Chapter 40.Cross-Cultural Aspects of Substance-Related and Addictive Disorders

In our ever-shrinking global village, the need for cross-cultural sensitivity and clinical competence increases along with the pace of our contact with other cultures, either through travel or via permanent resettlement. Clinical cultural competence is a lifelong journey. In this chapter, we identify the clinically relevant variables of culture and their implications for assessment and management of addictions. Most of the recent scientific literature in English addresses culture in the context of our modern multiethnic societies in the United States, Great Britain, Canada, and Australia. The definition of culture has shifted in the past several decades. Whereas the term culture has traditionally referred to an individual’s ethnicity or race, it has broadened to include such characteristics as a person’s sexual orientation. The concept of addictions has also changed. Specifically, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association 2013) now includes behavioral addictions (gambling disorder and Internet gaming disorder) alongside traditional substance addictions such as alcohol, cannabis, and cocaine. Although the focus of this chapter remains primarily on psychoactive substances, we include behavioral addictions (gambling, gaming) when possible due to their rising relevance in psychiatry and clinical psychology (see also Chapter 42 in this volume, “Behavioral Addictive Disorders”).