For some people, one of the major roadblocks to addiction treatment and recovery is simply not feeling understood. That was the case years ago for Derrick Yang when he was going through treatment for addiction and mental illness.
“A lot of times,” recalled Yang, who grew up in a Hmong refugee family, “I felt like no one really cared about me or people didn’t really understand what I was thinking. If there would’ve been someone who understood my background or my culture or who had gone through similar things as I did, that would have made me feel more willing to accept help.”
Understanding subtle, or not-so-subtle, cultural differences can make or break addiction treatment, said Sam Vitiello, treatment director for Wilder Recovery Services, a program of the St. Paul-based Amherst H. Wilder Foundation. Wilder Recovery Services offers outpatient addiction recovery options for adults from a wide range of cultural backgrounds with a focus on individuals of Southeast Asian ethnicities.
Programming at Wilder Recovery Services, Vitiello said, is culturally specific, created with a clear understanding of the importance of cultural literacy in treatment and recovery. Because cultural differences can be subtle and require a deep understanding of mores and customs that go beyond word-for-word translation, staff at Wilder created a “cultural broker” role. Cultural brokers are people with deep knowledge of a specific culture and language who work as in-depth translators of sorts, helping clinicians and clients bridge cultural gaps that can impede recovery. While traditional word-for-word translators are helpful, Vitiello said, cultural brokers’ innate understanding helps clients and clinicians go deeper faster.
Hua Xiong-Her, Wilder Recovery Services clinical manager, explained that personal history is key in the cultural broker role. “Cultural brokers are actually from the population of the client,” she said. “They have lived experience of having gone through similar situations. They hold the same values and beliefs as our clients, which makes it easier.”
Wilder’s cultural brokers are “individuals that worked within our company and said, ‘I have this desire to do this,’” Vitiello said. Training for the role includes background on substance use and mental health, so that cultural brokers have a vocabulary and understanding that helps them communicate with both parties.
“Sometimes what happens when you have outside interpreters is you are trying to explain in English what a certain term might be and then they are trying to come up with a word to explain that to their client in their language,” Vitiello said. “Our cultural brokers are trained in mental health and substance use, so they understand on more levels.”
Recently, a new role was added to the Wilder program where “peer cultural brokers,” or people with lived experiences with mental health and addiction as well as deep cultural knowledge, work closely with clients in recovery. Yang, who has worked at Wilder as a peer recovery specialist since 2017, is now a peer cultural broker. He said he relies on his personal history of mental health and addiction struggles to work with Hmong clients with similar backgrounds.
The peer cultural broker position, Vitiello said, “is one of the most influential roles I’ve ever seen, and I’ve been in the field a long time. Clients will say the same: To be able to connect to someone who has the experience of substance use and mental health and can also connect with them culturally is so impactful.”
Unlike traditional therapists, who avoid talking about their personal histories, a peer cultural broker mines their own life story for opportunities for client connection and understanding. “In my role it is OK for me to share,” Yang said. “It helps clients engage.”
Yang said he speaks openly about his own history of mental illness and addiction: “When I meet a new client, it is one of the things I tend to do. I let them be aware that I’ve had these types of experiences.” Knowledge of their shared experience helps clients more rapidly move to deeper discussion, Yang said. And he’s more than willing to lay himself bare to help others: “When I share my experiences, it helps clients understand that I am a person who has gone through similar things as they have. I’m completely comfortable with that.”
Addiction care with a culturally specific focus
There are days when Yang feels like a bridge builder, helping to forge connections between clients and clinicians, many of whom come from completely different backgrounds. Without a cultural broker in the room, he believes, important nuances can be missed.
“For instance, if a Hmong client says, ‘The stars don’t shine anymore. The sun is always dim,’ that is their way of trying to express the fact that they are very depressed,” Yang said. Because Yang has a deep understanding of Hmong culture and mental health and addiction treatment, he is able to accurately explain what that client was trying to say. A word-for-word translator may not have that level of understanding.
Yang also takes into account historic and generational trauma and the impact that may have on clients’ behavior. “I try to teach both parties from a cultural aspect what they might have gone through to help them understand some of the reasons why they think like they do or act like they do,” he said. “It’s not just the translating part. It’s also the helping hand that understands the cultures and the background of how they grew up.”
This approach of seeing a client’s culture as a central element in their recovery journey is a cornerstone of the way Wilder Recovery is structured, Xiong-Her said. The program is open to anyone, but its client base leans heavily toward immigrants, refugees and low-income communities of color. This reality helps make participants feel comfortable in a way that they may not feel in other treatment programs with a more white, European client base.
“Our clients come in and see other clients who are similar to them,” Xiong-Her said. “They see that they can go through this together. When someone looks like you, speaks like you, understands your culture, it helps so much.”
Wilder is a certified community behavioral health clinic, meaning all mental health and substance use disorder services are integrated and that services are billed based on a client’s ability to pay.
“We have all of our programs under one roof,” Vitiello said, explaining that because most people in addiction treatment also have other mental health care needs, this “one-stop-shop” approach makes it easier for clients to get the help they need: “The same day we do an assessment for treatment, we also determine what are the other needs for that individual.” Each client is assigned a care coordinator who assists with referrals.
Xiong-Her said having all these services under one roof “prevents clients from having to go to multiple sites and multiple clinics across the city. Especially for the client population we are trying to serve, it helps to be able to access services in one place.”
Wilder Recovery is an outpatient program, and clients participate in group therapy from 9-11 a.m. four days a week. There are three different groups, Vitiello explained: a Karen-specific group, a Hmong-specific group and a multilingual group with clients who speak different languages.
“We have Burmese, Nepali, English-speaking folks in that group,” Vitiello said. “We would not want to turn someone away if they didn’t speak English. In other programs in the Twin Cities they may turn someone away if they don’t speak English.”
An extension of a culturally specific addiction treatment program is culturally significant food. Treatment programs that only provide food from the majority culture can be off-putting for some people, Vitiello said, so at Wilder Recovery Services, food that appeals to the cultures they serve is always available.
“We provide food that brings joy to our clients,” Vitiello said. “We find that it’s incredibly helpful and welcoming to be able to cook a cup of noodles for someone before group. It’s just so important and that’s part of who we are.”
‘I wanted to help people’
For Derrick Yang, the peer cultural broker role feels like a perfect match for his skills and interests. “After going to school I felt like I wanted to help people,” he said. “The sense of purpose that I wanted for myself, what brought me joy, is knowing that I am helping someone achieve their goals. I have had a lot of issues similar to the people I work with, not just from the addiction but also the mental health part, too. That’s very important in the peer role.”
Though some of his older, more traditional Hmong clients may feel uncomfortable talking about mental illness and addiction, Yang said he’s discovered that many begin to open up after he tells his own story. During his years of struggle, Yang, who was eventually diagnosed with major depression, was hospitalized and civilly committed multiple times. Yang said a turning point came following a suicide attempt after which he realized he had the power to turn his life around.
“I had to question myself,” Yang recalled, “‘Am I really that bad a person, or is it the surroundings and culture around me that are that difficult?’ I then realized that by better understanding my cultural roots and how I fit within the larger community, those are things that I can change.”
Sharing his own struggles breaks down barriers and helps clients realize that he understands what they are going through at a deep level. “I’ve worked with therapists, counselors, case management,” Yang said. “A lot of my clients are really open minded to the ways I’ve changed and recovered — not just from mental health but also from the addiction. My life is really not that different from theirs.”
The close connections he forms with his clients help make recovery seem difficult — but possible. And that’s what Yang is aiming to do.
“If I can do it,” he said, “they see that they can, too.”