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No Place Like Home: Examining a Bilingual-Bicultural, Self-Run Substance Abuse Recovery Home for Latinos

Authors:

Abstract

Latinos often do not seek substance abuse services, and this might be correlated to the lack of culturally-modified substance abuse treatment approaches. Oxford House is the largest self-help residential recovery program in the U.S., yet few Latinos are among their current residents. In an effort to change this, bilingual-bicultural recovery homes were recently developed for Latinos. This article describes the process in opening these bilingual-bicultural houses and how sociocultural factors such as the family, simpatía, and gender roles impacted the living environment of these houses. In addition, language is highlighted as a key factor to the comfort and success of Latinos living in Oxford Houses. Based on these experiences, the article addresses several obstacles/barriers that impacted this process and possible feasible solutions to these challenges. One challenge is the Latino family system. While this may provide a supportive, cost-effective option for some; it can also perpetuate a cycle of codependence and substance abuse.
No Place Like Home: Examining a Bilingual-Bicultural, Self-Run
Substance Abuse Recovery Home for Latinos
Richard Contreras, Ph.D.,
Project Director at the Center for Community Research at DePaul University in Chicago, IL USA
Josefina Alvarez, Ph.D.,
Core Faculty at the Adler School of Professional Psychology in Chicago, IL USA
Julia DiGangi, MA,
Clinical-community doctoral student at DePaul University in Chicago, IL USA
Leonard A. Jason, Ph.D.,
Professor of Psychology at DePaul University and the Director of the Center for Community
Research in Chicago, IL USA
Laura Sklansky,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Inga Mileviciute,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Elbia Navarro,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Daisy Gomez,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Sandra Rodriguez,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Roberto Luna,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Roberto Lopez,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Sharitza Rivera,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Gilberto Padilla,
Requests for reprints should be sent to Leonard Jason, Center for Community Research, DePaul University, 990 W. Fullerton Ave.,
Suite 3100, Chicago, IL. 60614., ljason@depaul.edu.
NIH Public Access
Author Manuscript
Glob J Community Psychol Pract
. Author manuscript; available in PMC 2012 September 11.
Published in final edited form as:
Glob J Community Psychol Pract
. ; 3(3): .
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Richard Albert,
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Stephanie Salamanca, and
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Frank Ponziano
Research assistant and recruiter at the Center for Community Research at DePaul University in
Chicago, IL USA
Richard Contreras: rcontrer@depaul.edu; Josefina Alvarez: jalvarez@adler.edu; Julia DiGangi: jdigangi@depaul.edu;
Leonard A. Jason: ljason@depaul.edu
Abstract
Latinos often do not seek substance abuse services, and this might be correlated to the lack of
culturally-modified substance abuse treatment approaches. Oxford House is the largest self-help
residential recovery program in the U.S., yet few Latinos are among their current residents. In an
effort to change this, bilingual-bicultural recovery homes were recently developed for Latinos.
This article describes the process in opening these bilingual-bicultural houses and how
sociocultural factors such as the family,
simpatía
, and gender roles impacted the living
environment of these houses. In addition, language is highlighted as a key factor to the comfort
and success of Latinos living in Oxford Houses. Based on these experiences, the article addresses
several obstacles/barriers that impacted this process and possible feasible solutions to these
challenges. One challenge is the Latino family system. While this may provide a supportive, cost-
effective option for some; it can also perpetuate a cycle of codependence and substance abuse.
Keywords
Latinos; substance abuse; recovery; residential; culturally-modified
Introduction
According to the U.S. Census (2009), Latinos make up 15.1 % of the population and are the
largest ethnic group in the U.S. This growing and diverse group is comprised of Mexicans
(9.7%), Puerto Ricans (1.4%), and other Latinos (3.9%). As the population grows, so too
does their rates of substance abuse and dependence. For example, rates of illicit drug use
among Latinos increased from 6.2% to 7.9% from 2008 to 2009 (SAMHSA, 2010).
However, due primarily to language and cultural barriers, Latinos differ from other groups
in their rates of seeking treatment, utilization of services, and length of treatment (Alegría et
al., 2007; Lundgren, Amodeo, Ferguson, & Davis, 2001; Ojeda & McGuire, 2006). At
present, Latinos have been shown to underutilize substance abuse and mental health
treatment services when compared to other ethnic groups (Alegría et al., 2007; Schmidt &
Weisner, 2005). One of the primary reasons for Latinos’ underutilization of services appears
to be the lack of culturally-appropriate programs (Alegría et al., 2007). It is particularly
unfortunate that there is a lack of culturally-specific substance abuse options because
research indicates that Latinos consistently report positive treatment experiences and are
least likely to relapse when they receive treatment and support from individuals who are
aware of their cultural values and beliefs (Flicker, Waldron, Turner, Brody, & Hops, 2008;
Field & Caetano, 2010).
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As the population of Latinos who need substance abuse recovery options grows, culturally-
appropriate treatment options become increasingly important. One such option may be
Oxford Houses, a self-help recovery model, offering a drug-free environment for residents.
Research indicates that African-Americans and European-Americans have benefited from
living in an Oxford House for more than 30 years (Jason, Davis, Ferrari, & Bishop, 2001;
Jason & Ferrari, 2010). Results have shown that living in an Oxford House is associated
with positive changes in social networks and higher levels of abstinence over a two year
period, compared to usual aftercare (Jason, Olson, Ferrari, & Lo Sasso, 2006; Jason, Davis,
Ferrari, & Anderson, 2007). Despite the effectiveness of Oxford Houses as a recovery
option, a study that examined 170 Oxford Houses throughout the country found that Latinos
represented only 3% of residents (Jason et al., 2007). Findings from qualitative research
suggest that the underutilization of Oxford Houses by Latinos may be due to several factors,
including lack of knowledge about this program as well as language and cultural barriers
(Alvarez, Olson, Jason, Davis, & Ferrari, 2004).
In order to address a lack of culturally appropriate substance abuse recovery options for
Latinos, male bilingual-bicultural houses were opened to create a culturally-comfortable
environment. While language might be the most observable difference, these bilingual-
bicultural Oxford Houses were designed to promote Latino-centric values, like familism,
simpatía
, and
personalismo
. These values have been associated with Latino culture and
current literature indicates that integrating them in treatment interventions may be associated
with greater retention and better outcomes (Alvarez, Jason, Olson, Ferrari, & Davis, 2007).
The purpose of the article is to depict the recent efforts to open male bilingual-bicultural
Oxford Houses in the suburbs of Chicago. Furthermore, it addresses how specific cultural
values have changed the living environment in these bilingual-bicultural Oxford Houses,
while maintaining the integrity of the Oxford House model. It is anticipated that the
information provided in this article may assist others who may be considering opening
similar bilingual-bicultural recovery homes.
Opening a Male Bilingual-Bicultural Oxford House
Oxford House
Oxford House is a self-help, sober living environment that operates on a democratic basis.
The main goal of Oxford House is recovery from substance abuse. These houses are also
financially self-supported. Residents pay their equal share of the rent and other expenses
(e.g., electric bill, cable bill). Weekly business meetings are held in an Oxford House in
order to follow-up with the financial situation of the house. Oxford House has no prescribed
length of stay for residents. Professionals are not directly involved with the Houses, and
residents must follow three simple rules: pay rent and contribute to the maintenance of the
home, abstain from using alcohol and other drugs, and avoid disruptive behavior. Violation
of the above rules results in eviction from the House (Oxford House, Inc., 2008). There is a
distinction between an Oxford House and halfway houses. Halfway houses have an active
rehabilitation treatment program where the residents receive intensive individual and group
counseling (Hohman & Gait, 2001). No such in-house services are available for individuals
living in an Oxford House.
Rational for a Male Bilingual-Bicultural Oxford House
Male bilingual-bicultural Oxford Houses were created based on a National Institute of
Health (NIH) funded research project titled
Evaluating a Bilingual Voluntary Community-
Based Healthcare Organization.
The goal of this NIH-funded project is to evaluate the
effectiveness of the Oxford House model with Latino/a residents whose values, beliefs and
behaviors differ depending on their level of acculturation. Bilingual-bicultural Oxford
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Houses are promoted as Latino recovery homes in which residents are 100% Latino and can
communicate in either English or Spanish. Residents have a choice to live in either a
bilingual-bicultural or a traditional Oxford House (i.e., non-bilingual-bicultural houses with
people of varied racial backgrounds). Latino/a residents, who agree to participate in the
study, are interviewed before they enter either Oxford House. Residents are re-interviewed
six months later to capture their experiences in the Oxford House. In conjunction with
DePaul University’s research team, Oxford House, Inc. opened its first male bilingual-
bicultural Oxford House in October, 2009 in the suburbs of Chicago, and a second house
was opened in May, 2010.
Selecting the Location
The process begins by selecting a location to open the Oxford House. Detailed instructions
on how to open a house are in the
Oxford House Manual
(Oxford House, Inc., 2008). Randy
Ramirez, a recruiter and the Illinois representative for the Oxford House, was the person
responsible for opening the new bilingual-bicultural Oxford House under the guidance of
Leon Venable. According Ramirez, the first step was to find a house that provided an
adequate living environment for six individuals to live together. Other considerations
included access to public transportation and jobs. In particular, this recruiter stated, “For (the
Latino house), you want to find houses that are in communities that are culturally-sensitive
or culturally-friendly. You want to make sure you set up in cities where they do not have
any anti-immigration ordinances” (R. Ramirez, personal communication, February 12,
2010). Thus, locating houses in communities that would be more welcoming of Latinos was
an important consideration. Efforts were made to open the bilingual-bicultural Oxford
House in or near a Latino community. The goal was to allow residents access to bilingual
social services, medical clinics, churches/religious organizations, and Latino businesses.
Outreach
The word outreach refers to the method of locating, contacting, and recruiting groups that
are invisible, hidden, or otherwise difficult to engage (Elwood, Dayton, & Richard, 1996).
There are two common approaches used to recruit potential residents: passive and active
outreach. Passive outreach involves giving out information to the target population through
various methods (e.g., flyers, advertisements) whereas active outreach involves direct
contact with probable residents (e.g., presentations, telephone calls, interviews) (Elwood et
al., 1996).
Successful Outreach Strategies
In order to access the target population, outreach was done collaboratively with a well-
known Latino substance abuse residential treatment agency. The relationship between
Oxford House and the Latino substance abuse treatment agency represented a strong
continuum of care in that individuals were able to graduate from residential care to a more
independent living model (i.e., Oxford House). The Latino Oxford House recruiter
frequently gave presentations about the Oxford House model to individuals who were in
residential treatment, thus providing them with an aftercare housing option. One of the most
effective outreach strategies applied in the context of this effort was regular visits to the
treatment programs and other community based organizations to build rapport with the staff
and program participants. For instance, our recruiter invited current Latino Oxford House
residents to participate in our recruitment efforts. These current residents who accompanied
the recruiter to various presentations were able to provide a contemporaneous perspective on
what it was like to currently live in an Oxford House.
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Recruiting Latinos
Treating potential residents in a culturally-sensitive manner can help break down barriers
and increase the possibility of recruiting Latinos (Yancey, Ortega, & Kumanyika, 2005).
Recruiters need to be familiar with the traditions, customs, and rituals of those Latinos they
are attempting to recruit to an Oxford House. The recruiter is the most important person in
the outreach process. Our Latino Oxford House recruiter is bilingual and bicultural who is
culturally-sensitive and able to establish a strong rapport with potential Latino Oxford
House residents.
In addition to identifying and maintaining contact with recruitment sites, the Latino Oxford
House recruiter plays a key role in outreach as they develop and maintain a strong bond with
Oxford House residents. For example, our recruiter has been asked to transport residents to
employment agencies, help residents obtain food stamps, or advocate to help a resident
locate affordable outpatient substance abuse treatment. Personal contact may be particularly
effective for recruiting Latinos as it provides the opportunity to build rapport and establish
trust. Personal contact and showing respect are consistent with traditional Latino values that
emphasize the importance of personal relationships and respect toward those in authority
(Skaff, Chesla, Mycue, & Fisher, 2002). The Oxford House model allows for close
relationships to develop between recruiters and residents because recruiters are usually
Oxford House alumni who continue to stay in touch with the organization. According to a
Latino Oxford House recruiter, the primary goal when interacting with potential Latino
residents is to decrease the level of mistrust. A key goal is to address any uncertainties about
the Oxford House model and how it works. It is crucial that the Oxford House model and the
recovery process be understood. An Oxford House is a place where they will acquire their
independence by getting a job and being able to sustain themselves in this home.
Furthermore, they must understand that an Oxford House is an environment that promotes
recovery and social support (G. Padilla, personal communication, February 12, 2010).
The Interview and Orientation Process
After a house is selected, the next step is to recruit potential Latino residents who are in
recovery. The selection process is done through interviewing. The language of the
interviews is an important factor that has been shown to influence the effectiveness of
interventions for Latinos (Griner & Smith, 2006). Prior to the opening of the bilingual-
bicultural Oxford Houses, all Oxford House interviews were conducted in English. Thus,
when there were Spanish-speaking applicants, an interpreter needed to be present during the
interview process. With the opening of the Latino Oxford Houses, Spanish-speaking Latino
applicants are now able to receive information about the Oxford House expectations, rules,
regulations, and guidelines in Spanish. Moreover, during the interviews, applicants are able
to provide information that may be personal and sensitive—such as their history of
substance abuse, reasons for applying to Oxford House, and their goal and desire to recover
—without an interpreter. An additional component of the bilingual-bicultural Oxford Houses
is that potential residents are interviewed by Latino Oxford House residents who understand
their language/culture.
Latino Residents and the Job-Seeking Process
Oxford House residents are required to find and maintain a job and pay rent. Residents who
are unemployed are required to record their employment efforts in a job log which is
reviewed at weekly business meetings. According to a Latino Oxford House recruiter,
Latino residents may have difficulty finding jobs due to lack of English skills, immigrant
status, lower levels of education, and discrimination (G. Padilla, personal communication,
February 12, 2010). Yet, several Latino residents have found jobs within the first month of
living in an Oxford House. Most residents that live in the bilingual-bicultural houses have
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found jobs according to their current skills. For example, they have obtained jobs in
construction, banquet hall services, shoe sales, and hair salons. They found these jobs by
referrals from other residents, visiting a former employer, receiving a tip at an A.A. meeting,
searching online, and getting help from temporary employment agencies.
Cultural Values and Changes to the Oxford House Environment
Culture represents the language, religious ideals, habits of thinking, patterns of social and
interpersonal relationships, suggested ways of behaving, and norms of conduct that are
passed on from generation to generation (Lu, Lum, & Chen, 2001). Latino cultural values
and beliefs will be present in a living environment where Latinos/as reside such as in an
Oxford House. Cultural values presented in the article are chosen because they were
prevalent among the Latino Oxford House residents. Furthermore, these are cultural values
that were observed by the Latino Oxford House recruiter/representatives, research staff, and
by means of informal discussions with Latino Oxford House residents.
Latino Oxford House Residents
It is important to note that Latinos are not a homogeneous group. In the United States, the
Latino population is comprised of individuals from 22 different countries, each embracing
unique traditions, customs, music, dialects, and food. Other important factors to consider are
ethnic identity, cultural norms, levels of acculturation, gender, education, socioeconomic
status, and immigration patterns, all of which are related to their belief systems and
behaviors (Wells, Klap, Koike, & Sherbourne, 2001). Although we use the term Latino
throughout the article, the majority of the Oxford House residents are from Mexico and
Puerto Rico.
Language
The most visible change seen in a male bilingual-bicultural Oxford House is the use of both
Spanish and English by its residents. According to Oxford House representatives, the ability
to communicate in English or Spanish has helped individuals in the bilingual-bicultural
homes adjust better to their new living environment. Prior to the opening of the male
bilingual-bicultural houses, it was reported by Oxford House representatives that when
Latinos with poor English skills would come into the house, they were more likely to feel
isolated and more frequently left the Oxford House after short residencies. As research
findings have demonstrated, Latinos with substance abuse have better outcomes in
culturally-modified residential programs than in traditional treatment programs (Kail &
Elberth, 2003; O’Connell et al., 2005; Waters et al., 2002)
Personalismo and Simpatía
The value placed on
personalismo
and
simpatía
in interpersonal relationships is consistent
with the collectivistic orientation espoused by many Latinos (Schwartz et al., 2010). Trust is
established based on the person’s behavior in a relationship and not on formal titles or
background. For this reason, it is important for Latinos to establish close and personal
relationships with those who will assist them in their recovery process.
Simpatía
refers to the
value placed in Latino culture on smooth and pleasant social relationships. It is the tendency
to avoid conflict and promote harmonious interpersonal relationships by being agreeable and
pleasant in character (Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002). Since Latino
residents tend to hold a group-oriented mindset, they usually attempt to foster a stable
environment and reach agreements on most things. In some cases, residents avoid
expressing disapproval about something agreed upon by the majority of residents, and may
be careful not to display any demeanor that could be perceived by others as a conflict.
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Based on conversation with several of the Latino residents, residents who live in the male
bilingual-bicultural Oxford Houses described their living environment as amiable and
supportive. While these cultural values are perceived as positive attributes, they may
interfere with the guidelines established by the Oxford House Organization. For example,
there have been several situations where Latino residents did not confront someone who
may have been using illicit substances to avoid a conflict. According to the Oxford House
guidelines, it is required that residents who are using a controlled substance be asked to
leave the house immediately.
Familism
Familism refers to the tendency among Latinos to value family relationships. Latinos have
been shown to maintain contact with family and rely on family as a source of support (Lugo
Steidel & Contreras, 2003). The definition of family in the Latino culture includes extended
family, such as grandparents, cousins, uncles, and aunts (Raffaelli, & Ontai, 2004).
Individuals in a family are held together by common loyalty to each other, to their family
name, and to the relationships they enjoy, as distinct from relationships with those outside
the family. The Oxford House model itself uses a support system that is very similar to the
support seen in a family. According to the Latino Oxford House recruiter has observed
Latino residents in the male bilingual-bicultural Oxford Houses spend a considerable
amount of time with one another. At the same time, residents have invited their own families
to visit their house in order to meet and interact with other residents. Based on this
observation, the integration of two families--the residents’ biological and their newly formed
Oxford House families—is common among Latino residents.
The experience described by a current Latino Oxford House resident highlights the presence
of familism in the men’s bilingual-bicultural house. Latino Oxford House residents tend to
make it a priority to be together physically and emotionally; they “check up” on each others’
job situations, and share food with each other instead of keeping their own individual
supplies. It appears that family values, which clearly manifest themselves in a bilingual-
bicultural Oxford House, may play a crucial role in the recovery process.
Gender Roles
Traditionally, a man must show that he is strong, and physically powerful. Cultural lore
would suggest that a true man should not be afraid of anything, and he should be capable of
drinking great quantities of liquor without necessarily getting drunk (Gonzalez-Guarda,
Ortega, Vasquez, & De Santis, 2010). In actuality,
machismo
is a complex construct that
also refers to having pride in personal conduct, respect for others, love for family, and
affection for children (Galanti, 2003; Gonzalez-Guarda, Ortega, Vasquez, & De Santis,
2010). The Oxford House model embraces certain values of
machismo,
in that residents are
generally employed and pay their fair share of the rent. Learning to be responsible,
maintaining a job, contributing to the maintenance of the house, and having healthy
relationships with others are components of
machismo
that are supported in Oxford House.
According to several Latino Oxford House residents, many feel a sense of pride when they
are able to gain employment and begin the slow process of financially supporting their
families again.
Food
Overall, food serves to reinforce ties among residents while allowing them to express their
traditions. As mentioned earlier, residents tend to share food and prepare meals for
everyone. It appears that residents prefer sharing food and having meals together to
strengthen relationships and promote cohesiveness. According to a Latino resident at a male
bilingual-bicultural Oxford House, the residents agreed to have breakfast together on
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Sunday mornings, feeling that they needed more activities as a group. At another male
bilingual-bicultural house, residents planned picnics together and held several cookouts
during the summer. These cookouts also allowed them to invite their neighbors to the
barbeques. Sharing of food is a caring gesture and is used to strengthen relationships.
Lessons Learned
Beginning in July 2009, outreach efforts began in an attempt to specifically recruit potential
Latino residents for Oxford Houses. As we witnessed the opening of these male bilingual-
bicultural Oxford Houses, many important lessons have been learned about Latinos.
Specifically, there appears to be three central issues that one should be prepared to address
when engaging in outreach efforts with Latinos/as who may be appropriate for Oxford
Houses:
Accessibility: As a minority group, Latinos/as may have less familiarity with accessing
services than other groups. When outreaching to Latinos/as, it is important to engage in
a candid discussion of issues related to their concerns and help Latinos/as develop
feasible solutions to address these challenges. Likewise, it is important that they realize
Oxford House, regardless of their immigration or criminal background, is a real, fair
and safe option for them.
Familism: This may be both a protective and a risk factor for Latinos/as in recovery.
Because the Latino family system can be extensive and insular, Latinos/as in recovery
may seek support from their family. While this may provide a supportive, cost-effective
option for some, it can also perpetuate a cycle of codependence and substance abuse. In
particular, Latinas may have the most difficulty accessing Oxford Houses. For example,
a Latina may be reluctant to agree to live in an Oxford House if her family does not
agree with this idea; if a wife/daughter/sister does consent without discussing this with
her husband/dad/family, they may assert authority and reverse the decision.
Linguistic and cultural accommodations: By virtue of living with a group of people,
communication is essential to the success (or failure) of an Oxford House. Recent
experiences integrating Latinos into Oxford Houses have highlighted how important
language is in the comfort and success of individuals living in Oxford Houses. While
monolingual Spanish speakers certainly indicate a preference for living with other
Spanish speakers, many bilingual Latinos/as have indicated that they feel most
comfortable in an environment which facilitates use of both languages. The elimination
of language barriers make residents feel more empowered to share their experiences and
support their fellow residents without the hesitancy of being misunderstood due to
cultural differences. Similarly, attention to cultural values in the day-to-day running of
the house may facilitate retention of Latinos/as, particularly for those individuals who
identify more strongly with their cultures of origin.
Next Step-Female Bilingual-Bicultural Oxford House
Thus far, the focus of this article has been on the opening of the two male bilingual-
bicultural Oxford Houses. Efforts are presently underway to open a female bilingual-
bicultural house. Although research indicates that Latinas are less likely to use substances
than Latinos and other women in the U.S., the women who do use substances may
experience similar problems to Latinos and, in some cases, their need for treatment may be
more severe (Alvarez et al., 2004). As attempts are being made to recruit Latinas for a
potential bilingual-bicultural Oxford House, it is likely that there may be many of the similar
barriers that have prevented Latinos from becoming Oxford House residents. Language,
cultural, and gender specific barriers compound treatment disparities for Latinas (Alvarez et
al., 2004). Another factor related to cultural values is the difficulty of ending relationships
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that might perpetuate an unhealthy lifestyle and low self-esteem (Wong & Longshore,
2008).
It is hypothesized that a female bilingual-bicultural Oxford House can meet the needs of
Latinas seeking recovery. The Latina’s identity is closely related to her relationships with
immediate and extended family members and recovery takes place within this extended
network (Black & Hardesty, 2000). Fortunately, an Oxford House fosters the types of
relationships that many Latinas feel are necessary for recovery. Support that resembles
assistance from extended family members helps many Latinas participate and follow
through with treatment (Black & Hardesty, 2000). Jason, Olson, and Foli (2008) reported
that women living in Oxford Houses overcome obstacles to recovery by helping each other.
Fellow female residents provide “a type of unofficial and informal job assistance program,”
connecting new residents with possible employment opportunities that they have personally
encountered (Jason et al., 2008). Latinas may associate effective treatment outcomes to their
relationship with a fellow recovering addict who becomes their close friend and someone
they can trust (Black & Hardesty, 2000). Furthermore, Oxford Houses are stable, safe
environments in which women can live with their children. Many women want their
children to participate actively in their recovery process and report that their children serve
as a motivation for participating in treatment. For example, some Latinas rely on their
children to notice their improvements and to encourage them to sustain their rehabilitation
efforts (Black & Hardesty, 2000). Thus, efforts to recruit Latinas will emphasize the
communal, family-like atmosphere of an Oxford House.
Summary
Oxford Houses offer a specific type of substance abuse recovery that is presently
underutilized by Latinos (Jason et al., 2007). As a growing body of research highlights the
need for culturally appropriate treatment options for substance abuse recovery, DePaul
University, in conjunction with Oxford House, began to investigate Oxford Houses as a
recovery option for Latino men and women in need of sustainable, drug-free housing
options (Alvarez et al., 2009). Recognizing that cultural issues were a central challenge to
recruitment and maintenance of Latinos in Oxford Houses, various steps were taken to
ensure the cultural sensitivity of the model. As delineated by this article, recruitment of
Latinos into Oxford House has rested on: 1) recruiters who can increase trust and build a
good relationship with potential residents; 2) relationships with widely recognized and
trusted individuals or Latino agencies/organizations.
Through dedication, communication and culturally sensitive outreach efforts, male
bilingual-bicultural Oxford Houses were established in Illinois. These houses may be an
effective option for Latinos/as who are Spanish-dominant and/or identify more strongly with
their ethnic culture. Bilingual-bicultural Oxford Houses may provide a living experience that
is more culturally-congruent with the needs of Latinos/as. For example, these bilingual-
bicultural houses are more likely to use culturally-congruent communication styles,
characterized by an emphasis on relationships, downplaying direct conflict in relationships
in order to preserve harmony, and respect. While the road to recovery is littered with
challenges, a bilingual-bicultural Oxford House may help Latino/as, who identify primarily
to their culture, to remain abstinent.
Acknowledgments
We appreciate the support of Paul Molloy and Leon Venable and the many Oxford House members who have
collaborated with our team for the past 15 years. The authors appreciate the financial support from the National
Institute on Alcohol Abuse and Alcoholism (NIAAA grant numbers AA12218 and AA16973). We would like to
thank Theodora Binion Taylor and Fran Bassett from the Illinois Department of Human Services Division of
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Alcoholism and Substance Abuse (DASA). Without DASA’s participation, the opening of the Latino Oxford
Houses would not be possible. We appreciate DASA’s leadership to empower individuals with addictions to lead
healthy and drug-free lives.
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... Because many do not undergo formal SUD treatment, they may not receive referrals to this recovery resource. Another explanation given is that many recovery houses do not offer their services in the Spanish language or incorporate aspects of Latino culture, making them less attractive to some Latinos with SUDs (Alvarez, Jason, Davis, Ferrari, & Olson, 2004;Contreras et al., 2012). ...
... Despite their low numbers, two studies found that Oxford Houses contributed to the recovery of Latino residents (Alvarez et al., 2009;Contreras et al., 2012). Among the benefits identified were peer support, a sober living environment, and an emphasis on personal accountability. ...
... Among the benefits identified were peer support, a sober living environment, and an emphasis on personal accountability. Intervention studies on bilingual/bicultural Oxford Houses, created by researchers to assess their effectiveness for Latinos, found that using the Spanish language and emphasizing cultural values such as personalismo (i.e., close and personal relationships), simpatía (i.e., harmonious interpersonal relationships), and familismo (i.e., emphasis on family) made the modified recovery residence more culturally appropriate for Latinomale residents (Contreras et al., 2012;Jason et al., 2013). ...
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Our ethnographic study on help-seeking pathways of Latino immigrants in northern California reveals that they turn to anexos in their treatment and recovery quest. Anexos are linguistically- and culturally-specific recovery houses with origins in Mexico and Alcoholics Anonymous and a long history in Latino communities across the United States. Drawing on the findings of our study, we characterize the anexos and compare them to other recovery residences using National Alliance for Recovery Residences (NARR) criteria. The description and comparison reveal that anexos cannot be placed into a single NARR residence category. We discuss why this is the case.
... Recruitment of participants took place from fall 2009 to spring 2012 for a larger NIH-funded study aimed to examine recovery homes for Latinos in recovery from substance abuse [68,75]. A cadre of bilingual/bicultural Oxford House alumni and research assistants was formed to facilitate outreach, recruitment and assessment of Latino participants. ...
... Given the collectivistic orientation of Latino cultures, Latinos may benefit from community-based programs that promote sobriety. Mounting evidence suggests that communal recovery settings promote a sober and inviting environment for Latinos to continue their recovery [68,75]. Our findings suggest that the practice of screening for substance use and dependence should be complemented with the assessment of anxiety symptoms as well as important psychosocial factors discussed in the present study. ...
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Latinos are exposed to adverse psychosocial factors that impact their health outcomes. Given the heterogeneity and rapid growth of this population, there is an urgent need to understand the mechanisms through which psychosocial factors impact substance abuse and anxiety between immigrant and U.S. born Latino adults. The present study employs a multi-group path analysis using Mplus 7.2 to examine generational differences in the paths between affiliation culture, years of formal education, contact with important people, and length of full-time employment to substance abuse and anxiety in immigrant and U.S. born Latino adults who completed substance abuse treatment. A total of 131 participants (Mage= 36.3, SD ± 10.5, 86.3% males, 48.1% non-U.S. born with a mean length of stay of 19 years in the U.S. (SD ± 13.71) in recovery from substance abuse completed self-report measures. Results from the multi-group path analysis suggest that being more affiliated to the U.S. culture is associated with substance abuse, whereas years of formal education and longer full-time employment is associated with reduced anxiety in the immigrant group. Conversely, frequent contact with important people and affiliation to the U.S. culture are associated with fewer years of substance abuse, whereas longer full-time employment is associated with substance abuse in the U.S. born group. Anxiety and substance abuse was correlated only in the U.S. born group. The implications of these findings are discussed.
... Recruitment of participants took place from fall 2009 to spring 2012 for a larger National Institutes of Health (NIH) funded study aimed to examine recovery homes for Latinos in recovery from substance abuse. 42,43 A cadre of bilingual/bicultural recruiters and research assistants collaborated in the outreach, recruitment and assessment of Latina/o participants. Research assistants utilized Internet search engines (i.e., Google, Yahoo) and state wide databases of health services and mental health providers to generate a list of substance treatment programs, hospitals, and community-based agencies servicing Latinos. ...
... 57,58 In this vein, Latinos in recovery from substance abuse disorders may benefit from community-based recovery programs that utilize community assets. 42,43 Our findings suggest that screening and assessing substance use should be complemented with the assessment of family conflict, cultural orientation, and key cultural constructs (i.e., Familismo, collectivism). The information gathered at preand post-treatment may be used for research as well as to inform SAT providers on important aspects to address in their clients' aftercare plan. ...
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The significant research gap on Latino adults who completed substance abuse treatment (SAT) impacts the provision of substance use prevention and treatment for this population. Given the need for culturally-appropriate SAT for Latinos, research that examines the role of cultural constructs and acculturation in relation to substance use behavior is warranted. The purpose of the present study is to test, based on the social control theory, a multiple moderation model using the PROCESS macro(1) to examine the moderating effect of Familismo on the association between history of family conflict and years of substance abuse on Latino males who completed SAT at different levels of acculturation (i.e., cultural orientation). Generational status (i.e., immigrant, U. S. born) and age are used as covariates. A total of 117 Latino male participants (Mage= 37, 54% non-U.S. born with a mean length of stay of 19 years in the U.S.) who completed SAT from facilities located in the metropolitan area of Chicago completed self-report measures. Results from the multiple moderation analysis showa significant three-way interaction (family conflict × Familismo × acculturation), indicating that participants with Latino and bicultural orientation who endorse average to high levels of Familismo have fewer years of substance abuse compared to those with U.S. mainstream culture orientation and low Familismo. Findings illustrate the need for SAT that assesses for family conflict and integrates cultural aspects to reduce substance use behavior on Latino males.
... In an effort to study this issue in more detail, we developed in Illinois culturally modified Oxford houses. Outcomes from these residents were compared to outcomes for Latinos within traditional OHs (Contreras et al., 2012). In that study, Jason et al. (2013) found significant increases in employment income, with the size of the change significantly greater in the culturally modified Oxford Houses. ...
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Research indicates that Latinos underutilize substance abuse interventions; cultural variables may contribute to difficulties accessing and completing treatment for this group. As a result, there is a need to understand the role of cultural constructs in treatment outcomes. The purpose of this study was to investigate how levels of collectivism (COL) and individualism (IND) relate to length of stay and relapse outcomes in self-run recovery homes. We compared Latinos in several culturally modified recovery Oxford Houses to Latinos in traditional recovery Oxford Houses. By examining COL and IND in the OH model, we explored whether aspects of COL and IND led to longer lengths of stay and better substance use outcomes. We hypothesized that higher levels of COL would predict longer stays in an Oxford House and less relapse. COL did not have a main effect on length of stay. However, COL had a significant interaction effect with house type such that COL was positively correlated with length of stay in traditional houses and negatively correlated with length of stay in the culturally modified condition; that is, those with higher collectivism tended to stay longer in traditional houses. When we investigated COL, length of stay, and substance use, COL was negatively correlated with relapse in the culturally modified houses and positively correlated with relapse in the traditional houses. In other words, those with higher COL spent less time and had less relapse in the culturally modified compared to the traditional Oxford Houses. The implications of these findings are discussed.
... However, there is conflicting evidence regarding Latinos' participation in, and benefit from, 12-Step recovery groups (Arroyo et al., 2003;Tonigan, Miller, Juarez, & Villanueva, 2002), and there is little research on Latinos' use of other sources of support, including culturally tailored mutual aid groups (García & Gonzalez, 2009;Gilbert & Cervantes, 1986). More research is needed on community-based modalities of care that address the unmet needs of Latinos with substance dependence (Alvarez, Jason, Davis, Olson, & Ferrari, 2009;Contreras et al., 2012). ...
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This article reports results from a preliminary ethnographic study of a new and largely unknown self-help organization for Latinos with substance use disorders, known as “4th and 5th Step Group” (in Spanish, Grupo de Cuarto y Quinto Paso, “CQ”). It describes the nature of CQ, aspects of group membership, and members' experiences of the organization. Although findings are preliminary, they provide critical information on a potentially important therapeutic resource. More rigorous research with larger and more diverse samples of Latinos participating in CQ is warranted.
... In addition, tightly knit groups moderate such phenomenon as stereotyping (Rydell, Hugenberg, Ray, & Mackie, 2007), impression formation (Dasgupta, Banaji, & Abelson, 1999), and attitude change (Rydell & McConnell, 2005). Similarly, the presence of the cultural value familism in the culturally-modified OH, residents make it a priority to "checkup" on each other's job situations and provide various employment leads (Contreras et al., 2012). In other words, in a culturally-modified OH, residents may be more comfortable with their ethnic culture, have greater proximity, homogeneity, dedication to common purpose, and collective behaviors, and these factors may lead to more opportunities to share job leads and to have better economic outcomes. ...
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The current study compared traditional recovery homes for individuals with substance use disorders with homes that had been modified to feature culturally congruent communication styles. Findings indicated significant increases in employment income, with the size of the change significantly greater in the culturally modified houses. Significant decreases in alcohol use over time were also found, with larger decreases over time in the traditional recovery homes. Use of prescribed medications and days using drugs significantly decreased over time, but not differentially for those in the two types of recovery homes. The implications of these findings are discussed.
... These characteristics may affect willingness to live independently or in group settings, for example, and they may also affect the roles of staff or residents in managing aspects of recovery. Preliminary research is beginning to examine approaches to adapt features of recovery homes to better meet the cultural needs of specific racial-ethnic populations (16). However, more research is required to explore the effectiveness of these adaptations. ...
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The unique, influential, and successful characteristics of “outreach” as a risk‐behavior‐reduction intervention among active drug users is examined. Specifically, we argue that outreach workers’ performance is the distinctive and strategic use of communication both to overcome drug users’ systemic estrangement and then to teach HIV risk‐prevention behaviors. The article provides an ethnographic description of four outreach workers’ abilities to locate and recruit hidden populations, and to establish trust necessary to engage members of those populations in risk‐reduction interventions. The essay closes with theoretical conclusions and implications relevant to current public discussions on outreach and federal HIV expenditures.
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Our ability, as leaders in public health scholarship and practice, to achieve and measure progress in addressing racial/ethnic disparities in health status and health care is severely constrained by low levels of participation of racial/ethnic minority populations in health-related research. Confining our review to those minority groups federally defined as underrepresented (African Americans/blacks, Latinos/Hispanics, and Native Americans/American Indians), we identified 95 studies published between January 1999 and April 2005 describing methods of increasing minority enrollment and retention in research studies, more than three times the average annual output of scholarly work in this area during the prior 15-year period. Ten themes emerged from the 75 studies that were primarily descriptive. The remaining 20 studies, which directly analyzed the efficacy or effectiveness of recruitment/retention strategies, were examined in detail and provided useful insights related to four of the ten factors: sampling approach/identification of targeted participants, community involvement/nature and timing of contact with prospective participants, incentives and logistical issues, and cultural adaptations. We then characterized the current state of this literature, discussing implications for future research needs and directions.
This study analyzed secondary data collected from a recovery home specifically for Hispanic female substance abusers, and from four other recovery homes. Demographics, drug use history, and length of stay were compared to determine if participants of the culturally specific home remained in the program longer, and the reasons why. Results indicated that the women in the Hispanic recovery home stayed over a month longer and were more likely to be poor, unemployed, and methamphetamine or heroin addicts. Regression analysis was used to determine how these and other characteristics predicted length of stay, a variable that has been found to correlate with successful outcomes. Length of stay was associated with the culturally specific program, prior arrests, and years of problem drug usage. Implications for program design and treatment are discussed.
The goal of this study was to develop an attitudinal familism scale that can be used with relatively less acculturated Latinos and that assesses all relevant aspects of the construct. An 18-item scale composed of original items and adapted items from previous scales was tested on a sample of 124 Latino adults. An exploratory factor analysis revealed the following four factors, accounting for 51.23% of the total variance: Familial Support, Familial Interconnectedness, Familial Honor, and Subjugation of Self for Family. Cronbach’s alpha for the scale was found to be .83. Validity analyses revealed significant negative correlations between some aspects of familism and acculturation scores and indicators of exposure to the U.S. culture, confirming previous findings on the subject.
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Much of the literature on drug treatment for women demonstrates a need for gender-oriented, family-centered treatment. Based on observations of a treatment program for Latina women and life histories of female Puerto Rican substance abusers, we expand this argument by describing a trajectory of recovery for female Puerto Rican drug abusers that emphasizes their relationships with children, family, kin and treatment staff. We also identify dilemmas that arise when incorporating these trajectories of recovery into treatment programs. They include (1) the need to balance the interests of mothers with the interests of children; (2) the need to mediate kin and family dynamics that may be counter-productive to recovery, and (3) the importance of establishing treatment contexts that facilitate trust and personal connections without compromising professional distance.
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("Cultural Competency and Achieving Styles in Clinical Social Work" is a duplicate item imported by ResearchGate from the journal's website.) However, there are additional products of the authors collaboration including the following: Chen, S., & Lu, Y.E. (2001). Research and practice in community care and social support. Indian Journal of Gerontology, 15(1&2):109-125.
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Recent publications have suggested that research with diverse ethnic groups requires a reexamination of the methods and measures that have been developed on European-American samples. This is a methodological paper, sharing the lessons learned in the field by one research team. It reports on a study of persons with type 2 diabetes and their partners that included both Latino and European-American participants. Involvement of a multiethnic research team, the willingness to be flexible, and a healthy skepticism about our current methods are among the suggestions that emerge. More specifically, the article addresses such topics as the establishment of trust in the participants, language and meaning, the practical implications of cultural values, and the impact of social class on procedures. © 2002 Wiley Periodicals, Inc.
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In this article, we present findings from 2 studies designed to explore gender-related socialization in Latino/a families. In Study 1, 22 adult Latinas (ages 20–45) completed in-depth interviews. In Study 2, 166 Latino/a college students (58% women; M age 21.4 years) completed self-report surveys. Study 1 findings suggest that many Latino/a parents socialize their daughters in ways that are marked by traditional gender-related expectations and messages. Results of Study 2, which included descriptive analyses and the creation of scales to explore family correlates of gender-related socialization, support and expand these findings. Male and female respondents described different experiences of household activities, socialization of gender-typed behavior, and freedom to pursue social activities or gain access to privileges. Parental characteristics, particularly gender role attitudes, were linked to gender-related socialization. Findings are discussed in light of the developmental and cultural literature on gender-related socialization.