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Substance Use Among Refugee and Conflict-Affected Children and Adolescents

  • M. Claire GreeneEmail author
  • Jeremy C. Kane
Chapter
  • 28 Downloads

Abstract

Though substance use is common in displaced populations, the majority of existing research is among adults. This is a limitation because morbidity for substance use increases during adolescence, and an earlier age of onset of alcohol and drug abuse is associated with more severe substance use outcomes later in life. Despite the elevated risk of substance use and related consequences for children (0–18 years) and, more specifically, adolescents (10–19 years), most studies and prevention or treatment interventions in refugees have been restricted to adults. This chapter will review research on alcohol and other drug use among refugee children and adolescents resettled in low-, middle-, or high-income countries. Given the limited research in this population, we will also review relevant studies conducted among conflict-affected, disaster-affected, and immigrant children and adolescents and discuss how this information may be applicable to refugee children. We will conduct a scoping review of the academic and unpublished epidemiologic research to characterize the patterns and burden of substance use in refugee children and adolescents, risk and protective factors, and interventions that have been tested in refugee and comparable child and adolescent populations. We will present available evidence regarding the feasibility and effectiveness of substance abuse treatment and prevention strategies and discuss the implications of these findings for future research and practice.

Keywords

Alcohol Substance Drug Substance use disorder Alcohol use disorder Intervention Refugee Children Adolescent 

References

  1. 1.
    Abatemarco DJ, West B, Zec V, Russo A, Sosiak P, Mardesic V. Project Northland in Croatia: a community-based adolescent alcohol prevention intervention. J Drug Educ. 2004;34(2):167–78.CrossRefGoogle Scholar
  2. 2.
    Allen ML, Hurtado GA, Yon KJ, Okuyemi KS, Davey CS, Marczak MS, et al. Feasibility of a parenting program to prevent substance use among Latino youth: a community-based participatory research study. Am J Health Promot. 2013;27(4):240–4.  https://doi.org/10.4278/ajhp.110204-ARB-52.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    American Society for Addiction Medicine. ASAM patient placement criteria for the treatment of substance related disorders. 2nd ed. Chevy Chase: American Society of Addiction Medicine; 2001.Google Scholar
  4. 4.
    Andrade EL, Evans WD, Barrett ND, Cleary SD, Edberg MC, Alvayero RD, et al. Development of the place-based Adelante social marketing campaign for prevention of substance use, sexual risk and violence among Latino immigrant youth. Health Educ Res. 2018;33(2):125–44.  https://doi.org/10.1093/her/cyx076.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Barnett E, Sussman S, Smith C, Rohrbach LA, Spruijt-Metz D. Motivational Interviewing for adolescent substance use: a review of the literature. Addict Behav. 2012;37(12):1325–34.  https://doi.org/10.1016/j.addbeh.2012.07.001.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Becker SJ, Curry JF. Outpatient interventions for adolescent substance abuse: a quality of evidence review. J Consult Clin Psychol. 2008;76(4):531–43.  https://doi.org/10.1037/0022-006X.76.4.531.CrossRefPubMedGoogle Scholar
  7. 7.
    Betancourt TS, Newnham EA, Layne CM, Kim S, Steinberg AM, Ellis H, Birman D. Trauma history and psychopathology in war-affected refugee children referred for trauma-related mental health services in the United States. J Trauma Stress. 2012;25(6):682–90.  https://doi.org/10.1002/jts.21749.CrossRefPubMedGoogle Scholar
  8. 8.
    Betancourt TS, Newnham EA, Birman D, Lee R, Ellis BH, Layne CM. Comparing trauma exposure, mental health needs, and service utilization across clinical samples of refugee, immigrant, and U.S.-origin children. J Trauma Stress. 2017;30(3):209–18.  https://doi.org/10.1002/jts.22186.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Bolton P, Lee C, Haroz E, Murray L, Dorsey S, Robinson C, et al. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand [Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.]. PloS Med. 2014;11(11):e1001757.  https://doi.org/10.1371/journal.pmed.1001757. (Accession No. Cn-01112532).CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Botvin GJ. Preventing drug abuse in schools: social and competence enhancement approaches targeting individual-level etiologic factors. Addict Behav. 2000;25(6):887–97. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11125777.CrossRefGoogle Scholar
  11. 11.
    Cluver LD, Meinck F, Steinert JI, Shenderovich Y, Doubt J, Herrero Romero R, et al. Parenting for Lifelong Health: a pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. BMJ Glob Health. 2018;3(1):e000539.  https://doi.org/10.1136/bmjgh-2017-000539.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cohen JA, Mannarino AP, Deblinger E. Treating trauma and traumatic grief in children and adolescents. New York: Guilford Press; 2006.Google Scholar
  13. 13.
    Das KN. Stateless Rohingya refugees sucked into booming Bangladesh drug trade. Reuters. 2017. Retrieved from https://in.reuters.com/article/myanmar-rohingya-bangladesh-drugs-idINKBN1662M8.
  14. 14.
    Das JK, Salam RA, Arshad A, Finkelstein Y, Bhutta ZA. Interventions for adolescent substance abuse: an overview of systematic reviews. J Adolesc Health. 2016;59(4S):S61–75.  https://doi.org/10.1016/j.jadohealth.2016.06.021.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Elder JP, Litrownik AJ, Slymen DJ, Campbell NR, Parra-Medina D, Choe S, et al. Tobacco and alcohol use-prevention program for Hispanic migrant adolescents. Am J Prev Med. 2002;23(4):269–75. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12406481.CrossRefGoogle Scholar
  16. 16.
    Ezard N, Debakre A, Catillon R. Screening and brief intervention for high-risk alcohol use in Mae La refugee camp, Thailand: a pilot project on the feasibility of training and implementation. Intervention. 2010;8(3):223.CrossRefGoogle Scholar
  17. 17.
    Flynn AB, Falco M, Hocini S. Independent evaluation of middle school-based drug prevention curricula: a systematic review. JAMA Pediatr. 2015;169(11):1046–52.  https://doi.org/10.1001/jamapediatrics.2015.1736.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Glick P, Al-Khammash U, Shaheen M, Brown R, Goutam P, Karam R, et al. Health risk behaviours of Palestinian youth: findings from a representative survey. East Mediterr Health J. 2018;24(2):127–36. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29748941.CrossRefGoogle Scholar
  19. 19.
    Godley SH, Meyers RJ, Smith JE, Karvinen T, Titus JC, Godley MD, et al. The adolescent community reinforcement approach for cannabis users, Cannabis Youth Treatment (CYR) Series, vol. 4. Rockville: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration; 2001.Google Scholar
  20. 20.
    Godley SH, Smith JE, Passetti LL, Subramaniam G. The Adolescent Community Reinforcement Approach (A-CRA) as a model paradigm for the management of adolescents with substance use disorders and co-occurring psychiatric disorders. Subst Abus. 2014;35(4):352–63.  https://doi.org/10.1080/08897077.2014.936993.CrossRefPubMedGoogle Scholar
  21. 21.
    Gordon RS Jr. An operational classification of disease prevention. Public Health Rep. 1983;98(2):107–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/6856733.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Greene MC, Ventevogel P, Kane JC. Substance use services for refugees. Bull World Health Organ. 2019;97:246–246A.CrossRefGoogle Scholar
  23. 23.
    Griffin KW, Botvin GJ. Evidence-based interventions for preventing substance use disorders in adolescents. Child Adolesc Psychiatr Clin N Am. 2010;19(3):505–26.  https://doi.org/10.1016/j.chc.2010.03.005.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hogue A, Liddle HA, Becker D. Multidimensional family prevention for at-risk adolescents. In: Kaslow FW, Patterson T, Kaslow FW, Patterson T, editors. Comprehensive handbook of psychotherapy: cognitive-behavioral approaches, vol. 2. Hoboken: Wiley; 2002. p. 141–66.Google Scholar
  25. 25.
    Horyniak D, Higgs P, Cogger S, Dietze P, Bofu T. Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking. Ethn Health. 2016;21(3):284–99.  https://doi.org/10.1080/13557858.2015.1061105.CrossRefPubMedGoogle Scholar
  26. 26.
    Kane JC, Murray LK. Implementation of evidence-based mental health treatments in Zambia. Paper presented at the Zambia Ministry of Health Research Dissemination Meeting, Lusaka, Zambia, 2018.Google Scholar
  27. 27.
    Kane JC, Murray LK, Cohen J, Dorsey S, Skavenski van Wyk S, Galloway Henderson J, et al. Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia. J Child Psychol Psychiatry. 2016;57(10):1194–202.  https://doi.org/10.1111/jcpp.12623.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kane JC, Johnson RM, Iwamoto DK, Jernigan DH, Harachi TW, Bass JK. Pathways linking intergenerational cultural dissonance and alcohol use among Asian American youth: the role of family conflict, parental involvement, and peer behavior. J Ethn Subst Abus. 2018:1–21.  https://doi.org/10.1080/15332640.2018.1428709.
  29. 29.
    Kasirye R. Efficacy of a peer interactive youth-led drug prevention programme: a UYDEL-UNODC project. International Journal of Prevention and Treatment of Substance Use Disorders. 2015:69–78.Google Scholar
  30. 30.
    Kelly JF, Urbanoski K. Youth recovery contexts: the incremental effects of 12-step attendance and involvement on adolescent outpatient outcomes. Alcohol Clin Exp Res. 2012;36(7):1219–29.  https://doi.org/10.1111/j.1530-0277.2011.01727.x.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kelly JF, Dow SJ, Yeterian JD, Myers M. How safe are adolescents at Alcoholics Anonymous and Narcotics Anonymous meetings? A prospective investigation with outpatient youth. J Subst Abus Treat. 2011;40(4):419–25.  https://doi.org/10.1016/j.jsat.2011.01.004.CrossRefGoogle Scholar
  32. 32.
    Kohli A, Remy MM, Binkurhorhwa AK, Mitima CM, Mirindi AB, Mwinja NB, et al. Preventing risky behaviours among young adolescents in eastern Democratic Republic of Congo: a qualitative study. Glob Public Health. 2017:1–13.  https://doi.org/10.1080/17441692.2017.1317009.
  33. 33.
    Levey EJ, Oppenheim CE, Lange BC, Plasky NS, Harris BL, Lekpeh GG, et al. A qualitative analysis of factors impacting resilience among youth in post-conflict Liberia. Child Adolesc Psychiatry Ment Health. 2016;10:26.  https://doi.org/10.1186/s13034-016-0114-7.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Litrownik AJ, Elder JP, Campbell NR, Ayala GX, Slymen DJ, Parra-Medina D, et al. Evaluation of a tobacco and alcohol use prevention program for hispanic migrant adolescents: promoting the protective factor of parent-child communication. Prev Med. 2000;31:124–33.CrossRefGoogle Scholar
  35. 35.
    Maalouf W, Campello G. The influence of family skills programmes on violence indicators: experience from a multi-site project of the United Nations Office on Drugs and Crime in low and middle income countries. Aggress Violent Behav. 2014;19(6):616–24.  https://doi.org/10.1016/j.avb.2014.09.012.CrossRefGoogle Scholar
  36. 36.
    Marsiglia FF, Ayers SL, Baldwin-White A, Booth J. Changing Latino adolescents’ substance use norms and behaviors: the effects of synchronized youth and parent drug use prevention interventions. Prev Sci. 2016;17(1):1–12.  https://doi.org/10.1007/s11121-015-0574-7.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Massad SG, Shaheen M, Karam R, Brown R, Glick P, Linnemay S, Khammash U. Substance use among Palestinian youth in the West Bank, Palestine: a qualitative investigation. BMC Public Health. 2016;16:800.CrossRefGoogle Scholar
  38. 38.
    McCleary JS, Shannon PJ, Cook TL. Connecting refugees to substance use treatment: a qualitative study. Soc Work Public Health. 2016;31(1):1–8.  https://doi.org/10.1080/19371918.2015.1087906.CrossRefPubMedGoogle Scholar
  39. 39.
    McDonald L, Doostgharin T. UNODC global family skills initiative: outcome evaluation in Central Asia of Families and Schools Together (FAST) multi-family groups. Soc Work Soc Sci Rev. 2013;16(2):51–75.CrossRefGoogle Scholar
  40. 40.
    Murray LK, Skavenski S, Kane JC, Mayeya J, Dorsey S, Cohen JA, et al. Effectiveness of trauma-focused cognitive behavioral therapy among trauma-affected children in Lusaka, Zambia: a randomized clinical trial. JAMA Pediatr. 2015;169(8):761–9.  https://doi.org/10.1001/jamapediatrics.2015.0580.CrossRefPubMedGoogle Scholar
  41. 41.
    Nagata JM, Hathi S, Ferguson BJ, Hindin MJ, Yoshida S, Ross DA. Research priorities for adolescent health in low- and middle-income countries: a mixed-methods synthesis of two separate exercises. J Glob Health. 2018;8(1):010501.  https://doi.org/10.7189/jogh.08.010501.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    National Institute on Alcohol Abuse and Alcoholism. Alcohol screening and brief intervention for youth: a practitioner’s guide. Bethesda: NIAAA; 2012.Google Scholar
  43. 43.
    National Institute on Drug Abuse. Principles of adolescent substance use disorder treatment: a research-based guide. Rockville: National Institute of Health; 2014.Google Scholar
  44. 44.
    Papas RK, Sidle JE, Gakinya BN, Baliddawa JB, Martino S, Mwaniki MM, et al. Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction. 2011;106(12):2156–66.  https://doi.org/10.1111/j.1360-0443.2011.03518.x.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Pengpid S, Peltzer K, Van der Heever H, Skaal L. Screening and brief interventions for hazardous and harmful alcohol use among university students in South Africa: results from a randomized controlled trial. Int J Environ Res Public Health. 2013;10(5):2043–57.  https://doi.org/10.3390/ijerph10052043.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Petruzzi LJ, Pullen SJ, Lange BCL, Parnarouskis L, Dominguez S, Harris B, et al. Contributing risk factors for substance use among youth in postconflict Liberia. Qual Health Res. 2018;28(12):1827–38.  https://doi.org/10.1177/1049732318761863.CrossRefPubMedGoogle Scholar
  47. 47.
    Posselt M, McDonald K, Procter N, de Crespigny C, Galletly C. Improving the provision of services to young people from refugee backgrounds with comorbid mental health and substance use problems: addressing the barriers. BMC Public Health. 2017;17(1):280.  https://doi.org/10.1186/s12889-017-4186-y.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Pullen SJ, Petruzzi L, Lange BC, Parnarouskis L, Dominguez S, Harris B, et al. A qualitative analysis of substance use among Liberian youth: understanding behaviors, consequences, and protective factors involving school youth and the school milieu. Int J Ment Health Psychiatry. 2016;2(1).  https://doi.org/10.4172/2471-4372.1000116.
  49. 49.
    Rastegar D, Fingerhood M. The American Society of Addiction Medicine handbook of addiction medicine. New York: Oxford; 2016.Google Scholar
  50. 50.
    Robertson EB, David SL, Rao SA. Preventing drug use among children and adolescents. 2nd ed. Bethesda: National Institute on Drug Abuse; 1997.Google Scholar
  51. 51.
    Salas-Wright CP, Vaughn MG. A “refugee paradox” for substance use disorders? Drug Alcohol Depend. 2014;142:345–9.  https://doi.org/10.1016/j.drugalcdep.2014.06.008.CrossRefPubMedGoogle Scholar
  52. 52.
    Sphere Association. The sphere handbook: humanitarian charter and minimum standards in humanitarian response. 4th ed. Geneva: Sphere Association; 2018.CrossRefGoogle Scholar
  53. 53.
    Stanger C, Budney AJ. Contingency management approaches for adolescent substance use disorders. Child Adolesc Psychiatr Clin N Am. 2010;19(3):547–62.  https://doi.org/10.1016/j.chc.2010.03.007.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    United Nations High Commissioner for Refugees, & World Health Organization. Rapid assessment of alcohol and other substance use in conflict-affected and displaced populations: a field guide. Geneva: World Health Organization; 2008.Google Scholar
  55. 55.
    United Nations Office on Drugs and Crime. International standards for the treatment of drug use disorders. UNODC. 2016. Retrieved from http://www.unodc.org/documents/International_Standards_2016_for_CND.pdf.
  56. 56.
    United Nations Office on Drugs and Crime. International standards on drug use prevention, Second updated edition. UNODC. 2018. Retrieved from https://www.unodc.org/documents/prevention/standards_180412.pdf.
  57. 57.
    UNODC. World drug report 2013. United Nations; 2013.Google Scholar
  58. 58.
    Waldron HB, Kaminer Y. On the learning curve: the emerging evidence supporting cognitive-behavioral therapies for adolescent substance abuse. Addiction. 2004;99 Suppl 2:93–105.  https://doi.org/10.1111/j.1360-0443.2004.00857.x.CrossRefPubMedGoogle Scholar
  59. 59.
    West B, Abatemarco D, Ohman-Strickland PA, Zec V, Russo A, Milic R. Project Northland in Croatia: results and lessons learned. J Drug Educ. 2008;38(1):55–70.  https://doi.org/10.2190/DE.38.1.e.CrossRefPubMedGoogle Scholar
  60. 60.
    Widmann M, Apondi B, Musau A, Warsame AH, Isse M, Mutiso V, et al. Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use. Soc Psychiatry Psychiatr Epidemiol. 2017;52(11):1425–34.  https://doi.org/10.1007/s00127-017-1368-y.CrossRefPubMedGoogle Scholar
  61. 61.
    Winters KC, Tanner-Smith EE, Bresani E, Meyers K. Current advances in the treatment of adolescent drug use. Adolesc Health Med Ther. 2014;5:199–210.  https://doi.org/10.2147/AHMT.S48053.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    World Health Organization, & United Nations High Commissioner for Refugees. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Geneva: WHO; 2015.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of PsychiatryColumbia University/New York State Psychiatric InstituteNew YorkUSA
  2. 2.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of EpidemiologyColumbia UniversityNew YorkUSA

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