The result section is structured in the following manner. First, the important role of refugees’ prospects and opportunities within the German receiving context in the link between countries of origin and post-migration substance (mis)use is presented. Then, the relation between living conditions and substance (mis)use is examined as a matter of substance availability, evolving distress in refugee shelters, and the socio-spatial features of the respective accommodations. This is followed by a third section on the relevance of social contact. Therein, we report on the observation that the family separation increases substance (mis)use. Furthermore, we describe how social belonging is negotiated by substance (mis)use among peers. Separate presentation of the findings from SSIs and FGDs was perceived as redundant, as the FGDs were considered as resembling the general sense of the SSIs in their entirety. Regardless, wherever the FGDs brought up further or divergent aspects, the emerging of the finding from the FGD is reported as such.
Refugees’ prospects and opportunities shape the link between countries of origin and post-migration substance (mis)use
Substance (mis)use was mainly reported among male refugees younger than 30 years. In addition to age and gender, key persons defined subgroups that (mis)use substances frequently by country of origin or language area (e.g., Farsi speakers). Afghanistan, Iran, and Syria were the countries of origin mentioned the most. Interestingly, when talking about refugees from African countries, key persons often did not name the country but referred to the continent. Narrations relying on continents/countries of origin suggested them to determine the pattern of substance (mis)use and substances consumed (i.a., H_8, B_4, FGD_CL). In contrast, other key persons (i.a., A_7, CL_4, B_8) completely neglected such a direct link between substance (mis)use and country of origin and offered alternative explanations: “I think I would not so much limit it to nationalities, but rather to the context in which the people here move around” (F_4, Pos. 22).Footnote 3
Within the SSIs and FGDs, this setting was specified by enduring asylum cases and uncertain perspectives (e.g., in terms of family reunification; i.a., A_2, EL_2, FGD_C), precarious accommodation (i.a., HL_2, E_4, FGD_C) as well as limited rights and opportunities regarding meaningful activities (e.g., work permit, participation in integration/language courses, i.a., AL_4, F_5, FGD_C) and health care (i.a., CL_6, E_8, H_2). Key persons reported the link between the setting of refugees’ everyday lives, and substance (mis)use equally for rural and urban areas as follows:
In the vast majority of cases, it is the people who are sitting at home, who are not allowed to do anything. Uhm and actually have no prospects anymore and are just waiting to see what happens and are also afraid about what happens next. (GL_3, Pos. 20)
Where there are few prospects, where there is a lot of despair, there is often a high level of substance use, and the harder the situation and the less prospects there are, the higher I would estimate the risk [for substance use]. (H_6, Pos. 19)
Especially for refugees who have little hope and few prospects, some key persons believed that what refugees are jeopardizing with substance (mis)use seems to weigh less compared to the advantages of the (mis)use (e.g., self-regulating effect): “So they know that it [substance use] is filthy, but it’s not filthier than the situation they’re in at all” (E_2, Pos. 98).
The post-migration settings, prospects, and opportunities described are depending on the refugees’ countries of origin or their nationality.Footnote 4 Thus, as shown in Fig. 1, our data suggests the link between countries of origin and substance (mis)use to be indirect and to a large extent shaped by refugees’ prospects and opportunities in the receiving country.
The link between living conditions and substance (mis)use as a matter of substance availability, distress, and socio-spatial features
In general, refugees’ living conditions were dominant among the key persons’ reports on refugees’ substance (mis)use habits and the availability of certain drugs. The data conveys the impression that most of the refugees that (mis)use substances live in refugee shelters. In contrast, little was described about substance (mis)use among refugees who live in private spaces; potential confounding between the type of accommodation (shelter vs. private) and residential status, as described above (see Fig. 1), must be considered. The reasons for high substance (mis)use in refugee shelters surmised by the key persons (i.a., H_12, E_10, FGD_G), were in the first place related to the little privacy and autonomy entailed by life in a shelter:
Especially when I’m sitting in a facility like that for a long period of time, uhm, I am only allowed to cook at certain times, only allowed to take a shower at certain times, only allowed to do laundry at certain times, I don’t have anything to do all day, uhm, then there are factors that actually, uhm, eventually put pressure on the psyche, and can not only increase the use of addictive substances but actually also lead to a change in mood. (CL_2, Pos. 73)
But the other flatmates in this room [...], they want to [...] smoke, smoke pot, consume, listen to music and that is often a problem for them. They don’t want to be in this room anymore, and they want somehow, either somewhere else or a single room for themselves. But this is not available at all. (C_8, Pos. 69)
In addition, interviewees and FGD participants reported the remarkable availability of substances in refugee shelters due to drug dealing (i.a., A_4, C_8, GL_2), as well as fellow housemates recommending substance use based on their own “positive” experiences, for example, to tackle insomnia, without explaining or knowing what the substance is and what risks it brings (i.a., C_3).
I think that if you don’t use drugs now and you share a room with someone who does use drugs, it can either put you off or maybe lead to you being infected. So, I think that it has more to do with the social context. (F_4, Pos. 22)
And the initial contact worked [...] via people from one’s own culture, one’s own language, who then said, ‘You’re so sad, you’re under so much stress. Have a smoke!’ And some had an idea about what they were consuming, and others did not. (A_4, Pos. 21)
When discussing unaccompanied minors, who in Germany are usually housed in youth welfare living facilities, some interviewees identified these closely supportive living contexts as a protective factor because strict rules are applied; in contrast, community shelters were associated with far less support, supervision and rules for their residents (i.a., G_8, H_5, EL_2). Accordingly, several key persons (i.a., B_7, FGD_A, FGD_G) pointed to the age-related obligation to move into bigger community shelters, as a critical moment regarding the personal development of young adults and substance (mis)use:
And I think it’s difficult to make the transition at all from an unaccompanied minors facility, which is very supportive and very intensive and has surely somewhat replaced the family. Most of them were simply kicked out without mercy as soon as they turned 18 [...] And that means they moved into the shared accommodation on their 18th birthday. And that was not a good transition. (E_7, Pos. 66)
In contrast, if teenagers were believed to have succeeded in creating meaningful future perspectives, they seemed to easily quit (mis)using substances (i.a., E_2, CL_5, HL_2). This reinforces the expounded relation between refugees’ social ecology and substance (mis)use:
So if they have prospects and a path that they can follow, then smoking pot no longer plays any role at all, for 2/3 of those who did it before. So, it really drops rapidly then and, uhm, is also stopped by itself. (C_4, Pos. 125)
In addition to the examination of refugee shelter facilities as social ecology settings themselves, the data shows that the socio-spatial locating of refugee shelters within rural areas and likewise within cities were reported to affect refugees’ substance (mis)use. Especially in rural areas, the social ecology component was emphasized for refugee shelters located, for example, “in the middle of the forest without Internet” (CL_5, Pos. 92) or in areas where “at night, [it] is really very dark here already on [the] street” (CL_5, Pos. 124). Few activities, restricted mobility, and limited autonomy were believed to increase boredom among refugees located in rural areas and thus increase substance (mis)use (i.a., CL_4, GL_5, FGD_C). These links were reported, although illicit drugs were perceived as less available in rural than in urban areas (i.a., AL_5, FGD_E):
Community accommodations […], are mostly in a relatively rural area and not so well connected. Which is also often a problem. Then they have to somehow; then there is only one bus then and then. (...) The less self-determined one lives, the more one consumes, as one can imagine, that it is simply a stress factor. (HL_4, Pos. 17)
An issue frequently raised by the interviewees and taken up by FGD participants was boredom (i.a., CL_5, AL_4, FGD_F). Taken together with key persons’ assumption that the deficient and poor accessibility of (mental) healthcare, addiction care, or prevention services in rural areas (i.a., GL_5, HL_1, FGD_AL), those factors were described as relevant, especially for refugees with little German language proficiency; they believed substance (mis)use to be hereby encouraged or maintained among refugees in rural areas. In addition, higher availability of substances, a sense of belonging to a community (e.g., the urban open drug scene), and health care services were described as pulling refugees either occasionally or permanently from rural to urban areas (i.a., E_7, FGD_A, FGD_CL). According to the data, refugees were surmised to do so although they would risk losing their right to accommodation, government benefits, and/or legal consequences because residential status comes sometimes with restricted freedom of movement (e.g., restricted to one administrative district; i.a., HL_2, FGD_A, FGD_CL).
Moreover, in urban study sites, the issue of the location of a shelter was likewise perceived as crucial and potentially affecting substance (mis)use. For instance, at one study site, several interviewees (i.a., E_4, E_7, FGD_E) reported a significant number of refugees that (mis)use substances who had arrived as unaccompanied minors and were at the time accommodated in a hostel near to the open drug scene.
Absence of refugees’ families and social belonging influence refugees’ substance (mis)use
Social contacts or their absence were observed to affect refugees’ post-migration substance (mis)use, regardless of whether the key persons were talking about refugees in rural or urban areas. For instance, a large share of refugees that (mis)use substances was described as being in Germany without their families (i.e., children, partners, parents), just like the unaccompanied minors mentioned above. This seems to be the case as well for women; for instance, women traveling solo were reported to (mis)use alcohol, cannabis, and illicit drugs (i.a., GL_3, FGD_G, FGD_CL), whereas women with children and partners mainly stand out due to non-medical use of pharmaceuticals (i.e. B_4, EL_3, FGD_AL). The former were assumed to be older than in their mid-20s, including several transwomen.
The underlying mechanism of solo traveling as a determinant of substance (mis)use was described as having two parts. On one hand, substance (mis)use was reported as a consequence of the loss of structure, responsibility, and “social control” (G_2, Pos. 20), previously imposed by families (i.a., C_2, DL_4, FGD_E). In other words, as described by a refugee interviewee: “Those who don’t have any family at all, attachment and control go missing” (A_6, Pos. 4). On the other hand, key persons associated the absence of refugees’ families with experienced loneliness, missing sorely the family members left behind and worrying about their lives (i.a., A_6, C_8, HL_1).
In addition to conditions provided by having migrated with or without family, regarding peers and how they are associated with substance (mis)use, teenage refugees stand out in our data. Interviewees reported frequently an affiliation with the age-related peer trend of (mis)using cannabis and alcohol. Several interviewees (i.a., B_6, F_8) perceived these behaviors as offering teenagers a sense of belonging:
I think it’s also because, in the usual contexts, such as school, they were also integrated here [...], and then they did what the others were doing (laughs). So, you could also see it a bit as, well, integration in the traditional sense. They also did what was typically available here at this point. (EL_2, p. 28)
Amid forced migration, belonging to any social group in the receiving context seems to be a relevant motive for (mis)using substances (i.a., A_3, H_2, GL_4). To give another example from the SSIs; communities built up over years in Germany (e.g., the Iranian community) were described as offering not only peer contact and a sense of belonging for refugees who had arrived recently, but also increase the availability of substances that one might not expect to be widespread in the receiving country (e.g., opium; i.a., A_5, E_2, E_11).
In contrast, regarding ecstasy pills as an illicit drug widely used by young people in Germany, there are few reports by key persons on ecstasy (mis)use by young refugees. One reason prominent in our data is the inadequacy of psychostimulants for refugees’ motives for substance (mis)use. Additionally, during an FGD, participants discussed a divergent assumption related to the lack of accessibility of nightlife venues for refugees due to discrimination and the thus decreased influence of peer trends related to substance (mis)use existing in those social contexts: “It is difficult for young refugees to access party drugs due to discrimination at the doors of clubs and pubs and high prices” (FGD_G, Pos. 32).