Alcoholism among Pacific Islanders

Asian Americans and Pacific Islanders (AAPIs) are often classified as one minority group when discussing statistics within the United States. This minority group is considered to be the fastest growing racial group in America, the American Psychological Association (APA) reports. At the time of the most recent census, there were nearly 1.5 million American Pacific Islanders.

In general, AAPIs tend to abuse substances and suffer from addiction at lower rates than the general American population. Typically, one of the largest age demographics to abuse substances and require treatment for addiction are those between the ages of 18 and 25. The Asian American Psychological Association (AAPA) publishes that recent data suggests that AAPIs in this age demographic (adolescents and young adults) were less likely to need treatment for a substance use disorder than those from other racial or ethnic groups, close to 14 percent as opposed to 21.5 percent respectively. Asian American Pacific Islanders are also less likely to seek treatment for addiction or substance abuse when they do need it, however.

Alcohol is the most commonly cited substance of abuse for Asian Americans and Pacific Islanders who do seek treatment. The Treatment Episode Data Set (TEDS) Report publishes that in 2010, approximately 64 percent of Asians and Pacific Islanders (APIs) admitted to an addiction treatment program reported alcohol as their primary substance of abuse compared to 60 percent of all admissions. Alcohol is a common substance of abuse among Pacific Islanders.

Native Hawaiians, Pacific Islanders, and Alcoholism

Pacific Islanders are a specific subset of the AAPI racial group made up of people who may be native to islands, such as Hawaii, Guam, the US Virgin Islands, American Samoa, the Northern Mariana Islands, Polynesia, Fiji, Micronesia, the Marshall Islands, Australia, and other islands in the Oceana region. There are large communities of Pacific Islanders residing stateside in California, Oregon, Washington, Utah, Nevada, and Texas, among other places.

Many Pacific Islanders reside within, or come from, US territories or the state of Hawaii. Native Hawaiians and Pacific Islander Americans, often termed NHPIs for short, typically have lower incomes, lower levels of completed education, and larger families than Caucasians and other ethnic groups, the Asian Nation publishes. The NHPI subset of the Asian American and Pacific Islander demographic tends to be more disadvantaged than the Asian American racial group as well. Asian Americans are often portrayed as a “model minority” with high levels of education and success, while NHPIs may not achieve these same levels of financial and educational solvency as regularly.

All of these factors can contribute to alcohol abuse and addiction. When separated out from the AAPI demographic, Native Hawaiians and Other Pacific Islanders struggled with alcohol addiction more often than other races; over 6 percent of Native Hawaiians battled addiction compared to over 4 percent of Caucasians based on national surveys taken between 1999 and 2002, as published by the Journal of Ethnicity in Substance Abuse.

Ethnic minorities, such as Pacific Islanders, may face discrimination, bullying, low socioeconomic status, and high levels of stress on a regular basis. Stress, social pressures, and low self-esteem can all cause a person to engage in actions or behaviors that may be considered risky or self-destructive, including alcohol and/or drug abuse. Isolation and boredom that may come from living in an island community, and may also contribute to higher levels of alcohol consumption.

Underage drinking is a potential risk factor for addiction, as alcohol can interfere with normal brain functioning and development. The journal Addictive Behaviors reports on a study indicating that Native Hawaiians and Pacific Islander high school students had some of the highest alcohol, tobacco, and other drug use (ATOD) among the AAPI demographic. Alcohol is a common coping mechanism used to escape reality, combat stress, or lower anxiety. As a depressant, alcohol lowers inhibitions, decreases stress and anxiety, and increases pleasure, at least temporarily. When consumed in binge or heavy drinking* patterns regularly, alcohol abuse can cause a person to become physically and psychologically dependent on the substance.

When a person becomes dependent on alcohol, it can become difficult to stop drinking as withdrawal symptoms and cravings for alcohol are common when alcohol processes out of the body. A person may then be unable to control their drinking, and addiction can be the result. The National Institute on Alcoholism and Alcohol Abuse (NIAAA) publishes that over 16 million Americans struggled with alcohol addiction in 2015.

*Binge drinking is defined by NIAAA as a pattern of consuming alcohol that raises a person’s BAC (blood alcohol concentration) up to 0.08 g/dL or above which typically occurs when a man drinks four drinks, or a woman drinks five drinks, in the span of two hours or so. Heavy drinking is defined as binge drinking five or more times in a month.

Special Considerations for Treatment

Pacific Islanders may face specific barriers to treatment that may keep them from seeking help when it is needed. As a culture, APIs can be very private and hesitate to call attention to issues of substance abuse within the family. Guilt, shame, and fear of bringing dishonor to the family name can make it difficult for a Pacific Islander to admit that they have an issue with drinking or that help outside of the family is needed. Addiction may be discounted altogether or seen as a sign of “weakness” that is not tolerated.

Social stigmas against seeking help for mental health and/or addiction concerns exist across all racial demographics, but they may be even more pronounced in the API minority. Cultural, religious, and spiritual factors may all make a Pacific Islander less likely to recognize that their drinking may be problematic, and to enter into a treatment program that uses primarily Western medical techniques.

The Substance Abuse and Mental Health Treatment Services Administration (SAMHSA) reports that treatment programs should focus on integrating care in order to bridge the gap between Western medicine techniques and models that are culturally sensitive to this specific population group. For instance, SAMHSA highlights the importance of community and family involvement in the treatment and recovery process for Native Hawaiians, stating that involving local elders, or kupunas, can be highly beneficial. These kapunas can work with clinicians to develop an intervention and/or treatment program that is culturally sensitive, and includes both traditional cultural and Western methods. Cultural education can help to improve self-esteem and raise a person’s self-image and idea of their own self-worth, as a person in general and as a Pacific Islander, specifically.

Treatment programs that are culturally sensitive to the Pacific Islander population may also be more beneficial when they are gender-specific, as men and women typically hold very different roles in the Pacific Islander culture. Programs that cater to genders separately may be especially helpful. Involving community members and spiritual leaders in treatment can help with creating a treatment program that meets the needs of this specific population as well.

Additional barriers to treatment that Pacific Islanders may face include:

• Lack of education
• Financial difficulties and/or limited or no health insurance
• Language barriers
• Limited access to local treatment programs

There may not be as many treatment programs locally for Pacific Islanders who live in isolated communities, and individuals may have to travel great distances in order to obtain help. Language barriers can also be an issue for Pacific Islanders when seeking a pertinent treatment program. Treatment providers will need to speak the language, and also be culturally sensitive and understanding regarding the specific discriminations and difficulties that Pacific Islanders may face in their daily lives.

Often, substance abuse and mental health issues can present as physical medical problems. Individuals may complain of headaches, stomach upset, or physical pain, which may actually be symptoms of a mental health or substance use disorder. This could partly be due to a lack of education or understanding about addiction and mental health, and not a form of denial. Providers need to be aware of this potential to ensure they are asking the right questions upon admission to identify any underlying issues that could benefit from treatment.

Lack of medical coverage and health insurance as well as limited financial resources can also present barriers to treatment. Treatment programs often have many resources for families and individuals to better understand how to use insurance for addiction treatment and to make treatment financially feasible.

Pacific Islanders who struggle with addiction will benefit from learning new and effective coping mechanisms for dealing with everyday stress and from learning how to derive value from themselves both as individuals and as part of a bigger community. Treatment programs will need to teach life skills and relapse prevention strategies that will be helpful for lasting recovery. There are a wide variety of specialized addiction treatment programs that exist to help individuals of all races and cultures, so it’s important to find one that is right for one’s specific situation.