in Asia would immediately be disinterested in having to shame themselves by involving their family elders in their personal addiction that could cause their family to lose face. Therefore, programs such as SMART Recovery have made “Person-Centered” its core principle as an ever evolving, evidence-based platform. We are a recovery model that goes beyond the Bio-Psycho-Social Model by incorporating Balance into the equation. What better way to adhere to a person’s culture than by helping them to achieve their version of lifestyle balance?

I take cues from very close friends on what’s acceptable behavior towards addiction ambivalence in Poland. I study virtually under a PhD during SMART meetings to find out what Recovery Proficiency is classified as in Lagos, Nigeria. I am learning slowly and steadily what Malaysians who are being treated for Chemsex Disorder wish to achieve through Harm Reduction and support groups.

The unifying feature is the program we all share and the understanding and respect that our differences are our strength, not our obstacles. Let learning about the cultures your clients thrive in become a glorious experience of wonder you both can traverse together, rather than an obstacle holding you back from your shared recovery goal. I wish you all the best on your journey.