A “refugee paradox” for substance use disorders?

Abstract

Background Few, if any, studies have systematically examined the link between nativity and substance use disorders (SUD) among refugees using national samples. As such, it remains uncertain if the “immigrant paradox” for substance use can be extended to include refugees in the United States. Methods Employing data from the National Epidemiologic Survey on Alcohol and Related Conditions, we examine the lifetime prevalence of SUDs among refugees (n = 428) in contrast with non-refugee immigrants (n = 4,955) and native-born Americans (n = 29,267). We also examine the impact of gender and refugee duration on the relationship between nativity, refugee status, and SUDs. Results Refugees were between 3–6 times less likely than native-born Americans meet criteria for all SUDs examined, and significantly less likely than non-refugee immigrants to meet criteria for alcohol (AOR = 0.44, 95% CI = 0.41–0.47), cocaine (AOR = 0.54, 95% CI = 0.50–0.59), hallucinogen (AOR = 0.66, 95% CI = 0.58–0.74), and opioid/heroin (AOR = 0.62, 95% CI = 0.58–0.66) use disorders. The refugee-SUD link was significantly moderated by gender. Duration as a refugee was associated with increased risk for alcohol use disorder and decreased risk of cannabis and illicit drug use disorders. Conclusions Study findings provide evidence in support of a “refugee paradox” for SUDs among adults in the United States. Refugees are substantially less likely than native-born Americans to meet criteria for all SUDs examined and, albeit with weaker effects, significantly less likely than non-refugee immigrants to meet criteria for a variety of SUDs.

Mood, anxiety, and personality disorders among first and second-generation immigrants to the United States

“…Additionally, in examining the associations between immigration status and mental health disorders, we controlled for diagnoses of lifetime alcohol use disorders (abuse/dependence) as well as lifetime drug use disorders (abuse/dependence on heroin, hallucinogens, cocaine/crack, marijuana, stimulants, painkillers, tranquilizers, or sedatives). Prevalence estimates for substance use disorders among native-born Americans and immigrants are not reported in this study, but are available elsewhere (Salas-Wright and Vaughn, 2014). …”

“…Mental illness risk factors experienced in this phase include prolonged civil conflicts and wars (Goodman, 2004), sexual and physical abuse (Crisp, 2000), separation from family (Paardekooper et al, 1999), and prolonged stays in refugee and other transitionary camps (Steel et al, 2006). Individuals who have endured these experiences report mental health and behavioral disorders, including depression, anxiety, psychosis, anger, violence, and posttraumatic stress disorder (Paardekooper et al, 1999; Steel et al, 2002; Fazel et al, 2005; Pumariega et al, 2005; Steel et al, 2006; Liddell et al, 2013; Salas-Wright and Vaughn, 2014). In the resettlement phase, immigrants often have to contend with and acclimatize to a new socio-cultural and economic environment.…”

“…Several protective factors are postulated to explain these counter-intuitive results, including: social support, cultural beliefs and practices, extended family support networks, and lower rates of substance misuse (Escobar, 1998; Escovar et al, 2000; Schwartz et al, 2010; Marks et al, 2013; Salas-Wright et al, 2014b; Salas-Wright and Vaughn, 2014; Suárez-Orozco et al, 2014). In addition, the healthy immigrant effect—the selective process whereby only those in relatively good health elect to migrate—is also postulated to explain these health dissimilarities ( Jasso et al, 2004; Akresh and Frank, 2008).…”

Substance Use Disorders Among First- and Second-Generation Immigrant Adults in the United States: Evidence of an Immigrant Paradox?

“…Overall, this body of research suggests that immigrants to the United States, relative to the native born, are less likely to initiate and develop substance use disorders. Evidence for this phenomenon, also referred to as the "healthy immigrant effect," has been observed among a variety of behavioral (e.g., antisocial behavior, intimate partner violence) and health (e.g., chronic disease, obesity) outcomes as well as among emigrants from various global regions and in multiple receiving nations (Kennedy et al, 2014;Salas-Wright and Vaughn, 2014;Vaughn et al, in press, 2014aVaughn et al, in press, , 2014b. Fundamentally, the paradox is that, despite having disproportionately lower income and education levels, immigrants are often healthier than their native-born counterparts.…”

“…Investigations from adult samples focused on emigrants from Mexico (Borges et al, 2009(Borges et al, , 2012, the former Soviet Union (Guarino et al, 2012), Asia (Moloney et al, 2008;Wong et al, 2007), and Latin America (Alegría et al, 2008;Ojeda et al, 2008) have found trends similar to those identifi ed in younger samples. Studies of adults in the United States have been hampered by their inability to examine the stability of the relationship between substance use and immigration across multiple immigrant generations or among emigrants from various regions of the world (Johnson et al, 2002;Li and Wen, 2013;Salas-Wright and Vaughn, 2014).…”