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Alcohol as a problem for the South Asian community

In recent years there has been growing awareness of alcohol problems in members of the South Asian community in the UK.While the overall level of alcohol problems remains substantially lower in South Asians than in the indigenous population, the problems are probably increasing and there is evidence that South Asians may be particularly vulnerable to some adverse effects of alcohol such as liver disease. Some special treatment services for South Asians have been established.

Here, Narinder Gharial, Mental Health Project Manager for the Confederation of Indian Organisations (UK) gives her personal perspective on why alcohol matters to the South Asian community.

It needs to be said at the outset that it is not possible to embrace the diversity of South Asian peoples in a single definition of culture. The South Asian culture is not homogeneous. It encompasses a large geographical area covered by India, Pakistan, Bangladesh and Sri Lanka. In addition there are regional variations in these countries that reflect clan, tribal and caste differences. There are many religions practised in these regions and hundreds of languages spoken including innumerable dialects. This picture is further complicated by the migration history of South Asians to countries in Asia, Africa, South America, Europe the Middle East and USA and islands such as Mauritius in the Indian Ocean and Trinidad and Tobago in the West Indies.

Culture has been defined as the learned values, beliefs, norms and way of life that influence an individual’s thinking, decisions and actions in certain ways. It would also be useful to consider culture as a process which is dynamic and evolving. This means that in the context of South Asians living in the UK, the culture of first generation immigrants has been subjected to knocks and jolts and the values that they arrived with have needed to be revised in face of shifting immigrant status, financial constraints, employment regulations and housing deprivation. The second generation South Asians are struggling to juggle two value systems – the domestic one and the external one. For many young people the balancing of identities is proving stressful. It is against this backdrop that this piece is pitched.

The Alcohol Research Forum in its report for Alcohol Concern (2002) identified significant gaps in the knowledge base collated by past research into alcohol misuse in the black and minority ethnic groups. These groups had been pathologised and homogenised by poorly conducted research and outdated material. This meant that the needs of minority groups could not be effectively addressed. It is for this reason the alcohol related services for ethnic minority groups are not perceived as accessible or sensitive.There are also very low levels of awareness of sources of advice relating to alcohol misuse.

Levels of alcohol misuse

The 2001 UK census was the first to ask a specific question of ethnic origin and religion. When confined to England the proportion of ethnic origin is 9.1% of which just over half are of South Asian origins. This census also recorded religious differentials of ethnic minority populations in England as 3.1% Muslim, 1.1% Hindu, 0.7% Sikh, 0.5% Jewish and 0.3% Buddhist. This spectrum of religious differential in the South Asian communities does not necessarily reflect countries and regions of origin of the ethnic population. It is important to be aware of this difference when reviewing drinking patterns and support services that are available.

Drinking in the South Asian communities has not been equated with ‘being sociable’ as is the case in many Western societies.This however, is changing and many young people are now drinking with the same attitudes as their white counterparts.The difference is in the experience of the South Asian young people.They feel that their culture is not as permissive.When juggling the different value systems their identity, beliefs and faith come into question. Crisis in identity can lead to misuse of alcohol with associated feelings of anxiety, guilt and conflict. It is for this reason that any difficulties associated to the use of alcohol often remain largely hidden.

Bradby andWilliams (2006) reported on research into alcohol use in 824 British born 14-15 year olds in 1992 and followed this in 1996 with further research of 492 18-20 year old South Asian young people.These young people were found to be more abstinent from alcohol use than non-South Asians in both age groups. Muslims were more abstinent than Sikhs or Hindus. Asian girls were more abstinent than Asian males. Abstinence was seen to be for cultural and religious reasons.

Understanding the south Asian culture

In South Asian communities culture places strict parameters of what is normal and what is not normal behaviour. There are huge expectations from young people in terms of respectful behaviour towards elders, safe guarding the ‘family name’ and generally behaving in an acceptable and accepting manner. It is for this reason that individuals who experience any difficulty in their life feel unable to talk about it. Everyday experiences of South Asian individuals will help to reveal why they are not able to acknowledge their difficulties. This hampers any discussion or understanding of the difficulties. One of the fundamental aspects of their being is that they do not exist as individuals (although this is changing) but as part of the family and other groups – not as separate entities but as extensions of each member with the responsibility of carrying the name and preserving the entity of the group. This means that ‘letting down’ the group is not an option. For South Asians security is at the crux of their existence. The need to be always secure has its origins in their family structure and migration patterns. Traditionally families have existed as part of clans which have struggled to survive along land and occupational divides. As individuals have migrated they have tried to preserve the divides and in many cases these divisions have shifted from the original rationale to a less meaningful one. In the countries of their origin these divides may be dissipating as a result and, changing social values and legislation. In the UK however, the communities have continued to function along the groups that they originally belonged to. This means that the groups are insular and the families within the groups are constantly monitored from within and from these on the outside. There is a huge burden on individuals of ‘performance’ related behaviour. Each member carries a responsibility to the person next on the hierarchy and in this respect is answerable to that person.

The reasons for problematic drinking can be manifold. Liability to develop alcohol problems can be both environmental and individual. Research has shown that alcohol problems can be inherited. They can also coexist with certain psychiatric conditions. In addition stressful life styles prompted by family expectations and cultural boundaries can lead to increased alcohol consumption.

Alcohol problems

In my very personal view many individuals in South Asian families are seen as actors. They have to perform in terms of having a sound education, serious career prospects, a respectable job, marital status, have children, own a property and provide care for the elders. When anything occurs to disrupt the expected transition of life then the individual actor is seen as a failure. This failure can lead to problems with alcohol. The problem with alcohol is then perceived as an additional failure. Therefore, any debate or acknowledgement of the problem is rife with issues of honour, shame and stigma.

He or she feels alone. This would be the experience of most young people with similar difficulties. What is specific to young South Asians is that they feel more isolated because they are answerable to the family, the extended family and the community group that they belong to. Speaking about the problem would expose them to all of these units and shame would be brought onto the family.The difficulties experienced by anyone who has a problem with alcohol are exacerbated. It is not just the issue of health implications and personal and social causalities resulting from alcohol use. Most importantly the individual feels isolated and unable to speak to anyone.

What is the experience of a young South Asian who has difficulties with alcohol?

Reports on alcohol and ethnicity note that there are low levels of uptake by minority ethnic groups in all preventative and supportive services. Orford et al (2004) comment that despite growing levels of alcohol use among second generation migrant populations there remain low levels of awareness, perceived accessibility or sources of advice relating to drinking. Most of the respondents appeared to believe that the most accessible help was at health centres and GP surgeries. Discussions with the family or close friends was not seen as an option. This raises the very important issue of the appropriateness and accessibility of services available for ethnic minority groups. Services at all levels such as basic education and health promotion advice to rehabilitation and recovery care need to be culturally sensitive. Many community health and welfare professionals have limited knowledge of and awareness of alcohol related issues. Clients may not be able to access suitable support services through referrals even if there are services that are culturally and linguistically appropriate. Few mainstream service providers have much competence in dealing with the needs of ethnic minority groups. Ethnic monitoring is also lacking which makes it impossible to ascertain whether an adequate level of service is being provided.

The study on Alcohol Use and the South Asian and African Caribbean communities (2006) comments on what needs to be in place to ensure greater sensitivity and availability of services. The recommendations are based on interviews with agencies providing high levels of service. Some of the key points made are:

  • Training of staff
  • Cultural matching of staff to client
  • Cultural, political and social understanding of client
  • Quarterly consultation of user
  • Working with families
  • Offering complementary therapies

Above all services need to be flexible and creative. Traditional models of counselling are often not appropriate to meet the needs of ethnic minorities.When working with South Asian clients the counsellor or any other support worker needs to understand the family structure, the community group and the issues of conflict experienced when individuals try to fit in with main stream culture or other minority cultures. The workers need to develop a way of thinking about the clients whilst valuing and acknowledging their way of being.

It is paramount that young South Asian individuals experiencing difficulties with alcohol find someone to speak to, someone who will not judge them and someone who will hold them through recovery.They should also feel secure about confidentiality issues and have confidence in the professionalism of support workers.

It is important to acknowledge that every culture is changing and evolving. Within every culture there are pockets of shifting value systems. Sometimes one’s very own culture can facilitate recovery through religion and spirituality and thus make it possible to come out of alcohol without treatment.

Leininger MM (1991) Culture Care Diversity and Universality – A Theory of Nursing. New York National League of Nursing, New York.

Alcohol Concern (2002) Research for Action on Alcohol, London. Bradby H.& William R. (2006) Is Religion or Culture the Key feature in Changes in Substance Use after leaving School? Young Punjabis and a Comparison Group in Glasgow. Ethinic health Capital 11(3), 307 - 24

Orford J, Johnson MRD, Purser R (2004) Drinking in Second Generation Black and Asian Communities in the English Midlands. Addiction Research and Theory 12(1), 11-30

Johnson MRD, Banton PM, Dhillon H, Subhra G & Hough J (2006) Alcohol Issues and the South Asian & African Caribbean Communities. The Alcohol Education and Research Council, London.