Etiology and Perceived Meaning of Substance Use Among Gang-Affiliated Refugee Youth in Urban Kenya

Background & Purpose: Refugee youth who have experienced prolonged exposure to cumulative traumas before and during forced migration are at high risk of developing mental and behavioral health issues. Living in resource-poor and highly adverse circumstances, some refugee youth displaced in urban settings use substances as a means to cope with negative consequences of trauma and concurrent challenges. Specifically, among vulnerable or high-risk youths identifying as victims or perpetrators of community violence, substance use has become part of their daily routines, a mechanism for survival, and holds cultural significance behind its use. This study aims to explore underlying causes of substance use and their meaning in the context of forced migration and refugee traumas within the Somali refugee community in low-resource urban settings.

Methods: The study was conducted in Eastleigh, a Somali-populated community in urban Kenya. Using a chain-referral sampling method, the research team identified and recruited a total of 20 gang-affiliated Somali refugee youth (14 males and 6 females), whose ages range from 17 to 29 (M=21.94, SD= 2.97). We conducted in-depth individual interviews with a semi-structured interview guide to explore the meaning and causes as well as the patterns of substance use in the context of refugee traumas and gang-group activities. Researchers matched interviewer and interviewee by gender due to gender-specific and sensitive topics and one male and one female multilingual Somali youth leaders conducted interviews in either Somali or English /Sheng (a Swahili and English-based cant) and transcribed them word by word into English. A hybrid thematic analysis that combines an inductive coding and a priori template was utilized for qualitative data analysis.

Results: Findings showed that all gang-affiliated refugee youth utilized a variety of substances such as khat or miraa, cigarettes, shisha, and alcohol are utilized, either solely or combined. Our analysis revealed a few overarching themes that highlight a pathway to substance use, which includes: 1) searching for protection; 2) coping with past and current trauma; 3) stuck in substance use; and 4) vicious cycle of trauma. Substance use is a way to build bonding with peers while involving in culturally and socially deviant behaviors to show their frustration, anger and resistance to the community that failed to provide protection and basic necessities. Substance use became a means for survival as well as an immediate reliever of psychological pains and anxiety when these youth deal with haunting memories from past traumas to current adversities as the perpetrator as well as victim of social conflicts and community violence.

Conclusion: Findings revealed how cumulative traumas have created the vicious cycle of violence and substance use as means to cope with painful memories and unmet needs through gang affiliation. Our results provide further insight to the shifted meaning of substance use in the Somali community as social structures and support systems collapsed due to war and prolonged displacement. This study provides practitioners and policy makers with further insights on coping mechanisms of vulnerable refugee youth and implications for contextually-relevant interventions to build community resilience and coping resources.