Special needs of refugees with substance use disorders from conflict-affected countries: a comparison with German-born individuals.

Background: Refugees seem to be at enhanced risk for substance use disorders. At the same time, they have less access to services and their health needs remain poorly understood. This study aims to evaluate the specific needs of refugees as compared to German-born individuals seeking help for substance use disorders.

Methods: We conducted an observational case-control study using all treatment episodes in outpatient addiction facilities in three German federal states during the year 2020. A total of 719 refugee clients were matched to 713 German-born individuals using propensity score matching. We compared potential needs related to features of substance use as well as different psychosocial areas.

Results: The final sample of refugees was composed of n = 384 (26.8%) cases from Afghanistan, n = 214 (14.9%) from Syria and n = 121 (8.4%) from Iraq. Clients consulted mostly due to cannabis use (44.8%) or opioid use (20.1%). Intravenous use of drugs and needle sharing was significantly lower in refugees (p < 0.05). A higher proportion of refugees than Germans lived in provisional housing, were unemployed or in charge of minor children (p < 0.05). Mental and physical comorbidities were significantly higher in refugees (p < 0.05). They were also more likely to have been victims of violence and less likely to present violent behaviors.

Conclusion: Refugees with substance use disorders differ regarding a spectrum of psychosocial issues from German-born individuals. This highlights the need to link addiction treatment with other parts of the health care and psychosocial support systems to provide adequate care for this group.