Essay Grade

Substance Use Disorder and Recovery via Tele-Rehabilitation for Women in Rural North
Georgia
by
Megan Lee Barton
Master of Philosophy, Walden University, 2020
MBA, Kennesaw State University, 2010
BBA, Kennesaw State University, 2004
Proposal Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Human Services:
Family Studies and Intervention Strategies
Walden University
[last month of term you graduate] 20XX
Abstract
Drug and alcohol abuse and addiction is a growing health concern. The purpose of this
qualitative study was to learn about women living in rural North Georgia and their
experiences using online rehabilitation tools.
***ADD TO ABSTRACT***
Substance Use Disorder and Recovery via Tele-Rehabilitation for Women in Rural North
Georgia
by
Megan Lee Barton
Master of Philosophy, Walden University, 2020
MBA, Kennesaw State University,2010
BBA, Kennesaw State University, 2004
Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Human Services:
Family Studies and Intervention Strategies
Walden University
[last month of term you graduate] 20XX
Dedication
This is dedicated to women in the midst of the struggle. Knowing there are
women who have come through the same exact storm is important to keep on fighting.
Always look forward.
Acknowledgments
I would like to thank my best friend and husband Casey. This process could not
have occurred without his constant support and encouragement. I would also like to
thank our 3 beautiful daughters, Kiersten, Madilyn, and Caylee, for understanding the
time needed to accomplish this. I also could not have done this without the help and
knowledge of Walden faculty.
Table of Contents
List of Tables ………………………………………………………………………………………………………. ii
List of Figures …………………………………………………………………………………………………….. iii
Chapter 1: Introduction to the Study (APA Level 0 Heading) ……………………………………..1
APA Level 1 Heading ………………………………………….. Error! Bookmark not defined.
APA Level 2 Heading ……………………………………..Error! Bookmark not defined.
Chapter 2: Literature Review …………………………………………………………………………………15
First Heading ………………………………………………………. Error! Bookmark not defined.
Chapter 3: Research Method ………………………………………………………………………………….27
First Heading ………………………………………………………………………………………………….27
Chapter 4: Results ………………………………………………………………………………………………..28
First Heading ………………………………………………………………………………………………….28
Chapter 5: Discussion, Conclusions, and Recommendations ……………………………………..30
First Heading ………………………………………………………………………………………………….30
References …………………………………………………………………………………………………………..31
Appendix A: Title of Appendix ……………………………………………………………………………..45
Use this table of contents (TOC) as an example of what one looks like. When it comes
time for creating your own TOC, RIGHT CLICK anywhere in the Table of Contents,
select UPDATE FIELD, then select UPDATE ENTIRE TABLE or UPDATE PAGE
NUMBERS ONLY, and click OK.
The table of contents will be generated using the style tags from the template; you will
also be able to automatically update the TOC, both added headings and page numbers.
i
List of Tables
Table 1. A Sample Table Showing Correct Formatting …………………………………………… 28
Table 2. Another Sample Table ……………………………………………………………………………. 28
When you update the list of tables, the table number and title will come in without
a period between them; you will need to manually add that period after all table numbers,
as shown for Table 1. In addition, the title will retain the italics from the narrative when
the List of Tables is updated. Once your list is finalized, select the entire list and change
it to plain type.
ii
List of Figures
Figure 1. Figure caption goes here ………………………………………………………………………….xx
The List of Figures is not set up to automatically update. If you have figures in
your document, type them in manually here, following the example above.
Alternately, follow these instructions, which will allow automatic updating of the
List of Figures.
1. Use the cursor to highlight the figure number and caption where they appear in the
narrative chapters. (Figure 1. Figure caption.)
2. Press Shift + Alt + the letter o). In the Mark Table of Contents Entry that comes up, you
will see the figure information that you highlighted in the Entry box. Put A in the Table
Identifier box. Put 1 in the Level box. Do not close the Mark Table of Contents Entry
box. Work can be done while it is open.
3. Continue to follow this protocol for all figures. You will see parenthetical entry field
coding beside each figure caption when you have the formatting showing.
4. Close the Mark Table of Contents Entry box.
5. Place your cursor on the List of Figures page in the TOC.
6. Open the References tab.
7. Left click Insert Tables of Figures.
8. In the Table of Figures box that comes up, put a check in the “Show page numbers” and
“Right align page numbers” boxes. Remove the check from the hyperlink box. Put dot
leaders in the Tab leader box. Under General, format is “from template.” Caption label is
“Figure.” Put a check in the “Include label and number” box.
9. Go to Options. Remove check from “style” box. Put a check in the “Table entry fields”
box. Put A in the Table identifier box. Click OK. Click OK again on initial Table of Figures
box.
10. The figures will appear on the List of Figures page. You may have to reformat the
spacing and font. If the captions themselves change in the narrative, this whole process
must be repeated. If only the page numbers change, do this:
a. Left click to place the cursor anywhere on the figures mentioned on the List of
Figures page.
b. Right click “Update field.”
c. Place bullet in circle for option to update page numbers only.
d. Left click OK.
e. The page numbers will update automatically.
iii
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Chapter 1: Introduction to the Study
Introduction
Drug and alcohol addiction as a major health problem throughout the world
(Miller, 2013). The World Health Organization (WHO; 2014) indicated that worldwide,
5.5% of the world’s population suffer from drug or alcohol addictions. The National
Survey on Drug Use and Health (NSDUH) showed that slightly less than 11% of
Americans with substance use disorder (SUD, which can include drugs or alcohol) were
able to receive treatment at a facility (Center for Behavioral Health Statistics and Quality,
2016). Some of those suffering from addictions are not able to or choose not to get help
with their substance use disorders (Cook, et al., 2013).
Different definitions exist for the term recovery. One definition is generalized as
a journey a person takes over time, including multiple stages throughout the process
(Substance Abuse and Mental Health Service Administration, 2012). These stages can be
seen as early recovery, sustained recovery, and stable recovery (Betty Ford, 2007). Neale
(2014) discussed recovery as abstinence, or reduction in use of substances, that results in
better living situations, better health, employment, or some positive outcome. Recovery
from dependence on a substance is seen as a voluntary act, maintained by change in
lifestyle to include sobriety (abstinence) health, and community involvement (Betty Ford,
2007).
In 1991, The U.S. Department of Health and Human Services developed an office
to focus on the health and wellness of women (National Institute Drug Addiction, 2018).
The National Institute of Drug Addiction (NIDA) focused on studies in women as the
2
biological differences between men and women became more prominent in addictions to
drugs and alcohol (NIDA, 2018). An entire department titled the Office of Research on
Women’s Health is dedicated to determining the differences between the genders on
health-related topics (NIDA, 2018). Women face unique challenges surrounding
substance and alcohol abuse that are also impacted by culture and geography (Wilsnack,
2013). A few of these challenges facing women entering recovery include problems with
domestic violence, victimization, sexual assault and trauma (Evans, Padwa, Li, Lin &
Hser, 2015). These instances can lead to co-occurring disorders in women to include
depression, anxiety, and low self-esteem (Evans et al., 2015).
Background
The following articles form the background to this research.
1. Benavides-Vaello, Strode and Sheeran (2013) discussed the use of technology for
treating persons with substance abuse to reduce disparities. .
2. Dixon and Chartier (2016) presented that alcohol is the most abused drug in the
rural areas within the United States.
3. Edmond, Aletraris and Roman (2015) showed the fundamental and quality
difference that exists between the rural and the urban treatment centers.
4. Ghia, C. J., Patil, A. S., Ved, J. K., & Jha, R. K. (2013) acknowledged that
telemedicine is increasingly becoming a widely recognized concept globally.
5. Hickson, Talbert, Thornbury, Perin, and Goodin (2015) discussed online
technologies, and how there is a more efficient and better care system.
3
6. Melemis (2015) acknowledged that four primary ideas exist for relapse
prevention.
7. Pullen and Oser (2014) highlighted substance abuse as a major concern in both
urban and rural areas, with more focus on the rural areas.
8. Sigmon (2014) focused on the access to treatment for those who are in rural
America. The specific target treatment for the study is on opioid dependence.
9. Wang, Becker and Fiellin (2013) is premised on the fact that rural areas in the
United States have shown an increase in overdose deaths due to the nonmedical
use of prescription opioids.
10. Zanaboni, Knarvik and Wootton (2014) explored the state of application of
routine telemedicine with specific reference to Norway
Problem Statement
Substance abuse is a steadily growing concern (Pullen & Oser, 2014) in rural
America (Sigmon, 2014). According to the U.S. Census Bureau (2016), a rural area is
defined as areas of population not classified as urban. Areas of urban populations are
denser, with more developed territories, leaving areas farther away from city centers to be
classified as rural (U.S. Census Bureau, 2016). In general, rural areas lack easy access to
quality healthcare (Pullen & Oser, 2014). Throughout the United States, rural areas
report physician shortages, travel difficulties, and lack of specialized treatment options
(Warren & Smalley, 2014).
Alcohol and substance abuse in Georgia is a social problem that has caused a
significant level of social and economic problems (SAMHSA, 2016). In a paper,
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“Gender Impact Assessment of Georgia’s Drug Reform”, the Gender Equality Council of
the Parliament of Georgia (GECPG) indicates that there are over 45,000 substance abuse
cases in Georgia. Out of this number, 10% are women (Gender Equality Council of the
Parliament of Georgia, 2017). Even though lack of rehabilitation is a threat to individual
health and well-being, there remain significant hindrances to the treatment of abusers of
substances (Pullen & Oser, 2014). One of the primary challenges to the treatment of
substance abuse is the availability of resources in communities (Edmond, Aletraris &
Roman, 2015), while marginalization and stigmatization are other devastating challenges.
One proposed way to overcome the obstacles in addiction recovery in rural areas is the
use of online systems.
One such option for rehabilitation from substance use disorder is that of
telerehabilitation, a sub-discipline of telemedicine. Telemedicine is one of the most
recent improvements in the provision of medical services (Mid-Atlantic Telehealth
Resource Center, 2016). It allows medical practitioners to provide medical services to
patients without ever meeting them. It refers to the use of various forms of technologies
and communication systems to offer rehabilitation services and assist the affected persons
to start living independently (Mid-Atlantic Telehealth Resource Center, 2016).
A study of online substance abuse recovery was completed in the United
Kingdom in 2015, comprising of smart phone apps, online groups, and websites
(Graham, Irving, Cano, & Edwards, 2018). This study revealed a strong correlation
between those in established and stable recovery and the usage of some type of virtual
recovery tool. Established or stable recovery is a period of sobriety of more than 5 years
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(Betty Ford, 2007). The study did not reveal if online services for those beginning
recovery, or those in early recovery, which is a period of time less than 1 year, were used,
which suggests further research is needed to understand recovery change via online
sources with a focus on gender (Graham et al., 2018).
Best et al. (2016) describes the amount of judgment from outsiders women
receive in comparison to men when dealing with substance use disorders. According to
the Federal Center for Substance Abuse Prevention (2017), about 2.7 million women in
the United States abuse drugs or alcohol. Some women may know that they are
struggling and will take pills or alcohol while hiding whereas other women will view it as
a social activity and will not agree to see it as a problem (Bepko, 2014). Women face
pressure to have everything together, meaning a perfect balance between work, raising
kids and other social activities. It is for this reason that once a woman gets addicted,
accepting that they are addicted is quite hard and seeking treatment is even harder
(Bepko, 2014).
Although the aforementioned research regarding deliveries of rehabilitation
services for women suffering from substance abuse and alcohol addiction illuminates
important findings, I have found no research that has examined how women located in
rural areas who suffer from addiction use telerehabilitation as a primary recovery option.
Purpose of the Study.
The purpose of this general qualitative study is to gain deeper understanding of
the experiences of recovery from substance abuse disorders among women in rural North
Georgia who are limited in access to in-person treatment options and rely on online
6
rehabilitation services. The research will explore the experience of recovery stabilization
from substance abuse and related diseases. Focus will be limited to women clients of
recovery treatments living in North Georgia. The online treatment platform provides a
private and convenient option for drug and alcohol addiction recovery (Griffiths, 2015).
Health related outcomes have been studied from the social media platform of
recovery, showing positive benefits, with little negative impacts (Merolli, Gray, &
Martin-Sanchez, 2013). Highly trained medical experts can provide therapeutic
intervention via the internet. This platform offers numerous benefits in addition to the
traditional recovery approach. Differing interactions via online such as counseling, peer
groups, and other tools for successful recovery are available. More engagement online
will positively influence the results of addiction treatment for women clients in rural
areas.
Utilizing the online tools, the women of North Georgia will benefit from full
flexible schedules 24/7, therapeutic support, and continual progression in counseling.
Connection is a strong part of recovery, and through online applications, women can stay
connected to counselors and set up appointments as needed. Length of online meetings
and sessions will vary, but the nature of interaction will depend entirely on the woman
and her desire for support (Griffiths, 2015).
Research Question
What are the experiences of recovery from substance abuse disorders among
women in rural north Georgia who are limited in access to in-person treatment and who
rely on online rehabilitation services?
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Theoretical Foundation
Framework
The self-regulation theory will serve as the theoretical framework for this study.
The self-regulation theory developed by Baumeister and Bandura (1989) is a self-directed
management system that involves guiding one’s thoughts, feelings and behaviors towards
the attainment of certain goals (Baumeister & Vonascha, 2015). It involves what we feel,
think, say or do that helps in controlling our urges, emotions and behaviors (Baumeister,
1994). This theory is effectively used for impulse control, illusion control, goal
attainment and management of sickness behavior making it eligible for this study
(Baumeister & Vonascha, 2015).
Bandura claimed that humans control behaviors through self-regulation and the
behaviors associated with the social cognitive theory and social learning theory
(Baumeister, Bratslavsky & Muraven, 2018). Schunk and Zimmerman reviewed the
theory and came up with particular strategies that contribute to an individual’s learning
process that leads to self-regulation (as cited in Panadero, 2017). Baumeister designed
four components of self-regulation to be the standard of behaviors that are desired, the
motivation to meet the standards, analyzing and evaluating situations and ideas and the
willpower to control urges (Baumeister, Bratslavsky & Muraven, 2018).
Individuals engage in their own learning in three stages: planning, monitoring and
reflection (Panadero, 2017). The individual lays out strategies to tackle the tasks,
monitors their performance and reflects on the outcome (Panadero, 2017). In monitoring
of health-related issues, the self-regulatory model may be used. It describes the stimulus,
8
cognitive and emotional responses, the coping responses and evaluation of the coping
responses and health outcomes (Baumeister & Vonascha, 2015). Patients are guided in
identifying their health problems, the risks and issues involved and an action plan to
handle the problem (Panadero, 2017). The self-regulation theory is applied by an
individual who takes control and evaluates his/her behaviors to attain satisfaction trough
life experience.
Definitions
Recovery – Recovery, for the purposes of this paper, will describe the process of
change that an individual achieves through abstinence and improved health, wellness, and
overall quality of life. (Center for Substance Abuse Treatment, 2007).
Telehealth – The usage of electronic information and telecommunication
strategies to support and promote long-distance clinical health care, patient and
professional healthcare education, and health and public safety administrations.
(Department of Health and Human Services, 2019).
Telemedicine – Similar to telehealth, telemedicine is the practice of the medical
field using technology to deliver care at a distance. Physicians in one location can utilize
telecommunications infrastructure to provide adequate care to a patient who, for one
reason or another, is separated from them. (AAFP, 2017).
Tele-Rehabilitation – Rehabilitation through traditional techniques, but utilized
through telecommunication devices like computers, web-cams, and telephones. (Peretti,
2017).
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Relapse – The return of a disease or the signs and symptoms of a disease after a general
improvement period. Moreover, the returned use of addictive substances or behaviors.
(NIH, 2018).
Substance Abuse – The usage of illegal drugs, prescriptions, over-the-counter
drugs, or alcohol for purposes other than what they were initially intended for. Typically,
these substances are abused or utilized in excessive amounts that do not have clinical
reasoning. (NIH, 2018).
Opioid Dependence – The dependency on opioids, a substance used to treat
moderate to severe pain. A dependence on drugs like morphine and codeine are
detrimental to the receptor in the central nervous system. (NIH, 2018).
Rural Areas – Areas in the continental United States that are open country and
settlements with fewer than 2,500 inhabitants. (USDA, 2019).
Urban Areas – Unlike rural areas, urban areas refer to larger places where the
space around them is high in population density. Urban areas do not follow clear
municipal boundaries and are often classified with inhabitants of roughly 50,000 people.
(USDA, 2019).
Treatment – The desired course of action between a doctor and patient in
rehabilitating an ailment of disease. Plans are structured around or deliberately designed
to curtail the disease or ailment through medication, procedures, and medical devices.
(Hart, 2020).
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Rehabilitation – The process to restore mental or physical health incurred from an
injury or disease. The programs are used in order to allow someone to function in normal
or near-normal life. (NIH, 2018).
Medical Practitioners – A practitioner is an individual who is qualified and
experienced to work in a specific medical profession. A doctor or nurse are considered
healthcare practitioners. (NIH, 2018).
Assumptions
The nature of this study will be qualitative inquiry with a general approach that
will focus on the lived experiences of women living in rural north Georgia who utilize
online treatment for recovery from substance use disorder. According to van Manen
(2014), the heart of human experiences presented to the researcher has meaning to the
participants through their surroundings, and how their meaning influences behaviors.
Purposeful sampling will align with the purpose of this qualitative study. Sampling will
allow for selection of participants to meet the requirements needed to further the study
(Suri, 2011).
Individual interviews will be conducted, utilizing semi-structured
questions. A total sampling of between 12 to 15 women will be selected on a voluntary
basis, ensuring anonymity through only voice recording. Women will be a minimum of
eighteen years old, with no age limit. Some will have entered into recovery on their own
decision and some may have been assigned to it through court ordered processes. The
location of the participants will be in Northern Cherokee County in the state of Georgia.
Selection will be from more rural areas, with a minimum of 20 mile drive to the closest
treatment option for addiction recovery. Participant pool will lead to a better
11
understanding of the experiences of women entering into recovery from substance use
disorders.
Scope and Delimitations
In this study, the focus is on the analysis of the experiences in stable recovery for
women living in rural north Georgia who treat substance use disorders through online
rehabilitation services. The deeper understanding under investigation may accrue a
qualitative attachment to the research methodology investigated. Hence, it is imperative
to focus not on outside events, but on the experiences being presented. Following a
thorough analysis of women seeking online treatment on drug abuse online, there has
existed a limited scope and need to research the particular field to find out the motivation
behind the action (Matua & Van Der Wal, 2015). The motivation behind the whole
concept points to the fact that there are gaps within community centers charged with
engaging the society in containing substance abuse amongst women in the Georgian
community. From a sample of women, it was agreed that drug and substance abuse
problems had online choices and should be expanded to other territories for better service
(Van Manen, 2014).
Of specific interest is:
a) The experiences in stable recovery for women living in rural north Georgia; and
b) The treatment of disorders through online rehabilitation services.
Data will be analyzed through thematic content analysis. Through this technique, the
common patterns across a data set will be established. During the analysis of collected
data, individuals will read and re-read data, then label and code for broad patterns of
12
meaning. The themes will be reviewed to ensure that the data will correlate (Braun &
Clarke, 2014). Themes will be named and then defined appropriately. Write up will
include quotes from the interviews.
Limitations
The method to be used, semi-structured interviews has its shortcomings. First, the
method can be time-consuming and utilizes many resources. Additionally, the technique
requires confidentiality which has to be assured and if not, the participants may feel
hesitant to share information. The skills to analyze the data can be a problem as there are
chances of construing so much (Van Teijlingen, 2014). A main limitation may be
achieving the correct sample size.
According to Babione (2015), saturation is the point in a qualitative research
where new data and analysis only confirm previous conclusions. Consequently, it
determines when to stop data collection and analysis. At the saturation point, the theory
appears clear and is easy to construct since there are no gaps of unexplained phenomena.
Sirakaya-Turk et al. (2017) considers saturation to be reached when no new concepts can
emerge and the data cannot contribute any further to theoretical development. Data
repetition and redundancy begins to appear and further collection is unproductive since it
yields no new information. According to Phillips (2014), any additional information after
saturation becomes redundant because the purpose of qualitative research is to discover
the context and diversity rather than a large number of participants with the same
experience.
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The failure to achieve saturation has a negative impact on the research quality and
the validity of the results (Fusch & Ness, 2015). Further, there is no universal data
collection method for attaining data saturation. According to Fusch & Ness 2015, some
methods have a high probability of reaching saturation than others. Data collection
approaches depend on the study design and hence researchers should select a study
design that is explicit about reaching data saturation (Fusch & Ness, 2015). Saturation
should be operationalized in a method consistent with the theoretical position, study
questions, and the adopted analytical context (Saunders et al., 2018).
Ethical Procedures
One of the things that will be ensured in the study is research confidentiality. The
consent of the interviewees will also be sought before carrying out the study. The
research aim and objectives will be made known to the researchers as well. A steady
focus to keep and remove any bias of the researcher will be maintained, after using any
experiences necessary to gain complete confidence from participants.
Significance
Overdose deaths increased at a more rapid rate in the state of Georgia than the
national average last year (CDC, 2018). In 2016, 928 Georgia residents died in the
circumstances related to substance use disorder (Cupit, 2018). During 2017, the number
of overdose deaths reached 1,035 people living in Georgia (Cupit, 2018). The mortality
rate in Georgia is now considered an epidemic crisis. Deaths relating to drug abuse in
Georgia for 2018 reached 2000 people. This study will provide useful information
benefitting women living in rural North Georgia battling substance abuse issues. The
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results from this study will provide a contribution to the literature on understanding
addictions in women with less access to treatment (King et al., 2018). Significance will
be seen through a reduction of barriers to treatment and recovery by improving the online
ability to treat substance use disorders.
The results gathered from this research will contribute to literature by revealing
depths of substance abuse in women. Knowledge obtained from this study could promote
social change through recommendations from collected information towards policy
makers in rural areas (King et al., 2018) to increase availability of services for those
suffering substance use disorders. The ripple effect of this information will reduce deaths
in the community from addiction because more availability to recovery help will be
available. Policy makers within the state of Georgia will be involved in positive changes
for availability of treatment for women suffering from substance use disorder. This study
will be fundamental in importance by reducing the number of deaths in the area thru
online recovery options.
Summary
*** IS THIS WHERE THE SUMMARY OF CHAPTER 2 GOES??***
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Chapter 2: Literature Review
History of drug abuse/addiction/dependency
In the History of substance abuse research in the United States, VanGeest et al.
(2016) ascertained that substance abuse is one of the most widely studied aspects of
human health in the United States. Drug or substance abuse is the use of a drug in
amounts that are harmful to individuals’ health or others. There are many reasons why
people engage in the use of drugs irrespective of their background or age. According to
Robinson (2019), people do experiment with recreational drugs out of curiosity to have
some enjoyable time or because some other people like friends are doing it, reducing
stress or other problems, or maybe as a result of depression. Substance abuse and
addiction results not only from the use of illegal drugs like cocaine or heroin but also
from prescribed medications, which include painkillers or sleeping pills. In the U.S, most
people are addicted to prescribed drugs such as painkillers (Segal, 2019). In most parts
of the United States, Opioid painkillers abuse has become so powerful and has paved the
way for the use of more dangerous drugs (VanGeest et al., 2016). Substance abuse has
been going on in the United States for a long time, but it was not until the last parts of the
19th century that many scholars started taking an interest in the matter (Sarvet & Hasin,
2016).
Development of Drug Addiction
According to Melinda Smith (2019), drug use can easily lead to addiction based
on various factors. Any person can develop problems of drug use, but vulnerability
differs from one person to another. Some of the things that play a role in this include the
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individual’s family, mental health, and the environment he/ she socialize from. Other
factors include the history of addiction within the family, Abuse, traumatic experiences,
depression and anxiety, and the method of administering the drug, which includes
injection or smoking. *******NEED MORE****
Drug Use and Addiction in Georgia
Alcohol use
In Georgia, drug and substance abuse is one of the most felt health crisis, and this
is a severe challenge that the population faces and which take distinct forms. According
to Lakeview Health publication in 2019, Alcohol is probably the most abused drug in
Georgia. Although it is widely accepted as a regular social activity, many people have
become addicts in a way that is affecting them negatively.
The rate of use of this substance varies with the geographic location of the
residents, primarily rural and urban areas. There has been a lot of concern about Alcohol
Use Disorder among these populations and there is a need for humanitarian help in
addressing this problem. (WHO GHO, 2016). Alcohol use disorder is mainly a big
concern among conflict-affected civilians (Ga Dept of health, 2019). This is because they
are often exposed to traumatic and occurrences that bring about complications such as
depression and anxiety.
This exposure to traumatic events and violence result in alcohol use as a form of
self-medication. Armed conflicts and related displacements of people arise to poor living
conditions and poverty, and loss of properties. This makes alcohol a solution strategy to
these stressors. Alcohol use and addiction is the leading cause of non-communicable
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diseases such as cirrhosis, heart conditions and diabetes to these populations (Almli &
Lori, 2018). It also results in behavioral and other social impacts such as violence which
is based on gender. This is a big problem in many areas affected by conflicts.
Georgia has been marked by conflicts that involved secessionist movements in the
1990s and in 2008 which led to displacements and setting up internally displaced
people’s camps (WHO, 2016). These displaced communities are faced with