Harm Reduction Journal
Volume 15, Issue 1, 2018

Challenges and opportunities for implementation of substance misuse interventions in conflict-affected populations (Review) (Open Access)

Greene M.C.* , Kane J.C. , Khoshnood K. , Ventevogel P. , Tol W.A.
  • a Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Rm. 888, Baltimore, MD 21205, United States
  • b Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Rm. 888, Baltimore, MD 21205, United States
  • c Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
  • d Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
  • e Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Rm. 888, Baltimore, MD 21205, United States, Peter C. Alderman Foundation, Kampala, Uganda

Abstract

Alcohol and other drug misuse are significant but neglected public health issues in conflict-affected populations. In this article, we review the literature on the challenges and strategies for implementing substance misuse treatment and prevention services in conflict and post-conflict settings in low- and middle-income countries. We identified nine studies describing interventions in conflict-affected populations residing in Afghanistan, Croatia, India, Kenya, Kosovo, Pakistan, and Thailand. Six of these nine studies focused on refugee populations. Reports revealed challenges to intervention implementation, as well as promising practices and recommendations for future implementation that we characterized as existing in the inner and outer contexts of an implementing organization. Challenges existing in the outer context included low political prioritization, lack of coordination and integration, and limited advocacy for access to substance misuse services. Challenges within the inner context related to competing priorities and a shortage of providers. Resource limitations existed in both the inner and outer contexts. Stigma was a challenge that threatened implementation and utilization of substance use services in situations when substance use interventions were not congruent with the roles, structure, values, and authority of the system or implementing organization. Future research should focus on developing, applying, and evaluating strategies for overcoming these challenges in order to make progress toward meeting the need for substance misuse services in conflict-affected populations. © 2018 The Author(s).

Author Keywords

Substance misuse Alcohol misuse Conflict displacement Implementation

Index Keywords

Vulnerable Populations vulnerable population Pakistan Afghanistan refugee health care planning India alcohol consumption Croatia Kosovo Thailand conflict human Refugees middle income country war statistics and numerical data health service Consumer Advocacy Substance-Related Disorders alcohol Kenya Health Plan Implementation drug dependence Humans Health Priorities substance use Review Armed Conflicts stigma Interinstitutional Relations organization and management low income country drug misuse Delivery of Health Care public relations health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85057455463&doi=10.1186%2fs12954-018-0267-1&partnerID=40&md5=c3e7ed07f1c73950ca66352407d3e783
DOI: 10.1186/s12954-018-0267-1
ISSN: 14777517
Cited by: 1
Original Language: English