Epidemiology of substance abuse among migrants compared to native born population in primary care

Abstract

Immigrants have lower levels of alcohol and substance abuse, however, those that do consume show higher levels of both comorbid mental disorders and problematic alcohol/substance use. It would appear to be the case that issues specific to immigrant cultures, such as extreme stigmatization of substance and alcohol use, may serve to promote social marginalization and inhibit treatment access.

Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people

“…Broadly, our main finding that substance use disorders were lower amongst migrants, regardless of refugee status, is consistent with previous Swedish studies [22,27], including with respect to alcohol use disorders [23]. This appears to be a robust finding globally [22–27], sometimes even in the presence of significant trauma, suggesting that cultural norms and behaviors with respect to substance use may shape risk [46]. This argument may also explain why the effect of PTSD on substance use disorders appeared to be greater in the Swedish-born population.…”

“…This could have occurred if migrant groups were more or less likely to only be identified via primary care. It has previously been reported that refugees in Sweden struggle to access healthcare services [43], sometimes due to a fear of being deported [27]. Other obstacles to accessing healthcare may include language, legal, gender, or stigma-based barriers [44].…”

“…Harmful alcohol consumption in Bhutanese refugees in Nepal was also no higher than typically observed in Western populations [20], while a further study in the US [21] reported that refugees were 3–6 times less likely to meet criteria for substance use disorders than the nonmigrant population. With regards to non-refugee migrant groups, current research also suggests that alcohol-related disorders are less common compared with host populations in the US [22], Scandinavia [23–25], and Spain [26,27], although not from one study in France [28]. Risk of other substance abuse disorders may also be lower in non-refugee migrants [22], although these have received less research attention to date.…”

“…Many studies have been based on cross-sectional surveys [22,24–27], prevalence data [20,22,24,26,27], small samples [24,26,27], imprecise definitions of refugee status [18], or substance use behaviors rather than disorder [20,24,25], making it difficult to draw firm conclusions about the risk of substance use disorders in refugee and non-refugee migrant groups. Few population-based, longitudinal studies on this topic have been conducted, with rare exceptions [19].…”

The Use of E-Cigarettes Among U.S. Immigrants: The 2014 National Health Interview Survey

“…Previous research suggests that immigrant families tend to stigmatize substance use (e.g., smoking and alcohol). 52,53 This finding was reflected in a study by Osypuk and Acevedo-Garcia that examined attitudes toward tobacco-control policies by immigrant communities in the United States and found that immigrants were twice as likely as U.S. natives to support smoke-free policies in public environments. 54 This negative attitude toward smoking among immigrants may extend to e-cigarettes.…”