News

Drinking alcohol is as much a part of British life as leaves on railway lines and rain during Wimbledon fortnight. And, like the trains and the weather, the use - and misuse - of alcohol is an issue that cuts across all groups in society, regardless of culture or religion.

Yet it is easy to see why alcohol abuse has been viewed historically as "a white problem". Research shows that men and women from all ethnic minority groups, except Irish people, are not only less likely to drink alcohol, but to drink smaller quantities and less often.¹

Unsurprisingly, then, alcohol dependence is less widespread in these groups. While 75 out of 1,000 white adults are dependent, the figures are lower for black adults (60 per 1,000) and Asians (25 per 1,000).1 But less prevalent does not mean non-existent.

Similarly, it seems that no religious groups are exempt from the impact of alcohol use, even if their religion prohibits drinking. Studies have revealed that not all Muslims abstain, and that some Hindus and Sikhs drink above recommended levels.1

The reasons for drinking given by people from ethnic minority groups reflect those expressed by the white population. But in addition there are specific triggers for using alcohol that are particular to minority groups.

One of these is social inequality. People from ethnic minorities are more likely to face discrimination in housing, employment and health services. In addition, racism may contribute to low self-esteem and mental distress, so increasing the likelihood of drinking.

But in many ethnic minority communities drinking is frowned upon and those with alcohol problems fear being stigmatised.

"There is a strong taboo regarding the Muslim religion and drinking that acts as a deterrent, but it can also result in drinking and the associated problems being hidden," says Gersh Subhra, senior lecturer at the School of Health and Community Studies at the University of Derby. "It is harder to respond to those problems if they are trying to hide them but, by coming forward to an agency, they run the risk of people finding out."

He believes that agencies need to develop alternative ways of persuading people to approach them, and that language is crucial. Someone with alcohol problems who does not speak English is unlikely to walk into an agency where they speak only English, he says.

The forthcoming national alcohol strategy, due this summer, provides an opportunity to improve services for all groups in society. Although the strategy consultation document published last autumn did not have a specific section focusing exclusively on ethnic minorities, it did ask for information on whether there were "specific issues around minority ethnic attitudes to and use of alcohol".

Alcohol Concern wants the strategy to be broad and include specialist treatment services. Richard Phillips, director of policy and services, hopes it will bring better and more needs-led commissioning. It is widely expected that the National Treatment Agency, which oversees treatment for drug abuse, will take on responsibility for alcohol, something that Phillips welcomes.

"Commissioners need a push to take responsibility for delivering services that reflect the needs of the whole community. It's beginning to happen in the drugs field as the NTA is driving it," he says.

But many people from minority groups are reluctant to seek advice other than from their GPs - tier one services - and shy away from, for example, drop-in centres on tier two. "People from ethnic minority communities are in touch with tier one services," Phillips says. "They go to GPs but then they are not going from there to tier two because they see them as being white. One way is for us to go out to find them."

Services are not culturally appropriate as many were established years ago for clients that were predominantly white middle-aged men, Phillips says. He considers the notion of addiction to be one that is culturally bound, where drinking a couple of pints several times a week might be considered problematic within minority groups but not necessarily by services.

"If they go to a traditional NHS consultant-led service they may not meet the criteria but within their culture it might be catastrophic and affect their standing in the community," he says.


One way to improve the cultural suitability of services would be to increase the number of staff from ethnic minorities who work in them. Kirit Mistry, a national development officer for the Federation of Black and Asian Drug and Alcohol Professionals and Communities, criticises the shortage of workers from ethnic minorities in the alcohol field. He feels that to tackle the recruitment problem people in minority communities need to be made aware of what an alcohol worker does.

"For Asian people, working in drugs and alcohol is not seen as a reputable career. They want their kids to work in business and medicine," he says.

Agencies should have specific posts for ethnic minority workers, he says. But as long as there are not enough workers from minority groups, staff who are carrying out the work with these communities need to be trained to be culturally aware. In addition, services need to be promoted in various languages and use made of community venues, such as places of worship.

The use of alcohol by people from minority communities is not only here to stay, but is likely to increase, as second and subsequent generations experiment alongside their peers. But, as it stands, the smaller numbers of people from minority groups misusing alcohol means that appropriate service provision is lacking and is not always considered a priority. To fail to acknowledge and respond to this glaring oversight would be to the detriment of the long-awaited strategy.

¹ Acquire, Alcohol Concern's quarterly information and research bulletin


Reasons for not accessing services

• Stigma: alcohol may be discouraged or prohibited.
• People are unaware of services. 
• Services provided only in English.
• Excessive drinking is considered to be a medical problem.
• The belief that "white services are for white people".
• Drinking is hidden so they are not encouraged to seek help.

New roots

"If established services were adaptive and really took into account people's linguistic and cultural needs there wouldn't be a need for our service," says Lennox Drayton, team leader at New Roots, an alcohol service for ethnic minorities. 

New Roots is a London-based service that has attempted to overcome the problem of stigma preventing people from minority communities accessing alcohol services. It offers help in more general settings, including community centres, GP surgeries and health centres - where people "could be coming for anything". 

Drayton says: "It has enabled us to access communities and make services available for people who otherwise would not want to set foot through the door of an alcohol service."  New Roots offers advice, information and counselling, using a model of harm minimisation.  

People can self-refer or are referred by other professionals such as doctors and social workers. Clients come from a range of cultural backgrounds. About a quarter are Muslim. Workers are able to conduct sessions in a range of languages including Punjabi, Bengali and Arabic. 

Drayton believes that awareness must be raised to combat misunderstanding among ethnic minority communities and encourage people to seek help. 

"The problem exists right across all communities," he says. "Lack of understanding inhibits people from accessing the treatment they require. When New Roots started one of the main findings was that drinkers from black and minority ethnic communities only came to light when they were in crisis, like in hospital."