**15. Cultural competence in the community**

Aside from improving cultural competence in organizations, it is equally important to focus these efforts on refining communities. With minority populations migrating to different communities in the United States, there is an urgent need to make communities more inclusive (e.g., increase awareness of implicit bias and understanding of groups' needs through CLAS and other culturally responsive practices) toward diverse populations [103]. This diversity and inclusion may help mitigate some of the psychosocial stresses related to SUD among minority populations. Access to treatment for clients is usually available in their own neighborhoods and communities, and therefore it is critical for SUD treatment programs to adopt a community approach to cultural competence. Mounting evidence suggests that programs with greater knowledge and investment in minority communities are more likely to increase access to care [104]. Programs investing in communities of color may also benefit some of the most vulnerable members of society, such as homeless individuals [105].

Clients with SUD issues should feel comfortable accessing providers in their own communities that offer a safe and acceptable space for them to seek health care options. Efforts should be made to culturally integrate communities to develop programs and policies that are meaningful for diverse populations and to ensure cultural values are shared across the population [103, 106]. Cultural competence in the community setting could lead to the inclusion of community members and even increased participation and involvement in community issues [103]. Cultural competence could lead to numerous benefits from the individual to the communal level and lead to improved health outcomes by increasing understanding, acceptance, and respect for diverse clients and their communities [107].

## **16. Conclusion and future directions**

The evidence provided in this chapter suggests that Latinos, as the largest ethnic minority group in the U.S., have a distinctive history of substance use and help-seeking behaviors. The socialization of substance use in their lives and the role of substances in their history of immigration, for instance, are important issues that may be impacted by structural racism. The prevalence of SUD in Latinos is affected by factors, such as unemployment, acculturation stress, and discrimination. Discrimination, in terms of exclusive prevention and treatment policies and practices by funders, regulators, and service providers, maybe one of the most critical factors contributing to SUD. A clear example is the bifurcated opioid treatment system, where low income and publicly insured Latinos are more likely to receive methadone, while mid- and high-income non-Latino Whites are more likely to receive buprenorphine, a medication with significant advantages to obtain, impact, and side effects.

Latinos have also distinctive prevalence rates regarding the use of specific substances. Some of these substances are more accessible in some regions of the United States. Latino adolescents also have unique primary substances of choice (e.g., marijuana and methamphetamine) compared to adults, and the prevalence of use among these youth reflects their developmental stage, with much higher

use during thrill-seeking ages that decreases as adolescents age. Overall, ecological factors, such as family, employment, migration, and discrimination, play an important role in Latino substance use and need to be studied further.

Cultural competence has become a critical approach to understand and respond to the substance use disorder issues experienced by groups vulnerable to discrimination and/or racism. In the past 30 years, research in the definition, operationalization, and assessment of this concept has slowly gained attention because of its potential to improve prevention and interventions to address SUD. But significant challenges remain to implement culturally responsive practices in social, educational, and government institutions to reduce acculturation stress related to Latino substance use and access to SUD treatment. Additional research is needed to establish the impact of key components of culturally responsive practices (e.g., inclusive policies, matching provider and clients based on language and cultural background) with different areas that support minorities achieving sobriety.

Future research is needed to understand the risk and protective factors for problematic substance use and treatment access among Latino migrants and future generations of Latinos living in the United States and intervene with structural factors, such as immigration and inclusive policies and responsive organizational practices to improve Latino health. If resilience factors can be identified and encouraged, addiction and its adverse medical and social consequences can be reduced. Latinos have become the fastest-growing population entering SUD treatment. The distinctive nature of Latinos' patterns of substance use, substance of choice, cooccurring mental and primary care issues, and barriers to access care highlights the importance of developing and implementing culturally informed interventions that consider clients' background, immigration experience, and linguistic service needs to help reduce substance abuse among Latinos. Policies and practices that are culturally responsive also referred to as antiracist may have the foundation and drive to have a significant impact on eliminating disparities and promoting the health equity that Latinos have long deserved.

*Cultural Competence as a Response to Structural Racism in Latino Substance Use and Access… DOI: http://dx.doi.org/10.5772/intechopen.103710*
