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The Need for Cross-Cultural Counseling in Addiction Treatment

The Need for Cross-Cultural Counseling in Addiction Treatment


The new push for addiction counselors these days is to be client centered. This means a focus on compassion, collaboration, and especially meeting clients where they are, but what does that really mean? To meet clients where they are, should we have to understand their cultures? And if so, how do we do so? In this column, I will define culture, speak to the concept of “cultural sensitivity” versus “cultural competency,” and demonstrate the importance of culture in the addiction counseling process. 

Counselors are required to be respectful of clients of all cultures and backgrounds. Many people call this “cultural competence,” though “competence” would mean that we fully understand everything about clients’ positions or cultures. While it is likely impossible to be “competent” in any culture, including our own, it is possible to be sensitive to a culture that is not ours.


Cultural differences exist in clients’ socioeconomic status, racial or ethnic identification, gender, sexual orientation, physicality, cognitive ability, religion, and more. So what do we mean by “culture?” According to Alley Dog, an online psychological glossary,

Culture is the set of ideas, behaviors, attitudes, and traditions that exist within large groups of people (usually of a common religion, family, or something similar). These ideas, behaviors, traditions, etc. are passed on from one generation to the next and are typically resistant to change over time. Cultures vary widely not only across the world, but even right next door. For example, if you live in America and then visit different areas of Europe, you may notice that people often get closer to each other physically in social settings—tables are often closer together at restaurants, people stand closer to each other when they speak, etc. These are examples of cultural differences (“Culture,” n.d.).

Another definition, found on Merriam-Webster’s website, defines culture in three different ways (n.d.):

• “The customary beliefs, customs, arts, etc., of a particular society, group, place or time”

• “A particular society that has its own beliefs, ways of life, art, etc.”

• “A way of thinking, behaving or working that exists in a place or organization (such as a business).”

To delve into this concept a little deeper, let us look at the definition of multicultural counseling. Multicultural counseling is, according to Sue and Torino,

Both a helping role and process employing strategies and goals congruent with individuals’ experiences and cultural values; recognizes persons’ identities in individual, group, and universal dimensions; advocates using universal and culture-specific techniques and roles in the healing process (1994).

Counselors may use this definition interchangeably with “cross-cultural counseling,” but perhaps a better definition of cross-cultural counseling is,

The pursuit and application of universal and indigenous theories, strategies (e.g., direct service, consultation, training, education, prevention), and research paradigms of counseling and mental health help seeking, grounded in an in-depth examination, understanding, and appreciation of the cultural and epistemological underpinnings of countries located worldwide (Altmaier & Hansen, 2011).  

This leads to asking the following question: “Should someone’s counselor be someone from that client’s culture or can the counselor be someone who is culturally sensitive?” (Akutsu, Lin, & Zane, 1990). According to Akutsu et al., “It seems that the culturally responsive nature of the counselor is most important here, since empathetic involvement has been demonstrated to be a key predictor of counselor credibility” (1990).


Any cross-cultural addiction counseling must also demonstrate a benefit for families as a whole. The role of each family member must be respected in counseling, and counseling should be conducted in accordance with the family and cultural values. For instance, it would be helpful to conduct sessions in an environment comfortable and familiar to the participants—a school or church might be a better choice than a treatment center or agency. Individuals should not be pushed to a level of participation with which they are not comfortable.


Within the concept of culture there is a wide variety of identities, languages, and subcultures. Also, within each of these cultural aspects, differences in values, behaviors, and attitudes will vary based on the generation, acculturation, ethnic experiences, socioeconomic status, enculturation, gender, religion, region, age, sexual orientation, visibility, and history of discrimination. Many or all these factors can mold people’s perspectives of themselves as well as influence how they view life. To provide more effective cross-cultural counseling, counselors must be aware of their communication style, counseling style, and client expectations. Having and utilizing a large repertoire of verbal and nonverbal behaviors will be beneficial to this goal (Zhang & Dixon, 2001).

How addiction counselors speak to clients is as important as what counselors say in all counseling, and especially in cross-cultural counseling. Consider the following aspects:

• Tone of voice, (pleasant, with volume audible, but not too loud)

• Articulation of each word (important, especially with clients whose native language is not English)

• Checking with clients regarding rate of speech (i.e., not too slow or fast)

• Avoiding slang, technical jargon, and the use of ethnic communication styles that are not naturally a counselor’s own

In some cultures, verbal communication may be more formal than it often is in the greater American culture. Counselors should not assume that a first-name basis is appropriate for all client relationships. Assume formality when in doubt, or ask clients how they prefer to be addressed. Too much chatting, too many questions or being “too nice” may cause clients to feel uneasy or suspicious. Beginning counseling sessions with open-ended questions and using more reflective statements than questions can help establish and increase rapport, as can demonstrating patience, respect, and an awareness of clients’ cultures.

Subject matter may influence the success of cross-cultural interviewing. Certain subjects may not be acceptable to clients for discussion, such as those not typically shared with an unfamiliar person. Personal or family affairs, questions about family or spouses, and “personal” concerns such as alcohol or drug use may be considered private matters. If so, counselors might need to explain why it is necessary to ask certain questions. Or, counselors can say to clients, “Please tell me any time you do not want to answer a question.”

Culturally sensitive counselors will need to learn how to overcome language barriers posed by clients who use English as a second language, especially how to use interpreters effectively with non-English-speaking clients (US Department of Agriculture, 1986). A final consideration in cross-cultural counseling is to identify the expectations of clients. One example might be that clients with high adherence to their cultural values may strive to maintain a role in counseling that protects the family honor. Another example could be clients who expect immediate symptom relief from a goal-oriented, authoritative counselor (Kim, Atkinson, & Umemoto, 2001).

In conclusion, multicultural counseling is possible with cultural sensitivity combined with client-centered addiction counselors. This means we need well-trained counselors who see compassion, collaboration, and meeting clients where they are—plus cultural sensitivity—as the necessary ingredients for cross-cultural or multicultural counseling. It is culturally sensitive for us all to remember that we will never know everything about a culture, including the one with which we identify. c

About the Author

Pete Nielsen, CADC-II, is the CEO of the California Consortium of Addiction Programs and Professionals (CCAPP). Mr. Nielsen has worked in education as a campus director, academic dean, and an instructor. He has also worked in the SUD field for many years as an interventionist, family recovery specialist, counselor, and administrator.


Akutsu, P. D., Lin, C. H., & Zane, N. W. S. (1990). Predictors of utilization of counseling among Chinese and Caucasian students: A test of the proximal-distal model. Journal of Counseling Psychology, 37(4), 445–52.

Altmaier, E. M., & Hansen, J.-I. C. (Eds.). (2011). The Oxford handbook of counseling psychology. New York, NY: Oxford University Press.

“Culture.” (n.d.). Retrieved from https://www.alleydog.com/glossary/definition.php?term=Culture

Kim, B. S. K., Atkinson, D. R., & Umemoto, D. (2001). Asian cultural values and the counseling process: Current knowledge and directions for future research. The Counseling Psychologist, 29(4), 570–603.

Merriam-Webster. (n.d.). Culture. Retrieved from https://www.merriam-webster.com/dictionary/culture

Sue, D. W., & Torino, G. C. (1994). Racial-cultural competence: Awareness, knowledge, and skills. In R. T. Carter (Ed.), Handbook of racial-cultural psychology and counseling: Vol. 2. Training and practice (pp. 3–18). New York, NY: Wiley.

US Department of Agriculture. (1986). Cross-cultural counseling: A guide for nutrition and health counselors. Washington, DC: Author.

Zhang, N., & Dixon. D. N. (2001). Multiculturally responsive counseling: Effects on Asian students’ ratings of counselors. Journal of Multicultural Counseling and Development, 29(4), 253–62.