Substance use instruments for refugees-systematic review

Abstract

Background Substance use is a problem among refugee populations. Instruments which assess substance use have been translated into different languages, but are not culturally sensitive. This research gap has to be filled to acquire information about substance use disorders in refugee populations, especially from Arabic countries, as a confession to using substances in those countries is culturally problematic. Methods Following databases were systematically searched: EMBASE, PubMed, CINAHL, Web of Sciences and PsychInfo resulting in 2659 hits. After removing 5 duplicates, 2650 studies were screened. After exclusion of irrelevant studies, 264 studies were assessed for eligibility and 128 studies were, so far included. Inclusion criteria were original studies, migrant or refugee participants, minimum age 18 years, usage of quantitative measures and substance use as the outcome. A data extraction sheet was developed with three reviewers working on it. Results 49 studies were found to use validated instruments. Most frequently used was the AUDIT (n = 17), followed by the WMH-CIDI (n = 11) and the CAGE questionnaire (n = 9). The majority of the studies (n = 55) used self-developed instrument with few items. To our knowledge, no study used a culturally sensitive adapted questionnaire. Conclusions More studies used self-developed items for assessing substance use than validated instruments. None of the studies used a culturally sensitive adapted instrument. This is a clear indication that such an instrument is needed for research and treatment. With a culturally sensitive instrument, the care for refugees and migrants could be improved and adjusted, possibly resulting in better public health outcomes. Main messages As refugee populations continue to grow, an adequate screening instrument for substance abuse/dependence for these individuals is missing. With the development of a culturally sensitive instrument, identification and treatment of refugees and migrants can be improved.

Substance (mis)use among refugees as a matter of social ecology: insights into a multi-site rapid assessment in Germany

“…This made it impossible to distinguish between substance use, misuse, addiction, or any other type of SUD within the analysis. If aiming at differentiation between forms of substance (mis)use, a study must be related to a clinical diagnosis while thoroughly reflecting on the issue of cultural sensitivity of respective screening instruments [ 77 ].…”

“…Furthermore, the qualitative exploration in this article might be tested within a sound quantitative survey for statistical significance. In addition, future research could investigate different SUD based on diagnostic criteria while accounting for the cultural and social sensitivity of terminologies related to substance (mis)use [ 15 , 16 ] and related challenges emerging when using screening instruments [ 77 ]. However, such an approach makes it necessary to directly study refugees that (mis)use substances.…”