• Can you tell us a bit about the book?

This book entitled ‘ill treatment’ is a first-hand lived experience account of the insidiousness that exists within the for-profit model for substance use disorder treatment. Throughout this non-fiction, I take you on my journey through whistleblowing to various entities within the United States and walk you through their respective processes yielding repercussions. Thereafter, in an autopsy of the failed facility, I present a for-profit circle of profiteers consisting of a super-elite; highlighting their greed and potentiation to practice the same pattern again.

• Why did you write it?

For me, my actions in the moment were based on sound ethics and upbringing. Thereafter, having been privy to this type of information, I feel there is a greater social justice element that needs to be relayed to the general population. By this I mean, folks in all circles, from those in need of care, families looking for treatment for loved ones, to clinicians, and even lawmakers. I wrote this book so that the general public can have direct factual accounts of how some of these bad players are not interested in efficacy, but rather profiting on the backs of those sick and suffering to ensure that the number in their bank accounts is massive. Transitively, my hope is that folks, with this knowledge, can do better research to not get taken advantage of, or worse, have a family member or loved one get caught up in this sick cycle. 

Further, my aim is provide insights as a foreshadowing if other countries are to adopt a similar system to that found here in the United States.

• What impact do you hope the book will have?

The only impact I would genuinely like to see is change. I would like to see current operating facilities practicing similarly to be held accountable. Further, owners and operators (ie bad players) are to be held accountable consistently.  

Simultaneously, I would hope that in the moment of juxtaposition where someone’s drug of choice is presented to them; I would pray that this information would sway them away from using. For if we use, we then choose to submit to be part of this system of profiteering within the ‘ecosystem of addiction’ (ie revolving door). I am hoping that the readers can look at our system through the lens of this book to question, is this truly helpful or is this a symptom of the disease of our entire healthcare system?

• What are some solutions for the challenges you’ve outlined?

The main challenge seems to be the consistent motif found in the United States: those with money tend to get away with crimes. We have seen this with the Sackler dynasty as they just recently declared bankruptcy to be able to evade further ramifications and pending lawsuits. This has been cited as ‘billionaire justice.’ This is another example of how the hyper elite can stand alone, profiteer, and walk away literally unscathed. This is a massive issue within our system. Further, on a more macro level, there is a systemic issue with the privatization of health care and coverage. Privatization of healthcare and commercialization of insurance is a faulty blueprint that started here in the United States, and in my research, is beginning to spread to other parts of the world (for mental health treatment, substance use disorder treatment, and medical treatment). My family in India confirmed that this is what is occurring there, I have colleagues in China stating that they are seeing the same phenomenon of private commercial insurance coming into their market. Friends in the UK have said similarly. Extended family in Toronto said similar.  

It almost begs to question, is this the ‘second wave’ of the Sacklers’ monopolizing on their created epidemic on a global level?

• How can people access the book?

For now, the book will be available online. Folks are welcome to sign up for updates as to when it will be coming out:

https://www.kapilnayar.com/ill-treatment

Hardback, paperback, and digital versions will be available internationally. 

Kapil Nayar MA LPC NCC ACS ChT

Doctoral Student I Counselor Education and Supervision

“Through a survey and interviews conducted by Asra: The Panjabi Alcohol Resource in 2020, we learned what challenges individuals are facing regarding alcohol use, what support they are accessing (if any), and how these supports are helping or hindering community members.

Our survey and interviews show a need for resources that are created for Punjabi communities with their specific needs, strengths, and prior experiences in mind. Throughout this report, we highlight the challenges that Punjabi communities are facing, how those challenges are being affected by the COVID-19 pandemic, the communities’ access to resources, and the ways that those resources have failed to serve their needs. We hope that the conversations presented throughout this report push us to develop culturally humble resources that acknowledge the specific challenges and strengths of Punjabi communities. 

We wanted to highlight the formulation of an ideal support system for those interlocutors that we had the pleasure of interviewing. Those that we spoke to highlighted the experiences of migration, poverty, and intergenerational trauma as ones that are key to be understood by healthcare providers and support systems. The ideal support system for them would be a space that is understanding of the fact that even though we all come from the same cultural background, we are a diverse community- from our heterogeneous experiences of mental health to when, how, and why our respective families immigrated. They would want separate spaces based upon the relationships people had to those they cared for – a space for people caring for their siblings, a place for young people caring for their parents, a space for spouses. In terms of the space for those caring for parents, they highlighted gender as a key player as there are different expectations of a son caring for a father vs. a daughter caring for a father. The community members also highlighted that they wanted to explore how spaces can be created for people who are not yet at the stage of having these conversations comfortably and asked: how can we create something that is more accessible, comfortable, and possibly anonymous? 

While this ideal only reflects a few, as we move to create more accessible and generous spaces for Punjabi communities, conversations like the one above are necessary to keep in mind so that support can be accessed. 

The entire report can be found here.”

On December 20th 2020, in collaboration with Taraki, our conversation series Broken Punjabi met virtually to discuss the challenges experienced by youth in the diaspora in regards to the farmer protests.

Although the Broken Punjabi conversation series has historically focused on the impacts of alcohol on Punjabi communities, this conversation encapsulated the various ways in which our communities have been impacted by the farmer protests.

Here are some reflections from the lovely participants and facilitators.

Defining “decenter” 

How do we center the voices of those on the ground? This is not to say our voices are not important or necessary but that they do not have to be at the center of the conversation. This movement, in fact, is not entirely about us (the diaspora). 

Understanding the contexts of India and the diaspora are necessary if we wish to decenter diasporic voices. What is oppression in India? How does it differ from our definitions? Particularly here, facism, nationalism, and the intersections and layered lived realities of caste were brought up by attendees. If we as a community are able to have difficult conversations around caste and class, this “hashing out” will actually bring us closer together. Of course within it, de-centering includes taking care of ourselves so we can hold space sustainably, effectively, and understand our greater role within this movement. We can hold space for it all.

Supporting our elders

Many members of our families, constantly brought up wanting to go to the protests themselves, perhaps feelings of longing and wanting to be in solidarity are invoked. In thinking about how we can support older generations in the diaspora (our parents, grandparents, etc.) there was an emphasis on getting members of our families to simply start talking about how the protests are affecting them. However, simply asking “how does this make you feel?” can be a difficult question to ask and answer. 

When we say that our parents can’t communicate their feelings, we really mean they can’t communicate them in our way. How can we come closer to a mutual understanding? Participants suggested looking at body language, discussing what is happening as opposed to directly asking how it is making them feel, and educating through storytelling. Asking your parents to tell you a story in relation to events as opposed to directly asking about feelings can provide similar answers. Frequently, we focus on the obstacles that prevent us from reaching our common goal and not necessarily on what works. Discussing what works, can help us better understand how we can achieve our common goals. When discussing different ways of having conversations or asking questions to our elders, some participants brought up storytelling in casual spaces like on the couch when drinking cha. 

Our impact does not have to be earth shattering. Speaking with your family, bringing up the intersections of caste, colonialism, and capitalism can create spaces of mutual learning. Although older generations may not use the same language and categories that we function within, this doesn’t mean these conversations are beyond their capabilities. Through truly and actively listening, we can learn from older generations and challenge what we have perhaps always assumed to be true. As one facilitator pointed out, although her grandmother was not using the word “anti-nationalist,” she was making statements that aligned with the term (see: the Ghadar Movement). In conversations around caste, we can challenge our assumptions around the term by asking our parents what role it has played in their lives and how they’ve understood it. What is the Punjabi or Hindi term for caste? We don’t necessarily have all the answers, all we can do is learn from each other.

Sometimes these endeavours can be overwhelming so it is important to remember that as we try to support those around us, we must not forget about ourselves. Sometimes something as simple as going into nature can be cathartic. As outlined by a participant, rest is resistance, not indulgence. 

Long-term inspiration

Particularly poignant were conversations around how the protests have served as a great source of inspiration for many in the diaspora. However, how do we harness this momentary inspiration and make it sustainable? 

Various members of our communities are showing up and exercising their right to protest, realizing that they too are political beings. However, this also means that they may clash with those who have been continuously engaging with politics. This is not to say that there is one “right” way to protest but to think about how we can approach people at various stages of their politicization. How do people who have historically engaged in political endeavours, extend the same kindness that was shown to them before they gained a political consciousness? Participants also spoke about organizing with purpose, not just passion and engaging with all individuals without alienation. Some suggestions on how to do this included teach-ins in Punjabi and English, translating information (including memes!), and taking care of ourselves. 

Our conversation ended with a reflective letter writing activity where participants were prompted to write a letter on how we can be of use; either to folks on the ground there, or to family/friends immediately in our communities. Participants were also provided with resources to email their local MP through a sample letter and the contact information of Canadians MPs. 

Networks of Care

Looking after ourselves and creating networks of care is essential to keep a revolution going. We all migrate through systems differently, whether it be our politics or our everyday engagements. It is about meeting people where they have landed and moving together. This can be with individuals who are new to protesting and political dialogue or with individuals who engage in dialogue in a way that is not familiar to you. Caring for ourselves and others sustains and spans generations and revolutions. When we approach spaces with care, we can listen better and more imaginatively, creating places of safety to co-learn. 

But this doesn’t mean that the process doesn’t get exhausting. Ultimately, you just do enough and that’s all you can do. 

For more information on the farmer protests and mental health-related work, you can access our resource list. 

We hope this provided you with some insight into our conversation. If you are interested in joining future conversations, be sure to follow us on social media for updates:

https://www.facebook.com/asranow

https://www.instagram.com/asra.now/

Tweets by asra_now_

By Ravia Dhaliwal

This is part two of a three-part series of articles based on Ravia Dhaliwal’s Undergraduate Honours paper “Sikh Punjabi Masculinity and Barriers to Mental Health and Addiction Supports,” from the University of Alberta’s Women’s and Gender Studies and Political Science program. If you haven’t already, read the first part: “How Addiction Begins: Opioid Addiction in Punjabi-Canadian Communities,” for the geopolitical contexts of how addiction begins for Punjabi Canadians. 

This second part attempts to answer the question, why are Punjabi men disproportionately afflicted with addiction issues? In my research, I found three overarching reasons: Being a Man, Hard Work, and Sex.

As a researcher, I focused on understanding masculinity as something that is taught, something that is “performed.” Here, masculinity is understood as something that is policed, where if someone does not act masculine enough, there are consequences. As a part of this policing process there are a number of things a man is expected to do and in Punjabi culture (also western culture and the global patriarchy), working hard and providing for loved ones is at the top of those expectations. 

In unpacking Punjabi masculinity, hard work plays a central role to identity development and self worth. Mouallem (2017) explains in Alberta’s contexts how “a lot of men’s sense of self-worth comes from his job and what he makes,” and if a man is unable to find that employment or make the money he needs to survive, his self-perception lowers, creating conditions where he may face mental health issues as a result of his paycheck.

The mental exhaustion that comes from the expectation that Punjabi men provide for their families is magnified by the fact that many immigrants’ educations are not recognized in Canada. As a result individuals work labour jobs to support themselves and their families. To increase the amount a person works, an increase of risk is involved including driving extra long hours as truckers or taxi drivers or working multiple jobs and overtime shifts. Furthermore, studies have found that the immigrant experience, which includes isolation from families and communities, language barriers, and racism, plays a large role in the creation and realization of mental health issues (Islam et al. 2017, 2, Dhaliwal-Rai 1992, 4). Understanding these experiences in conjunction with masculine expectations, we are able to see how the pressures are insurmountable. 

On top of this, men are often ill-equipped to work through mental health issues because speaking about feelings is not considered masculine, resulting in an ineffective way to deal with mental health issues (Mouallem 2017). In relation to masculinity, Oliffe et al. (2010) found that immigrant men said that the men’s depression signalled weakness while women’s signalled emotionality and fragility. As a result, men are likely to live with unresolved mental health issues and turn to other methods of dealing with emotions, such as drinking alcohol or consuming drugs. 

Furthermore, as exacerbated in Punjabi pop culture, using substances to increase productivity or deal with stress is exceedingly prevalent. As I briefly touched on in the first article of this series, the normalization of using doday (poppy pod tea) is not just a Canadian problem, but a transnational issue. Men who are addicted often see their addiction as normal. Especially because most men begin their usage to increase the amount they work, the use is justified. Historically, many farmers from Punjab used opium to perform physical labour on their farms, normalizing the medicinal use of opiates. Opium has a long history in Punjab and is commonly associated with agricultural work. As Sandhu (2009) finds, there is a distinct trend of an increase in opioid use during harvesting months. Specifically, bhuki (dried poppy husk) is used to increase productivity by suppressing one’s appetite (Chaudhary 2019). As opiates are highly addictive, self medication with opioids without correct dosages can lead to a reliance on the drug (Authors Interview, Dr. Singh, November 20, 2019). This means that health literacy or an understanding of the path to addiction is very difficult for some to understand. Addiction is not identified by the people who use opium, and it is often thought that willpower and self control will help them get rid of their addiction. 

What’s Masculinity Got to do With Mental Health and Addiction?

Masculine expectations for men play a large role in how the “good immigrant” in Canada is conceptualized. The “good immigrant” is one who complies to the neoliberal capitalist conceptions of working hard at their jobs (Boparai 2019, 46). Saran (2016) poses that immigrants view education as an “investment for economic returns and gaining access to white, middle class, mainstream society” (48). In this same way, I posit that immigrant men work to provide for their families to fit into hegemonic masculinity which in Western contexts constructs the ideal and most revered masculinity. These ideals of masculinity can be illustrated through Brannon’s Four Rules of Masculinity which are as follows:

1. “No sissy stuff,” avoid feminine behaviours,

2. “Be a big wheel”, aggressively strive for status and achievement, especially in sports and work, 

3. “Be a male machine,” solve problems without help, maintain emotional control at all times, and never show weakness to anybody, and 

 4. “Give ‘em hell,” take physical risks and be violent if necessary (N.A. 2016). 

Although hegemonic masculinity changes within the time and space it is constructed, these conceptions of Brannon’s rules of masculinity are helpful in the understanding of masculinity upheld by Sikh Punjabi men in post-migration contexts. 

Understanding Sikh Punjabi masculinity in post migration involves a consideration of the marginalization of racialized men in Canadian society, and masculinity literature. Connell’s (1995) conceptualization of “marginalized masculinities” is useful in comprehending the masculinity Sikh Punjabi men are expected to uphold. For the Sikh Punjabi immigrant, the experience of being a racialized immigrant who may not speak the language, plays a role in the constructions of masculinity they are expected to uphold. “Protest masculinity,”masculinity constructed in local working class settings and sometimes in ethnically marginalized men, is also helpful here in understanding Sikh Punjabi men. It “embodies the claim to power typical of regional hegemonic masculinities in Western countries, but lacks the economic resources and institutional authority” (80). Western and Sikh Punjabi ideals of masculinity overlap in the appreciation of work and productivity (McMillan 2018). The hegemonic masculinity in the West may require Sikh Punjabi men to uphold the rules of masculinity of “being a big wheel” and being a “male machine” (N.A. 2016), but the minority status of a Sikh Punjabi man creates a lack of “institutional authority” (Connell and Messerschmidt 2005, 848). 

Sikh Punjabi masculinity embodies the standards of the “model minority” and embraces conceptions of the “hardworking man” and of men being a “male machine” which are upheld in Canadian hegemonic masculinity (N.A. 2016). A model minority is the conception that a minority population, such as Punjabi’s in Canada, models the characteristics valued by western society. Mahalingam (2012) posits that Sikh Americans are one of the most successful South Asian immigrant groups. Although Punjabi Sikh’s have been successful in colouring their piece of glass for “Canada’s cultural mosaic,” the upward mobility they have is ultimately a result of the Punjabi-Sikh perspective on the world matching up with Western world view and being successful in Canada’s capitalist society. 

Many academics have compared the Punjabi Sikh work ethic to Weber’s “Protestant work ethic”: to work hard, save money, and educate one’s children (Mooney 2012, Tanabe 2014, Purchase et al. 2018). These conclusions, which aim to explain the relative economic successes of the communities still seem to lack “institutional authority” in Canada  (Connell and Messerschmidt 2005, 84). For example, Member of Parliament Amarjeet Sohi who gained political success and embodies many of the “rules of masculinity,” was laughed at by Conservative MP’s because of his past as a city bus driver (Trynacity, 2017). Alberta NDP politician Brian Mason, also a former bus driver, has never faced such remarks, the difference being his positionality as a white politician who can embody hegemonic masculinity and have institutional authority whereas Sohi’s political success and ability to “be a male machine” and work hard at a job is ridiculed because of the “lack of economic institutional authority” Sohi has due to being a racialized immigrant man who was previously employed as a bus driver (Connell and Messerschmidt 2005, 84).  

The rigidity of Brannan’s rule of masculinity shows how men’s mental health is disregarded overall, especially through the third rule of being a “male machine” which teaches men to “never show weakness to anybody,” or ask anyone or help (N.A. 2016). Sikh Punjabi masculinity, paired with the Sikh Punjabi perceptions of mental health, and the immigrant experience create the conditions for men to be in environments which would increase the likelihood of them having mental health issues. Without support which fit the understandings and experiences of Sikh Punjabi men, many are led to cope with reliance on alcohol and drugs (Weber 1996, 1716). 

The Strong Sikh Punjabi Man and Sex

Sex. Yes. The ever avoided subject. Pervasive, and suggested in much of Punjabi media, but evaded, bleached clean, and made virtually impossible to imagine through several overlapping issues. 

Much to my own surprise, an individual I interviewed highlighted how men on their swaag raat (wedding night) would receive a small dose of opium to enhance sexual performance. Following this tradition, an opiate-based drug, named Kamini Vidrawan Ras, commonly known as Kamini, is an opiate-based drug that is sold as an aphrodisiac. This stimulant contains 2-20mg of opioids per tablet (Singh and Kainth 2017). Specifically, Kamini is used to “prevent premature ejaculation, intimate anxiety, and other worries” men may have, in order to “prolong the sexual encounter” (Advani 2013, 10). Kamini is reported to be sold over the counter at many Indian grocery stores–  much like doday was sold in Canada. One of my interview participants mentioned that Kamini can be bought online, or brought from India and sold in Edmonton. The interviewee described that the whole point of Kamini, or taking opiates prior to a sexual encounter, is that if one is in  “control” of oneself, it is more masculine. It is not necessarily for pleasure, but to delay orgasm and to seem more masculine (Author’s Interview, November 15, 2019). In this case, men’s opiate use can be directly tied with their masculinity. 

Talking about sex in the Punjabi community is so rare but as soon as it gets to the swaag raat, the pressure to have intercourse and reproduce is imposed on newlyweds. I had thought that maybe coming forward about addictions because of taking Kamini for reasons related to sexuality may act as a further barrier to accessing care. Contrary to my thoughts, Dr. Singh found that many of his patient’s families were concerned about their son’s or nephew’s sexual and intimate life, especially when it came to having children (Author’s Interview, November 20, 2019). I found that there is a plethora of research on the “Dhat syndrome” – a condition of premature ejaculation which is researched and treated through drugs like Kamini (Avasthi et al 2017).  Moreover, many Punjabi men come to Dr. Singh for testosterone replacement, to the point where the doctor was refusing to give patients more testosterone because their dosage was already high. Dr. Singh specifically mentioned that patients wanted testosterone injections because it would make them “stronger and make them more masculine” (Author’s Interview, Dr. Singh, November 20, 2019). The obsession with wanting testosterone injections as described by Dr. Singh and Dr. Smith may be related to marginalized masculinity in Canada. On the other hand, it also highlights the self-perception and the social conditions which cause men to be obsessed with being more manly.  

Understandably, this is not what it takes to explain away addiction. Now that we know how addiction begins and what makes Punjabi men addicted, the third and final article in this series will unpack the barriers to support that they face and recommendations for health care providers. 

References:

Advani, Rahul. 2013. “Factors Driving Drug Abuse in India’s Punjab.” National University of Singapore, Institute of South Asian Studies. (177). https://www.files.ethz.ch/isn/170331/ISAS_Working_Paper_No__177_-_Factors_Driving_Drug_Abuse_in_India’s_punjab_24092013171919.pdf 

Boparai, Parmvir Singh. 2019. “Relationships between Culture and Masculine Identity Development in South Asian Canadian Immigrants,” Masters Thesis.  University of Seattle, Vancouver BC, Canada Site. http://52.160.103.123/bitstream/handle/20.500.11803/788/Parmvir%20Singh%20Boparai%20Thesis%20Final.pdf?sequence=2&isAllowed=y 

Butler, Judith. 1988. “Performative Acts and Gender Constitution: An Essay in Phenomenology and Feminist Theory.” Theatre Journal 40 (4) 519-531.

Dhaliwal-Rai, Karin. 1992. “Perspectives on Mental Wellness/Health of Sikh Punjabi Immigrants in the City of Surrey.” M.A. Thesis. Simon Fraser University. Google Scholar http://www.collectionscanada.gc.ca/obj/s4/f2/dsk3/ftp04/MQ61549.pdf

Chaudary, Vivek. 2019. “The Indian state where farmers sow seeds of death”  The Guardian. July 1, 2019. https://www.theguardian.com/global-development/2019/jul/01/the-indian-state-where-farmers-sow-the-seeds-of-death

Connell, R.W.. 1995. “The Social Organization of Masculinity.” In Masculinities, 76-86. St. Leonards, N.S.W.: Allen & Unwin. 

Connell, R.W., and James. W. Messerschmidt. 2005. “Hegemonic Masculinity: Rethinking the Concept.” Gender and Society 19 (6): 829-859. 

Hall, Kathleen D.  2004. “The ethnography of imagined communities: The cultural production of Sikh ethnicity in Britain.” The Annals of the American Academy of Political and Social Science 595 (1): 108-121.

Islam, Farah., Amanpreet Multani, Michaela Hynie, Yogendra Shayam Kwame McKenzie. 2017. “Mental health of South Asian youth in Peel Region”, Toronto, Canada: a qualitative study of determinants, coping strategies and service access. BMJ Open 7:e018265. doi:10.1136/ bmjopen-2017-018265https://bmjopen.bmj.com/content/bmjopen/7/11/e018265.full.pdf

Mahalingam, Ramaswami.  2012. “Misidentification, Misembodiment and the Paradox of Being a Model Minority” Sikh Formations 8 (3) 299-304. 

McMillan, Anna. 2018. “Edmonton Sikh parade draws tens of thousands to Mill Woods neighbourhood.” CBC News, May 20, 2018. https://www.cbc.ca/news/canada/edmonton/edmonton-vaisakhi-sikh-parade-1.4671638#targetText=Edmonton’s%20Sikh%20population%20has%20about,the%202011%20National%20Household%20Survey.

Mooney, Nicola. 2006. “Aspiration, reunification and gender transformation in Jat Sikh marriages from India to Canada.” Global Networks 6 (4): 389-403.

Mouallem, Omar. 2017. “Oil, Heartbreak, And Manhood: Behind The Mental Health Crisis of Alberta Oil Workers.” BuzzFeed News, August 2, 2017. https://www.buzzfeed.com/omarmouallem/oil-heartbreak-and-manhood

N.A., Shawn. 2016. Man up! The “Rules” of Masculinity. Accessed April 16, 2019. https://mavricproject.princeton.edu/2016/08/man-up-the-rules-of-masculinity/

Oliffe, John L., Steve Robertson, Mary T. Kelly, Philippe Roy, and John S. Ogrodniczuk. 2010. “Connecting Masculinity and Depression Among International University Students.” Qualitative Health Research 20 (7): 987-998. https://doi.org/10.1177/1049732310365700

Purchase, Sharon., Nick Ellis, Oliver Mallet, and Theingi Theingi. 2018. “Religious Social Identities in the Hybrid Self-presentations of Sikh Businesspeople” British Journal of Management 29: 99-117. 

Sandhu, Jaswinder Singh. 2009. “A Sikh Perspective on Alcohol and Drugs: Implications for the Treatment of Punjabi-Sikh Patients” 5 (1): 23-37 DOI: 10.1080/17448720902935037

Tanabe, Sean. 2014. “Let’s Meet at the Langar: How the Sikh community has persevered and Thrived in the US. Global Societies Journal, 2(0): 9-16. https://escholarship.org/uc/item/34c5582q

Saran, Rupam. 2016. Navigating model minority stereotypes: Asian Indian youth in South Asian diaspora. New York: Routledge.

Trynacity, Kim. 2017. “Conservative MPs laugh at Amarjeet Sohi’s past as a city bus driver.” CBC News. February 15 2017. https://www.cbc.ca/news/canada/edmonton/bus-driver-minister-laughter-1.3984808
Weber, Timothy R. 1996. “The influence of acculturation on attitudes toward alcohol and alcohol use within the Punjabi community: an exploratory analysis.” Substance Use Misuse 31 (11-12):1715–1732.https://www.tandfonline.com/doi/pdf/10.3109/10826089609063998

Understanding the needs of the Punjabi Community to address problems with alcohol.

The association of alcohol with Punjabi culture is one that is widely internalized whether it is through media and movies or in our everyday celebration culture. Many interactions within Punjabi families and friends often involve the consumption of alcohol. Sometimes this is an unspoken cultural norm that slips through the cracks, yet many families face the ramifications of problem drinking in their everyday lives.

Recently, under the supervision of a Physician focused on south Asian addictions, a medical student from UBC conducted an online survey of the Punjabi community asking questions such as “do you know someone with a drinking problem?”, “did you try and find help for this problem?” and “what was your biggest barriers to finding help?”. We found that 45% of people who knew someone with a drinking problem, did not try to find help. The three biggest reasons for this were: the person affected struggled to acknowledge their problem with drinking, people were worried about other’s opinions if they knew their family member struggled with alcohol use and thirdly, there was a lack of culturally appropriate resources for Punjabi families to access. Learn more about the study here.

One of the main issues identified in the Punjabi community was an inability to acknowledge when drinking habits have turned into an alcohol use disorder, which previously people would have called “alcoholism”. Since drinking habits are part of social interactions in Punjabi culture, it can be hard for someone to realize when alcohol consumption has exceeded normal drinking habits. In the medical world, there is “the 4 C’s” mnemonic that can help identify this issue: a Craving to drink which pushes you to seek out alcohol, a Compulsion that creates an irresistible urge to drink, a loss of Control over how much you drink at once and drinking despite negative Consequences to your life (i.e. financial, family or personal issues). Another indicator that your body has developed a dependence to alcohol is if you experience symptoms such as shaking, sweating, nausea, vomiting, insomnia or anxiety when you stop drinking. These are examples of withdrawal. Withdrawal from alcohol can be life threatening, as it can result in seizures or a more serious condition called delirium tremens which directly affects the brain. It is important to seek a medical assessment in those times.

The next step after recognizing there is a problem, is reaching out for help. It is important to understand that addiction is not a choice. It is a complex health problem, that like with any other disease, can be treated and managed with medication, therapy, and community support. The barrier in the Punjabi community is that we do not know what type of help is available. Beyond that, it is difficult to find help that is in Punjabi.  Research shows that when a doctor or provider has the same background and language of the patient, they are better able to help. Recently, we have launched www.asranow.ca a bilingual website in English and Punjabi that helps Punjabi families find resources and information about problem drinking. The site highlights all of the resources in Surrey, Vancouver and Abbotsford (and expanding in the future) that can support our community with alcohol use disorder. Examples of these resources include Punjabi speaking counsellors, groups, medical centres and rehabilitation centres. It can be found on Instagram, Facebook and directly through the internet by searching “asranow”. We hope this provides a first step to addressing this need in our community.

Ultimately, problem drinking is due to a multitude of factors in our community, and often we are isolated. People sometimes feel overwhelmed by guilt, uncertainty, fear, self-loathing, or the symptoms of the disease itself. If we can start having more conversations in our community, then we can break down stigma to reach out and get help (as a family member or as the person affected). This way we can realize this is a disease that can be treated, just like so many others, if we bring together mind, body, spirit and work to support families and individuals.

By Ravia Dhaliwal

This is part one of a three-part series of articles based on Ravia Dhaliwal’s Undergraduate Honours paper “Sikh Punjabi Masculinity and Barriers to Mental Health and Addiction Supports,” from the University of Alberta’s Women’s and Gender Studies and Political Science program.

This research was born out of personal experience. I had noticed that my family had been attending far too many funerals for young men who died by “heart conditions,” where we would later learn that they died because of an overdose.  

While doing my research, and talking to members of the Punjabi communities, I have realized this issue is not just something I have witnessed in my personal life, but it affects virtually every Punjabi person I have met.  Whenever I speak about it, someone usually comes forward with a deep personal connection to my thesis. While this may not be surprising, we all know on some level that addiction is an issue in our communities, but the extent to which it is talked about is terrifyingly low. 

For this research I relied on interviews with addiction service providers, and relevant news articles. 

Doday in Canadian Cities 

The transnational nature of Punjabi-Canadians is made apparent through how doday, an opiate also known as “poppy pod tea,” became an issue in Canadian cities and Punjab. In 2010, the BBC reported on Punjab’s drugs epidemic, the same year the Canadian news channels, including The Brampton Guardian and CTV News, reported on the emergence of doday in Surrey and Brampton. Doday were known to be sold at South Asian grocery stores, butchers, and other shops in most Canadian cities. From 2009 to 2010 many municipalities cracked down on opioid sales and several raids and seizures of doday, pheem, and other substances occured. 

Technically doday were illegal under the Controlled Drugs and Substances Act, but they were thought to fall under a “legal grey area” for users (Mulholland 2010). This was because doday usually ran undetected in drug tests, as there were not enough opiates to be detected (Mulholland 2010). In July 2010, Justice Bruce Durno, of the Ontario Superior Court of Justice  concluded that while doday are not as harmful as opium, and are not in the same category as cocaine, “it is more harmful than marijuana or other ‘soft’ drugs”, including being highly addictive. 

The Aftermath of Irresponsible Drug Policies

When the RCMP and regional police forces across Canada cracked down on doday sales, the illegality of doday was affirmed, and doday vanished from the market. After this nationwide breakdown, Indian butchers and Punjabi stores stopped selling doday, (at least officially). The specialists I interviewed for my thesis explained that when doday were pulled off the streets, there was no education or treatment options given for users to deal with their opiate addiction. They emphasized that opiate addictions “cannot be quit without treatment, it’s not possible”. As a result of doday being seized from Indian stores,  users went from drinking doday tea in the morning to using harder variations of opiates to cope with withdrawal symptoms. According to my interviews, this also led to a number of older Punjabi immigrants who used doday moving back to Punjab to manage their addictions. Some went to their doctors to receive prescriptions for Tylenol 3 or 4, and others switched to illegal options like heroin. According to an interviewee, heroin addiction and overdose was not a “big issue [in the Punjabi community] before, but it became a bigger issue after the poppy pods were banned”. 

So, why were doday banned? Community members voiced concerns about the usage of doday to local politicians  including Surrey-Newton MLA Harry Bains, and Brampton City Councillor Vicky Dhillon, who brought to the attention of the RCMP. 

In asking interviewees about how this addiction came to be, they emphasized that this population is one of “risk-takers,” and sometimes these risks can benefit them – especially in business. This risk-taking behaviour leads this patient population to be more susceptible to taking drugs like doday in order to work longer hours. He has seen this most prevalent with taxi drivers, truck drivers, and other workers who are able to work longer hours and make more money to provide for their families. 

The legal crackdown on doday happened over ten years ago, and the lack of services available to help people deal with withdrawals seriously affected the community with the use of more dangerous substances. The police response to the sale of doday was the result of politicians reacting to an increased use in their communities. An understanding of the danger of taking doday off of shelves may have changed the approach taken by politicians and police. Inevitably, the response taken by officials was harmful to Punjabi communities. A more holistic look  at  the fallout from the criminalization of sellers of doday, without giving the lifesaving resources people who are addicted is needed to understand the far reaching effects of the opioid crisis. 

The seizing of doday caused several life-threatening changes for dependent people. While the argument can be made that opium is illegal and doday should not have been sold, the seizing of doday lead people who were chemically dependent on opioids to use more dangerous substances. This led to an increase of opioid related deaths in Punjabi communities. Communities cannot be held solely responsible for the fallout from the seizing of doday. The legal and police response must share the blame. The laws and regulations around opioid use have been historically grounded in racist, colonial, anti-Chinese, anti-Indigenous sentiments (Mytrunec 2019, Giffen et al. 1991, 87). A more indepth look on narcotics policy and marginalized communities is necessary to understand the full effects of the opioid crisis, even during governmental responses, like Alberta’s “Opioid response”(Alberta 2020). 

To contextualize, Alberta’s opioid response was not fully geared up until 2015, likely because of a change in government (Alberta 2020). Nevertheless, there were several deaths and health problems related to the seizure of doday from shops without providing any remedy for these men. An inquiry into the effects of seizing doday would help communities understand the direct and indirect impact of treating drugs this way. While the current opioid response has saved many lives, a more holistic, community-based response is needed to tackle the opioid crisis in the Punjabi communities. As many other sources have found, using a one size- fits all approach to addiction never works. A specific, Punjabi-centered approach to addiction is needed. To reveal what a culturally relevant approach to addiction for Punjabis looks like, we must investigate how addiction begins. What are the factors that make Punjabi men vulnerable to addiction? These factors are diverse, and deeply rooted in Punjabi masculinity, and will be unpacked in my next post: Why Punjabi Men Get Addicted: Hard Work, Sex, and Being a Man.

 ¹The identities of these interviewees are disguised to ensure I adhere with my agreement with the  University of Alberta’s Research Ethics Office.

References

Alberta. 2020. “Opioid reports.” https://www.alberta.ca/opioid-reports.aspx

Faulder, Liane. 2019. “Edmonton doctor opens opioid clinic geared to South Asian community”. Edmonton Journal. June 24, 2019. https://edmontonjournal.com/news/local-news/doctor-opens-75-st-clinic-for-opioid-users-in-south-asian-community/

Giffen, P.J., Shirley Endicott, and Sylvia Lamberta. 1991. Panic and Indifference: The Politics of Canada’s Drug Laws: a study in the Sociology of Law Ottawa. Canadian Centre on Substance Abuse 

Mulholland, Angela. 2010. “Police, doctors warn of the growing use of ‘doda’ March 20, 2010. CTV News. https://www.ctvnews.ca/police-doctors-warn-of-the-growing-use-of-doda-1.493816