Developing an explanatory model of alcohol misuse among South Sudanese refugees in northern Uganda: A qualitative study

Alcohol misuse is a significant health problem among forcibly displaced populations including male South Sudanese refugees in northern Uganda, yet interventions are sorely lacking. Developing an explanatory model of alcohol misuse in this population is the first step to designing appropriate and effective interventions. The aim of the current study was to examine alcohol misuse in this setting and to conceptualize an explanatory model of alcohol misuse. A total of 57 interviews were conducted with male refugees (18+ years) with alcohol misuse (n = 17), their family members (n = 15), community and religious leaders (n = 15), and mental health and psychosocial support providers (n = 10) in Rhino Camp settlement in northern Uganda. A thematic analysis approach was used to inductively analyze the data. Alcohol misuse was identified as a significant psychosocial problem among men in this setting. The adversity (e.g. trauma, loss, poverty), psychological distress (e.g. demoralization), perpetuators (e.g. ease of availability of alcohol, family conflict), and consequences of alcohol use (e.g. interpartner violence, exacerbated poverty) were identified. An explanatory model emerged from the data showing a reinforcing relationship in which adversity causes psychological distress, which leads to increased alcohol use via a number of personal, interpersonal, community and societal perpetuators, and over time increased alcohol use amplifies psychological distress which further increases alcohol misuse. Given the need to address alcohol misuse in this population, this explanatory model of alcohol misuse can be used to inform prevention and treatment interventions for alcohol misuse. These interventions should endeavor to address the identified determinants of alcohol misuse while being cognizant of the social and cultural considerations specific to males in this population. •Alcohol use among South Sudanese male refugees was reported as problematic.•The current study proposes an explanatory model of alcohol misuse.•A vicious cycle of adversity, psychological distress and increased alcohol use was described.