Policy and practice briefingsMigrants, refugees and asylum seekers

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Issues

Europe has a long history of migration and the diversity of its ethnicities and religions creates complex links between ethnicity and drug use. More recently, following a high level of conflicts in the Middle East and Africa, more than 1.4 million people applied for asylum in the European Union in the last half of 2015 and the first half of 2016. Over half of the asylum seekers to the European Union in 2015 (53 %) were young adults (18–34 years), the age group most likely to use substances in Europe. Some lessons may be drawn from past research on migrants to Europe but must be viewed with caution because of cultural differences and reasons for migration.

Many migrants have lower rates of substance use than their host communities, but some may be more vulnerable to substance misuse for reasons such as trauma, unemployment and poverty, loss of family and social support, and the move to a normatively lenient setting. Drugs may be used to cope with trauma, boredom, uncertainty and frustration around immigration status. Vulnerability may be aggravated by poor knowledge about and access to treatment services.

Response options

The types of responses needed for this group include:

  • Cultural competency within existing services and assistance to overcome language barriers will be important in identifying and meeting needs of new migrants. Some studies report lower rates of health care utilisation, particularly for mental health problems. The longer the time taken to get residency the greater the use of mental health and addiction services, but unmet need still remains. Language problems and cultural factors may be major reasons for under-utilisation.
  • Preventive interventions for minority ethnic populations are not available in all EU countries. With respect to asylum seekers, general awareness-raising concerning the potential vulnerabilities and marginalisation of migrant groups is more common. Some interventions have used peer educators to provide information on drug use and its risks and drug and alcohol services.
  • There is a lack of policies to address migrant health, cultural barriers, language problems and addiction, and a lack of staff competence to work with migrants.

European picture

  • Undertaking needs assessments and establishing monitoring systems will be essential for identifying and addressing emerging problems and filling the current data gap in this area.
  • Sharing of good practice and programmes within and between countries may help to extend service provision to meet the needs of these vulnerable groups of individuals.
  • Future research should investigate the role that cultural continuities between the country of origin and the host country play in drug and alcohol use after migration.

Summary of the available evidence

Principal risk and protective factors for substance use problems relevant to the current migration situation

Risk factors Protective factors
Being single Some strong religious affiliations, e.g. being a devout Muslim
Coming from a culture in which substance use is normalised (e.g. opium, khat) Living in strong family unit
Boredom, unemployment Integration in new society language, employment or other activities
Traumatic experiences Good physical and mental condition
Poverty  
Poor knowledge about treatment services  
Living in run-down neighbourhoods and socially deprived areas  

Implications for policy and practice

The implications for future development of responses for this group include:

Basics

  • Migrant groups, such as the current wave of asylum seekers, may be at risk of developing drug problems. There is a need to increase awareness of vulnerabilities and reduce social exclusion of these people.
  • Services need to be alert to potential health issues, including drug problems, among asylum seekers and be prepared to address potential cultural barriers and language difficulties.
  • Monitoring of the health needs, including substance misuse issues, of new migrants is needed.

Opportunities

  • Services to address the needs of migrant groups are being developed in a number of countries and these should be identified and promising practice shared.

Gaps

  • Where specific needs are identified new services for prevention and treatment of problems need to be developed. These need to be evaluated so that the current limited evidence base is expanded.

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