Visions Journal

Bavenjit Kaur Cheema, MD, CCFP, CISAM

Reprinted from the Don't Erase Me: Why culture matters in mental health issue of Visions Journal, 2026, 21 (3), pp. 34-36

People of South Asian descent are often raised in a culture of collectivism, especially first- and second-generation immigrants. They’re taught to see themselves as part of a larger whole that includes their family, community and friends, rather than as isolated individuals. Understanding this, and the weight community carries in a person’s life, can be a powerful tool when supporting members of these communities through substance use and recovery. 

In everyday life, a strong sense of community is reflected through South Asian places of prayer (e.g., Gurudwaras), extended families, neighbours who feel like family and friendships that grow into lifelong support systems. Communities can offer consistent care and belonging. At the same time, they can also bring judgement, shame and fear of being talked about.¹ The same community that can hold someone through healing can make it much harder to ask for help.

Recovery within the collective

For some people struggling with substance use, community becomes a circle of care that facilitates healing. For others, it becomes a barrier. Embarrassment and fear of losing respect can prevent them from discussing or accepting help for their substance use. This is where healthcare communities become pertinent to a patient’s recovery.

Research supports what many of us see every day: social connection plays a major role in recovery from substance use. Strong social support is linked to:

• better treatment outcomes 
• lower relapse rates 
• improved mental health 
• feelings of connection to others 
• higher likelihood of staying in care and maintaining long-term recovery²

In contrast, social isolation increases the risk of substance use, relapse and early death.³

Local community, local support

In BC, South Asian men have experienced increasing rates of drug toxicity deaths.⁴ International research also shows South Asian men are more likely to experience disability or death related to alcohol use disorders compared to other populations.⁵ Yet despite these greater health risks, South Asian communities access the least number of resources for help.⁶

What creates this hesitation? A key barrier is the lack of culturally tailored resources and programs that help patients feel understood.6 When people seeking care are met with systems that misunderstand their lived realities, they may feel further isolated and withdraw from ongoing support.

The Roshni Clinic was created to close these gaps. Its goal is to provide culturally responsive addiction medicine care for South Asian people in BC. The clinic dates back to a needs-based assessment in the Fraser Health region that identified South Asian communities as underserved in mental health and substance use care. Thus, in 2017, the Fraser Health Authority created Roshni—meaning “light.”

Today, Roshni operates four days a week and includes a team of professionals who all speak either Punjabi or Hindi, including: 

• a physician 
• nurses 
• a social worker
• counsellors
• a peer support worker with lived experience

A warmer light

From the moment someone walks through the door at Roshni, the intention is to create an environment that feels like home, where patients don’t have to overexplain the basic principles of their lives or fear judgment. Some features of Roshni’s approach include: 

Shared language: The sense of ease is immediately palpable when patients hear their mother tongue spoken in the examination room. When people can describe their struggles in their own words, the fear and anxiety of seeking help begins to soften, and even those hesitant to engage in care may approach with curiosity.

Cultural knowledge: Roshni provides a deep understanding of the cultural contexts of substance use. Many patients describe using substances such as afeem (opium) or kamini, an Ayurvedic preparation containing opioids.

These substances are uncommon in Western addiction medicine, but deeply rooted in some South Asian contexts. They are often used for energy during physically demanding labour jobs and may not be recognized as harmful at first. Over time, dependence develops, and people seek help.

Linking culture with clinical expertise: Because the team understands both the cultural meaning and clinical risks of these substances, treatment plans are both realistic and trusted by patients. This may include:

• adjusting medication schedules around work hours 
• involving family members in treatment routines 
• using culturally meaningful explanations to help families understand substance dependence and recovery

Although Roshni is a self-referral clinic, many patients can initially be hesitant to engage in counselling and other psychosocial supports. The clinic’s model includes creating long-term relationships with physicians who see patients regularly. As trust grows with providers who speak their language and understand their world, patients often become more open to counselling and peer support.

Counselling at Roshni reflects this cultural lens: spouses, parents and adult children are frequently part of the conversation. Healing is not seen as something that happens alone, but within relationships. Over time, a new kind of community begins to form, one that is trusted to remain consistent and non-judgmental throughout the recovery journey.

Substance use care is difficult for anyone to access. But when people feel ostracized from basic principles of connection and community, their opportunity for recovery decreases further. Sometimes we need to lean on people who aren’t directly within our inner circle to find our own voice in our recovery journey.

Through creating micro-healthcare communities with a sense of belonging and acceptance, we shine a new Roshni (light) on the path of healing.