Keep it to yourself

Understanding South Asian women’s experiences of problematic substance use and support

This study focussed on the lived experiences of South Asian (SA) women who use(d) alcohol (and other drugs), exploring their trajectories into problematic use, and their engagement with support. Its three core aims were to:

explore their lived experiences of alcohol use and help-seeking
understand how non-alcohol-using women from SA communities respond to women’s problematic alcohol use
explore if and how alcohol practitioners offer support to SA communities, particularly women.

Literature Review

Following a review of the available research evidence and wider literature, and interviews with SA women in recovery for problematic substance use, SA women who don’t use substances, and specialist drug and alcohol practitioners, Galvani et al., (2023) summarised the key messages:

Accurate recording of data is needed that captures substance use by ethnicity and religion, to understand the differences between and within ethnic groups. For example, substance use is forbidden in Sikhism, but the Punjabi culture (where Sikhism is the predominant religion) has a tradition of heavy alcohol use in familial celebrations.
Research needs to be conducted that focuses on South Asian communities. There is a void in evidence that focuses on the experiences and needs of those from South Asian communities who use substances, as well as their families. Evidence building can help to inform policy and practice development.
Generational differences must be considered. The limited research shows that younger South Asian women are consuming alcohol more than previous generations; and there is an underrepresentation of young people in treatment setting. However, older generations must not be overlooked, as research also showed how women were turning to alcohol when their children grew up and left home.
Religious affiliation must be recorded in treatment data because despite proscriptions against alcohol use in religions practiced by South Asian communities, adherence to religious edicts do not shield against risky or problematic drinking.
The cultural expectations and impact of izzat is a barrier to South Asian women’s support seeking. The hidden nature of substance use among South Asian women can prevent the associated harms from being addressed.
Gender must be considered in designing support services, as double standards exist between SA men’s and women’s drinking with women judged more harshly than men for substance use, driving women to drink in secret.
Domestic and sexual abuse, as well as childhood abuse, are common experiences among SA women as well as controlling behaviour from parents, partners and in-laws. Responding to trauma as a factor of problematic substance use must be considered in treatment support and design.
Knowledge and understanding of substance use and its related problems is lacking among SA communities, and resources must be developed that fill this knowledge gap in a culturally sensitive way.
Despite the rise in problematic substance use among SA men and women, and the rise in treatment engagement, there is a gap in service provision for people from South Asian communities that is culturally tailored and gender responsive.
A key difference between mainstream and specialist services is the nuanced cultural understanding held by specialist services negating the need for people to repeatedly explain the cultural expectations and challenges they face.

Data Collection

Three groups of people participated: i) SA women in recovery, ii) SA women in the communities, and iii) practitioners from specialist ethnic minority alcohol services or from specialist projects within wider services.

A range of qualitative methods were used to collect and record new data including focus groups, semi-structured interviews, and narrative portraits.

Findings

Interviews with South Asian women in recovery

18 South Asian women in recovery participated in interviews revealing experiences of trauma, conflict, abuse, and histories of familial alcohol use among male relatives.

Experiences of domestic and sexual violence and abuse were common as was controlling behaviour from male partners, fathers, brothers and in-laws.
The shame and stigma they experienced resulting from their alcohol use was often worsened by family fears of community disapprobation.
The women were careful about where they drank, with whom, and often would hide their drinking.
Family support was mixed – some had positive experiences, others experienced family rejection – but family ignorance of alcohol and how to support or seek help for the woman was common.
The women were often the only SA woman in the treatment services or groups they attended. They had accessed a range of services from self-help literature to periods of significant inpatient rehabilitation.
The women had varying experiences of help from faith groups or faith-based alcohol support networks.

“…it’s something I feel so important because is such a hidden, it’s such a hidden part of addiction. Asian women drinking or taking whatever substances, is such a hidden part of addiction“
Rosie, South Asian woman in recovery

Focus Groups with women in the community

Seven practitioners were interviewed who worked for specialist alcohol services or projects for ethnic minority people.

29 women took part in five community focus groups with over half of them stating they knew people who drank heavily or had problems relating to their alcohol use.

There was a strong message about the cultural disparity and double standards between men and women’s drinking and the tolerance of men’s drinking and the intolerance of women’s drinking.
Women were viewed as being judged more harshly on every level, including their alcohol use, driving women to drink in secret.
Women were seen as keepers of the family image and needed permission to do many day-to-day tasks. Women drinking alcohol, therefore, was seen as ‘another level’ and subject to stigma and community gossip.
There were mixed views about generational differences in drinking with some discussion reflecting the greater pressures on younger women, particularly at university or socially, to drink alcohol.
None of the women were aware of services for SA women in their communities and recognised the challenges this presented for women seeking help.

“I mean in general, it goes for anything for dating, drinking, drugs, anything, smoking anything, I think it’s a lot worse when it comes to women, but these are just my experiences.”
Focus Group 2, woman 2

Interviews with specialist alcohol practitioners

Seven practitioners were interviewed who worked for specialist alcohol services or projects for ethnic minority people.

Only one of the services was set up to provide services to women and this is now subsumed within the agency’s wider remit. Six of the seven agencies provided services other than alcohol support.
All the practitioners described a complete lack of service provision for both men and women from minority or migrant communities in the wider alcohol service landscape.
Culturally-specific features of the specialist services were considered responsible for attracting people from those communities.
Four of the seven practitioners spoke of the difficulties engaging SA women in their services and made considerable efforts to do so in terms of outreach and partnership work, often over a long period of time.
The key difference between mainstream and specialist services was the nuanced cultural understanding held by specialist services negating the need for people to explain repeatedly the cultural expectations and challenges they faced.
Specialist services also understood the risks women took and fears they faced if they were identified within the community.

“They feel that we understand the cultural values. That we understand the cultural barriers and difficulties they go through. And they feel that we kind of like spend more time with them because we’re community based.”
Specialist practitioner 5