Alcohol, Ethnicity & BAME Multiple Disadvantage

06 December 2021

By Sohan Sahota, Managing Director and co-founding member of BAC-IN, a Nottingham based, specialist drug and alcohol recovery support service for individuals, families and young adults from Black, Asian and Minority Ethnic (BAME) communities.

In this blog post, Sohan Sahota discusses alcohol, ethnicity and BAME multiple disadvantage. Sohan highlights the challenges faced, shares his new book, Shades of Recovery, and information on BAC-IN, plus calls for action to tackle inequalities, address unmet needs, and improve treatment and recovery, prevention, research, and training. This is part two of the two-part SHAAP blog series on alcohol and ethnicity (read part one).

The context

‘Addiction is a destructive and tragic affliction that can cause physical and emotional harm and cost lives. We have the best health service in the world and we now need to marshal its resources to protect those affected by addiction and ensure that they receive the treatment and support they need’.
Matt Hancock, Health Secretary, November 2019.

People recorded as white British made up the largest ethnic group in treatment (84% or 222,775) with a further 5% from other white groups. No other ethnic group made up more than 1% of the total treatment population.
Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 2017-2018.

The challenge

It has long been recognised that people from BAME backgrounds are under-represented in alcohol treatment services, and service providers believe the prevalence of harmful alcohol use in BAME communities is underestimated. Cultural taboos, barriers to engagement, and cultural/religious stigma continue to keep harms hidden and communities suffering with untreated addiction.

As we continue to deal with all the pandemic throws at us, BAME people who are impacted by the harms of alcohol face even more challenges. Access to culturally appropriate, equitable, and effective support for BAME people affected by addiction who are seeking help is still a systemic issue in need of address. Generations of BAME communities have been failed by poor alcohol policy, commissioning decisions and service design coupled with the lack of culturally appropriate recovery services, and treatment options have left many families suffering in isolation with untreated addiction disorders. If the system stays as it is, the crisis will have lasting consequences for BAME citizens living in the UK for generations to come. Cultural understanding is key in designing better services for ethnically diverse populations, in co-production, equal partnership and collaboration with these communities. I further point towards this in a recent article featured in DDN Magazine, Recovery for all, it’s time to stop overlooking the needs of Black, Asian and Minoritised communities, which explores cultural barriers to access, engagement and uptake of mainstream treatment. I also spoke at the 2021 conference: The impact of stigma on people with addiction: the effect on policy and practice with Danny Hames, Chair of NHS Addictions Provider Alliance, of my lived experience of addiction, stigma, unmet needs and the lack of culturally appropriate support.

Urgent action is needed to address these issues. Recommendations from decades ago can longer remain shelved. We must act now.

Stories of recovery

However I’m just one person and it’s important to listen – and respond – to the stories of many. That’s why I’ve written a book, Shades of Recovery, which tells the stories of people from diverse ethnic backgrounds who are often marginalised, seldom engaged and regularly underserved in society while battling with addiction and their search for recovery.

Written during a period of profound global uncertainty and an era overwhelmed by a range of crises — from economic, to public health, to racial injustice — this book asks readers to centre themselves in the lived realities of people and communities in the UK with addiction and substance misuse problems on the hard edges of injustice; those trying to survive multiple, complex, and intersectional social problems, trauma, and harms; and those falling through the damaging gaps of complex and interconnecting systems.

A cultural response

In early 2000, building on my own experiences and inspired by the experiences of others, I co-founded BAC-IN, which is now an award winning, grassroots community service.

BAC-IN delivers addiction recovery and rehabilitation services and our approach is holistic, adaptable, culturally sensitive and inclusive, enabling individuals to access support with addiction recovery, mental health and additional well-being services. BAC-IN was driven in response to an ‘unmet need’ and gap within commissioned mainstream drug and alcohol support services.

BAC-IN developed a service that recognises the distinct and unique intersectional injustices faced by the communities we serve and how to effectively address the deep-rooted and multi-layered causes of social distress that leads to addiction in BAME groups.

The service is delivered by a highly skilled team with cultural expertise who support people in an environment that acknowledges cultural heritage, ethnicity, faith, family dynamics, religious practices, diverse lived realities, and belief systems.

This sophisticated approach understands and addresses the broader strands of severe and multiple disadvantage (SMD) – debt, domestic violence, and experiences of the care system, homelessness, mental health, poverty, unemployment and contact with the criminal justice system - coupled with the impacts of racism, alienation, discrimination, shame, stigma, family dishonour, and mistrust of mainstream treatment services often leading to a painful life of addiction and social fragmentation.

Mainstream services fail to identify, let alone address and meet, these complex and interconnected needs.

‘The positive impact of recovery reaches far, from the individual to their family, to their community, and then wider civil society. The impact of BAC-IN's person-centred peer model and expert practice, which integrates lived, learned, and practiced expertise to provide culturally tailored and inclusive recovery services for BAME communities, is much needed. Not only does it urgently address the long-ignored and neglected needs of BAME communities across the UK struggling with addiction, but it also addresses the structural inequalities faced by communities, and provides much-needed inspiration for innovation across other interconnecting health and social-care services and systems’.
Foreword, Shades of Recovery, 2021.

What next?

In recognition of the underrepresentation of BAME communities in alcohol treatment – because of all the complex issues outlined above – we at BAC-IN propose an urgent change in alcohol policy that recognises the gaps in services, that is willing to address unmet needs of ethnic and minoritised communities and seriously consider investment in culturally appropriate support for people from diverse backgrounds. We recommend systemic and structural change at all levels of alcohol treatment including policy, commissioning, service design, service delivery, prevention, treatment, research, and community outreach and engagement. Indeed, in the previous SHAAP blog post in this two-part series on alcohol and ethnicity, Stacey Jennings discusses the need to properly assess and address ethnicity in alcohol research, highlighting that we must improve representation of ethnic minorities across inclusion, reporting, and analysis.

A collaborative approach to partnership working is crucial to allow all aspects of population needs to be taken into consideration, with inclusion of diverse voices and cultural expertise in service implementation, redesign and development.

We need to develop services that are fit for purpose, that possess the capacity to deliver, reach and engage people who need help. Too many vulnerable lives are being compromised by the harms of alcohol.

Research highlights that BAME communities would particularly benefit from peer-led, culturally responsive recovery models, ideally led by people with lived experience, but currently there is no incentives in the system for developing or investing in such services. Moving forward we need investment in existing BAME led recovery organisations and a greater investment in the development of peer led recovery organisations for all marginalised groups who are under-represented.

To reduce inequalities, gaps in services, unmet needs, under-representation in treatment, recovery, prevention, research and training we recommend the following:

Calls to action:

Robust research should be carried out to adequately assess the level of substance misuse health needs among people from BAME communities in collaboration, and co-produced with BAME people with lived experience and cultural expertise;
National alcohol policy must reflect the evidence gathered over the years through research and consultations and develop specific recommendations to address the treatment and recovery service gap for people from BAME backgrounds;
Local and national commissioners must work in collaboration with people from BAME backgrounds in the design, delivery and assessment of current treatment and recovery service provisions to ensure that the service offer meets their needs;
NICE psychosocial interventions should include culturally responsive recovery models as an evidence based, culturally tailored modality of treatment and recovery;
Local commissioning arrangements should introduce ring-fenced spending for BAME-specialist services that can deliver culturally responsive and high-quality treatment and recovery services;
A judicial review should be undertaken to examine and review how local authorities develop and commission local services across all communities and in particular BAME populations and make recommendations to avoid continued failings and the continued exclusion of BAME communities from local services;
Embed cultural competence training and culturally informed trauma care.