Substance Use and Cultural Diversity: An Experience with the Nepalese Community in the UK
Culture plays a central role in forming the expectations of individuals about potential problems they may face with drug use.
Cultural factors are also influential in shaping our perspectives and attitudes towards substance use. While substance use disorder can affect individuals from any racial, ethnic, or gender background, cultural identity and values can serve as both protective and exacerbating factors in addressing substance use problems.
These factors influence how individuals experience, perceive, and cope with substance use, and they shape access to resources, social support, and treatment. Understanding these dynamics can improve the effectiveness of prevention, intervention, and recovery efforts.
Protective Factors Related to Racial, Ethnic, Gender, and Cultural Identity
Cultural Values and Traditions
The rich traditions of family and community support within many racial and ethnic groups serve as powerful protective factors. This strong social cohesion fosters a sense of belonging and responsibility, effectively reducing the likelihood of substance use. In Nepalese communities, the strong focus on family and interdependence can motivate individuals to refrain from behaviours, such as substance use, that could potentially strain family relationships.
Engaging in spiritual and cultural practices, such as ceremonies, rituals, and religious activities, can offer valuable coping mechanisms, bring deep meaning, and strengthen emotional resilience, which in turn can help lower the risk of substance abuse. Many Nepalese communities do different rituals and cultural activities for support, where religious teachings discourage substance use and offer a strong support network.
Cultural Identity as a Source of Strength
Embracing a positive cultural or ethnic identity is incredibly important for building resilience. When people feel a strong connection to their culture, it can instil a deep sense of pride and purpose. This, in turn, helps protect against engaging in risky behaviours like substance use. Programs that incorporate cultural teachings and traditional practices in Indigenous communities have been successful in preventing substance abuse by promoting pride in one’s heritage.
Treatment programs that are tailored to an individual’s cultural identity have higher success rates. Interventions that are culturally relevant, such as bilingual key workers or gender-sensitive interventions, can be more effective than generic approaches.
Access to Culturally Competent Resources
In certain communities, there are prevention and intervention programs that focus on substance use within the context of cultural norms, values, and practices. These programs can serve as a protective factor by offering resources in a culturally sensitive manner. Culturally tailored substance use prevention programs often take into account the unique stressors related to identity and discrimination, which can lead to increased participation and positive outcomes.
Exacerbating Factors Related to Racial, Ethnic, Gender, and Cultural Identity
Discrimination and Marginalisation
Experiencing racism, discrimination, and marginalisation can elevate stress levels, trigger anxiety, and intensify feelings of isolation, which in turn may lead individuals to turn to substance use as a way to cope with these overwhelming emotions. In Nepal, indigenous communities that are marginalised may encounter systemic discrimination, resulting in heightened levels of stress which in turn contributes to an increased prevalence of substance use within these communities. Gurkhas who migrated from Nepal to the UK often belong to different indigenous communities. Individuals face a higher risk of substance use due to the societal stigma, bullying, and lack of acceptance they experience both within their own communities and from the wider society.
In some societies, the use of substances or the presence of mental health issues are often stigmatised and perceived as personal shortcomings or moral failings rather than legitimate health issues. This societal attitude can create barriers for individuals, making it difficult for them to seek help or acknowledge their struggles. As a result, they may resort to further substance use and experience social isolation.
In Nepalese communities, where honour and family reputation are highly valued, admitting to substance use issues may be seen as bringing shame to the family, discouraging individuals from seeking help.
Access Barriers to Treatment
Members of minority racial or ethnic groups often encounter systemic barriers that limit their access to healthcare services tailored to their specific cultural and linguistic needs. These barriers can include a lack of culturally competent healthcare providers, language barriers, and limited awareness of available treatment options within their communities. As a result, individuals from these groups may be less likely to engage with treatment programs and may experience less favourable health outcomes than the general population.
Gender and Family Dynamics
In some Nepalese families, traditional gender roles may prevent women from seeking help for substance use issues. Women, in particular, may experience increased shame or concern about how they will be treated by their family or community. A Nepalese woman struggling with substance use may avoid treatment out of fear that her addiction could lead to family dishonour or a breakdown in her marriage, especially in conservative communities where women are expected to uphold the family’s reputation.
Starting of Nepalese Support Group
We started the Nepalese Support Group via a Zoom meeting in July 2021 in order to support Nepalese service users to engage effectively with The Forward Trust. The Nepalese Support Group plays a crucial role in helping Nepalese drug users by providing culturally relevant support, emotional support, and practical assistance tailored to their unique needs and challenges. The Support Group bridges the gap between The Forward Trust and the Nepalese community, creating a safe and trusted environment for individuals struggling with substance use.
We now hold a Nepali-speaking Zoom meeting every Monday, providing a safe space for Nepali-speaking service users. We aim to launch a Nepali-speaking 12-step meeting in the community.
In Ashford and Folkestone, we also hosted a community awareness program tailored to the Nepalese community. During the event, we shared valuable insights about the array of services provided by The Forward Trust and guided them on how to access these services effectively. This helped to increase the number of Nepalese service users in our service.
Protective cultural factors can give people emotional strength, a sense of who they are, and positive ways to deal with things To deal with drug and substance misuse, we need to think about different cultures and identities. We should give people the help that fits them and make sure that treatment works for everyone.
I believe that in order to support Nepalese individuals, it’s important for Drug and Alcohol services to create programs that are culturally sensitive and accessible to the Nepalese community. By actively engaging with the community, providing language support, and reducing stigma, we can encourage more people to seek the help they need.