Substance use disorders among forcibly displaced people : a narrative review

Abstract

Purpose of review Forced displacement, from wars, terrorism, internal disputes and environmental disasters, has been witnessed throughout human history. Forcibly displaced people face unimaginable difficulties and atrocities in their attempts to survive. Provision of support often focuses on basic needs, such as food, shelter and essential health demands. We present here a narrative review informed by syndemic theory to understand the existing literature on the associations between substance use disorders and experiences of forced displacement. Recent findings The risk factors associated with SUDs are similar to or overlap with those experienced by forcibly displaced people, yet there is substantial heterogeneity in patterns and prevalence of substance use across the different forcibly displaced people. Despite recognition that SUDs among forcibly displaced people are concerning, there are large gaps in knowledge. These include questions around whether forced displacement is directly and consistently linked with SUDs prevalence, what the patterns of risk and resilience look like across different cultures experiencing different causes of displacement over varying durations, and what constitutes effective interventions for these groups. These gaps are at least partly due to research having been disproportionately conducted in developed countries rather than in low- and middle-income countries. Summary Specifically, we categorise syndemic risks of both forced displacement and substance use disorders into four areas: trauma and violence, loss and instability, transit and resettlement and acculturation. We use causal loop diagramming to illustrate important synergistic interactions. We propose a research and intervention policy agenda informed by a broad and varied stakeholder base, accounting for generational and life-course effects and context specific cultural, structural and economic priorities and values.