The Colonial Character of the Drug Treatment Superstructure: Theorizing Collective Cultural Resistance to Varying Manifestations of Coercive Control

ABSTRACT

Despite being one of the smallest racial/ethnic groups in the State of Hawai‘i (~10–21%), Native Hawaiians have persistently and disparately comprised the largest racial/ethnic group in the state public treatment system (≥43%). One outcome of Hawaiʻi’s history as a colonial subject, is that social institutions of the State became characterized by the imposition of social control emphasizing the maintenance of punishment mediated through the dynamics of state-sanctioned coercion. At both the individual and community level, implications are drawn out to hypothesize that treatment avoidance or community-wide disengagement patterns of help-seeking, is a manifest expression of collective cultural resistance to what has long been regarded by Hawaiian communities as a “haole [foreign] system” of medicine. While cultural interventions imbued with cultural sensitivities remain relevant to improving treatment care, there is a false assumption embedded within the current treatment paradigm, projecting a doctrine of repeated and prolonged calls for cultural competence and cultural humility to correct the status quo of cultural deficiencies in the publicly funded treatment system. This article proposes an alternative theory, arguing that the source of the problem is the existence of a drug treatment superstructure itself, rooted in the historical reproduction of colonial persecution and continued subjugation of Native Hawaiian identity.

KEYWORDS:

• Hawaiian
• substance use
• treatment
• help-seeking
• service utilization
• drug abuse
• colonial and postcolonial scholarship

Disclosure statement

No potential conflicts of interest was reported by the author(s).

Notes

¹ In Hawai‘i, ADAD contracted adult and adolescent residential and outpatient drug treatment services (and less characteristically so for non-ADAD contracted modalities and outpatient methadone assisted treatment) maintain a criminal justice affiliated treatment population census of over 90%. ADAD sponsored reports (such as PHAC, 2022), to the contrary, maintain the claim of “voluntary self-referral” rate of 50–60% among Native Hawaiian. Readers must question that statistic as the classification of “self-referral” by service modality and ethnicity of the service user is not disaggregated by adolescent versus adult. Questions regarding the number of adult Hawaiians receiving outpatient or residential substance abuse treatment services due to criminal justice affiliation compared to non-criminal justice involvement in ADAD contracted and non-contracted providers in the State appear unaccounted for. In addition, the definition of “self-referral” appears still to include Hawaiians who “self-refer” themselves to treatment due to affiliation with the criminal justice system via arrest preceding admission, pretrial sentencing precipitating the admission, or post-conviction diversion. Finally, ADAD sponsored reports approximating Native Hawaiian “treatment need” define treatment need as any occurrence of substance use (in line with the criminal justice system’s abstinence-only stance), which is inherently problematic given such operationalization is in tautological form, warranting drug treatment irrespective of the severity, complexity, and chronicity of substance use (see PHAC, 2022).