Cultural Influences on Substance Use

Cultures around the world have used psychoactive substances medicinally, spiritually, and socially since ancient times.

For example, a psychedelic mushroom known as Amanita muscaria has been used ceremonially in Asia for 4,000 years or more, according to research from 2022. Mead, the first drink containing alcohol, has been used since 6000 BCE.

Indigenous people in Central and North America also used psychedelic mushrooms and cacti for spiritual and medicinal purposes long before colonization. People in Muslim cultures traditionally smoked hashish.

The substance of choice for Europeans was alcohol, according to research from 2007. Early American colonizers consumed 7.5 million gallons of rum a year.

In other words, using substances and alcohol has been a social and spiritual mainstay of almost every culture around the world for thousands of years.

Humans have often used these substances to achieve certain mental and physical states, whether it was having a glass of mead during a social occasion or using peyote for a spiritual ceremony.

While alcohol and psychoactive substances such as opium were widely used in the Americas, the wave of Protestantism that started in the late 1900s started to change that.

Christian moralists began to view alcohol and some substances in a negative light. They spread the idea that these substances could corrupt a person’s spirituality and nature.

The negative view of certain substances, and the laws that were created to defend this view, were also influenced by xenophobia and racism.

Although Americans previously smoked opium in large quantities, anti-Chinese racism caused white people to start labeling this substance as “foreign” and “dangerous.” The outlawing of cannabis in the 1910s and 1920s was created to criminalize different groups.

By learning more about the historical origins of substance and alcohol use (and the laws that were created to regulate it), it becomes clear that culture has had a large impact on how we, as a society, view and define substance use.

Culture greatly affects how different groups use substances and view substance use. To be clear, “culture” goes beyond just ethnic or linguistic groups.

For example, binge drinking is common and often socially encouraged in many university settings. The same could be said for other micro-communities such as people who like certain types of music.

In other words, “culture” can be defined in many different ways, and it’s crucial to allow people to define their own cultures.

The effect of colonization on substance and alcohol use

Colonization has effected the patterns of substance use for people of different cultures, particularly for the American Indians and Alaska Natives (AIAN) people who were already here when colonizers arrived.

Prior to this colonization, AIAN people used alcohol sparingly and only during specific ceremonies, according to research from 2007.

After colonization, people of AIAN cultures started to use alcohol more often.

The reported numbers of alcohol-related deaths among AIAN are inconsistent because of the lack of research among AIAN people.

While some studies found that alcohol-related deaths were higher among AIAN people than white people, others show little or no difference at all, according to the Centers for Disease Control and Prevention (CDC).

Some AIAN elders believe that a disconnect from traditional culture has contributed to the high levels of alcohol misuse in their communities.

Acculturation and substance use

The same theory could explain why people who acculturate to the new “home” culture after they immigrate (such as an Hispanic migrant worker becoming acculturated to U.S. culture) may have higher rates of substance use than an immigrant who remains connected to their home cultures.

Research from 2011 discussed how Hispanic people who migrate to the U.S. as children have a higher chance of substance use disorder compared to those who migrate as adolescents or adults, but a lower chance than Hispanic people born in the U.S.

A strong cultural identity doesn’t always protect people from substance use. For example, a 2017 study found that white youth who had a higher ethnic identity were more likely to misuse substances such as cannabis and alcohol.

Other cultural factors

Listing every factor from every culture around the world that could impact substance use can be challenging. But here are some other common cultural factors that could come into play:

• interpersonal communication styles
• individualistic versus collectivist culture
• patriarchal versus matriarchal culture
• cultural and generational trauma (such as structural racism)
• use of substances in social or spiritual events
• role of extended family

A person’s cultural identity is inseparable from who they are. Whether they’re a white American who doesn’t think of themselves as having a strong cultural background or a new immigrant who’s tied to their ethnic identity, culture will be relevant in every step of the treatment process — starting with evaluation and screening.

For example, some cultural groups may be less likely to seek treatment or be honest about their substance use with healthcare or mental health professionals.

This barrier to treatment could be due to a stigma around seeking treatment for mental health issues such as substance use disorder that exists in their culture. Or they may have other reasons to mistrust authority.

For example, according to research from 2006, up to 70% of people displaced from Vietnam, Laos, and Cambodia experience symptoms of PTSD because of the war and violence that they experienced in their countries of origin. This could lead to mistrust in the government and authority, including substance use counselors.

Language can also be a barrier to treatment. If healthcare or mental health professionals aren’t able to communicate with people from various cultures and communities, this could present barriers during evaluation and screening.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) suggests that treatment providers consider the following areas during the screening and assessment process for any mental health condition, including substance use disorder:

• cultural identity
• cultural explanation of the illness (for example, if someone views their addiction as a punishment from a god)
• cultural factors related to the person’s environment and functioning
• cultural factors between the treatment provider and the client (for example, if the treatment provider is part of a cultural group that has historically oppressed the client’s cultural group)
• overall cultural assessment

Regardless of these important cultural considerations, substance use disorder doesn’t discriminate based on culture.

Anyone of any race, country, gender, and more can develop a substance use disorder. But cultural identity and values can both protect and worsen substance use problems in some cases.

Culture affects every step of the treatment process, from whether or not someone seeks treatment to how much they trust the mental health professional providing treatment.

In general, it’s crucial for mental health professionals to strive for cultural competence in therapy. This could help people of different cultural groups feel comfortable going to treatment.

Some experts recommend mental health professionals practice “cultural humility,” which differs from cultural competence.

Cultural humility understands that it’s impossible to fully understand everything about a culture that you’re not a part of. Instead, mental health professionals can ask questions and allow clients to teach them about their cultural identities and values.

It’s crucial not to make any assumptions about the client’s cultural beliefs based on stereotypes or ethnocentric values (that belong to the mental health professionals’ own culture).

For example, a white mental health professional could encourage a young adult from a more collectivist culture to gain independence and move out of their parent’s home. They may not realize the value placed on family in these cultures, nor that “independence” is a Western value that other cultures may not place so much importance on.

Cultural factors also come into play during the recovery process. Recovery may look different for each cultural group.

For example, a full recovery could mean not only recovering from symptoms of substance use disorder but also reconnecting to their cultural identity or recommitting to spiritual or religious practice.

Culturally responsive substance use treatment is critical.

Research from 2011 shows that many culturally and linguistically diverse groups aren’t getting the substance use treatment they need. Black and Latinx people are less likely to get substance use treatment and more likely to drop out before completion.

By adopting culturally responsive services, people who need help may be more likely to feel comfortable seeking it out.

The intersection of culture and substance use is a complex one and can’t be reduced down to probabilities and numbers.

Culture is an interwoven checkerboard of various identities that include — but aren’t limited to — race, gender, national origin, profession, immigrant status, and more.

By committing to providing culturally responsive outreach and treatment services, mental health professionals can ensure that people of all cultural groups receive adequate care for substance use disorder.