“Stuck in between two worlds”: Substance misuse among first generation ethnic-Nepali Bhutanese youth and young adults with a refugee life experience

Objectives There is limited information on the dynamics of alcohol and other drug (AOD) misuse among refugee youth. Over 90,000 ethnic-Nepali Bhutanese refugees have resettled in the United States since 2008, and there is increasing concern for AOD misuse among youth and young adults. The objective of this research was to understand factors influencing the development of AOD issues and barriers to prevention and help seeking among Bhutanese youth and young adults (ages 14-24). Methods A total of 35 Bhutanese youth and adults participated in key informant interviews. A total of 47 individuals participated in 8 focus groups with Bhutanese parents, Bhutanese youth and young adults, AOD service providers, police and probation officers, Bhutanese business owners, and educators. Data were analyzed using thematic content analysis and informed by the Transnational Theory of Cultural Stress for Alcohol and Other Drug Misuse Risk. Results Issues related to Bhutanese history and culture included accessibility of AOD and community stigma. Specific to family dynamics, parental engagement, parent-child communication, and family cohesion acted as risk and protective factors. Finally, the theme of communication and trust with external stakeholders revealed that external stakeholders had difficulty engaging with the Bhutanese community and linking people to prevention and intervention services. Conclusions Findings have implications for culturally-tailored approaches to address AOD misuse. Prevention initiatives need to include efforts within the Bhutanese community, with a focus on family functioning and addressing intergenerational conflict. Psychoeducation for other stakeholder groups is critical to facilitate culturally-sensitive responses to community needs and issues.