Six rapid assessments of alcohol and other substance use in populations displaced by conflict

Abstract

BackgroundSubstance use among populations displaced by conflict is a neglected area of public health. Alcohol, khat, benzodiazepine, opiate, and other substance use have been documented among a range of displaced populations, with wide-reaching health and social impacts. Changing agendas in humanitarian response-including increased prominence of mental health and chronic illness-have so far failed to be translated into meaningful interventions for substance use.MethodsStudies were conducted from 2006 to 2008 in six different settings of protracted displacement, three in Africa (Kenya, Liberia, northern Uganda) and three in Asia (Iran, Pakistan, and Thailand). We used intervention-oriented qualitative Rapid Assessment and Response methods, adapted from two decades of experience among non-displaced populations. The main sources of data were individual and group interviews conducted with a culturally representative (non-probabilistic) sample of community members and service providers.ResultsWidespread use of alcohol, particularly artisanally-produced alcohol, in Kenya, Liberia, Uganda, and Thailand, and opiates in Iran and Pakistan was believed by participants to be linked to a range of health, social and protection problems, including illness, injury (intentional and unintentional), gender-based violence, risky behaviour for HIV and other sexually transmitted infection and blood-borne virus transmission, as well as detrimental effects to household economy. Displacement experiences, including dispossession, livelihood restriction, hopelessness and uncertain future may make communities particularly vulnerable to substance use and its impact, and changing social norms and networks (including the surrounding population) may result in changed - and potentially more harmful-patterns of use. Limited access to services, including health services, and exclusion from relevant host population programmes, may exacerbate the harmful consequences.ConclusionsThe six studies show the feasibility and value of conducting rapid assessments in displaced populations. One outcome of these studies is the development of a UNHCR/WHO field guide on rapid assessment of alcohol and other substance use among conflict-affected populations. More work is required on gathering population-based epidemiological data, and much more experience is required on delivering effective interventions. Presentation of these findings should contribute to increased awareness, improved response, and more vigorous debate around this important but neglected area.

Alcohol and substance use in humanitarian and post-conflict situations

“…In a review of 10 studies on substance abuse, Ezard has suggested that substance use (e.g., alcohol, opiates or minor tranquilizers) is common in some displaced settings (14).…”

Broadening the scope of epidemiology in conflict-affected settings: opportunities for mental health prevention and promotion

“…For example, an epidemiological study in conflict-affected Timor-Leste found high rates of psychotic-like symptoms (predicted by traumatic events) which were strongly associated with disability (Silove et al, 2008;Soosay et al, 2012). Similarly, rapid assessments in a variety of refugee populations have identified alcohol and substance use disorders as an important mental health problems (Ezard et al, 2011). Very little research has focused on dissociative disorders in conflict-affected settings, even though they have been shown to be associated with exposure to traumatic events and may be a common idiom of distress in conflict-affected populations (van Duijl et al, 2010).…”

Terrorism, civil war, one-sided violence and global burden of disease

“…This study also contributes to the evidence base necessary to establish priorities among agencies working with conflict-affected populations to rebuild substance abuse treatment systems and related healthcare infrastructures. Strengthening substance abuse treatment systems among conflict-affected populations will be critical to implementing more comprehensive treatment services for substance use disorders including cognitive, behavioral and drug therapies for substance dependence and identification and treatment of a variety of physical and psychiatric disorders that are often comorbid with substance use disorders (Ezard et al, 2011).…”

“…Substance abuse health care services are disrupted through damage to water supplies, electricity, and sewage disposal necessary for health services to operate, coupled with injury, death and disappearance of health care workers (Ezard et al, 2011;Hansch and Burkholder, 1996;Perrin, 1996). Agricultural systems are disrupted resulting in food rations, an important ingredient that has been implicated in facilitating home-brewed alcohol production in conflict-affected populations (Adelekan, 2006;Ezard et al, 2011).…”