Aetiology of Coexisting Mental Health and Alcohol and Other Drug Disorders: Perspectives of Refugee Youth and Service Providers

Abstract

In the general population, people with comorbid mental health (MH) and alcohol and other drug (AOD) disorders (comorbidity) have great difficulty accessing appropriate services, and poor outcomes. Little is known about comorbidity in resettled refugees in Australia. This study was designed to identify risk factors and patterns of comorbidity development in young people from refugee backgrounds living in a disadvantaged urban region of Adelaide, South Australia. This qualitative study utilised in-depth semi-structured interviews (n = 30) with resettled refugee youth and workers from MH, AOD, and refugee support services. Thematic analyses were conducted to investigate the aetiology of MH and AOD disorders in young refugees. Interviews with both groups revealed how the interrelated nature of risk factors may place young people from refugee backgrounds at heightened risk of experiencing MH and AOD problems. The situations and conditions described by both groups are discussed under six main themes: pre-migration experiences of torture and trauma; familial factors of intergenerational conflict; post-migration adjustment difficulties in terms of language, culture, education, and employment; exposure to and availability of substances; maladaptive coping strategies and self-medication; and access to information and services. Implications for psychologists and MH professionals are identified, emphasising the need for clinicians to understand the complexities surrounding the aetiology of comorbidity in these youth. The initial assessment needs to be comprehensive, including pre-and post-settlement experiences and cultural and family dimensions of their current situation. Treatment may often need to simultaneously address multiple contributing factors and involve culturally sensitive psychoeducation.

Relationships Between Integration and Drug Use Among Deported Migrants in Tijuana, Mexico

“…A possible explanation for this finding is that uninsured participants may have limited access to appropriate care for mental health conditions, and may turn to substance use as a coping mechanism, as has been reported among other migrant samples [e.g. 57, 58]. Documentation status was not independently associated with drug use, but it is likely that this underpins the health insurance findings.…”

Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review

“…Substance use was commonly examined in the context of mental health. Two case studies described use of drugs including opiates, cocaine and cannabis to self-medicate symptoms of PTSD among refugees and asylum seekers [ 34 , 98 ], and seven qualitative studies identified coping with trauma and loss as reasons underlying the use of alcohol and drugs [ 52 , 71 , 81 , 92 , 95 , 108 , 122 ]. Three studies examined the association between khat use (a mild stimulant native to the Horn of Africa) and mental health outcomes among Somali refugees, with mixed findings [ 86 , 87 , 99 ].…”

“…An assessment of 180 services providing mental healthcare and substance abuse treatment across a number of European settings found that only 10% provided specific programs for refugees and/or asylum seekers [ 115 ]. Similarly, limited access to drug and alcohol information and services was identified as a key factor associated with substance use and mental health comorbidity for refugee young people in Australia [ 108 ].…”

Occupational Experiences of Refugees and Asylum Seekers Resettling in Australia

“…Similarly, some of the studies indicated that children may also experience bullying in school (Edgeworth, 2015;Nathan et al, 2013), or misunderstandings with law enforcers (Run, 2013). According to two reports, encounters may decrease the confidence and ability people have to engage in socially oriented occupations, thereby compromising the formation of new relationships within their changed context (Burchett & Matheson, 2010;Posselt et al, 2015).…”