A systematic review of qualitative research on substance use among refugees

Abstract

Aims: To evaluate qualitative research on substance use and substance use disorders (SUDs) among refugees in terms of practitioners' and substance users' attitudes, beliefs and experiences. Methods: Six medical, allied health and social sciences databases (EBSCO, PubMed, ScienceDirect, Web of Science, Scholar and the Cochrane Library) were systematically searched in a time frame between January and April 2021 to identify original peerreviewed articles describing qualitative findings related to substance use among refugees (alcohol, illicit drugs, tobacco and prescription drugs). Study selection, critical appraisal and detailed extraction were performed via the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Systematic Reviews (PRISMA) (2018). Three independent reviewers selected the relevant abstracts and articles. Synthesis of the evidence identified prominent themes relating to the context and consequences of substance use.Results: Twenty-six studies were included in this review. Twenty-three studies applied qualitative methods and three applied mixed methods. Synthesis of the evidence from the included studies resulted in four main findings: there is a considerable susceptibility of refugees to substance use and SUDs; the harmful consequences of substance use are complicated by the social insecurities of refugees; there are rather high barriers to treatment and health facilities for refugees in many host countries; and there is a strong need to improve effective access to treatment, interventions and prevention approaches. Conclusions: Refugees are at high risk for substance use and substance use disorders and often face high barriers to treatment and interventions in host countries.

Commentary on Saleh et al: The triple burden of stigma experienced by forcibly displaced people with substance use disorder ‐ considerations for research and practice

“…In their systematic review of qualitative research on substance use among refugees, Saleh et al . describe how stigma, racism and other forms of discrimination have led to encounters with police, incarceration, social and intergenerational conflicts and barriers to stable employment and integration into host communities among refugees who use drugs [1]. While in its infancy, research on substance use among displaced populations is growing, and it is necessary for researchers, practitioners and policymakers to consider the implications of how we respond to and report on these needs to avoid compounding the stigma faced by displaced populations.…”

“…First, we must center the social and structural determinants as the principal drivers of substance use and SUD among displaced populations in research on substance use [15]. Secondly, we should prioritize the evaluation of interventions and policies that are designed to reduce stigma and related barriers to seeking and accessing SUD prevention and treatment services [1, 16, 17]. Promising strategies include implementing interventions and policies that explicitly address the social and structural drivers of substance‐related harm, such as providing stable housing, employment opportunities and supporting basic needs [18], as well as transdiagnostic and integrated interventions that address substance use within the context of other related public health conditions (e.g.…”

“…Forcibly displaced people who use substances or are living with a substance use disorder (SUD) face a 'triple burden' of stigma due to their status as an internally displaced person, refugee or asylumseeker; their intersectional identity as part of a minoritized racial, ethnic, political, religious or other persecuted group; and their use of alcohol and other drugs. In their systematic review of qualitative research on substance use among refugees, Saleh et al describe how stigma, racism and other forms of discrimination have led to encounters with police, incarceration, social and intergenerational conflicts and barriers to stable employment and integration into host communities among refugees who use drugs [1]. While in its infancy, research on substance use among displaced populations is growing, and it is necessary for researchers, practitioners and policymakers to consider the implications of how we respond to and report on these needs to avoid compounding the stigma faced by displaced populations.…”

“…Understanding the needs and providing services related to SUD in displaced communities are neglected areas in humanitarian response and research [2][3][4]. Displaced populations face many risk factors for substance use and SUD-exposure to potentially traumatic events, socio-economic adversity and disrupted social networks and family supports [1,2,[4][5][6]. This information has been used to call for further investments in epidemiological and operational research to generate evidence that can inform effective treatment and prevention of SUD in this population [4,7].…”

“…Secondly, we should prioritize the evaluation of interventions and policies that are designed to reduce stigma and related barriers to seeking and accessing SUD prevention and treatment services [1,16,17]. Promising strategies include implementing interventions and policies that explicitly address the social and structural drivers of substance-related harm, such as providing stable housing, employment opportunities and supporting basic needs [18], as well as…”