According to the 2010 U.S. Census, it was reported that Asian-American and Pacific Islanders (AAPI) are one of the fastest-growing racial groups in the country, comprising about 18 million people (​Racial and Ethnic Minority Populations, 2017).​ With a growing population, there is little evidence of AAPI substance use due to the lack of research that examines the patterns of drug use of members who do not identify as white, African American, or Latinx American (Wallace et al., 2002). According to Ja and Aoki (1993), many studies on drug use often exclude Asian Americans entirely or place them in the broader category of “other.” One of the main reasons for these insufficient numbers is the belief that drug use among AAPI is not a concern.
These beliefs often stem from various research that found AAPI has a lower prevalence and use compared to other ethnic or racial groups (Austin, 1999). This renders the stigma of AAPI as a model minority, which perpetuates the false narrative of Asian Americans as a law-abiding group who achieve higher levels of success than the general population. A vast majority of studies have connected stigma to substance use, which is significant and rapidly increasing within AAPI communities (Harachi et al., 2001; Ja & Aoki, 1993; Jang, 1996; Nemoto et al., 1999; O'Hare & Tran, 1998; Zane & Huh-Kim, 1994).
Addressing Gaps and Needs for Services
Along with the societal perceptions of the success of AAPI in the United States, cultural factors make it difficult for Asian Americans with a substance use disorder to seek help. There is the notion that AAPI is more likely to seek help and support from personal networks such as friends, family, or religious affiliations prior to consulting with professionals in regard to mental health services. Also, the impact of substance use disorders among AAPI is often kept secret from family members and friends until intervention such as arrest, hospitalization, or homelessness is needed or forced on them (Price et al., 2002).
Various themes have emerged examining substance use behaviors in AAPI including the effects of assimilation on drug-using behaviors, the concept of acculturation, and the need for effective approaches that recognize mental and emotional health. Studies indicate there is an increase in the likelihood of AAPI using drugs due to the adoption of a culture with different norms and values. In adjusting to the mainstream culture, young AAPI is more likely to disobey the “protective nature of their parent’s culture” and engage in more risky behaviors related to drug use (Moloney, Hunt, & Evans, 2008). In addition, acculturative stress can be accounted for by the tension between competing cultures held by parents’ traditional values with newly adopted ones. As a result, drug use may be treated as a “coping mechanism'' to restore the conflicting pressures that are experienced or placed on young AAPI (Berry et al., 1987; Bhattacharya, 2002; Bhattacharya & Schoppelrey, 2004).
Research also suggests that drug use is directly related to the experiences of being AAPI, more specifically the experience of feeling “in-between” or torn between Asian and American cultures (Moloney, Hunt, & Evans, 2008). Numerous accounts of study participants show illicit drug use as a form of self-medication due to feelings of loneliness, anxiety, and/or depression as a result of straddling between one’s own culture and the American culture. A lack of support or community results in this disconnect between the two different cultures. Thus, providers may consider adopting an acculturative-stress model lens in order to create services that are responsive to the needs of the AAPI community.
Barriers to Treatment and Access to Services
Compared to other ethnic groups, AAPI is greatly underrepresented in treatment across different settings (James, Kim, & Armijo, 2000). This underrepresentation is largely due to low reporting and is likely driven by barriers to accessing treatment. For instance, according to Sakai et al. (2005), it was found that AAPI substance-dependent patients were ​less likely​ to enter substance use treatment (roughly 8%) compared to non-AAPI substance-dependent patients (16%). Furthermore, based on the findings of Niv, Wong, and Hser (2007), substance use treatment for AAPI was vastly similar to other racial/ethnic groups. In other words, treatment outcomes were comparable to AAPI and non-AAPI groups. This highlights the importance of AAPI to receive services and access to treatment needs.
Although there are many studies that show AAPI not seeking treatment, there are also several barriers that exist to accessing care. The most common barrier among AAPI is the subject of shame in asking for help or seeking treatment. Traditionally, AAPI responds with denial or attempts to manage the issue within the family itself. This shame is caused by perceptions that the family has failed to solve the problem, which results in abnormal functioning or suppressing feelings of drug use. A lack of recognition or identification of a substance use disorder is another barrier to accessing care. Often, AAPI somatizes their mental health issues and seeks treatment for physical symptoms rather than its biopsychosocial causes (Sue et al., 1995). A level of awareness and understanding of the signs and symptoms of a substance use disorder become amiss and subsequently contribute to this barrier. Lastly, the lack of culturally-relevant services tailored to specific AAPI language and cultural values and beliefs presents a barrier to accessing care.
Although there are few studies on this topic, those that exist show insufficient evidence of health and social service providers being trained in AAPI values and beliefs, culturally-appropriate treatment strategies, and harm reduction behaviors. Among ethnic minority clients, research shows that harm reduction approaches have been empirically supported and effective (Blume and Lovato, 2010). Therefore, the implementation of culturally-sensitive harm reduction or assistance of specialized harm-reduction therapy can help empower and promote healing for AAPI communities.
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