Supporting solutions for South Asian women: Developing models for alcohol 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.
• A comprehensive literature review and search of grey literature provided the foundations for the study.
• Three groups of people participated:
  • SA women in recovery
  • SA women in the communities
  • 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.
• 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.
• 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.
• 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.
• Future alcohol service needs identified for SA women included:
  • Discrete, separate, services are needed for SA women seeking alcohol support. This should be in the local communities and would be best placed within a service that women would frequent for a range of reasons, for example, a women’s centre or health centre.
  • Improved knowledge and education about alcohol (and other drugs) for the SA communities is needed, particularly where to go to seek help for themselves or a relative.
  • Greater outreach to ethnic minority communities is needed to build relationships and trust. This would take time.
  • Services need to evidence the safety and trust of the service and not assume that the organisation’s confidentiality policy would address the risks and fears they faced.
  • Faith leaders and faith groups need to play a role in educating the communities and providing individual support.
• A new model of alcohol support that meets the needs of SA women has been developed around the four ‘S’s – Setting, Structure, Skills and knowledge, and Staffing. It is a model that is SA woman-centric and reflects the cultural sensitivities required to enable SA women to access services more readily.
• A tool for the improvement of existing alcohol services poses questions in five areas of service: i) environment, ii) service, iii) staffing, iv) training and v) assessment & interventions, enabling existing services to maximise their reach to, and support of, SA women in need of alcohol support.
• Finally, a process map has been developed that offers a pathway to developing service provision while seeking to maximise its chances of success for SA women in need of alcohol support.

This book 'Alcohol, Izzat and me: South Asian women in recovery' accompanies this research project and is grounded in the lives of 18 women from South Asian communities in the UK.

The experiences presented in this book have been drawn from the fuller narratives of women who had the courage to speak out about their experiences of alcohol (and other drug) use. Their names have been changed to protect their anonymity.

This guidance document 'Supporting South Asian Women with Problematic Substance Use: Policy and Practice Guidance' also accompanies the report and booklet. It is for practitioners who support people impacted by problematic substance use and policy makers who commission substance use services and/or develop substance use strategies.