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Substance Use Disorders Among Forcibly Displaced People: a Narrative Review

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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.

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Funding

No funding was received for this work. SA has received speaker honoraria from Camurus, Indivior, Gilead and Janssen unrelated to this work. SA has received research grants from the Australian National Health and Medical Research Council. MP has consulted for Opiant Therapeutics, Game Day Data, Baria-Tek, the Addiction Policy Forum, AXA and Idorsia Pharmaceuticals; has been involved in a patent application with Yale University and Novartis; has received research support from Mohegan Sun Casino; has consulted for and/or advised gambling and legal entities on issues related to impulse-control/addictive disorders; has performed grant reviews for research-funding agencies; and has given academic lectures in grand rounds, CME events and other clinical or scientific venues. AMB has received unrestricted educational grants from Indivior and Camurus. He is the President of the International Society in Addiction Medicine (ISAM). He has performed grant reviews for research-funding agencies and has given academic lectures in grand rounds, CME events and other clinical or scientific venues. NE is employed by St Vincent’s Health Australia for the New South Wales Government and has received research funding from the Australian Government for unrelated work.

Author information

Author notes

  1. Hussien Elkholy, Joseph Tay Wee Teck and Shalini Arunogiri have contributed equally as first authors.

    Nadine Ezard, Marc N. Potenza and Alexander M Baldacchino have contributed equally as senior authors.

Authors and Affiliations

  1. Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Hussien Elkholy

  2. School of Medicine, University of St Andrews, St Andrews, Scotland, UK

    Joseph Tay Wee Teck & Alexander M Baldacchino

  3. Humankind Charity, Leeds, UK

    Joseph Tay Wee Teck

  4. Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, VIC, Melbourne, Australia

    Shalini Arunogiri

  5. Turning Point, Eastern Health, Melbourne, Australia

    Shalini Arunogiri

  6. Red Cross, Geneva, Switzerland

    Merit Ramses Asaad

  7. Department for General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany

    Franziska Baessler & Christoph Nikendei

  8. Heidelberg Academy of Sciences and Humanities, Heidelberg, Germany

    Franziska Baessler

  9. Department of Psychiatry & National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India

    Roshan Bhad

  10. Department of Social Anthropology, University of St Andrews, St Andrews, UK

    Emanuela Nadia Borghi & Stavroula Pipyrou

  11. Prevention, Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime (UNODC), Vienna, Austria

    Anja Busse

  12. Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA

    Hamed Ekhtiari

  13. Royal College of Psychiatrists (RCPsych), London, UK

    Subodh Dave

  14. Institute of Psychiatry, University of Bolton, Bolton, UK

    Subodh Dave

  15. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal

    Marica Ferri

  16. Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA

    Claire Greene

  17. National Institute of Alcohol Abuse and Alcoholism (NIAAA), Bethesda, USA

    George F. Koob & Aaron M. White

  18. Imperial College, University of London, London, UK

    Christos Kouimtsidis

  19. Surrey and Borders Partnership, NHS Foundation Trust, Leatherhead, UK

    Christos Kouimtsidis

  20. World Health Organisation (WHO), Geneva, Switzerland

    Dzimtry Krupchanka & Vladimir Poznyak

  21. National Institute on Drug Abuse (NIDA), Lexington, USA

    Nora D. Volkow

  22. Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran

    Arash Khojasteh Zonoozi

  23. National Centre for Clinical Research on Emerging Drugs, UNSW Medicine, Sydney, Australia

    Nadine Ezard

  24. St Vincent’s Hospital, Sydney, Australia

    Nadine Ezard

  25. Yale School of Medicine, Yale University, New Haven, USA

    Marc N. Potenza

  26. Connecticut Mental Health Center, New Haven, USA

    Marc N. Potenza

  27. Connecticut Council on Problem Gambling, Hartford, USA

    Marc N. Potenza

  28. International Society in Addiction Medicine (ISAM), Calgary, Canada

    Alexander M Baldacchino

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  1. Hussien Elkholy
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  2. Joseph Tay Wee Teck
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  7. Emanuela Nadia Borghi
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  11. Marica Ferri
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  12. Claire Greene
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  13. George F. Koob
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Contributions

HE, JT, MNP and AMB conceptualised the article. JT, HE, MNP, AMB, SA, MCG, NE and AMB conducted the data curation and produced the first draft. JT, HE, AKZ and HE contributed with graphs designing and data interpretation. MRA, FB, ENB, SD, MF, GK, CK, DK, CN, SP, VP, NDV, AKZ, HE and AMW reviewed and edited the draft and contributed with new ideas and materials. JT, HE, MNP and AMB incorporated all comments, revised the article and produced the final version which had been reviewed and approved by all co-authors. HE and JT had coordinated the whole process supervised and supported by MNP and AMB. HE, JT and SA had contributed equally as first authors, while NE, MNP and AMB had contributed equally as senior authors.

Corresponding author

Correspondence to Hussien Elkholy.

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The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions or policies of the UNODC, WHO, EMCDDA, Red Cross, ISAM, NIDA, NIAAA and the Royal College of Psychiatrists or any funding agencies. None of the remaining authors has any conflict of interest to declare.

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Elkholy, H., Tay Wee Teck, J., Arunogiri, S. et al. Substance Use Disorders Among Forcibly Displaced People: a Narrative Review. Curr Addict Rep 10, 341–352 (2023). https://doi.org/10.1007/s40429-023-00467-6

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  • DOI: https://doi.org/10.1007/s40429-023-00467-6

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