Earlier this month, Volteface Director Paul and Research Officer Nicole hopped on a train to Nottingham to visit BAC-IN, a grass roots, peer-led addiction recovery service for BAME people. During our visit, we spoke to Co-founder/Managing Director Sohan Sahota and Senior Recovery Worker David Thomas to get a sense of what BAC-IN do, and how it all came about. We also heard valuable insights from support workers and service users about their experiences with the service, as well as the range of challenges facing BAME people suffering from addiction.
Founded in 2003 by people in recovery, BAC-IN (Black and Asian Cultural Identification of Narcotics) is an award-winning specialist drug and alcohol recovery support service for individuals and their families from Black, Asian and other minority ethnic backgrounds. Taking a holistic and culturally sensitive approach to recovery, crucially, all the support workers have first person insight into the experiences of service users.
Not only do they share their lived experience of recovery from addiction, they also share an understanding of their cultural contexts, and reflect the cultural, religious and ethnic backgrounds of the people they help. This vital layer of experience and understanding is something that is currently missing for BAME people when accessing mainstream treatment services, representing just one of the many challenges they uniquely face in recovery.
Sohan and David shared insights from their extensive experience—spanning decades—working in and around treatment services, but one issue was consistently present across the realms of service commissioning, design and delivery, research, community outreach and prevention efforts: BAME people have been underrepresented and their needs overlooked throughout each level of the treatment framework.
This is reflected in the number of BAME people accessing services; in England in 2020/21, only 7% of people in treatment identified as Black or Asian. The data for Nottingham also shows BAME people being starkly underrepresented, with 84% of people in treatment being white, despite making up only 65.4% of Nottingham’s population.
There are multiple reasons for this, not all of which have been properly understood due to a lack of research into the issue.
Acknowledgement of institutional racism in the UK is well established; there is an increasing understanding that the persistent health inequalities between BAME and white people—when controlling for socioeconomic status—can be attributed to structural racism. Addiction recovery services are far from immune to this issue. BAME people may face cultural insensitivity, biases and even active discrimination; current and ex-service users shared some of these experiences with us and described the negative impact it had on their recovery process.
For most BAME people suffering from addiction, accessing formal support involves embarking on a recovery journey where they are the only BAME face among majority white treatment staff and service users. This is often an alienating experience which, understandably, is daunting to many BAME individuals and can deter them from seeking treatment; this is enhanced by the distrust that often exists between BAME people and medical professionals due to negative past experiences. Additionally, they may encounter language barriers, creating a further disconnect between service users and the treatment environment.
Experiencing stigma can be a significant issue for BAME people with substance use disorders. On top of the wider societal stigma surrounding drug use, BAME people often face additional stigma from within their communities due to more culturally specific attitudes towards substance use and abuse. This can lead to people being discouraged from or choosing not to speak up and seek help for their problem; it can also make recovery more difficult if there are high levels of stigma within their support network.
The BAC-IN team also expressed how some patterns of substance use are somewhat normalised in certain BAME communities which, again, can discourage people from seeking help or lead to their issues not being taken seriously by those around them. This is not to say that facing stigma and invalidation is unique to BAME people; these are both experienced by white people too. However, there are specific dimensions and dynamics to the experiences of BAME people—including cultural, racial and religious aspects—which are not being properly understood, addressed or engaged with by mainstream treatment services.
We also got the chance to speak to Shimea Anderson, a support worker at BAC-IN who works with young people struggling with addiction. She described how the young people she worked with felt supported and understood at BAC-IN in a way they had not elsewhere. However, Shimea also gave us insight into the way in which young BAME people—especially those coming from low income backgrounds—are being failed on multiple fronts. From the education system to the criminal justice system and the addiction recovery system, many young BAME people are simultaneously vulnerable to the risk-factors for developing addictions and to disproportionate punishment for drug-related crimes, whilst also facing more barriers to treatment than their white counterparts. Again, Shimea’s insights affirmed the need for treatment and recovery services that truly understand the multiple disadvantages faced by young people from BAME backgrounds.
Overall, as a consequence of these various barriers to treatment, BAME people are more vulnerable to developing problems such as mental health crises, family breakdowns and unemployment as they are left to try and manage their addiction without professional support.
It is important to consider how this all fits in with other dimensions of the drug policy environment in the UK. BAME people are vastly overrepresented in the criminal justice system for drug offences whilst being dramatically underrepresented in recovery services. Therefore, this equates to the UK’s drug policies being an instrument through which BAME people simultaneously experience systematic punishment and a systematic neglect of their needs.
BAC-IN has been working tirelessly to address some of these issues and help bridge the gap between the support needed by BAME communities and the support they are actually able to access. Apart from providing a safe space free from alienation and discrimination, the fact that their recovery model is culturally informed is the key to its success.
They aim to hold a deep cultural understanding of multiple dimensions of each service user’s experience; this includes—but is not limited to—their core beliefs, their worldview and their experiences of racism. Importantly, BAC-IN also seeks to understand and address the stigma faced by service users in a culturally-specific way.
Speaking to the BAC-IN team and its service users, it became clear that being supported through recovery by someone who understands, respects and even shares your ethnic and cultural background is invaluable. Above all, everyone we met expressed how BAC-IN is not only a beacon of hope for BAME people suffering from addiction in Nottingham, but it is also a collective of people that felt like a family.
Its limited funding, however, means that BAC-IN can only reach a relatively small number of people, with support workers expressing how tirelessly they work, always going above and beyond their allotted role to provide support to service users. Of course, being underfunded is an issue felt acutely by most treatment services— not just BAC-IN—and this is something that has been recognised by the UK government in their latest 10 year drug review, which includes a pledge to invest £780 million into drug treatment and recovery services.
Yet, apart from the fact that this injection of cash is unlikely to even reverse the cuts to drug treatment services seen since 2010, expanding access to services for BAME people was only mentioned very briefly and very vaguely in the review. Considering how the existing commissioning system unequivocally fails to reach enough minority ethnic people in need of help, failing to thoroughly address these issues will result in this investment widening racial inequalities in treatment.
Ultimately, whilst BAC-IN are doing incredible work and are looking to spread their approach across a larger region, BAME people cannot be the only people serving and advocating for the needs of the BAME community. There needs to be an open acknowledgment among treatment providers, commissioners, policy makers and advocates of the service gap for people from BAME backgrounds, even if it is an uncomfortable conversation for some. Beyond this, we need a large-scale transformation of the addiction treatment system in the UK to ensure that everyone—including marginalised groups—has access to appropriate, effective and equitable support.
Find out more about BAC-IN and support their work here
This piece was written by Nicole Borgers, Research Officer at Volteface. Tweets @NicoleBorgers