Problematic Alcohol and Substance Use among Conflict-Affected Populations in Sri Lanka

 

 Dr. Umaharan Thamotharampillai and Dr Ruwan M Jayatunge 

The long-term accumulation of stressors in post-conflict regions is under-discussed. Experts believe that there is a close connection between war trauma and addiction disorders. People living in post-conflict settings are at high risk of developing addictions. The trauma of war can significantly increase the risk of developing alcohol and substance use disorders. Alcohol and substance use addiction has been identified as a war-related social problem.

Complex interaction between biological predispositions and psychological and social factors upsurges substance abuse (Coleman, 1993). There is a comorbidity between problematic alcohol and substance use and war trauma exposure. Victims of war trauma are deeply affected—emotionally, physically, politically, and spiritually. These individuals can be considered a vulnerable population. These individuals with trauma-related distress often use alcohol and drugs as a negative stress coping mechanism and in a problematic manner.

The 30-year armed conflict in Sri Lanka had a negative impact on the health and well-being of people. The aftermath of the Eelam War has triggered mental health problems, including addiction issues. War trauma has been identified as a key risk factor for the emergence of alcohol and substance use disorders. These addictions cause negative health and social outcomes, affecting individuals, families, and communities.

Substance use disorders are cumulative in conflict-affected areas in Sri Lanka. The prevalence of depression, post-traumatic stress disorder, adjustment disorders, and other mental health issues has contributed to a rise in addiction-related behaviors. Moreover, weakened infrastructure, under-functioning healthcare systems, mass unemployment, poverty, and lack of social opportunities have created a breeding ground for addiction issues. Alcohol and substance abuse contribute significantly to the morbidity and mortality in war-affected areas.

There is a strong, bidirectional link between substance abuse and traumatic experiences (Simmons & Suárez, 2016). McFall and colleagues (1992) were of the view that PTSD arousal symptoms are strongly related to the substance.

Mostly the people use drugs/alcohol to escape from their emotional and physical pain. Drug addiction may be regarded as a disease of the brain reward system (Vetulani, 2001). According to Baker and team (1986), drug cravings are organized within a memory network. Addictive substances enhance the functioning of the reward circuitry of the brain, producing the 'high' that the drug user seeks (Gardner, 2011). It causes hedonic dysregulation within brain circuits, and it leads to addiction. 

People who persistently abuse substances often experience an array of social, financial, and mental/physical health problems. As described by Liang et al. (2011), there is a strong relationship among alcohol, tobacco, and illicit drug usage and mental disorders. These addictions negatively affect their quality of life. There is a high morbidity and mortality related to alcohol and substance abuse. Data indicate that conflict-affected populations are at risk, and effective psychosocial measures are needed to address these issues. The identification and management of alcohol and substance use disorders are essential in the war-affected areas. A multidisciplinary approach is needed to provide psychosocial support for the conflict-affected population. The affected individuals require intense monitoring and supportive therapy. The mental health authorities should implement programs on drug prevention and rehabilitation in affected areas.

  

Dr. Umaharan Thamotharampillai, MBBS MD, is a Consultant Psychiatrist at Jaffna Teaching Hospital

Dr. Ruwan M. Jayatunge, M.D., PhD, is a medical doctor and a clinical psychologist, and also a member of the American Psychological Association (APA). He is a guest lecturer at Sri Lankan and North American universities.     

 

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