Culturally tailored care for South Asian people who use substances

We’d love to hear from you so that we can create the best possible podcast for primary care providers. Once you’ve finished listening, please take our short (5-minute) evaluation here.

SHOW NOTES

Summary

In this episode of the Addiction Practice Pod, journalist David Ball and addiction medicine physician, Dr. Nitasha Puri, discuss the importance of culturally tailored care, drawing on Dr. Puri’s research and experiences from working at Roshni Clinic, which provides care for South Asian adults in Surrey, BC. David and Dr. Puri also speak with Anmol Swaich, a researcher and community organizer with the Surrey Union of Drug Users about the historical context of drug policy and drug criminalization in BC, and its impacts on South Asian communities. Additionally, they talk with Robin, a member of the South Asian Committee with the Surrey Union of Drug Users, about her experiences accessing substance use care as a South Asian woman and what care providers can learn from her journey.

Learning Objectives

1. Describe how social and cultural norms among South Asian communities in BC can influence substance use patterns.
2. Define culturally tailored care and identify examples of how to incorporate these principles into substance use care.
3. Understand the barriers to care among South Asian individuals who use substances related to racism, sexism, and drug policy.

Lineup

In this episode, you’ll hear:

• 2:44 – Dr. Nitasha Puri, Co-host – Medical Lead, Roshni Clinic, Fraser Health Authority; Clinical Associate Professor, Department of Family Practice, University of British Columbia; Lead Investigator, Rahi: Walking Toward Culturally Connected Wellness
• 14:31 – Anmol Swaich, Guest – Community Organizer for Surrey Union of Drug Users; Researcher with the BC Centre on Substance Use and Master of Science Candidate at Simon Fraser University’s Faculty of Health Sciences
• 14:31 – Robin (pseudonym), Guest – Member of Surrey Union of Drug Users, South Asian Committee

Clinical Pearls

Here’s what listeners can take away from this episode:

1. Practicing culturally tailored care requires the understanding that there are many diverse cultures and languages within South Asian communities across British Columbia. For example, South Asia encompasses India, Pakistan, Bangladesh, Sri Lanka, and other parts of the Middle East and migrated diasporic populations that now live in African nations. Instead of making general assumptions, tailor the care to the individual client and their unique cultural identity.
2. Structural racism and stressors, discrimination, and intergenerational trauma experienced by South Asian communities and individuals in British Columbia are factors impacting family systems and cultures. As clinicians, it is important to adapt care practices to respond in healthy and effective ways to the substance use care needs of individuals from racialized populations.
3. Language barriers and concerns around stereotypes based on ethnicity and culture can prevent individuals from accessing and  staying engaged in substance use care. Approaching conversations with clients in a curious and non-judgmental way can help clients to feel more comfortable sharing their experiences. It is crucial to clearly and empathetically explain to the client what they are experiencing and what they might experience during treatment (e.g., the physiological effects of opioid agonist treatment). Recognize and understand that clients may choose to bring a trusted person to help translate for them.

Resources

South Asian-specific substance use supports

• Surrey Union of Drug Users (SUDU): A social movement group of individuals in Surrey who have used or are currently using drugs and provide support, resources, and education to drug users in their community
• Roshni Clinic: Program for South Asian adults in Fraser Health, with services in English, Punjabi, and Hindi by health care providers who specialize in substance use care
• Concurrent Disorders Program for Youth: Program in Fraser Health for youth with mental health and substance use—two South Asian clinicians available
• Pathway to Freedom: Recovery program (90-day) in Surrey offered in English, Punjabi, Hindi, and Urdu
• South Asian Community Hub (SACH): Non-profit organization offering wrap around services for individuals and families in BC facing health and social challenges through a South Asian perspective in multiple languages
• Asra – the Punjabi Alcohol Resource: Services and educational resources for Punjabi families who struggle with alcohol use and are seeking help for themselves or a loved one; both in English and Punjabi
• Culturally Adapted Cognitive Behavioural Therapy (CaCBT): Research led by the Centre of Addiction and Mental Health (CAMH) with partner organizations nationwide to create tools for an evidence-based and effective psychotherapy for Canadians of South Asian origin

Supports for care providers

• 24-7 Addiction Medicine Clinician Support Line: 778-945-7619
• South Asian Toxic Drug Crisis Resources: Videos, posters, and handouts in multiple languages including Hindi, Punjabi, and Urdu
• The BCCSU’s HelpWithDrinking.ca: Several patient handouts in Punjabi (e.g., medication handouts)

Reports and statistics

• BC Coroners Service. Unregulated Drug Deaths in B.C. (to Sep. 30, 2024). Updated October 24, 2024. Accessed November 19, 2024.
• BC Emergency Health Services. Overdose and Drug Poisoning Data. 2024. Accessed November 19, 2024.
• Fraser Health Authority. Chief Medical Health Officer’s Report 2019. 2020
• Ministry of Mental Health and Addictions. Escalating BC’s response to the overdose emergency. 2018.
• Statistics Canada. The Canadian census: A rich portrait of the country’s religious and ethnocultural diversity. October 26, 2022. Accessed November 19, 2024.
• Thandi G, Chahal S, Cheema M. A Review of Substance Abuse Services for South Asian Punjabi Sikh Communities in Surrey and Surrounding Areas. Genesis Family Empowerment Society. Published 2012. Accessed February 24, 2024.

Journal articles

• Agic B, Mann RE, Tuck A, Ialomiteanu AR, Bondy SJ, & Simich L. Gender differences in alcohol use and risk drinking in Ontario ethnic groups. Journal of Ethnicity in Substance Abuse, 2015:14(4), 379–391.
• Khera GS, Nakamura N. Substance use, gender, and generation status among Asian Indians in the United States. Journal of Ethnicity in Substance Abuse, 2016:17(3), 291–302. 
• Naeem F, Khan N, Sohani N, Safa F, Masud M, Ahmed S, Thandi G, Mutta B, Kasaam A, Tello K, Husain MI, Husain MO, Kidd SA, McKenzie K. Culturally Adapted Cognitive Behaviour Therapy (CaCBT) to Improve Community Mental Health Services for Canadians of South Asian Origin: A Qualitative Study. Can J Psychiatry. 2024 Jan;69(1):54-68.
• Naeem F, Khan T, Fung K, Narasiah L, Guzder J, Kirmayer LJ. Need to culturally adapt and improve access to evidence-based psychosocial interventions for Canadian South-Asians: a call to action. Can J Commun Ment Health. 2020;38(4):19-29.
• Puri N, Allen K, Rieb L. Treatment of alcohol use disorder among people of South Asian ancestry in Canada and the United States: A narrative review. J Ethn Subst Abuse. 2020 Jul-Sep;19(3):345-357. 
• Randhawa A, Puri N. Understanding culturally tailored approaches in males of Punjabi ancestry with alcohol use disorder at Roshni Clinic. The Annals of Family Medicine, 2022:20(1), 3198.

News articles

• Larsen K. Gurdwara in Surrey, B.C., raises alarm after spike in international student overdose deaths. CBC News. January 18, 2023. Accessed October 1, 2024.
• O’Malley S . Reducing addiction stigma in Muslim communities. Centre for Addiction and Mental Health. January 12, 2021. Accessed October 1, 2024.
• Singh V. Overdose  crisis affecting South Asian community in Vancouver. Langara Voice. March 1, 2023. Accessed October 18, 2024.