A study of 20,000 adults in Kano, Kaduna and Katsina states found 85% in multidimensional poverty and 18.5% screening positive for high-risk substance use.
The research, reported by The Conversation, is described by its authors as one of the largest of its kind in west Africa.
It measured deprivation with a multidimensional poverty index, assessed anxiety and depression with the Kessler psychological distress scale, and screened for harmful substance use with the alcohol, smoking and substance involvement screening test.
Participants were also asked how they cope with stress.
The poverty figure is significantly higher than Nigeria’s national multidimensional poverty rate of 62.9%, a comparison the researchers say reflects how precarious the region is economically.
The index measures not only income but access to education, healthcare and basic living standards.
On mental health, 45.2% of respondents scored in the high range on the Kessler scale, which asked about symptoms of anxiety and depression over the past month.
The authors note that studies in general healthcare settings in Nigeria typically find that 20% to 30% of people experience common mental disorders, and say their figure suggests climate-stressed communities represent a particularly vulnerable group.
Substance screening found cannabis was the most common substance, used by 12.4% of participants, followed by prescription opioids such as the painkiller tramadol at 9.1% and alcohol at 7.8%.
The researchers flag the widespread use of prescription drugs obtained without prescriptions as especially worrying because of the risks of dependence and overdose.
Asked about coping, 67.5% of respondents relied primarily on what the study classifies as unhealthy strategies, including avoidance, emotional discharge and behaviours that provide temporary relief but create longer-term problems.
Substance use is given as a prime example of that pattern.
The study also records testimony from participants. A farmer in his 40s said: “When the farm fails, there is no money for food, let alone school fees.
The worry does not leave my head. I take the local gin just to sleep at night.”
A man in his 20s described the pressure around him: “My friends use tramadol. They say it helps them forget that there is no work and no future.
I have tried it too when the stress becomes too much. Everyone is doing something to escape.”
A woman whose husband had left to find work in the city said: “The men drink because they cannot provide. The women cry because there is nothing to give the children.
This life is hard, and hard lives make people do hard things.”
The authors argue the findings cut across policy areas, describing the problem as a health issue, a development issue, an agricultural issue and a climate adaptation issue at once.
They reject the idea that substance use in poor communities is a moral failing or simply a matter of personal choice, presenting it instead as a response to overwhelming stress and hopelessness.
Mike Blyth/Wikimedia Commons, CC BY
They set out three responses.
Mental health and substance use prevention should be integrated into climate adaptation and food security programmes, so that efforts helping farmers adjust to changing rainfall patterns also address psychological distress, and food aid is paired with screening for substance abuse.
Social protection schemes and livelihood diversification are needed so that people have income beyond rain-fed agriculture and are less exposed to climate shocks.
Community health workers should be trained to identify and refer people with mental health and substance use issues, given what the authors describe as too few psychiatrists in Nigeria to meet the need.
The researchers describe strong connections between poverty, psychological distress and substance use: people who are poor are more likely to be distressed, and people who are distressed are more likely to use substances.
They call these patterns clear and statistically robust.
They also set out the limits of the design.
The study was a snapshot taken at one point in time, which the authors compare to a photograph of a crowd: you can see who is standing together, but not who arrived first or who led whom.
While poverty and substance use go hand in hand in the data, the study cannot say which causes which, or whether both are caused by something else.
Proving that chain of events conclusively would require following the same people over several years, watching their circumstances and behaviour change.
The authors direct the implication at aid providers, writing that humanitarian and development programmes which ignore substance abuse are failing to address a key driver of poverty.
When people use drugs or alcohol to cope, they write, they become less able to work productively, less able to care for their families and less able to recover from the next climate shock, with health deteriorating, stigma following and a downward spiral setting in.
Source: The Conversation
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