South Asian community medical examiners welcome latest low-risk alcohol guidance

A physician who treats addiction at a clinic specifically for South Asian patients says Canada’s latest guidance on alcohol bolsters his efforts to convey the message about associated harms to a community that’s at higher risk for conditions akin to heart disease.

“I’m really glad to finally hear that there may be support from objective guidelines for the knowledge that we already knew,” said Dr. Parm Brar, who works on the Roshni Clinic in Surrey, B.C., which opened in 2017 and provides services in Punjabi and Hindi.

“That is something that we are able to use as a part of our resources so far as with the ability to say to people, ‘Well, look, there’s this objective evidence for this, that it’s harming you,’” Brar said of updated guidance by the Canadian Centre on Substance Use and Addiction.

The CCSA overhauled recommendations on alcohol use this month, saying no amount of booze is secure and that greater than seven standard drinks per week puts people at higher risk of cancer and heart disease.

That’s a drastic change from its guidelines in 2011, when it said men could safely devour 15 drinks per week while women could have 10 drinks.

The CCSA didn’t provide suggestions on the best way to reach specific communities with its messaging, but medical examiners say they hope to handle issues akin to language while providing culturally sensitive information to the South Asian community as they fight to convey that just two drinks per week at the moment are considered low risk.

Brar, who can also be a physician within the emergency room of Surrey Memorial Hospital, said South Asians, which make up a big proportion of the population within the region, sometimes address the problem as a family, accompanying relatives whose alcohol consumption starts to interfere with their every day lives.

Those that show up or are referred by their family doctor to Roshni, which implies light in Hindi, are typically within the grip of an addiction to alcohol and sometimes already at high risk of complications including liver and heart disease, Brar said.

“We all know that South Asians that don’t drink alcohol are at high risk of cardiac disease. It’s just the best way the physiology and the biology work in our South Asian population,” he said.

“The challenge is that alcohol is so entrenched in our culture, that it’s almost made to feel prefer it’s not a harmful substance,” Brar said of the prevalence of alcohol at some social gatherings.

“We comprehend it’s a carcinogen, we comprehend it’s terrible in your liver and your heart. It’s so well intertwined inside our culture that it’s going to take time to detach,” he said.

“I feel it is a step in the best direction,” Brar said of pointing people to the updated guidance, which emphasize health risk at higher consumption levels for all populations.

Baldev Mutta, CEO of Punjabi Community Health Services, which operates within the Ontario cities of Brampton and Mississauga, said the CCSA’s guidance is prompting him to reconsider the non-profit’s harm-reduction model in favour of abstinence while still providing counselling for individuals who decide to in the reduction of or are coping with addiction.

“We at the moment are debating whether PCHS as a corporation should take a position that, ‘Look, no drinking is secure. These are the implications of drinking.’ These are the discussions we’re having internally.”

Mutta said he’s “struggling” with the best way to communicate why the updated guidance advises that as much as two drinks every week, as an alternative of two drinks per day, as previously really helpful, at the moment are considered low risk, based on the most recent research evidence.

“All of this leaves type of a posh situation for me. How can we make sense of this from an even bigger perspective?” he said of how a latest approach will probably be perceived as plans will soon be underway to start out a latest education and awareness campaign in April.

He said alcohol consumption amongst Sikh men specifically is a growing concern and contradicts the faith’s prohibition against addictive substances.

“It’s very interesting that individuals who follow the faith refuse to smoke because smoking can also be prohibited within the Sikh religion. Nevertheless it’s equally forbidden to drink and yet Sikhs drink.”

He said significant use of alcohol amongst Sikhs has roots in India’s colonial history when numerous Punjabi men were within the British army and took part within the custom of officers drinking within the mess hall.

“Every soldier was allowed to buy two bottles of rum every month. Even after retirement, they may go to a canteen and on a subsidized rate they may purchase two bottles of rum.”

Former soldiers continued the tradition of drinking within the evening at home of their villages, he said, adding alcohol was introduced at weddings within the Nineteen Fifties before becoming a daily part of varied celebrations.

“We’ve got an issue of drinking excessively. It’s accepted by the culture. It is a component of each celebration, house-buying, weddings, birthday parties, get-togethers, business meetings.”

Mutta said there’s a necessity for research into alcohol use among the many vulnerable South Asian community as a way to higher understand specific barriers and improve access to treatment.

A review of limited literature related to alcohol use disorder amongst people of South Asian descent in Canada and the US, published in 2018 in the web Journal of Ethnicity in Substance Abuse, says that group may struggle to receive care despite increased morbidity.

The review, led by Dr. Nitasha Puri, now a clinician researcher on the BC Centre on Substance Use, says immigrant, refugee and racialized populations have a lower participation in health promotion, prevention and services compared with others and that barriers may include language and stigma.

“Given the uniquely high risk of alcohol use issues and morbidity amongst South Asians, it is obvious that a more focused and nuanced understanding of (alcohol use disorder) treatment on this (population) is vital,” says the review, which notes no North American studies focus specifically on South Asians in alcohol treatment settings.

This report by The Canadian Press was first published Jan. 26, 2023.

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