Demonised drinkers

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.”