Asian Americans have long been presented as the “model minority” in the United States – intelligent, hardworking, and stereotypically more willing to assimilate to their adopted culture than other immigrants. This facade masks real mental health and alcohol use problems within the Asian American community that often go unnoticed and undiagnosed by even professional clinicians.
From a purely statistical perspective, Asian Americans seemed to have largely avoided the substance abuse problems affecting other ethnic groups in the United States. The National Institute on Alcohol Abuse and Alcoholism found that Asian Americans drink less than white Americans and African Americans: 38 percent compared to 59.8 percent and 43.8 percent, respectively. According to Public Health Reports, Japanese Americans struggle the most with substance abuse among a particular population of Asian Americans.
One widely speculated reason for the lower-than-average rates of alcohol consumption among Asian Americans is what is known as “alcohol flush reaction,” sometimes (and perhaps derogatorily) referred to as “Asian flush.” Over 30 percent of people of East Asian descent (Chinese, Taiwanese, Japanese, and Korean people) have a gene that does not break down alcohol as it should. It is a natural mutation and not typically found in people of other ethnic lineage. The failure of the gene to properly deconstruct alcohol in the body leads to moderately unpleasant symptoms after even minimal alcohol consumption:
- Increased body temperature
- Blotches on the skin, causing itchiness
The effects are harmless, but they are uncomfortable, and the Alcohol Research & Health journal posited that many East Asians avoid drinking because of this. However, other research has found that “determined drinkers [will] ignore the discomfort and continue drinking.”
The Model Minority Stereotype
The Journal of Ethnicity in Substance Abuse cautions that alcohol flush reaction, as well as the “model minority” stereotype, leads many clinicians to be “less likely to diagnose Asian Americans with alcohol use disorder.” Clinicians not used to working with people of Asian descent might perceive fewer clinical symptoms of alcohol use disorder among such a population.
For reasons like this, alcohol use disorder among Asian Americans tends to go unreported and undiagnosed. Urban Institute notes that the “model minority” perception papers over many of the inequalities and painful realities that Asian Americans experience. For example, other research published in the Journal of Ethnicity in Substance Abusenotes that Asian Americans born in the United States face high rates of pressure to adopt the cultural practices and norms of their adopted homeland while still remaining faithful to the traditions of their parents, such as speaking one language at home and another at school. This stress is a driver for many such Asian Americans having higher rates of substance abuse than first-generation immigrants, according to findings published in the Journal of Studies on Alcohol and Drugs.
This may be because while first-generation immigrants were unlikely to engage in American-style drinking habits, their children and grandchildren (second- and third-generation Asian Americans, respectively) are adopting the values and practices of their homeland at a much faster rate. Being born in the United States means being born with a higher probability of developing a drinking problem than people born outside the US, according to Derek Iwamoto, an assistant professor in the department of psychology at the University of Maryland, College Park. Iwamoto authored a research study that found that alcohol abuse increased from 0.74% to 3.89% among Asian Americans, between the ages of 18 and 25, between 1991 and 2002, which led NBC News to write that “heavy episodic drinking and alcohol abuse are increasing among US-born Asian American adults.”
Heterogeneity and Cultural Barriers
Iwamoto lamented that not enough research focuses on actual patterns of alcoholism among Asian Americans, instead choosing to focus on the alcohol flush reaction. Researchers writing in the Journal of Psychoactive Drugs fear that the attention given to alcohol flush reaction creates an impression that Asian Americans are “immune” to the effects of problematic drinking or substance abuse in general. In reality, however, Asian Americans are nonetheless prone to addiction disorders and need the same kind of help that people of any ethnic background would.
The journal also points out that “Asian heterogeneity and cultural barriers” have prevented researchers from collecting accurate data about rates of substance abuse within Asian American communities. As with a number of other immigrant communities in the United States, there are also cultural issues of taboo, denial, and honor (specifically, dishonor) that are incurred when discussing a problem like alcohol abuse, underlying mental health causes and conditions, and the treatment thereof. The combined institutional barriers, and weak (or even nonexistent) community infrastructure when it comes to support and recovery accountability, make it increasingly difficult to treat a number of different ethnicities that fall under the “Asian American” umbrella.
The researchers writing in the journal say that “cultural factors” (such as family involvement) have to be taken into consideration when dealing with rates of alcoholism among Asian Americans, and also when creating effective treatment models for this population.
Drinking in Asian American Culture
Because of factors like this, Asian Americans are notably less likely to seek professional mental health services, or to delay seeking treatment, until their symptoms have become too disruptive to live with, even though the rates of mental health problems among Asian Americans is comparable to such rates among the general American population. According to the Journal of Substance Abuse, Asian Americans tend not to talk about their mental state of mind or their problems with addictive substances, and rehabilitation and recovery services within their communities are underused.
Within Asian American families, issues of alcohol abuse are viewed as a source of shame and dishonor being cast upon the family unit. There is immense pressure for families to maintain a successful image, especially among immigrant families who tend to feel compelled to prove to their American counterparts that they belong in their adopted home.
Discussing a drinking problem tends to be avoided or outright denied, and the idea of talking to a stranger (someone outside of the family) about personal problems is highly frowned upon. When Asian Americans ask for help, they tend to go to close relatives or friends from their own community; those who go outside of their inner circles tend to consult practitioners of traditional and holistic Asian medicine. By the time a practitioner of “Western” methods of substance abuse treatment is brought into the picture, the damage caused by the alcohol abuse is usually severe. For reasons like these, 33% of Asian American patients usually drop out of treatment before completion, according to a study published in the Journal of Consulting and Clinical Psychology.
To this point, research quoted by the American Psychological Association has found that Asian Americans have a 17.3% chance of developing a psychiatric disorder in their lifetimes, but are 33% less likely to admit to it, or get help for it, than white Americans. A study found that only 8.6% of Asian Americans actually went to a mental health professional for help compared to 18% of the general population seeking such a service. However, when treatment services are culturally sensitive toward the concerns of Asian Americans, “participation in recovery programs tends to increase.”
Culturally Sensitive Treatment
Cultural sensitivity entails providing appropriate assessment measures and screening tools. Asian Americans often express themselves emotionally differently than members of other ethnicities, even more so when discussing issues of distress relating to mental health and substance abuse. For example, they may not show signs of depression or suicidal thoughts on standard screening tests, and they may be reluctant to divulge their personal struggles to a therapist (and/or a therapist from a different ethnic background). However, the Huffington Post suggests that practitioners might be able to get to the heart of the matter by talking about psychosomatic symptoms (e.g., headaches, sleep disturbances, or indigestion) as a way of gradually steering the conversation toward feelings and emotions.
A significant factor in making alcohol abuse treatment more appropriate for Asian Americans is family. Family has long been a key part of Chinese civilization, for example, and that has carried over for many Asian American families, especially those tracing their roots back to East Asia. People looking for alcohol use disorder counseling should have the support and encouragement of their parents, siblings, and other close relatives (which may be a sphere much wider than what white Americans consider to be their own respective “close relatives”) for the need for recovery to be validated. Failure to secure this investment might be construed as letting the family down while having them on board for the program maximizes the chances that treatment will be effective and beneficial. The Psychiatry journal notes that practitioners should thus consider family involvement to be one of the top priorities for a culturally sensitive treatment schedule for Asian Americans.
Other ways treatment providers can improve their outreach to Asian Americans suffering from alcohol use disorder is by including bilingual programs in their services, as well as making allowances for religious customs and even cognitive patterns shared by this particular demographic. It may even be necessary to involve practitioners of traditional Asian medicine if that will help the client feel more comfortable engaging with therapeutic methods. Similarly, psychosocial services, like support groups, must also be adapted to take cultural considerations into account. Expecting a client from a traditionally conservative Asian background to be emotionally vulnerable in a 12-Step setting will almost certainly backfire.
Alcohol Abuse among South Asian Americans
Many different ethnic lineages fall under the general “Asian American” umbrella. While most research looks at the Asian Americans descended from East Asian immigrants, more and more attention is being paid to how Asian Americans with parents from Southeast Asia, the Indian Subcontinent and the Middle East, are experiencing alcohol abuse within their respective communities. New Republic notes that, in much the same way that Americans of Chinese descent don’t engage with mental health providers as much as they should, there is a culture of silence regarding mental health among South Asians and their American children. In 1998, for example, a young Indian man studying to become a doctor in Massachusetts took his own life; his suicide note read, in part, “If I tell everything, I will lose everything.”
Much like Americans descended from East Asian parents, South Asian Americans are also driven by issues of family honor and proving themselves to their white American peers. Priya-Alika Elias, the New Republic writer, explains that “toughing it out” in the face of stress is “something you’re used to hearing in South Asian culture,” where the higher the threshold of pain, the bigger the bragging rights. The concept of asking for help is unthinkable. Asian cultures are inherently communal in nature, and upholding the family’s honor by never showing weakness is, in many ways, more important than personal wellbeing. For a growing number of South Asian Americans, the only way to cope with the pressure is to drink, and to hide the drinking from friends and family so no one asks too many questions. Even among those who are aware of a friend’s alcohol abuse, the topic is not discussed; the only time it surfaces is when the problem becomes too severe to ignore any further.
Statistically, South Asian Americans between the ages of 15 and 24 have a high chance of developing major depressive disorder. A report issued by the Asian and Pacific Islander American Health Forum (which, in its title, suggests that no one listens to Indian Americans despite their stress and depression) found that young South Asian American women have a higher suicide rate than the general US population, but South Asian Americans have “the lowest rate of utilization of mental health services,” for reasons tragically similar to those expressed by East Asian Americans.
In 2004, an article published in the Women & Health journal found even more similarities. Indian immigrants felt more comfortable using traditional home remedies for depression and would only see a (Western) doctor as a last resort, one they could not afford and made them feel even more uneasy. Doctors at the University of Missouri suggested that South Asians tend “not to report their pain to avoid burdening others or being seen as weak.”
Writing in New Republic, Priya-Alika Elias (of Indian descent herself) opined that the traditional way is to prefer silence over asking for help. Traditional Indian culture lionizes endurance and stoicism, especially when “subjected to the social pressure of conforming to a model minority stereotype.” Elias does not mention that East Asian Americans are often subjected to the same standard, but the effects she lists, such as asking for help when the problem becomes too severe to control, are almost exactly the same.