Trauma led us to substance use: an interpretative phenomenological analysis of refugee youth experiences with substance use during the COVID-19 pandemic in Uganda

Introduction: Refugee populations experience significant psychological stress in host countries. The COVID-19 pandemic worsened pre-existing vulnerabilities and also presented new vulnerabilities for substance use. The study was conducted to examine the pattern of substance use during and after the COVID-19 pandemic among youth residing in a rural refugee settlement camp in north-western Uganda. Methods: The study was conducted in a refugee settlement camp in north-western Uganda. We used an interpretative phenomenological analysis framework to explore substance use among young people. We conducted eight in-depth interviews and four focus group discussions among youths between the ages of 18-30 years. Results: We identified two master themes: (1) trauma led us to substance use and (2) desire for belonging and identity kept us in substance use. Young people recounted stories of trauma which served to initiate and promote substance use among them. COVID-19 restrictions on social isolation, social distancing and military enforcement of the restrictions exacerbated previous experiences of trauma resulting in substance use. Refugees, who were already separated from their families in the host country, engaged in substance use following further parental and social isolation, loneliness and reduced support systems in refugee camps. The reduced financial support, unemployment, closure of businesses and schools provided additional motivation to engage in substance use among young people. Surviving the refugee camp heightened the need for belonging to a group. The desire to belong in, to fit in and to stand out in the group altogether served to provide further avenues for substance use among young refugee populations. Conclusion: Interventions for substance use among refugee youth, particularly during a pandemic, ought to consider the complex landscapes for refugees and their multiple layers of vulnerabilities. Peer pressures and group influence should be given special considerations while planning mitigation measures.