Exploring problem use, discrimination, ethnic identity and social networks

Challenges and support needs among persons with a migration background who use drugs in four European metropolitan cities

BACKGROUND

Persons who migrate for economic reasons, along with asylum seekers and refugees, face multiple personal experiences and societal inequalities that increase the risk of mental health problems and substance dependency, compounded by intersectional social and economic vulnerabilities. The precarious situation and limited access to care of persons with a migration background who use drugs (PMWUD) in Europe raises concern. Therefore, this qualitative study explores the challenges and support needs of a sample of PMWUD in vulnerable situations living in Amsterdam, Athens, Berlin and Paris.

METHODS

This study employed a community-based participatory approach. Through semi-structured interviews with PMWUD (n = 99), we identified  (service) needs of a diversity of PMWUD in Europe. Participants were recruited through a combination of community gatekeepers, venue-based sampling, and snowball sampling. Trained community researchers conducted the interviews, which focused on participants' living situation, substance use, physical and mental health, and employment opportunities.

RESULTS

Despite substantial heterogeneity among the PMWUD, several common themes emerged across all groups. Participants frequently mentioned early childhood adversity, limited social networks leading to loneliness, medical, psychological, and substance use issues, histories of personal violence or poverty, homelessness, lack of necessary documents for health care, social security, and employment, and encounters with the criminal justice system. These intertwined and mutually reinforcing factors simultaneously functioned as barriers to care and support, alongside other barriers such as linguistic and cultural differences, and stigma and discrimination. Due to social exclusion, migration, and substance dependence, participants had limited reliable social networks. Therefore, they often had to rely on accessible and low-threshold services. Harm reduction services played a significant role in providing support to PMWUD. Most PMWUD indicated that basic needs for hygiene and food were met thanks to local organizations. Differences in housing opportunities and access to harm reduction services were identified in each city.

CONCLUSION

Structural barriers toward treatment and care, often related to administrative requirements, stand in the way of appropriate care for PMWUD. Linguistically and culturally sensitive outreach activities with limited practical requirements could break down social and treatment barriers.

Recovery Capital among Migrants and Ethnic Minorities in Recovery from Problem Substance Use: An Analysis of Lived Experiences

Migrants and ethnic minorities (MEM) are known to be disadvantaged concerning risk factors for problem substance use and resources to initiate and sustain recovery (i.e., recovery capital). Yet, the voices of MEM are largely overlooked in recovery literature. This study explores recovery capital through 34 semi-structured interviews with a diverse sample of MEM in recovery in two ethnically diverse cities in Belgium. A Qualitative Content Analysis using recovery capital theory allowed us to identify various recovery resources on a personal, social, and community level. While physical and human recovery resources play a central role in participants' narratives, personal recovery capital is closely intertwined with meaningful social networks (i.e., social recovery capital) and recovery-supportive environments that maximize opportunities for building culturally sensitive recovery capital (i.e., community recovery capital). Though MEM-specific elements such as culture, migration background, stigma, and structural inequalities play a significant role in the recovery resources of MEM, the largely "universal" nature of recovery capital became clear. The narratives disclose a distinction between "essential" and "acquired" recovery capital, as well as the duality of some recovery resources. The need for developing recovery-oriented systems of care that are culturally responsive, diminish structural inequalities, and facilitate building recovery capital that is sensitive to the needs of MEM is emphasized.

Recovery capital among migrants and ethnic minorities: A qualitative systematic review of first-person perspectives

This systematic review of 15 qualitative studies explores recovery capital among migrants and ethnic minorities (MEM). The results of the framework analysis indicate that addressing barriers to recovery and (often minority-related) root causes of problem substance use is vital to recovery among MEM, as well as building recovery capital on personal, social and community level. The review unpacks the importance of "cultural" and "spiritual" elements of recovery capital both inside and outside treatment, the interconnectedness of the different dimensions of recovery capital, as well as their intertwinement with root causes of substance use and barriers to recovery. The results point out the importance of offering culturally and trauma-sensitive relational support and building recovery capital through recovery-oriented systems of care. Moreover, this study highlights the need for further research concerning recovery in MEM populations.

Non-national clients in Belgian substance use treatment

Purpose

Substance use treatment (SUT) among migrants and ethnic minorities is an underresearched domain in European countries, although preliminary studies point out disparities in treatment use and access compared to general populations. This paper aims to identify the main characteristics of and the types of services solicited by non-nationals in Belgium.

Design/methodology/approach

This paper compares the types of SUT services used by Belgian and non-national clients. Second, the referral source for Belgian and non-national clients is considered. Third, the study compares the client characteristics of Belgian and non-national clients. This descriptive analysis is based on aggregated data sets in the European treatment demand indicator (TDI) registry including all Belgian treatment episodes between 2012 and 2014.

Findings

Non-national clients were more often located in outpatient SUT and were less often referred by general practitioners and hospitals, compared to Belgian clients. Third-country clients appear to have lower socioeconomic statuses (education, employment, housing) than Belgian clients. Non-national youngsters and third-country females appear to be underrepresented in Belgian SUT compared to their presence in the general population. The gender gap is larger among third-country clients than among Belgian clients.

Research limitations/implications

These associations between nationality and solicited services, gender, education, employment, housing and referral document treatment gaps among some non-nationals that require special attention in targeted treatment. In the European context, further research is needed on better monitoring migration background in the European TDI registries.

Practical implications

The overrepresentation of non-nationals in low-threshold opioid substitution treatment services and their underrepresentation in high-threshold residential services requires an in-depth analysis of the core goals of these respective services. Residential services, for instance, should consider how a dominant focus on speech therapy hampers access to treatment for these populations and how access for these populations could be enhanced by modifying or diversifying methods in treatment.

Originality/value

To the best of the authors’ knowledge, this is the first paper that analyses the national indicator in a European TDI data set.