Community perspectives on substance use among Bhutanese and Iraqi refugees resettled in the United States

Abstract

Premigration trauma and postmigration stressors put refugees at high risk for mental health concerns, including substance use. However, there is limited systematic research on substance use in refugee communities exists. We conducted exploratory qualitative research to examine Bhutanese and Iraqi refugee perspectives related to the use of recreational substances after resettlement in the United States. Data were collected through separate focus groups with 28 Bhutanese and 22 Iraqi adult men. Focus groups were facilitated by an experienced clinician with an in-person interpreter, audiorecorded, and transcribed. Transcripts were checked for accurate translation and then analyzed using a conventional content analysis approach. Findings revealed similarities and differences between the two refugee groups with regard to recognizing excessive use, triggers for use, and preferred modes of outreach and intervention. Findings also revealed postmigration changes in substance use behaviors stemming from issues related to access, cost, and perceived legal ramifications.

Conceptualizing Mental Health Through Bhutanese Refugee Lens: Findings from a Mixed Methods Study

“…Findings on the Bhutanese community's negative and positive cultural coping strategies provide implications for targeted programs and services. Study findings allude to negative coping mechanisms such as alcohol, substance use, suicidal ideation, and suicide attempts, consistent with prior studies (Adhikari et al, 2015;Michaels et al, 2010;Mirza et al, 2018). Bhutanese refugees feel more comfortable seeking help from friends and family than from professionals (Chase & Sapkota, 2017), consistent with prior studies showing that this community generally views care seeking as negative and a sign of weakness (MacDowell et al, 2020).…”

A systematic review of qualitative research on substance use among refugees

“…Similar motives were reported among Liberian, Karen and Bhutanese refugees [34, 44, 52]. Additionally, Iraqi refugees who use prescription painkillers in the United States reported that many Middle Eastern countries overuse pain medications, including opioid medications, even without prescriptions [44]. In another study, Syrian refugees indicated that taking substances helped them connect with people and feel like a part of their new community.…”

“…African refugees in Australia reported that traumatic experiences associated with migration, family separation, integrational conflict and a lack of education and employment were the main motives for using illicit drugs [35]. Similar motives were reported among Liberian, Karen and Bhutanese refugees [34, 44, 52]. Additionally, Iraqi refugees who use prescription painkillers in the United States reported that many Middle Eastern countries overuse pain medications, including opioid medications, even without prescriptions [44].…”

“…Motives for using substances other than alcohol were discussed in seven studies among six different groups (i.e. African, Bhutanese, Columbian, Iraqi, Karen, Liberian and Syrian refugees) [34, 35, 39, 44, 51, 52]. African refugees in Australia reported that traumatic experiences associated with migration, family separation, integrational conflict and a lack of education and employment were the main motives for using illicit drugs [35].…”

Perceptions of Health Practices and Interactions with the US Healthcare System among Bhutanese Refugees: A Qualitative Approach

“…Research exploring the health practices of resettled Bhutanese refugees or their interactions with the US healthcare system is limited, focusing primarily on gynecological health among Bhutanese refugee women (Lor et al, 2018;Poudel & Dyer, 2013;Haworth, Margalit, Ross, Nepal & Soliman, 2014;Kingsbury 2017;Davey & Vallianatos, 2018), health practices and perceptions specific to mental health (Mirza et al, 2018;Subedi, Li, Gurung Bizune, Dogbey, Johnson, Yun, 2015;Im & Rosenberg, 2015). Research exploring health practices and interactions with the healthcare system is more prevalent in other refugee populations.…”