Prevalence and Patterns of Hazardous and Harmful Alcohol Consumption Assessed Using the AUDIT among Bhutanese Refugees in Nepal

Abstract

Aims: This study sought to ascertain the prevalence of hazardous and harmful alcohol consumption among Bhutanese refugees in Nepal and to identify predictors of elevated risk in order to better understand intervention need. Methods: Hazardous and harmful alcohol consumption was assessed using the Alcohol Use Disorder Identification Test (AUDIT) administered in a face-to-face interview in a census of two camps comprising ∼8000 refugees. Results: Approximately 1/5 men and 1/14 women drank alcohol and prevalence of hazardous drinking among current drinkers was high and comparable to that seen in Western countries with longstanding alcohol cultures. Harmful drinking was particularly associated with the use of other substances including tobacco. Conclusions: Assessment of the alcohol-related needs of Bhutanese refugees has permitted the design of interventions. This study adds to the small international literature on substance use in forced migration populations, about which there is growing concern.

Individual and Community Level Risk-Factors for Alcohol Use Disorder among Conflict-Affected Persons in Georgia

“…Evidence from other studies on conflict-affected civilian populations on the influence of age is mixed, with younger age associated with hazardous alcohol use in two studies of South East Asian refugees in the United States [17], [19], while a study of IDPs in northern Uganda observed higher levels among older age groups [43], and a study of Bhutanese refugees in Nepal observed no age effect [42]. Our study found no association of level of education with alcohol use disorder at the individual level (but there was in the community level analysis); and a study on harmful alcohol use among Bhutanese refugees in Nepal did observe an association between higher education and lower alcohol use disorder [42]. No association was observed between tobacco use and alcohol use disorder (for further details on tobacco use with the study population please see [67]), whereas the study of Bhutanese refugees in Nepal did report an association between tobacco use and hazardous alcohol use [42].…”

“…It seems that while patterns of episodic heavy drinking are commonly higher in younger age groups globally (particularly in high-income settings), such patterns are not yet present in Georgia (both for conflict-affected and general populations) and nor are they present in most other countries in the former Soviet Union [45]. Evidence from other studies on conflict-affected civilian populations on the influence of age is mixed, with younger age associated with hazardous alcohol use in two studies of South East Asian refugees in the United States [17], [19], while a study of IDPs in northern Uganda observed higher levels among older age groups [43], and a study of Bhutanese refugees in Nepal observed no age effect [42]. Our study found no association of level of education with alcohol use disorder at the individual level (but there was in the community level analysis); and a study on harmful alcohol use among Bhutanese refugees in Nepal did observe an association between higher education and lower alcohol use disorder [42].…”

A “refugee paradox” for substance use disorders?

“…As such, individuals living in refugee camps may be more likely to turn to alcohol than to other substances in an effort to cope with their forced relocation and the stressors of prolonged displacement. Moreover, in light of evidence suggesting that the prevalence of hazardous drinking is disproportionately elevated among individuals in refugee camps (Ezard et al, 2011, 2012; Luitel et al, 2013), it is reasonable to suspect that longer duration in such environments may place individuals at risk of developing SUDs.…”

“…Similarly, many refugees are exposed to high levels of trauma, which has been found to have important implications for the initiation and abuse of substances (Ouimette and Brown, 2003). Moreover, many refugees spend substantial periods of time living in exile in socially hazardous and high-risk environments that can expose them to risks for substance use/abuse (Ezard et al, 2011; Luitel et al, 2013). …”

A systematic review on tobacco use among civilian populations affected by armed conflict

“…The first reported a significant association between tobacco use and alcohol consumption among Bhutanese refugees in Nepal 49. The second study did not observe a significant association between nicotine dependence and hazardous alcohol use among conflict-affected persons in Georgia 57…”