Epidemiology of Alcohol and Substance Misuse Among Migrants A Rapid Evidence Synthesis

The stuff you want is in there

Systematic Reviews “Performing a rigorous systematic review is far from easy. It requires careful scientific consideration at inception, meticulous and laborious searching, as well a considerable attention to methodological detail and analysis before it truly deserves the badge ‘Systematic’ ” Hemingway & Brereton. 2009. Evidenced Based Medicine

Rapid reviews “Rapid reviews have emerged as a streamlined approach to synthesizing evidence in a timely manner -typically for the purpose of informing emergent decisions faced by decision makers in health care settings”. Khangura et al; licensee BioMed Central Ltd. 2012

The aim To determine the rates of illicit drug use and alcohol use by migrants within the European Union generally and the UK specifically

Incidence and Prevalence

Who is a migrant? There is no consensus on a single definition of a 'migrant‘ The definition of 'migrant' is not simply a technical problem, has an important effect on migration data and analysis generated from such data.

A definition The term migrant can be understood as "any person who lives temporarily or permanently in a country where he or she was not born, and has acquired some significant social ties to this country." This definition may not be entirely useful

Global figures 2013 Global migration statistics: 3 per cent of the world’s population are living abroad worldwide. 232 million international migrants United Nations Global statistics

Migrants Face individual and structural barriers to the health services in host countries Are under-represented as users of alcohol and other drug services Require strategies to improve the structures of health systems and social policies Agudelo-Suárez et al. BMC Health Services Research 2012, 12:461

Much of the evidence is from the USA

The evidence of occurence We searched 3 online bibliographic databases (Medline+; CinAHL; PsycINFO) Any systematic reviews of the epidemiology of illicit drug use or of alcohol use by migrants (however defined) reporting data relevant to a European context published since the year 2000 published in English article freely available

Search history

The evidence We found no reviews No individual studies

No shortage of USA based studies E.g. “Alcohol Consumption and Risk for Dependence Among Male Latino Migrant Farmworkers Compared to Latino Non farmworkers in North Carolina”

Studies from elsewhere E.g. Australia “Alcohol problems among migrants in substance use treatment: the role of drinking patterns in countries of birth” (Savic et al, 2014. Australian Journal Of Primary Health) Migrants’ beliefs about when to seek help for alcohol problems may differ from host-country norms clients from high consumption countries might have delayed seeking help in line with the alcohol norms in their country of origin

Government statistics

What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews Degenhardt et al. Drug and Alcohol Dependence 117 (2011) 85–101

Degenhardt et al Systematically reviewed availability and quality of data on the prevalence of use and dependence on meth/amphetamine, cannabis, cocaine and opioids.

Degenhardt et al found Qualitative evidence of illicit drug use and dependence for most countries, which hold over 98% of the world’s population aged 15–64 years. Dependence prevalence estimates existed in very few countries Dependence estimates are lacking even in high income countries that have required resources.

Where does this leave us?