Cultural competence in addiction psychiatry

GOAL: To inform clinicians regarding attitudes, concepts, and skills relevant to clinical cultural competence in addiction treatment. METHOD: On the basis of National Institutes of Health-American Psychiatric Association invitational conference, 2 Grand Rounds (Columbia University and the Mayo Clinic), and the authors' experiences. FINDINGS: Clinicians should consider their attitudes toward their own ethnic background and substance use. Cultural concepts useful in care of addiction include norm conflict, deviance-versus- pathology, emic-etic distinctions, ceremonial-versus-secular substance use, and cultural change. Relevant skills include taking a culture history, assessing cultural transference and countertransference, assessing and working with the patient's intimate social network, and considering cultural factors in pharmacotherapy and psychosocial therapies. All clinicians possess some level of skill in providing cross-cultural care, but can add to this skill level throughout a career of practice. Developing clinical cultural competence serves not only professional, but personal growth.