Dr. Geoffrey Maina conducted research and produced resources on substance use among immigrants and refugees. In this article he provides a case scenario, followed by risk factors for newcomer youth and adults, issues that affect help-seeking and practical recommendations you can use in your work.

Case scenario

Amira came to Canada as a refugee and has been living in Canada for seven years. Before relocation, he lived in a refugee camp for at least 10 years. Where he came from, opiates, and alcohol are commonly used substances that are accessible to refugees. At the point of migration, Amira was likely dependent on heroine and alcohol, a situation that was not screened during the medical admission procedure.

“Amira and his family settled in a south Saskatchewan city. They did not speak English and the one-year government sponsorship given to refugees was not sufficient to give them the stability they needed to be independent and productive members of society.

Since he was in his 50s, only low paying jobs were accessible to him. He needed to work at least 80 hours a week to provide for his family. In the evenings, and weekends, he often went to his friends’ house where they would drink until late in the night.

Two years ago, Amira began to develop neurological problems, and it was determined that it was due to chronic use of heroine and alcohol. Unable to work, and with his poor health he was admitted to a long-term care facility on account of his cognitive challenges.

His wife, who depended on him for financial support was left destitute. His 14-year-old son was forced to work to support his mother and two younger siblings. Because of working after school, the son’s grades began to deteriorate, and he started to develop anxiety and depression.

No one in the community allows their children to play with Amira’s children as the family is labelled a bad influence on account of his addiction. Amira’s wife is too ashamed to ask for help and since she doesn’t speak English, she cannot secure employment, even low paying jobs.

Reflecting on their experiences, Amira and his family are full of regret for coming to Canada. Although they are happy that they are no longer in a refugee camp that is unsafe, they grief the loss of family due to the mental health and addiction challenges. They have no social support to lean on. They can’t openly talk about their struggles because they often hear “you should be grateful you are here in Canada.”

Their story or versions of it is becoming very common among immigrants where either parents or dependents begin to use substances, bringing a lot of shame to the family, and communal estrangement.

Based on this scenario, what are some of the risk factors for substance use for the adults and children/youth?

Risk factors for adults

• Loneliness
• Isolation
• Pre-immigration substance use
• Cultural disconnection
• Risk factors for children/youth
• Peer pressure
• Lack of adult supervision
• Busy parents
• Ease of availability
• Acculturation pressure
• Mental health struggles- especially if undiagnosed trauma

What are some of the barriers to help-seeking?

• Stigma
• Shame
• Silence
• Lack of literacy
• Lack of culturally safe services

Recommendations for Service Providers

• Create awareness about the impact of substance use on the family and community
• When discussing a sensitive topic such as substance use and addiction in the community, it should be handled with sensitivity due to cultural dynamics.
• Conversations about substance use should not be judgmental and should focus on the positives to prevent alienating the affected community
• Create culturally safe support groups separated by gender
• Educate families on early signs of substance use
• Encourage health care providers to screen for substance use risks and disorders
• Use existing resources such as detox and pain clinics to increase access
• Provide access to timely youth counseling

Recommendations for leaders from health and settlement organizations

• Understand the risk profile for each community
• Substance use needs to be labelled as an emerging crisis among immigrants, who may not be able to deal with it without community support due to diverse social, integration and access to health services challenges.
• Organize consultative forums and bring community leaders, service providers and researchers together to deliberate on this issue and collectively create culturally acceptable and safe ways to address this emerging crisis.

Key takeaways

• Immigrants are struggling with substance use issues which requires the attention of decision-makers.
• Ethnic based data on substance use needs to be collected so we can know the scope of the issue among immigrants.
• We need to develop prevention intervention for dealing with risks associated with substance use among immigrants, which should take into consideration age, gender, and pre-immigration experiences.

Here is a toolkit you can use in your work. It includes facts about commonly used substances, early signs of substance use, and the journey to recovery. It outlines helping a loved one in the recovery journey and discusses harm reduction, and overdose prevention.