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

Abstract Background Previous research concluded that substance (mis)use is increasing among forcibly displaced populations. Nevertheless, little research has been conducted within a social ecological framework aimed at identifying and understanding the factors impacting substance (mis)use embedded in the post-migration context in high-income countries. Methods Rapid assessments (RAs), including 108 semi-structured interviews and 10 focus group discussions with key persons from different professional, volunteering and personal backgrounds, were carried out in German urban and rural areas. The RA approach of interviewing both, key persons and refugees, regarding substance (mis)use by refugee communities in Germany and not solely substance (mis)using refugees allowed us to gather multi-perspective knowledge on this sensitive topic. Data were analyzed, aiming at identifying determinants of substance (mis)use embedded in the post-migration context of refugees and at comprehensive and in-depth examination. Results As one main result, the commonly reproduced link between refugees’ countries of origin and their substance (mis)use was found to be mediated by the prospects and opportunities refugees have in receiving countries (e.g., work permit). Further determinants are related to living conditions in German refugee shelters and social relations with peers and families. The impact of refugees’ living conditions can be summarized as potentially increasing substance availability and distress, whereas the absence of family likewise produces a loss of control by family and traditional authorities and responsibility, allowing for substance (mis)use. Peers’ impact on substance (mis)use reflects a search for a sense of belonging. Conclusions Given that substance (mis)using refugees have limited to no control over the substance (mis)use triggering factors identified, common treatment and prevention approaches are challenged. Furthermore, we strongly recommend aiming for a holistic comprehension of refugees’ substance (mis)use by expanding the focus beyond individuals to the social ecological context in any attempt, including prevention, treatment, research and policy.