Foetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe physical, neurodevelopmental, and cognitive impairments that have occurred following exposure to alcohol during pregnancy. The diagnosis of FASD requires a complex assessment and confirmation of maternal alcohol consumption during pregnancy. Obtaining accurate and reliable assessment results can be difficult.

Researchers from the University of Western Australia have conducted a study to assess the challenges practitioners face when trying to gain information about prenatal alcohol exposure as part of a broader FASD assessment.

Interviews were carried out with the birth mother or responsible adult for 88 young people sentenced to detention in Western Australia.

Results found that:

• The birth mother provided information on prenatal alcohol exposure for 55 (63%) of the 88 young people. The other remaining accounts of prenatal alcohol exposure were mostly from relatives.
• Of the 88 young people with information on prenatal alcohol exposure, 41 (47%) had no reported prenatal alcohol exposure, 19 (22%) had either unknown or moderate‐quantity prenatal alcohol exposure, and 28 (32%) reported prenatal alcohol exposure at high‐risk levels
• 54% consumed a drink containing alcohol during pregnancy.
• The most common reported number of standard drinks containing alcohol consumed on a typical day during pregnancy was 7 to 9 drinks (26%)
• Only 29 of the 47 sources that confirmed prenatal alcohol exposure provided enough information to complete the questionnaire.

Obtaining a reliable measure of prenatal alcohol exposure using maternal recall and self‐report is likely to be limited due to suspected underreporting and lack of clarity as to what constitutes a standard drink. It is likely this is influenced by social stigma and recall bias. The authors suggest standardized recording on all antenatal birth records would aid later assessment for FASD and provide opportunities for advice and support for women who continue to drink.

The frequent collection, analysis and publication of data on psychoactive substance use among young people is essential to follow trends which can be used to inform practice and public health policy.

In India, psychoactive substance use is a growing problem among males and female. However, there may be gender differences in the effect of substance use, risk to developing addiction and reason for consumption.

A recent cross-sectional survey has analysed psychoactive substance use among 250 female students in North India.

Results from the study found that:

• Lifetime prevalence of psychoactive substance use was 13.6%
• 47% of the participants claimed they started using psychoactive substances out of curiosity or for fun
• Nearly 74% of the study participants belonged to uppermiddle-class socio-economic families.
• 12% described trying to stop but failing.
• Alcohol is the primary psychoactive substance used by female students.

These results highlight the need for further research into risk and protective factors associated with psychoactive substance initiation and continued use. The findings can also be used to guide prevention intervention.

Abstract

Introduction

Forced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research.

Methods

Seven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies.

Results

Forty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use.

Conclusion

Our understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.