Exploring Alcohol Use Among Karen Refugees Toward Culturally Grounded Interventions

Background and Purpose: There is evidence of growing concern about increased levels of problematic alcohol consumption and alcohol-related violence in both refugee camp settings and locations of resettlement.  Some contributing factors to increased levels of alcohol consumption have been identified and explored including displacement-related traumatic events and resettlement stress.  Refugees who are displaced due to political conflict often experience a range of traumatic and stressful events throughout displacement and resettlement including exposure to traumatic events such as imprisonment or gender-based violence, protracted periods of time in refugee camps and resettlement related stress.  Refugee communities may also experience a disruption in or loss of culture and cultural structures.  For example, conflict and displacement may prevent refugee families and communities from performing important cultural events such as weddings or funerals; may disrupt social bonds through separation; and may disrupt the transmission of cultural knowledge through stories, songs or music.  These experiences can influence patterns of alcohol consumption and may contribute to increased levels of alcohol consumption and an increase in negative consequences of alcohol use in communities displaced by political conflict.  Left untreated, problems with alcohol can impact successful resettlement.  There have been almost no studies conducted of refugee alcohol use that qualitatively explore refugees’ perceptions and experiences of alcohol use from their own perspective.  This study sought to explore refugees’ perceptions of, beliefs about and experiences with alcohol use after conflict-related displacement in two geographic locations: a resettlement community in the United States and refugee camps in Thailand.

Methods: In this qualitative study that drew from critical ethnographic and phenomenological methodologies, individual and group interviews were conducted with 62 participants in a Karen refugee community in St. Paul, MN and in refugee camps along the Thai-Burma border.  Resulting data were analyzed using Spradley’s (1979) domain analysis.

Results: Themes emerged from the data to suggest that both displacement related traumatic experiences and cultural patterns of use and beliefs about alcohol contributed to increased levels of problematic alcohol use and negative consequences of alcohol use during and after displacement.  Geographic location may have played an influencing role in patterns of alcohol use.  Participants said that many cultural structures and patterns were disrupted during displacement and this disruption of culture led to increased problems related to alcohol.  Finally, Karen participants described people with problematic alcohol use as people who were “following their hearts” and had stopped thinking about community and family and had begun to think only of themselves.  Consequently, re-focusing on family, community and culture were essential parts of the process toward quitting alcohol use. 

Conclusions and Implications: These findings contribute to the development of culturally relevant treatment programs that consider the cultural, historical and political factors that contribute to alcohol use in Karen refugee communities as well as the ways in which communal cultural values impact both use of alcohol and quitting problematic alcohol use.  In particular, this study identifies important knowledge about supporting resettling refugees who may be seeking treatment for problematic alcohol use.