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Dr. Fred Dyer-Emerging Adults

We are happy to announce that Dr. Fred Dyer, a national expert on clinical practice with Emerging adults will author this exhibit on African American Emerging Adults with Substance Use Disorders. Emerging Adults are between the Ages of 18 to 25. Their development and clinical needs are different from adolescents and most report not feeling completely adult. Dr Dyer's content will range from blog posts, articles, thoughtful quotes and clinical tips. Scroll below to read his posts. Dr. Dyer can be reached at 773 322-8425, dyertrains@aol.com, and www.dyertrainingandconsulting.org

Feedback Informed Treatment: Pursuing Clinical Excellence in Working with African American Substance using Emerging Adults

Most theories of counseling and evidence based practices were not developed with Africans in mind. Feedback Informed treatment is one evidence based approach which allows the clinician to tailor counseling to the unique needs of clients served. To that end, this approach can be culturally specific. It is the opposite of a one size fits all approach, which is a challenge of many evidence based practices. Feedback informed treatment calls for the therapist to get feedback at the end of each session and makes changes to the approach based upon that feedback.

As mentioned in previous posts, African American Emerging Adults with Substance Use Disorders often present with unique challenges which if not addressed can lead to premature termination from addictions treatment. These challenges include: poverty, mis-education, community violence, easy access to drugs and high rates of felony arrests. In spite of these challenges it is the alliance between the counselor and client that keeps clients engaged in treatment. Feedback informed treatment has been found to facilitate engagement. While having a voice is important to all emerging adults it is particularly important for African Americans who have often experienced discrimination and ostracism. Feedback informed treatment is empowering as it honors the clients need for autonomy and power to make decisions regarding the direction of his/her life.

Using the following three principles from (Miller,et al 2017) Feedback Informed Treatment, clinicians can engage in clinical excellence with African American substance using emerging adults, and observe better outcomes by: 1. Know your baseline. In other words is what you are doing with the client valid, reliable, and feasible?  2. Constantly engage in formal ongoing feedback. The question here is will the clinician formally seek and use feedback to guide service delivery?  3. Deliberate Practice, which refers to intentionally making changes in the approach based upon client feedback.

Finally, utilizing FIT results in the following benefits for the African American Emerging Adult and for the clinician.

Improves outcomes one client at a time.

Identifies areas where clinicians can improve their performance, generally and with specific cases.

Identifies cases at risk for getting worse or dropping out.

 At an agency level, helps reduce variability in performance between clinicians.

We owe it ourselves to continually strive to pursue excellence in practice, but much more important, we owe it to the client

Implementing Cultural Competence in a Trauma Informed Setting for African-American Emerging Adults with Co-occurring Disorders

The aforementioned title of this post reminds those of us who are working with African American Emerging Adults with Co-occurring Disorders, and/or those who desire to, that due to the early exposure of Adverse Childhood Experiences (ACE'S) and their impact psychiactrically, behaviorally and developmentally, when working with African Emerging adults it is necessary to be able to respond to the trauma in their lives in a culturally competent/sensitive manner.

 Laura Brown{2008} reminds us of the importance of cultural competence  in trauma informed care by stating that "Healthcare delivery of services for emerging adults  cannot be all inclusive without embracing, the need  for cultural competence/sensitivity, and even the best practices lack efficacy when culture is not incorporated as a trauma-informed solution. Additionally failure to bring cultural competence to the table can lead to missteps in genuinely helping African American emerging Adult trauma survivors or worse can result in deepening the wounds of trauma, creating secondary and tertiary traumas that are more painful than the original because they are appraised by victims and survivors as unnecessary wounds.

 As with other important topics time nor space affords the appropriate amount of time to discuss. However any discussion/treatment of trauma must and should include: Historical trauma and culturally competent/ sensitive practice parameters for healing historical trauma.

The following are a few principles for implementing culturally competent/sensitive trauma informed -care with African- American emerging adults with co-occurring disorders. 1. connect clients with resources they trust including types of professionals and traditional healers, 2. help clients to restore a sense of safety, 3. connect clients with elders who lived thru traumatic events and who managed trauma, discrimination, and setbacks, 4. remember it is important to ask clients "what the event means to them. It is clear that addressing cultural competency and utilizing cultural sensitivity in a trauma -informed setting with African - American emerging adults with co-occurring disorders is no longer an exception, but rather an expectation.

Biracial Emerging Adults and Substance Use Disorders

The topic of this post brings to mind a verse by the late singer Marvin Gaye in his song entitled What’s Going On, ”Come talk to me so you can see what's going on". These few words can reflect not only questions for the biracial emerging adult, but also the journey they may be on to figuring out who I am, where do I belong, where do I fit in, and can I be okay in my own skin. In this journey of discovery substance use continues to be an ever present challenge among all racial and ethnic groups, including biracial emerging adults (SAMHSA2010). Moreover, studies indicate that consequences of drug use vary by race and ethnicity such that minorities are more likely to experience adverse drug-related health and social consequences compared with whites. Despite the nation's growing demographic diversity (Marcera, Armstead&Anderson 2001) the prevalence and consequences of drug use among multiracial and ethnic groups are poorly understood.

Hispanics, are projected to be the U.S. majority population by 2050, obtaining national estimates of the prevalence of drug use among monoracial/ethnic and biracial/ethnic individuals is warranted. Multiracial individuals have unique experiences and challenges that continue to be unaddressed (Center for the Study of Biracial Children 2011). Multiracial young adults  often face unique conflicts related  to racial/ethnic identity, including, social marginality, educational, and occupational aspirations, defense mechanisms and coping strategies that are likely due to membership in more  than one racial or ethnic group (Gibbs &Huang 1998). The literature further  suggests that because of struggles with identity formation, which leads to low self-esteem and social isolation, multiracial  individuals may be at high risk of emotional, and behavioral health challenges including substance use disorders.

 An important  step in addressing alcohol and drug use among this  underserved, and often unacknowledged group is to utilize the  assessment phase of treatment and person centered individualized therapy to build rapport with clients and to help him/her understand contributing psycho-social factors to their substance use disorder. Treatment and recovery provides additional opportunities for the client to answer the questions, who am I, where do I belong and where do I fit in?

African American Emerging Adults with Co-occurring Substance Use and Psychiatric Disorders

Over two decades ago psychiatrist Kenneth Minkoff, MD coined the phrase, "dual Diagnosis is no longer an exception, but rather an expectation." This simple, yet profound statement is true today for clinicians who work with African American Emerging adults with co-occurring substance use and psychiatric disorders. According to research, emerging adults are particularly at risk for psychiatric disorder, and in a given year, over 40% of U.S. 18 to 29 year-olds meets criteria for psychiatric disorder. This is a higher rate than all other adult age groups.  Substance use even at levels that are non-diagnosable can result in a plethora of negative consequences for African Emerging adults, including: unwanted sexual experiences; poor school performance; weight gain; accidents; increased risk for certain cancers; and suicide. Additionally Corrigan, McCracken, and McNeilly (2005) provides eight negative impacts of dual diagnosis on individuals which include but are not limited to 1. More frequent/sever/psychiatric symptoms 2. More frequent hospitalizations 3. Less able to participate in treatment 4. Worse work history 5. More likely to be homeless 6. Greater rates of violence 7. Greater rates of incarceration 8. More frequent infections

Time nor space allows for a complete analysis, or discussion of such an important topic, However Bell and McBride (2010) offer guidance for moving forward with treatment as well as with prevention for African American Emerging adults with co-occurring substance use and psychiatric disorders. On the prevention side: 1. Understanding the exacerbations of mental illness, 2. Social pressures within drug-using networks, 3.lack of meaningful activities and social supports  for recovery, 4.Independent housing in high risk neighborhoods, and 5. A lack of Integrated dual disorders treatment. Some additional essentials  for treatment as well as relapse include: 1,Providing healthy and protective environments that support for recovery, 2. Helping African emerging adults formulate life  makeovers, i.e., obtaining satisfying employment, having friends who are not using drugs, developing support networks of others in recovery, finding a sense of meaning  and purpose, and providing specific and individualized integrated treatments for African American Emerging Adults with Co-occurring substance use and Psychiatric Disorders. 

 African American Substance Using Emerging Adults and the Five Features of Emerging Adulthood

The developmental theory of emerging adulthood postulates that there are five features which mark this unique developmental period. Arnett (2015) lists and delineates the following features: 1. Identity exploration: answering the question "who am I" and trying out various life options, especially in love and work; 2. Instability, in love, work, and place of residence; 3. Self-focus, as obligations to others reach a life-span low; 4. Feeling in- between, in transition, neither adolescent nor adult; and 5. Possibilities/optimism, when hopes flourish and people have an unparalleled to transform their lives. For African American substance using emerging adults, there are interesting question to ask, "For whom, and whose experiences fall under the rubric of emerging adulthood and its five pillars, and how might race and ethnicity impact the developmental period of emerging adulthood?”

Given the challenges that many African American substance using emerging adults face including: violence prone neighborhoods; lack of parental validation;  dropping out of school early; early pregnancy, running away from home; premature entry into adulthood; the absence of adult mentors, or pro-social  activities, substance use treatment should address the five features of emerging adulthood  but never forget that because of different cultural contexts and the myriad of experiences that African American emerging adults with substance use disorders have, additional struggles may need to be addressed in treatment.

Research reminds us that there are three motivations for substance use. 1. The drug experience motive, 2. The peer motive, and 3. The coping motive (Lecce & Watts, 1993). In summation African American Substance using emerging adults thru various modalities can learn to use their struggles and challenges to build resilience and become more motivated to live productive lives filled with purpose in recovery.

African Americans Emerging Adults with Substance Use Disorders and 12 Step Affiliations

There continues to be discussions, even debates concerning the relevance, importance and effectiveness of AA, and NA in general and for African American Emerging Adults specifically. Some of the questions raised by African American Emerging Adults include:  Why should I go to a meeting where I don't know anyone? Why should I attend meetings where no one looks like me?  Can anyone at those meetings understand what I have been through and what I'm currently going through?

In writing this blog I am reflecting on a phrase from the 60"s and early 70"s, "don't trust anyone over 25". The majority of the members of 12 step groups are over age twenty five. In my clinical practice with African American Emerging Adults I have found it helpful to provide a thorough education about how 12 step groups work. I educate them about the 3 parts to working a successful 12 step program: Attend meetings, Seeking sponsorship and working the 12 steps. I encourage them to attend 6 different meetings before they decide whether or not the program has value for them. They are encouraged to search for meetings where they feel most comfortable with some indicated that they would like to attend meetings with members of similar age and who share their ethnicity and drug of choice. 

There is also a value in introducing African American Emerging Adults to other pathways of recovery besides AA and NA. Letting them know that there are many paths, one destiny, recovery!

Addressing Substance  Use Among African American Emerging Adults In the Criminal Justice System

 When discussing African American Emerging Adult substance use, and the criminal justice system several salient factors should be considered. In the United States millions  of young adults have some contact with the justice  system, and that frequent and continued contact should give pause to ask the questions: Where is the emphasis on prevention and for those African American emerging adults who are arrested and convicted of drug related crimes? Where are the services to not only address those criminogenic factors, but also to address those substance use risk factors.? Since both interface and are interrelated, it appears that the focus continues to be incarceration. It is clear from studies  that disproportionate rates of incarceration of African American substance using emerging Adults leads to socioeconomic problems, mental health, and behavioral disorders, and continued substance use.

 Addiction is a complex yet treatable disease that affects brain function and behavior. No single treatment is appropriate for everyone. It is essential for those of us working with African American emerging adults with substance use challenges  find ways to decrease the high  rates of incarceration by focusing on modifiable risk factors, and see that spending money  on prevention, and intervention via substance  use treatment  will yield better  results than spending money on correctional facilities. With effective treatment of substance use disorders and alternatives to incarceration, African American emerging adults can go on to enjoy life, be productive, and raise families.

Developing Resilience in African American Emerging Adults Who Are At Risk for Substance Use Disorders: A Focus On Meaning and Purpose

 Given the multiple risk factors for heavy substance use which impacts many African America Emerging Adults, ranging from easy access to drugs, poorly performing schools, father hunger, the presence of gangs within communities,early criminal justice involvement and discrimination, how  can those of us who are committed to working with this population assist them in living  a drug free life? The answer is to help African American Emerging adults at risk for a substance use disorder develop resilience. There are many definitions of resilience.  Garbarino (1999) says that resilience is more than outside success, more than graduating from high school, staying out of jail, or holding a job. It also means developing a positive sense of self, a capacity for intimacy, and a feeling that life is meaningful. According to Walsh (2016) resilience can be defined as the capacity to rebound from adversity, strengthened and more resourceful. It is an active process of endurance, and growth in response to crises and challenges.

 There is a Japanese belief that everyone has the DNA, the trait and the cells to be resilient, and that resiliency must be practiced, developed and controlled (Bell and Suggs, 1998). Wolin and Wolin (1996) lists 12 characteristics of resilience. From their list the one which I believe encapsulates the remaining 11 is having a goal to live for which gives life meaning and purpose. Helping African Emerging Adults identify Meaning/purpose is a protective factor from developing a substance use disorder. Even with the presence of risk factors including poverty, discrimination, family alcohol and drug use etc., purpose can help them to thrive in the midst of risk. To help African American emerging adult clients tap into purpose I ask them a range of questions. How did you survive that? How have you been able to endure so much? What are your previous life challenges preparing you to do with the rest of your life? Does the challenges you have faced help create a mission for you? What is your life purpose? What are some steps you are willing to take today towards that purpose?

 Resources

 Bell, C., Suggs, H., (1998). Using Sports to Strengthen Resilience in Children: Training Heart. Child and Adolescent Psychiatric Clinics of North America. Volume 7, Issue 4, October 1998, Pages 859-865

 Garbarino, J., (1999). Lost Boys: Why our Sons Turn Violent and How We Can Save Them. Anchor Books. New York, NY.

 Walsh, F., (2016). Strengthening Family Resilience. Guilford Press. New York, NY.

 Wolin, S., Wolin, S., (1996). The Resilient Self: How Survivors of Troubled Families Rise Above Adversity. Random House. New York, NY.

Risk Factors for Substance Using African American Emerging Adults: Early Use of a Substance in Adolescence                                                            Leads to Abuse of the Substance in Emerging Adulthood

Often times substance use among African American Emerging is not considered within the context or background of adolescent development, and or peer group affiliations. The risk factor of adolescent substance use and expectancies which can impact on African American emerging adult use must be considered in prevention, treatment, family engagement as well as relapse prevention strategies. Consistent evidence suggests that those who use a given substance during adolescence are more likely to use and have problems with the use of the same substance as young adults. This is supported  by research on alcohol use{Floy, Lynam, Leukefield, and Clayton, 2004}.In a study  examining early adolescent substance use in relation to subsequent young adult substance use disorders, Gil et al. 2004} found that young adult  substance users began  using substances in early adolescence. Adolescents with alcohol -using peers  may be more  likely to belong to an early drinking trajectory into young adulthood, which in turn can lead to increased dependence. The important part here for those who have a passion and commitment to working effectively with African American Substance using Emerging Adults is to remember that before they entered into the journey of emerging adulthood many may not have completed the ongoing struggles of adolescence.

RACE, POVERTY AND OTHER RISK FACTORS FOR EMERGING ADULT SUBSTANCE USE DISORDERS

One could spend hours upon hours listing and debating risk factors for substance use among African American Emerging Adults. For the purposes of this blog the writer will cite just a few. The first risk factor for substance use is Race/ethnicity. A number of studies support an association between race/ethnicity and young adult substance use outcomes. One of the most commonly observed associations is an increased risk of alcohol use or problem use among White young adults {Arria et al., 2008: Gil et al., 2004. In addition to finding increased risk for Caucasians, Gil, Wagner, and Tubman[2004 also found increased risk of experiencing a variety of substance  use disorders in young adults for other race/ethnicity groups, particularly if they transition from abstaining in early adolescence  to regular use in young adulthood.

Another risk factor for substance use among African American emerging adults is poverty. Interesting poverty is sometimes {non-intentionally} left out of the conversation, when in this writers mind poverty should always be discussed. Regardless of the terms used. Whether it’s SES, or the Working poor, or abject poverty, poverty is a risk factor for alcohol and drug use, for violence and for mental health problems. The work of Bell and Jenkins, 1992 reminds us of the significance of poverty when discussing adolescent violence. Poverty interferes with an individual’s self concept and self esteem.  Family substance use history is also a risk factor for use as well. There is substantial  evidence that individuals  who are children of alcoholics are at an increased  risk  of heavy alcohol use, binge  drinking{Chassin et al.,2002,2004} or having an alcohol use disorder during their young adult years{Alati et al., 2005: King & Chassin, 2007} Siblings of young adults may also play a role  influencing young adult alcohol use behaviors. Research has found that alcohol use in young adulthood {mean age 25} was predicted by an older siblings use when they were in emerging adulthood. This was found to be true when the siblings were close in age.

Understanding Risk and Protective Factors for African American Substance Using Emerging Adults. {A Series}

In the understanding and developing of treatment planning , and for relapse prevention, it is imperative that those working with this population have some basic , but important tools/information in their tool box. At the outset it is necessary to remember the essential work of Urie Brofenbrenner who in the 70's introduced us to looking at and examining  behavior thru a systems lens, and which social workers had long since practiced. The African American emerging adult must navigate themselves through a macrosystem, an exosystem, a mesosystem, and a microsystem, and it is important to keep in mind that each system can and does impact on them and influences their risk for using, treatment compliance, as well as retention. This series will look at prevention Science as it relates to African American Emerging Adults, as well as the risk and protective  factors African American substance using emerging adults. 

There is a question which some may ask, and the question is a fair one. Which is, why review or focus on risk and protective factors for African  American Adults? The answer is that, not only is Emerging Adulthood an important developmental characteristic {which is considered the ages of 18-26} but it is also an important development characterized by peak  prevalence of substance  use problems, and problems related to use, which can set the stage for later  adult development. Lastly the Four top causes of death for Emerging adults are 1. Accidents, 2. Homicides, 3. Poisons/suicides, and 4. Substance Use. Consider the causes of death, then consider the lost of all that potential.  

The Importance of Identity Issues for African American Emerging Adults

In an article  by Jeffrey Arnett and Gene Brody titled  A Fraught Passage : The Identity Challenges of African American Emerging Adults. The aforementioned authors offer a much needed discussion regarding the identity challenges of African Emerging Adults, and how they face many of the same challenges of identity explorations as other emerging adults do. However  for African American emerging adults their identity explorations are complicated by the fact that these explorations are taking place within a society they perceive as possessing negative assumptions about them{Way,Santos,Niwa,& Kim-Gervey 2008}. Accoording to Erikson{1950} forming  a stable identity takes  place through assessing one's abilities and interests, reflecting on the persons one has admired in the  course of earlier development, and then trying  to find a match between one"s desires and goals  and the opportunities offered by society. But what if the range of opportunities is restricted due to racial prejudice. For  African American emerging adults, the challenge  is not just to sort out their own assessments of who and what they wish to be but to reject and overcome the negative stereotypes that others hold of them.

Emerging adulthood is the key period  for confronting these issues, not only because this is  when most people begin to move toward making enduring choices in love and work, but because this is the period when most move  further beyond the immediate social social world of family, friends, and neighborhood and into the larger society{Phinney,2006}.

African American Emerging Adults and Mental Illness

Mental illness affects 25-30% of adults ages 18 years and older in the United Sates in a given year {Kessler,Chiu,Demler,et,al2005}. Of those individuals , about 41% fail to utilize mental health services{Natioanl Institute of Mental Health, 2006} Studies show that factors such as race [being Afican American} and age and being between the ages of 18-29 or an emerging adult are associated with decreased  rates of mental health service utilization when compared to Caucasian emerging adults .

Additionally studies show when diagnosed with mental illness. African American adults 18 and older utilize outpatient mental service at only half the rate of their Caucasian counterparts{Davis&Ford,2004, Snowden&Yamada, 2005}.