Mexican American Culture Albert Ochoa
Social Work/Ethics 2430-002
Mequette M. Sorenson
4/1/2013
Anger Management in Spanish
One of the most significant lessons learned while taking SW/Ethics 2430 Mexican
American Culture is that the Mexican American population is disproportionately
underrepresented and underserved when it comes to mental health issues and substance abuse.
Very few of the substance abuse facilities provide bilingual substance abuse classes and even
fewer mental health classes that include specific access to things like Anger Management in
Spanish. The focus of this paper will be to examine solutions to rectifying this problem. This
paper will provide an approach to reasons for addressing the situation as well as possible avenues
towards implementation, a realistic strategy for creating Anger Management classes in Spanish,
costs associated with that implementation, possible areas of pushback, and interviews with
Mental Health professionals offering insight to the problem and possible solutions to the
problem.
Change and Implementation
Anger Management is a serious mental health issue in part because of the co-morbidity
associated with substance abuse. In my preliminary research of the Greater Salt Lake City area I
decided I would approach this topic through the lens of someone who’s first language isn’t
English and I’m not comfortable speaking English but have been court ordered to participate in
an Anger Management class. I do speak English but couldn’t find Anger Management classes
taught in Spanish. Either I didn’t look hard enough or I wasn’t looking in the right places. In the
Greater Metropolitan area of Salt Lake City, mental health and substance resources specifically
created for the Hispanic and Spanish speaking population are extremely limited.
According to the Office of Applied Studies, Substance Abuse and Mental Health Services
Administration (SAMHSA), “this report focuses on substance abuse treatment admissions and
treatment facilities in the Metropolitan Statistical Area (MSA)1 of Salt Lake City, Utah,2
hereafter referred to as Salt Lake City.” The report goes on to say that in 2008 16% of
admissions by Race/Ethnicity in Salt Lake City Substance Abuse treatment facilities were
Hispanic, while 70% were non-Hispanic.” This statistic is disturbing in that there is a 2 to 1 ratio
slanted in favor of non-Hispanics to receive services such as, Anger Management or other mental
health related services. The report goes on to state that, ”Combined 2004 to 2008 data indicate
that an estimated 2.5 million Hispanic adults-8.7 percent were in need of treatment for alcohol
use (and problems associated with substance abuse such as anger issues) in the past year. While
the difference between the rate for Hispanics and the national average (8.7 versus 8.1 percent.”
This is a relatively small difference but statistically significant. A final note from the report
which I found interesting in the light of what I learned in class about the acculturation between
national born Hispanic’s and those born in the United States, and that is that Hispanic’s born in
this country are more likely to develop problems with substance use and anger issues regardless
of age.
A Realistic Strategy
When first considering how I would approach the obstacle of creating a program specifically
designed for the Hispanic community and filling a vacant need I decided that I would contact
mental health professionals working in the area of substance abuse and mental health issues. I
spoke with Kristi Johnson, LCSW and clinical director for Odyssey House, Intensive Outpatient
Services. In my interview with Ms. Johnson I asked if she felt there was sufficient substance
abuse, mental health and anger management services for the Hispanic Community in the Salt
Lake area, Ms. Johnson replied, “there are never enough services for all that are in need, we live
in Utah and that comes with its own problems and limitations.” Finally I asked Ms. Johnson what
she thought of the idea of Anger Management classes taught in Spanish being made available
through Odyssey House, IOP, I went on to make my pitch to Ms, Johnson by pointing out that
many ethical requirements would be met as well as supporting Diversity within the Odyssey
House structure. Anger Management in Spanish would also fulfill compliance with Culture
Competence guidelines.
The next question I asked myself in terms of assisting professionals to better understand the
context of Hispanic clients I referred to one of the text we have used in class, “Explorations in
Cultural Competence,”(Weaver pg 143) Under the section of this chapter listed as History,
“Understanding Latinos requires knowledge of sociohistorical context of each particular group
(Padilla & Salgado de Snyder, 1992). A brief overview of key points in the history of the largest
Latino groups in the United States will assist helping professionals to understand the context of
Latino clients”. Understanding what the Hispanic client needs is key to a successful strategy.
Costs
The costs associated with the creation of an Anger Management class in Spanish if executed
under the umbrella organization such as Odyssey House, First Step House or The Haven would
be the most effective in terms of overhead. Costs per client to attend the group if the client were
in treatment would more than likely be funded by the county. Once again referring back to the
report by the Office of Applied Studies, Substance Abuse and Mental Health Services
Administration (SAMHSA), “The criminal justice system was the primary source of referral to
treatment in Salt Lake City (52 percent),” The Anger Management class in Spanish could be
offered for a sliding scale cost to those not funded by the county.
A breakdown of expenditures would include $30,000 per year (salary for a mental health
therapist or LSAC that is bilingual. $5,000 for printing cost for collateral information printed
both in English and Spanish, i.e. flyers brochures and mailers and $5,000 additional start up cost.
All educational materials would be provided by the Federal Government at no cost. The U.S.
Department of Health and Human Services Substance Abuse and Mental Health Services
Administration Center for Substance Abuse Treatment, publishes a workbook entitled, “Anger
Management for Substance Abuse and Mental Health Clients.” To reiterate this publication is
distributed at no cost. The Spanish version of the workbook is entitled,”Programa para El
Manejo Del Enojo en clientes con problemas de abuso de sustancias y trastornos de solud
mental.”
Possible Area and/or People of Resistance
In the second of my two interviews I spoke with Kayleen Davidson, LCSW. Ms. Davidson
spent time doing her LDS Mission in a South American country. She is also bi-lingual and often
will do court assessments for Spanish speaking clients. I asked Ms. Davidson if she felt the
Hispanic community would be open and accessible to Anger Management classes in Spanish?
She replied, “Of course you are always going to have Hispanic people that will be resistant to
change but like the non-Hispanic counterpart you will have folks that live in denial about their
mental health issues like anger associated with substance abuse.”
It makes sense that the Hispanic population would be reluctant to examining issues such as
mental health, anger issues and substance abuse. Part of this push back may derive from
problems with acculturation. According to a study entitled, Alcohol and the Hispanic
Communitypublished by the National Institute on Alcohol Abuse and Alcoholism, the report
states, “Acculturation is the process of adapting to the beliefs, values, and behaviors of a new
culture. A critical factor in predicting drinking patterns in the Hispanic community is level of
acculturation. Living and working in the United States, raising families here, speaking English,
and above all, getting an American education all contribute to adapting to American culture. But
as acculturation levels increase, so can alcohol consumption. The evidence is clear that as
women become acculturated to American life, they tend to drink more alcohol. There is mixed
evidence of the same effect for men.”
So do Hispanic people once they have acculturated seek treatment? Do Hispanics seek
treatment for alcohol problems? The report on Alcohol and the Hispanic Community goes on to
say, “About 8.3 percent of Hispanics in the United States needed treatment for alcohol problems
in the past year (data collected between 2002 and 2007). Of those in need, about 7.7 percent
received treatment in a special facility. Limited research shows that treatment can help Hispanics
who speak English and who are highly acculturated to American life. Nevertheless, Hispanics
with severe alcohol problems are less likely than non-Hispanic Whites to seek the treatment they
need. Hispanics also are less likely to join Alcoholics Anonymous, even though AA groups are
available for free and in Spanish.”
It is important that in offering any mental health or Anger Management class in Spanish that
stereotypes be avoided at all costs. It would be counterproductive to offer an Anger
Management class in Spanish (for men) with the belief that because of the machismo aspect of
Hispanic culture this characteristic might need addressing. Machismo and anger are two very
separate issues and as such sensitivity and being aware of one’s own biases or lack of education
concerning machismo. It should be acknowledged that any person that has substance abuse or
mental health issues when under the influence may tend to act out more aggressively and or
sometimes become violent. Again referring to the text used this semester, Explorations in
Cultural Competence, (Weaver pg 151) the author goes on to say, “Helping professionals must
be skilled in incorporating cultural factors into the assessment process (Applewhite, 1998). The
cultural context influences how emotional distress is expressed and can be interpreted. Culturally
based behaviors based on gender roles and expectations must be considered.” Regarding alcohol
dependence, mental health problems and anger issues,about 9.5 percent of Hispanics will have
alcohol dependence at some point in their lives, as compared with about 13.8 percent of non
HispanicWhites. But 33 percent of Hispanics who become alcohol dependent have recurrent or
persistent problems compared with 22.8 percent of nonHispanicWhites.
Comments from Interviews
In summary a few quotes from varies mental health professionals: Kayleen Davidson, LCSW
Odyssey House of Utah, Intensive Outpatient, “The Hispanic Community in Utah is extremely
under represented especially when it comes to mental health issues such as anger management
and substance abuse, providing more services would be the appropriate thing to do.” Kristi
Johnson, Clinical Director, Odyssey House of Utah, IOP stated, “As clinical director of Odyssey
House of Utah, Intensive Outpatient, I’m glad the idea of doing an Anger Management Class in
Spanish has been brought to my attention. This is one more opportunity to reach our goal
towards Cultural Competence.”
Community Organizations Committed to Change
Once again I will quote from the report provided by the Office of Applied Studies, Substance
Abuse and Mental Health Services Administration (SAMHSA), as to the state of treatment
facilities in the Salt Lake area as of 2008. “In 2008, 65 facilities in Salt Lake City offered
substance abuse treatment services: 53 facilities offered outpatient care, 24 facilities offered non-
hospital residential care, and 5 facilities offered hospital inpatient care. (Some facilities offered
more than one type of care.)Of the 53 facilities that offered outpatient substance abuse care, 62
percent provided intensive outpatient services, and 28 percent offered day treatment/partial
hospitalization. Regular outpatient treatment services were offered by 91 percent of outpatient
facilities.” These statistics show that as of 2008 there were many treatment facility that also dealt
in mental health problems one of which would be anger management but these statistics also fail
to highlight the access to the Hispanic community and the specific needs and sensitivity towards
the Hispanic population.
Conclusion
In preparation for the 1st part of this project, the poster board and the research paper I was
surprised that finding hard data was more of a challenge than I had thought it would be. This
struggle to find the hard facts about what anger management, substance abuse and mental health
services there are for the Hispanic community in Salt Lake City were reasons for alarm but also a
wakeup call that if change is to be made it certainly can start with me. Doing this project opened
my eyes that I can do something it may be small but better than nothing at all. To be aware is to
be alive, so I will encourage substance abuse, and mental health facilities such as Odyssey House
to consider the value, responsibility and privilege of creating programs such as, Anger
Management in Spanish specifically for the Hispanic community in Salt Lake City.
Works Cited
Alcohol and the Hispanic Community published by the National Institute on Alcohol Abuse and Alcoholism, niaaa.nih.gov/
Kayleen Davidson, Interview, LCSW Odyssey House of Utah, Intensive Outpatient
Kristi Johnson, Interview, LCSW and clinical director for Odyssey House, Intensive Outpatient Services.
Substance Abuse and Mental Health Services Administration (SAMHSA) The National Survey of Substance
U.S. Census Bureau. (2009). Metropolitan and micropolitan statistical areas. Retrieved on December 2, 2009, from
Weaver, N, Hilary “Explorations in Cultural Competence, Journeys To The Four Directions” pg 143 and 151) Published by Brooks Cole Cengage Learning 2005