Measuring Substance Use in Refugees: A Systematic Review of Assessment Instruments

Despite increasing research on substance use among migrants and refugees, little attention has been paid to the instruments assessing substance use in these populations. This systematic review examines the suitability of substance use instruments for use in migrant and refugee populations and the quality of the instruments.

A systematic search of the electronic databases PubMed, Web of Science, PsychINFO, and EMBASE was performed. Articles were eligible if they assessed substance use among refugees using a standardized instrument. Instrument properties were assessed using a standardized checklist, and the measurement properties were evaluated according to Terwee's criteria.

In total, n = 2654 studies were retrieved. Of those, we included n = 55 studies. The most frequently used instrument was the Alcohol Disorder Identification Test (n = 20, 36.4%) followed by the CAGE/CAGE4M and the Mini International Neuropsychiatric Interview (n = 7 studies each, 12.7%). Out of 24 instruments, 18 (75%) were developed in English. Content validity, cross-cultural validity, and criterion validity were unreported for most instruments (n = 13, 54.2%). None of the instruments were developed with input from refugees. Completion time of the instruments ranged from 1 to 120 minutes. Psychometric properties were either not assessed in refugees or were moderate.

None of the assessed instruments met all the psychometric criteria sufficiently. Therefore, it will be necessary to develop a rationale for instruments to better fit the needs of diverse groups of migrants and refugees. Accordingly, these instruments fitted to specific groups will allow for better measurement of substance use, diagnosis, and monitoring of treatment.