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An Exploration of Alcohol Use in Karen Refugee Communities in The An Exploration of Alcohol Use in Karen Refugee Communities in the Context of Conflict-Related Displacement A DISSERTATION SUBMITTED TO THE FACULTY OF THE GRADUATE SCHOOL OF THE UNIVERSITY OF MINNESOTA BY Jennifer Simmelink McCleary IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Dr. Elizabeth Lightfoot, Advisor and Dr. Elizabeth Wieling, Advisor July, 2013 © 2013 Jennifer Simmelink McCleary Acknowledgements This dissertation would not have been possible without a host of people – family, friends, colleagues, professors, mentors, participants, and others who fueled this project with hours of mentorship, conversation, insight, laughter, food and encouragement. First and foremost, this body of work would not exist without the participants who shared their stories and often their homes with me. I am grateful for the trust you put in me. I owe a deep, deep tablu doma to Eh Taw Dwe, my cultural liaison in Minnesota. Eh Taw graciously shared his culture, his history, his language, his story and, most importantly, his infectious laughter with me and I will forever be grateful to him for his gentle teaching on all things Karen. I am grateful to many teachers in Thailand: La Law Say, Dah, Pam and the rest of the DARE Network staff; Julia, Liberty, and Eh Ka Lu. A huge thank you to Sister Stephanie Spandl and Day Wah at MORE School for participant recruitment support that turned into what I know will be a life-long partnership. I consider myself extremely lucky to have entered the Ph.D. program in 2008 along with JaeRan, Ericka, Shweta, Sue, Seok Won and Kofi. Over the past five years we have shared laughter, tears, about a hundred Bombay Bistro celebratory dinners, statistics notes and writing support. I am so inspired by the way that each of you tirelessly pursues a deep intellectual and activist approach to social work scholarship and I know I will continue to grow from our friendships. i I am also grateful to my committee and their support during this journey. To my co-advisor, Liz Wieling, thank you for being not just a mentor but a friend. I am so grateful for your guidance and support and your example of how to be both a woman and a scholar. To my co-advisor, Liz Lightfoot, your support of this project extended to travelling with me to Thailand as I began my data collection there and I am so grateful to have shared that experience with you. Thank you for all of your support and mentorship through my entire program. To Dave Hollister, thank you for your gentle wisdom and guidance. To Patty Shannon, you have been a mentor to me since my first days in the Ph.D. program and I am so inspired by your vast experience and creative mind. To Liz Boyle, thank you for providing unique insight into the human rights aspect of this work. Last, but clearly not least, I am deeply grateful for my family and their enduring support. Mom and Dad: since I was a little girl reading every book I could get my hands on you have supported my love of knowledge and learning and provided examples of what it means to passionately pursue engaged and meaningful careers. Thank you for really meaning it when you told me I could be whatever I wanted to be. Kari and your family: thank you for giving me much needed joyful breaks from academia to play – from wine-filled girls’ nights to trampoline jumping sessions with Jake and Ella. Jason and your (growing!) family: I am so awed by your creativity and it inspires me daily. Kyle: during this journey you met me, swept me off my feet, married me, fed me, kept me daily entertained with your laughter and never, ever, once stopped believing completely in my ability to do this. I am so grateful for your love, your support, your joy and your intellect. I love you completely, confidently and joyfully. ii Dedication This dissertation is dedicated to my family whose love, laughter, joy, passion and creativity made me who I am today; and to my participants who graciously shared their lives with me. iii Abstract Refugees who are displaced due to political conflict often experience a range of traumatic events throughout displacement and resettlement including exposure to traumatic events such as imprisonment or gender-based violence, protracted periods of time in refugee camps or resettlement related stress. Refugees who are displaced across borders bring cultural beliefs and values with them, although often the structures that support culture such as family and community are disrupted due to displacement. All of these factors can influence patterns of alcohol consumption and the consequences of alcohol use. Traditionally, high levels of alcohol consumption in refugee communities have been explored using models of self-medication of trauma or acculturation (Ezard, 2011). There have been almost no studies conducted of refugee alcohol use that qualitatively explore refugees’ perceptions and experiences of alcohol use from their own perspectives. This dissertation describes a qualitative that study drew from critical ethnographic and phenomenological methodologies to explore the experiences and perceptions of alcohol use in Karen refugee communities displaced by political conflict. I collected data through focus group and individual interviews (N=62) and participant- observation in two locations: refugee camps in Thailand and a resettlement community in St. Paul, Minnesota. Analyzing the data using domain analysis (Spradley, 1979), I found that both culture and displacement related traumatic experiences contributed to increased levels of problematic alcohol use and negative consequences of alcohol use after displacement. I also discovered that geographic location may have played an influencing role on patterns of alcohol use. Participants said that many cultural structures and patterns were disrupted during displacement and this disruption of culture led to iv increased problems related to alcohol. Finally, Karen participants described people with problematic alcohol use as people who had stopped thinking about community and family and had begun to think only of themselves, which is counter to traditional Karen ways of thinking communally. These findings contain knowledge that will contribute to the development of culturally relevant treatment programs that consider the cultural, historical and political factors that contribute to alcohol use in Karen refugee communities as well as the ways in which communal cultural values impact both use of alcohol and quitting problematic alcohol use. v Table of Contents List of Tables . .viii List of Figures . ix Chapter 1: Introduction . 1 Chapter Overview . 1 Brief Study Description . 1 Study Background . 2 Problem Statement . 8 Research Questions . 9 Karen Populations in Burma, Thailand and the United States. 10 Definition of Terms . 21 Outline of Remaining Chapters . 24 Chapter 2: Literature Review and Theoretical Frameworks . 25 Chapter Overview . 25 Literature Review . 26 Theoretical Frameworks . 51 Chapter 3: Methodology and Procedures . 64 Chapter Overview . 64 Research Questions . 64 Research Design . 65 General Procedures and Study Structure . 75 Specific Procedures: United States . 80 Specific Procedures: Thailand . 83 Ethical Considerations . 87 Data Analysis . 88 Trustworthiness . .92 Chapter 4: Findings . 96 Chapter Overview . 96 Category I: Reasons for Alcohol Use . 98 Category II: Consequences of Alcohol Use . 116 Category III: Beliefs about Alcohol Use . 124 Category IV: Ways of Stopping Alcohol Use . 134 Category V: Women’s Ways of Using Alcohol . 141 Category VI: Youth’s Ways of Using Alcohol . 148 Chapter 5: Discussion . 154 Chapter Overview . 154 How Do Karen Refugees Perceive and Experience the Reasons for and Consequences of Alcohol Use? . 156 What Individual, Family and Community Level vi Factors Contribute to Alcohol Use? . 169 What Are the Relational Impacts of Alcohol Use at the Individual, Family and Community Level? . 178 What Do Karen Refugees Believe Would Be Effective In Stopping Problematic Alcohol Use? . 180 How Does Geographic Location (Refugee Camp or Country of Resettlement) Impact Alcohol Use? . 183 Women and Youth’s Ways of Using Alcohol. 185 Conclusion . 189 Chapter 6: Conclusion . 192 Chapter Overview . 192 Implications for Social Work Knowledge, Practice and Policy . 192 Limitations of this Study . 196 Directions for Future Research . 198 References . 200 Appendices . 220 Appendix A: Consent Form for Focus Groups: Minnesota . 220 Appendix B: Interview Guide for Focus Groups: Minnesota . 222 Appendix C: Consent Script for Thailand . 223 Appendix D: Interview Guide for All Interviews: Thailand . 225 Appendix E: Data Analysis Steps . 226 Appendix F: Categories, Themes and Sub-Themes . 227 vii List of Tables Table 1: Minnesota Participant Demographics . 78 Table 2: Thailand Participant Demographics . 79 viii List of Figures Figure 1: Multiple Pathways of Alcohol Use for Karen Refugees . 161 ix Chapter 1: Introduction Chapter.
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