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Immigrants and refugees__ Process and context of migration__ Governments, advocacy organizations, academics, and migrating persons often define the term "immigrant" differently, assigning unique meanings to the word, and often using the following terms somewhat interchangeably: aliens, immigrants, nonimmigrants, undocumented aliens, refugees, asylum seekers, and lawful permanent residents. The U.S. government classifies migrating persons into multiple categories based on both the type and legality of migration. "Lawful permanent residents" is the legal term for immigrants who have arrived in the United States through legal channels and with appropriate documentation. "Nonimmigrants" refers to students, tourists, short-term contract workers, and any person temporarily visiting the country while intending to return to their country of origin. "Illegal alien" is any immigrant who has entered the country illegally or who, although entering the country legally, has fallen "out of status." Illegal aliens may be deported at any time if brought to the attention of immigration authorities.[49] The term "illegal alien" has drawn much criticism from advocacy groups as a label that is demeaning and dehumanizing. For this Wikipedia entry, the term "immigrants" will be used to refer to both documented and undocumented migratory persons. The United States Immigration and Nationality Act of 1952 defines a "refugee" as any person who is outside his or her "country of nationality" and who is unable or unwilling to return to that country because of persecution or a well-founded fear of persecution, which must be based on the individual's race, religion, nationality, membership in a particular social group, or political opinion. The number of refugees allowed to enter the U.S. is restricted by quantity and geographic location of origin in accordance with federal policies. After one year of residence within the U.S., refugees may be eligible to obtain Lawful Permanent Residence status.[50] Despite the relatively short history of the nation, patterns and outcomes of immigration to the United States have been complex. Noted historians, journalists, educators, and scholars, such as Mindiola,[51] Zinn,[52] and Power,[53] have extensively detailed the evolution of federal immigration and refugee policy within the U.S., signifying the economic, political, and social contexts and motivations shaping policy initiatives. The nation's earliest immigration legislation, such as the "Free White Persons Act" of 1790 and the Chinese Exclusion Act of 1882, reflected political manipulations of the economic incentives and social pressures of the times and provided a foundation for the codification of discriminatory practices based upon race and nationality within later policy designs. Further policy actions, including the Johnson-Reed Act of 1924, the "Bracero" guestworker program begun in 1942 and consequent Operation Wetback in 1954, and the USA Patriot Act of 2001 continued the process of selective immigration and detention according to racial and ethnic categories. Consequently, immigrant and refugee accessibility to the United States is limited according to fiscal, political, and humanitarian priorities; "numerical ceilings" for each fiscal year are determined by Congressional budget and appropriations.[54] Immigrant and refugee migration is often analyzed as a process consisting of three phases: 1) the pre-migration or departure phase, 2) the transit phase, and 3) the resettlement phase.[55] Many economic, social, and psychological stressors are associated with each stage. Physical trauma and depression and anxiety due to separation from loved ones often characterize the pre-migration and transit phases. During the resettlement phase, "cultural dissonance," language barriers, racism, discrimination, economic adversity, overcrowding, social isolation, and loss of status regarding important social roles are just a few of the obstacles immigrants and refugees may encounter. For undocumented immigrants, difficulty obtaining work and fears of deportation are common. Refugees frequently experience concerns about the health and safety of loved ones left behind and uncertainty regarding the possibility of returning to their country of origin.[56][57] Cause__ Many of the genetic, psychological, and environmental factors identified as potentially contributing to the development of substance abuse behaviors by multiple-generation by non-recent immigrants and refugees are similar for more recent immigrants and refugees. Heritable genetic, cognitive, and temperamental characteristics may signify increased risk or protective factors for biological family members. Psychological theories, such as the psychoanalytic, behavioral, cognitive, and social learning models may help to explain the role of environment in shaping substance abuse behaviors and patterns. Sociocultural models focusing on family interactions, peer influences, and social environments may describe the interpersonal mechanisms partially leading to substance abuse behaviors.[58] However, several models have been proposed that specifically apply to the development of substance abuse behaviors and disorders among immigrants and refugees. The majority of these models relate to individual experiences of migration and assimilation, integration, and segregation upon entry into a new culture. One theory suggests that immigrants and refugees simply continue the substance use and abuse patterns and behaviors they maintained while residing in their country of origin, regardless of the stressors and any process of cultural adaptation they may experience in their new country.[57] Conversely, the acculturation (or assimilation) model proposes that substance abuse behaviors may be explained by examining the process in which recent immigrants and refugees adopt the attitudes, behaviors, and norms regarding substance use and abuse that exist within the dominant culture into which they are entering. With this theory, patterns of substance abuse among immigrants and refugees will more closely resemble the patterns of the dominant society than patterns existing within the culture of origin, if there are significant differences.[57] Similarly, the acculturative stress model suggests that substance abuse functions as a coping mechanism to attempt to deal with the stressors that result directly from the process of immigration, such as forced migration, involuntary settlement, "cultural conflict" and alienation, role transition and loss of status, economic insecurity, and the scarcity of resources.[57] Finally, the intracultural diversity model argues that universal theories attempting to explain substance abuse by immigrants and refugees fail to address diversity within and between cultural groups. This model proposes multiple pathways to addiction and recovery that cannot be generalized as applying to specific racial and ethnic populations. Proponents of this theory also point to intergenerational differences in substance abuse behaviors as evidence supporting the model and to identify potential risk and protective factors among individuals.[57][59] Empowerment social work and culturally competent practice__ The National Association of Social Workers (NASW) provides standardized guidelines regarding professional values and codes of ethical conduct for individual social workers. The NASW identifies the following core values: service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. Furthermore, the association provides detailed guidelines related to confidentiality, informed consent, self-determination, and many other aspects of practice with clients and colleagues.[60] All social work values and ethics are implicated in direct practice with immigrants and refugees; however, special attention must be paid to codes of conduct regarding client self-determination, informed consent, cultural competent practice, and confidentiality. A variety of strategies have been suggested for social work practice in the field of substance abuse recovery when working with immigrants and refugees. In a literature review of the research on immigration, acculturation, and substance abuse, Leow, Goldstein, and McGlinchy (2006) recommend tailoring intervention and treatment services and materials for specific racial and ethnic cultures by utilizing language, images, values, and norms belonging to each culture and incorporating knowledge of cultural themes, attitudes, family structures, and service access points. However, before services can be provided, they contend, social workers should recruit and consult with members of the immigrant and refugee communities they are intending to serve regarding program development and implementation. Additionally, social work staff and volunteers should demonstrate cultural competency in two significant ways: 1) by possessing the "attitudes, knowledge, and skills" necessary when working with diverse groups, and 2) by continually evaluating their personal values and beliefs and recognizing differences in perspective.[61] Similarly, Pumariega, Rothe, and Pumariega (2005) focus on the overall accessibility, acceptability, and relevance of programs for immigrants and refugees coming from specific cultural backgrounds. Differences in "symptom expression" between various racial and ethnic groups may bias both social workers and diagnostic tools during assessment and intervention efforts. Ignorance of the role and significance of such factors as site location, documentation, language, social stigma, and treatment methods on individual and community perceptions regarding services may render intervention and treatment efforts largely ineffective. The authors also discuss the importance of incorporating the process of cultural transition into direct practice with immigrants and refugees by utilizing unique practices from a culture of origin into "Western-oriented" mental health services and re-evaluating characteristics and traditions within that culture that have been "negatively valued" in dominant, American culture. This includes recognizing and building on existing individual and cultural strengths to increase resilience.[56] When working directly with refugees, Adams, Gardiner, and Assefi (2004) emphasize the necessity of interpreters and advise the use of a preventive screening tool, such as an adaptation of the Harvard trauma questionnaire, to gather information regarding exposure to physical and psychological trauma, the presence of acute and chronic illnesses, use of alcohol and other drugs, and participation (voluntary and coerced) in specific cultural and medicinal practices, such as female genital surgery. Furthermore, they highlight the importance of contextualizing and understanding the migration process by inquiring as to an individual's country of origin and reasons for migration, experience of migration (time spent in refugee camps, circumstances surrounding travel, etc.), social roles and status prior to migrating (employment, education, etc.), and the status and location of close family members.[62] Street Children__ Street children in many developing countries are a high risk group for substance misuse, in particular solvent abuse.[63] Drawing on research in Kenya, Cottrell-Boyce argues that drug use amongst street children is primarily functional – dulling the senses against the hardships of life on the street – but can also provide a link to the support structure of the ‘street family’ peer group as a potent symbol of shared experience.[64] Cottrell-Boyce criticized agencies working with street children for ‘importing’ Western rehabilitation models emphasizing detachment from negative peer pressure, for failing to appreciate the different social context within which dependence took place.[64] Dependence, Moore argues, is too often understood as a ‘measurable psychobiological “it” which can be separated from the social context in which dependence occurs’. Moore challenges this tendency, proposing that manifestations of substance dependence which occur in different circumstances cannot be treated as the same phenomenon, ‘the concept of dependence’, Moore suggests, ‘makes little sense unless it is situated within a specific social context’.[65] |
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