|Migrants, Displaced People and Drug Abuse: A Public Health Challenge (International Center for Migration and Health - ICMH, 1998, 60 pages)|
· In general, drug abuse (including alcohol abuse) prevention needs to build on evidence-based recommendations and less on intuitive responses. More evidence is urgently required on the (a) exact nature of substance abuse related problems in migrant communities; (b) psychosocial, and other contextual origins (aetiology) of these problems; (c) possible preventative responses to the problems; (d) how to effect implementation of preventative activities with migrant group participation; and (e) monitoring and evaluation of activity/programme impact and outcome.
· National policies for the prevention of drug abuse and the management of related problems should increasingly take into account and specifically address the needs of migrants. They should do so by incorporating current knowledge about the nature of migration in the EU and its impact on the propensity for drug abuse of all kinds.
· Drug abuse prevention should be comprehensive and involve activities that focus not just on the individual and individual risk behaviour, but also address the context in which migrant substance abuse occurs, building on current information derived from the neighbourhood, schools, the work place and social groups.
· Drug abuse prevention should create social, economic and political environments that strengthen, stimulate and support migrant community action to prevent drug abuse. Much more needs to be done to "hand over" more responsibility and capacity to migrant communities themselves so that they can tailor their own actions with the backup of other local services.
· All community based health care and social services should try to address the need for prevention and early treatment of drug abuse, taking into account the cultural and psychosocial dynamics that influence health seeking and use of health care services. They should especially focus more attention on vulnerable people such as women and adolescents, within migrant groups.
· More has to be done to encourage social welfare and criminal justice systems to out-reach to migrant groups and become more actively involved in community education and prevention of alcohol and other drug related deviance. The current social gap that exists between these systems and migrant communities is highly unproductive from both a prevention and treatment perspective.
· Social marketing strategies designed to prevent drug abuse among migrants should be tried and evaluated. The need to sensitise migrants to the problems associated with drug abuse are such that social marketing, using culturally adapted messages and strategies deserve to be tried.
· More routine monitoring of the health and social situation of migrants is called for, especially in the domain of drug abuse and its corollary health, social and legal implications. The possibility of developing a European-wide system to do this monitoring and create a database on migrant drug abuse should be explored.
· More care should be given to selecting health and social workers who have been specifically trained to work with migrants. In addition, more should be done to ensure that people from migrant communities are themselves recruited into the health and social services working with migrant communities.
· Given the importance of the family as a traditional source of support and a potential barrier to drug abuse more should be done through health and social policies to promote family cohesion and health. Similarly, support to the family should be generated through self-help groups and health and social care systems should look for ways of contributing to this too.
· Because social welfare systems are often the first point of contact for people with alcohol and other drug abuse related problems, staff of social welfare systems should be given training about alcohol and other drug issues and appropriate responses towards the migrant communities.
This pilot project has already contributed to sensitising municipal authorities and others that many of the social conditions confronting migrants expose them to the risk of drug abuse. It has also sensitised them to the fact that migrants may have unique problems and needs; these will have to be addressed if they are to be helped to prevent drug abuse. The fact that local administrations have been so supportive and willing to participate in the project is indicative of their desire to see the vulnerability of migrants reduced. The assumption that support would be forthcoming from municipal governments for intervention initiatives has been proved true by this phase of the study.
The project has gone far in creating a small network of local governments, NGOs and migrant populations involved in the study of risk of drug abuse in vulnerable groups such as migrants. There is reason to believe that the network could be extended to include other local authorities and migrant groups, with very sound possibilities of generating a movement for prevention of drug abuse among municipal authorities with migrant constituencies. The city network for migrant policy ELAINE will hold a thematic session using the outcome of this project in the fall of 1998.
The study has developed, and is now testing, a methodology which will be adaptable to other locations and groups. It addresses the specific context of migrant populations and takes into account the needs and options which are present in and for those populations. On the basis of the experiences gathered in this project a modified KABP instrument will also be prepared, taking into account many of the issue and questions that have emerged in the pilot project.
A follow-up project (MDAP2) should take the present project further using the experience gained in this pilot phase to create an infrastructure and mindset which allows drug abuse related problems among migrant populations to be assessed, prevented, and when they occur, effectively managed, and monitored.
MDAP2 should take the concept of community participation in the prevention of drug abuse further and assess its relevance to migrant populations, ensuring that vulnerable groups are themselves involved in identifying needs and problems, and helping them develop appropriate responses, including European database of drug abuse related problems among migrants in the EU.
Piloting a European state-of-the-art database using internet access and home page dissemination is a much needed. A standardised European monitoring instrument and national data from the EMCDDA national focal points could be a part of this. The city of Arhus has expressed a willingness to construct a local database and this could be designed as the pilot database site for the follow up to MDAP1.