Trajectories of Drug Abuse and Addiction Development Among FSU Immigrant Drug Users in Israel

Abstract

This qualitative study explores the trajectories of drug abuse and addiction development among former Soviet Union (FSU) immigrant users. It is based on in-depth interviews with 19 Russian-speaking recovering addict counselors employed in Israeli addiction treatment centers. The interview analysis yielded two main trajectories: one of abuse deterioration and the other of abuse initiation in the context of coping with immigration. The core issue that characterizes both trajectories is the immigrant users’ sense of loneliness. Participation in treatment appears as a path for regaining their sense of belonging. Implications for prevention and treatment based on the interviewees’ reflections, as well as on extant literature, are discussed.

Keywords

acculturation immigration/migration intergroup relations/prejudice drug abuse

Introduction

Similar to many Western countries, Israel tackles the issue of illicit drug abuse that is known to be closely associated with health-related problems, family dysfunction, psychosocial maladjustment, and crime (Ammerman, Ott, Tarter, & Blackson, 1999; D’Amico, Edelen, Miles, & Morral, 2008; Schwabe, Dickinson, & Wolf, 2011). Although the exact number of drug users in Israel is unknown, the official estimate is that 14,000 to 15,000 persons are addicted to hard drugs (Natan, 2011; Roshka, Mehl, & Florentin, 2011), and of them some 25% are immigrants from the former Soviet Union (FSU; Isralowitz, Reznik, Spear, Brecht, & Rawson, 2007). FSU immigrants account for approximately 13% of the Israeli population (Central Bureau of Statistics, 2016); yet according to information gathered in treatment services, FSU-origin users constitute 25% to 30% of their patients, and in therapeutic communities this percentage increases to nearly 50% (Ranz, Dekel, & Izhaky, 2012). The high incidence of drug dependence among FSU immigrants may be mainly attributed to high rates of substance abuse in their countries of origin (Isralowitz et al., 2007; Peles, Schreiber, & Adelson, 2014) as well as to the stress associated with immigration (Kagan & Shafer, 2001). Although several studies have explored the trajectories of drug abuse development in general population (Hser, Longshore, & Anglin, 2007; Tucker, Ellickson, Orlando, Martin, & Klein, 2005), little is known about the reasons and pathways leading to substance use among immigrants. Studying these pathways may help identify immigration-specific risk factors and design customized prevention and treatment strategies. According to this view, the article explores the trajectories of development of drug abuse and addiction among FSU immigrants based on the personal and professional experience of Russian-speaking recovering addict counselors. In this study, drug abuse is defined as chronic and escalating consumption of “hard drugs,” particularly opioids that are prevalent among Russian-speaking users (Guarino, Marsch, Deren, Straussner, & Teper, 2015).

Drug Abuse and Addiction

Drug addiction may be defined as the loss of control over drug use reflected in compulsive seeking and taking drugs despite adverse consequences (Chuan-Yun, Xizeng, & Liping, 2008). It is conceptualized as a final outcome of a process that begins with occasional drug-taking and ends with the consumption of excessive amounts of drugs to the detriment of the individual and society (Winger, Woods, Galushka, & Wade-Galushka, 2005). Epidemiological studies confirm that substance use typically begins in adolescence and steadily increases over time, reaching a peak during the period of emerging adulthood (Tucker et al., 2005). For many users, the excessive use of drugs declines rapidly thereafter—a process known as “maturing out.” For others, the abuse continues and extends into older adulthood (Upah, Jacob, & Price, 2015). The initiation of drug use later in life is rare (Agrawal & Lynskey, 2009) and is often associated with faster cessation (Hser et al., 2007).

Drug-taking behavior, and eventual addiction, is a result of multiple determinants. Genetic factors have been estimated to contribute 40% to 60% of the vulnerability to drug addiction, and personality and environmental factors provide the remainder (Chuan-Yun et al., 2008). Numerous studies have linked substance use and addiction to psychosocial and behavioral problems during late adolescence and emerging adulthood (Tucker et al., 2005). Such variables as antisocial or rebellious behavior (Hamil-Luker, Land, & Blau, 2004), conduct problems (Fergusson, Horwood, & Ridder, 2007), internalizing disorders (Lansford et al., 2008; Wittchen et al., 2007), and externalizing disorders (Costello, 2007; Lillehoj, Trudeau, Spoth, & Madon, 2005) during childhood and adolescence were found to be related to later drug abuse. Substantial research has demonstrated a link between substance use and family environment (Samek, Rueter, Keyes, McGue, & Iacono, 2015), especially such factors as lack of parental support, involvement and control (Barnes, Reifman, Farrell, & Dintcheff, 2000; Simons-Morton, Haynie, Crump, Eitel, & Saylor, 2001; Stice & Barrera, 1995), and older siblings’ influence (Samek et al., 2015). Social factors such as peer pressure and deviant friend associations are positively associated with drug abuse as well (Simons-Morton et al., 2001). On a larger scale, substance abuse may be connected to such factors as social ties to school, family, religion, and the labor market (Hamil-Luker et al., 2004).

Exposure to stress is considered to be a significant contributor to addiction vulnerability (DeWit, MacDonald, & Offord, 1999; Haller & Chassin, 2014; Schwabe et al., 2011; Sinha, 2008). Negative events and chronic stress that elevate levels of negative affect may lead to substance use as a means of self-medicating and managing negative emotional states (Audrain-McGovern et al., 2012; Clark, Ringwalt, & Shamblen, 2011; DeWit et al., 1999; Haller & Chassin, 2014). Moreover, a stressor acts as a threat to the physiological or psychological integrity of the individual, thus triggering multiple behavioral, emotional, and cognitive responses that may contribute to the development of addictive behavior (e.g., habit processes, brain reward circuits; Schwabe et al., 2011). Recently, several studies have demonstrated that stress associated with a person’s minority status may increase his or her risk of drug abuse (Benner & Wang, 2015; Goldbach, Berger Cardoso, Cervantes, & Duan, 2015; Livingston, Oost, Heck, & Cochran, 2015). In light of this article’s objectives, it would be of interest to explore how the stress of immigration is related to substance use among immigrants.

Immigration Stress and Drug Abuse

Immigration is generally conceived as a potentially stressful and challenging experience that involves coping with a series of losses and stressors, often accompanied by negative feelings (Benish-Weisman & Horenczyk, 2010; Kagan & Shafer, 2001; Yakhnich, 2008). Immigrant sources of distress include such difficulties as financial hardship, lack of housing and employment, language and cultural barriers (Ritsner, Modai, & Ponizovsky, 2000; Yakhnich, 2008), deterioration of family values (Gil, Wagner, & Vega, 2000), family stress (Driscoll, Biggs, Brindis, & Yankah, 2001; Kosner, Roer-Strier, & Kurman, 2014; Mirsky, Baron-Draiman, & Kedem, 2002), and living in high-density households or disadvantaged neighborhoods (Cervantes, Cordova, Fisher, & Kilp, 2008). Separated from their families and friends, some immigrants cope with these hardships by turning to alcohol and drugs (Cervantes et al., 2008; Gil et al., 2000; Kagan & Shafer, 2001). For example, Guarino, Moore, Marsch, and Florio (2012) reported that young immigrant drug users describe drugs as a powerful means for handling the stress of immigration, which is perceived as traumatic and frightening.

Studies conducted in the United States report that the majority of immigrants have a relatively low prevalence of substance use immediately after immigration, while longer duration in the United States is linked to an increased prevalence of substance consumption (Abraido-Lanza, Chao, & Florez, 2005; Bui, 2012; Li & Wen, 2013; Vaeth, Caetano, & Rodriguez, 2012). Age at immigration is a significant factor in substance use initiation, with younger age at immigration predicting higher risks of smoking, drinking, and drug use (Guarino et al., 2012; Kimbro, 2009; Li & Wen, 2013). This tendency may be explained by the young immigrants’ greater susceptibility to peer influences and their more ambiguous cultural identities (Li & Wen, 2013). Goldbach and his colleagues (2015) found a significant association between stress and immigrant adolescents’ alcohol use, with adolescents who reported using alcohol scoring significantly higher on family, economic, cultural, and discrimination stress.

Discrimination is widely recognized as a prevalent stressor among immigrants (Brettell, 2011; Li & Wen, 2013; Walsh, Fogel-Grinvald, & Shneider, 2015). Social exclusion, marginalization, and discrimination have been found to be related to substance use in immigrant and other minority populations, especially in adolescents and youth (Benner & Wang, 2015; Gibbons et al., 2012; Schwartz et al., 2014; Unger, Schwartz, Huh, Soto, & Baezconde-Garbanati, 2014; Walsh et al., 2015). Gibbons and his colleagues (2012) reported this association to be mediated by feelings of anger and hostility on the part of minority populations. They argued that substance use may serve discriminated persons as a way of coping by muting their negative affect associated with marginalization. Socioemotional distress that is linked to discrimination can thus lead minority populations to engage in self-medication behaviors related to substance use (Benner & Wang, 2015; Walsh et al., 2015).

Risky behavior (including drug abuse) among immigrants may also be examined within the framework of acculturation model (Berry, 1997, 2005). According to the model, the encounter of immigrants with a new society faces them with two major questions: (a) whether to maintain their former cultural identity, and (b) whether to develop relations with the host society and adopt its values and norms of behavior (Kurman, Eshel, & Zehavi, 2005). The model posits four possible acculturation strategies: integration, assimilation, separation, and marginalization. Research has shown that the strategy of integration, which incorporates maintaining one’s cultural identity and developing significant relations with the host society, enables the immigrant to form a multifaceted identity, promotes his psychological and sociocultural adjustment, and is linked to higher levels of mental and physical health (Berry, 1997; Walsh et al., 2015).

Conversely, the marginalization strategy—a loss of one’s former identity that is not accompanied by the development of a new identity—leads to a sense of not belonging to any culture and represents a failure of the acculturation process (Berry, 1997; Kurman et al., 2005). Multiple studies report marginalization to be a risk factor for antisocial behavior among young immigrants who feel alienated toward both the host society and the culture of origin. Antisocial and risky behavior may offer them a means of expressing their anger and obtaining a sense of belonging, a social status, and an alternative culture (Edelstein & Bar-Hamburger, 2007). In their recent study, Benner and Wang (2015) found that marginalization of immigrant and minority students can lead to self-medication behaviors related to substance use. Notably, immigrants’ acculturation attitudes may be significantly affected by expectations of the host society and its readiness to accept them (Amit, 2010; Kurman et al., 2005). Reluctance to accept foreigners may be perceived by the immigrants in terms of discrimination, stigmatization, and stereotypical perceptions, and impair their psychological adjustment.

Immigrants From the FSU in Israel

Since 1990, Israel has absorbed over a million immigrants from the FSU, which account for approximately 13% of the Israeli population (Central Bureau of Statistics, 2016). This massive immigration was set in motion by the breakup of the FSU followed by socioeconomic crisis, political instability, and growing antisemitism (Remennick, 1999). In recent years, the rate of immigration from the FSU has fallen to about 8,000 immigrants per year; however, this is still the largest immigrant group in Israel (Yakhnich, 2016b). In Israel, FSU immigrants constitute a distinct sociocultural group characterized by high levels of education and human capital (Kurman et al., 2005; Walsh et al., 2015); about 60% held academic degrees in science, technology, education, and culture (Remennick, 1999). The Israeli market was too limited and saturated to accommodate them, resulting in substantial downward mobility and occupational downgrading. Even though, studies have documented FSU immigrants’ high levels of employment (Amit, 2012; Central Bureau of Statistics, 2016; Raijman & Semyonov, 1997).

Immigrant families from the FSU are generally small, with one or two children (Yakhnich, 2016b), and are characterized by increased divorce rates and large number of single-parent households, as compared with native Israeli families (Kosner et al., 2014). Immigrant parents usually stress the importance of education and invest effort in their children’s studies. Their parenting is significantly based on parental authority and involves high levels of control, discipline, involvement, and demand for children’s obedience and self-restraint (Leipzig, 2006; Shor, 1999; Slonim-Nevo, Sharaga, & Mirsky, 1999; Yakhnich, 2016b). Parent–child relationships are often challenged by cultural differences in child-rearing practices, language difficulties, and lack of parents’ emotional and physical availability (Yakhnich, 2016b).

Recent studies suggest that FSU immigrants are still relatively concentrated in ethnic neighborhoods, have more social contacts within their ethnic group as compared with other immigrants (Amit, 2012), invest efforts in sustaining their language and culture (Remennick, 2006), and place greater emphasis on their Russian identity and language than on their Israeli identity (Ben-Rafael, Yubansky, Glockner, & Harris, 2006). Despite their high participation in the labor market, their income level is still lower than that of the native population (Central Bureau of Statistics, 2016).

Drug Abuse Among FSU Immigrants

Multiple studies point to high rates of alcoholism, heroin use, and drug-related infectious diseases found in the FSU (Heimer & White, 2010; Isralowitz et al., 2007; Joint United Nations Programme on HIV and AIDS [UNAIDS] & World Health Organization [WHO], 2002; Peles et al., 2014). In the FSU, drug use was not officially recognized as a social problem. However, in the mid-1990s, official concern over increasing recreational drug use prompted a change in policy direction. It was recognized that for many Russians, illegal drug use served as a means to identify with the Western lifestyle and to enjoy newly obtained freedom. In early 2000s, rates of drug use (particularly opiates injecting) in Russia and Ukraine sharply increased, especially among teenagers and young adults, and reached 3 times the rate reported by the United Kingdom (Klein, Roberts, & Trace, 2004). Moreover, during these years, FSU has experienced one of the fastest growing HIV pandemics in Europe, while the main driver behind the rate of infection was injecting drug use (Klein et al., 2004; Sarang, Rhodes, Sheon, & Page, 2010; UNAIDS/WHO, 2002). Due to government policies that emphasize law enforcement and harsh punishments for drug users, instead of harm reduction, the drug scene in Russia is pushed underground. As a result, the levels of drug use, as well as risky behaviors among vulnerable groups, remain high (Klein et al., 2004; Sarang et al., 2010).

This reality may partially explain FSU immigrants’ comparatively high rates of drug abuse. In Israel, about 25% of heroin users immigrated from FSU (Isralowitz et al., 2007). Data from the United States show a similar tendency, with FSU immigrant young adults constituting a vulnerable population with high prevalence of opioid use and injection-related risk behavior (Guarino et al., 2015).

Drug users, and especially heroin users, suffer extreme stigmatization within the FSU immigrant community. They are perceived as morally inferior, in marked contrast to the cultural acceptance of drinking (Guarino et al., 2012). This stigma positions drug use as a taboo subject for open and frank discussion, and perpetuates a general ignorance about drugs and addiction common in the FSU immigrant community (Guarino et al., 2015). Due to high stigmatization, as well as to the punitive nature of addiction treatment in the FSU (Elovich & Drucker, 2008; Sarang et al., 2010), immigrant users are reluctant to seek help with their addiction and have difficulty participating in treatment programs (Isralowitz, Straussner, & Rosenblum, 2006; Kagan & Shafer, 2001).

Generally, substance abuse develops in a social context which governs how drugs should be consumed (Anderson & Levy, 2003). Among immigrants, social norms structuring substance use in their society of origin generally endure after the relocation and continue to shape their patterns of use (Guarino et al., 2012). Studies of FSU immigrant drug users in Israel and the United States consistently point to their specific cultural patterns of drug use that were imported from their countries of origin: First, Russian-speaking addicts usually prefer heroin over other drugs (Guarino et al., 2012; Isralowitz et al., 2007; Ranz et al., 2012; Yakhnich, 2016a). Isralowitz and his colleagues (2006) reported that young drug users of FSU origin in the United States tend not to start with soft drugs, such as marihuana, but go straight to injecting heroin. In addition, FSU immigrants, unlike the native Israeli and American users, are often involved in polydrug use and simultaneous drug and alcohol consumption (Guarino et al., 2012; Isralowitz et al., 2007; Ranz et al., 2012; Yakhnich, 2016a). Furthermore, many immigrant users have a tradition of compounding self-made drugs from medicines (Yakhnich, 2016a). The above patterns are linked to historical and cultural factors such as predominance of opium and the shortage of other substances on the Russian drug market that forced the addicts to develop drug-producing skills, as well as the cultural acceptance of heavy drinking that reinforced the tendency to combine drugs with alcohol (Guarino et al., 2012; Yakhnich, 2016a).

A key characteristic of drug abuse among FSU immigrants is the “injection culture.” Multiple studies report Russian-speaking users’ high rates of injecting as compared with other cultural groups (Guarino et al., 2012; Isralowitz et al., 2007; Ranz et al., 2012; Yakhnich, 2016a). Injecting drugs exacerbates immigrant addicts’ medical problems and heightens their risk of vulnerability to infectious diseases (Isralowitz, Reznik, Rawson, & Hasson, 2009). In a qualitative study that explored drug abuse patterns among FSU immigrant addicts, the participants stated three main reasons for preferring injection: First, the types of drugs that were traditionally popular in the FSU (e.g., opium) could be consumed mainly by injection. Second, injecting is economical, as the user may use a smaller amount of substance to achieve the desirable effect. The third reason, according to the participants, has deeper cultural roots and is considered a reflection of a “Russian character” marked by extremeness and fearlessness. Apparently, injection practice that is socially accepted and not perceived as degrading in Russian addict culture (as opposed to Israeli) is passed from one generation of Russian-speaking users to the next; even young addicts of FSU descent who start using opiates in Israel usually tend to inject (Yakhnich, 2016a).

The Current Study

Over the past several years, there has been growing interest in studying developmental trajectories of substance use (e.g., smoking, drinking, “soft” and “hard” drug-taking; Tucker et al., 2005; Upah et al., 2015). Identifying distinct trajectories may help recognize similarities and differences in patterns of use across different subgroups of users, compare them on key psychosocial and behavioral outcomes, locate especially high-risk populations, and key out specific periods during which prevention efforts may be optimally effective. Moreover, it allows identifying factors that may predict individuals’ entering specific pathway, keeping on it or shifting away (Epstein et al., 2015).

Several studies (Cervantes et al., 2008; Gil et al., 2000; Guarino et al., 2012; Kagan & Shafer, 2001) stress the association between immigration and drug abuse and addiction, and suggest that some immigrants may use drugs as a means of coping with the stress of immigration and the experience of discrimination. In light of these findings, it is important to identify subgroups of immigrants that are found at high risk for entering different substance use trajectories, as well as factors that may contribute to the development of severe patterns of drug abuse and addiction. This study explores the trajectories of drug abuse and addiction development among FSU immigrant users, who constitute a significant proportion of Israel’s drug treatment patients and are perceived as culturally distinct and vulnerable population due to high rates of opioid use and injection.

The research questions are as follows:

Research Question 1: What are the main trajectories of drug abuse development among FSU immigrant users in Israel and in what way these trajectories are influenced/shaped by immigration and adaptation experiences?

Research Question 2: What immigration-related factors may explain immigrants’ vulnerability to drug abuse?

Answering these questions can help design appropriate and effective preventive strategies and promote treatment efforts among FSU immigrants and other immigrant populations as well.

Method

The article is based on data gathered as a part of a larger study which explored drug abuse culture prevalent among Russian-speaking users in Israel (e.g., distinctive patterns of substance abuse, unique criminal culture, values and norms that guide users’ behavior) and the relationship between this culture and the rehabilitation process (Yakhnich, 2016a). Qualitative phenomenological methodology was used (Creswell, 2007). The information was gathered by interviewing recovering addict counselors of FSU origin employed in addiction treatment centers and was based on their personal and professional experience.

Participants

In total, 19 male Russian-speaking recovering addict counselors were interviewed for this study. Their ages ranged from 29 to 52 years, with the majority aged 33 to 45. Twelve were married, two were divorced, and five were single. All had immigrated from the FSU (eight from Ukraine, five from Russia, three from Caucasus, and three from Belarus, Kazakhstan, and Moldova, respectively) during 1991 to 2001. Their ages at immigration ranged from 8 to 37 years. The duration of their substance abuse ranged from 4 to 27 years, and all but six had used drugs prior to immigration. Their abstinence period ranged from 4 to 16 years. All had been working in treatment facilities for 2 to 13 years (Table 1).

Table 1.

Participants’ Demographic Characteristics.

Name	Age	Marital status	Age at immigration	Country of origin	Duration of substance abuse (years)	Abstinence period (years)	Drug abuse prior to immigration
Grigori	30	Single	14	Belarus	4	9	No
Vladimir	35	Married +1	14	Caucasus	13	8	No
Garik	29	Married	8	Kazakhstan	12	6	No
Gennady	33	Married +3	15	Ukraine	14	4	No
Igor	33	Married +2	11	Moldova	15	5	No
Tolik	32	Single	11	Russia	5	16	No
Vitaly	37	Married +2	14	Ukraine	15	8	Yes (soft drugs)
Denis	30	Single	18	Ukraine	8	5	Yes (soft drugs)
Mark	37	Married +2	15	Caucasus	14	9	Yes (soft drugs)
Yefim	38	Single	22	Ukraine	13	5	Yes (soft drugs)
Roman	33	Married +1	18	Ukraine	12	8	Yes
Sasha	33	Married +1	18	Caucasus	15	5	Yes
Marat	52	Married +2	37	Russia	27	9	Yes
Alexandr	39	Divorced +1	20	Ukraine	16	6	Yes
Semyon	36	Divorced	20	Russia	7	11	Yes
Pavel	44	Married +2	28	Ukraine	17	12	Yes
Evgeny	40	Single	21	Ukraine	12	14	Yes
Nikolai	43	Married +4	22	Caucasus	19	15	Yes
Dima	42	Married +2	25	Russia	9	14	Yes

Procedure

Criterion sampling was used to select participants with a predetermined potential to provide information relevant to the study questions (Patton, 1990). The criterion was Russian-speaking recovering addict counselors who currently work in drug rehabilitation centers. The participants were recruited at their workplaces after receiving permission from the Ministries of Social Affairs and Health to interview counselors employed in treatment centers under their supervision. Upon receiving approval, the researchers contacted seven services (three therapeutic communities, three ambulatory treatment centers, and one hostel) and, after receiving the names of the Russian-speaking counselors employed by them, contacted the counselors by phone and explained the aims of the study. All the counselors agreed to participate, although not all were interviewed due to difficulties in schedule coordination. The interviews were held until the central themes expressed by the interviewees became repetitive, indicating that saturation had been achieved (Creswell, 2007).

The interviews were held at the participants’ workplaces, using the in-depth open interview technique (Kvale, 1996). The interview began by presenting the aims of the study and ensuring anonymity. After providing demographic data, the participants were asked to share their opinions about the specific nature of substance abuse among FSU immigrant drug users in Israel, relying on both their professional and personal experiences (provided they felt comfortable about this). Thereafter, the interviewees themselves chose the direction of the conversation, and all addressed issues that were both professional and personal. Although no advance questionnaire was provided, a list of themes to be addressed was prepared by the researchers, which included such topics as the general characteristics of Russian-speaking users, and the possible link between immigration and drug abuse. Once the interviewee had exhausted a particular issue, the conversation was directed to the next relevant theme. All interviews were conducted by the same researcher, who was fluent in both Hebrew and Russian as native languages. All but one interview were conducted in Hebrew, with the remaining one conducted in Russian at the interviewee’s request. The interviews lasted 60 to 90 min. All the interviews were recorded and later transcribed. Field notes were written during the interviews.

The study was approved by the Unit for Excellence in Research and Study of Addiction in the University of Haifa. All participants were informed about the voluntary nature of the study. They were assured that it was neither initiated nor supported by their employers, nor by any official agency. Their personal information remained confidential. Each interview was given a serial number, the participants’ names did not appear in the transcripts, and the names and numbers were kept in a separate document, assuring interviewee anonymity. Pseudonyms were used in the “Results” section.

Data Analysis

We identified “significant statements” during the first reading of the interviews which could contribute to our understanding of drug abuse development in the context of immigration, using a “horizontalization” process (Moustakas, 1994). These statements were grouped into clusters of meaning, for example, “The interviewee believes that there is a specific trajectory of addiction development among older immigrant users.” These clusters were reorganized during the process of identifying the central themes that emerged from the interviews. For example, the theme “Addiction Development Among Older Users” was composed of subthemes such as “Immigration as a Solution” and “Further Aggravation of Addiction.” Once the list of themes was complete, we reread the interviews to ensure that the statements were properly understood and that no significant statements were left out. The themes served as a basis for describing the trajectories of addiction development among FSU immigrant users (the essential structure) and creating a cohesive story (Creswell, 2007). The technique of “constructing a document within a document” (Ayalon & Sabar Ben-Yehoshua, 2010) was used in the writing process, with content analysis employed as an initial draft for the results chapter. After observation and interpretation, some themes were narrowed, others were emphasized, and connections were made between the various themes.

Credibility

Lincoln and Guba (1985) suggested the term “trustworthiness” as a measure of the performance level of qualitative research. According to Shkedi (2003), this measure replaces the concepts of reliability, validity, and generalization used in quantitative research. Shkedi suggests that qualitative researchers retain the chain of evidence for each step of the research, analyze the data in several stages, and write the final report as a “rich description” using interviewees’ quotations. In this study, exhaustive documentation was kept of all the interviews and the context in which they were carried out. Each stage of the analysis was documented separately. The “Results” section presents the interviewees’ perceptions by extensive use of their own words. Using the “constructing a document within a document” technique reduced the gap between the coding process and the writing of the research results, thus contributing to the study’s credibility (Ayalon & Sabar Ben-Yehoshua, 2010).

After completing the data analysis, we contacted eight of the participants and asked them to review the results and assess the adequacy of the emerging conclusions, a process referred to by Lincoln and Guba (1985) as “member checks.” All the participants confirmed the data. Some of them further explained, refined, and broadened the central issues that arose from the analysis. The results were modified to incorporate the participants’ comments when necessary.

As for the authors’ background on issues relevant to this study, both authors are social workers. Authors’ personal background on issues relevant to this study should be addressed. The lead author (who performed the interviews) immigrated to Israel from the FSU at age 13, and thus experienced the challenges of immigration. She has professional background in the field of drug users’ rehabilitation and research experience in areas of immigrant at-risk youth and immigrant families. The second author has professional background in the field of at-risk youth who dropped out of school and their families, while many of them are FSU immigrants. In addition, her research focuses on coping with various kinds of stress and risk-taking behavior (including, smoking cigarettes, consuming drugs, and sexual risk taking). We believe this personal and professional background helped the participants to feel more comfortable during the interviews and helped us to better understand and appreciate their experiences. At the same time, we strove at all times to distinguish between their perspectives and perceptions and our own.

Results

Two main trajectories of addiction development among FSU immigrants emerge from the data analysis. The most common one is characteristic of older users who immigrate with already existing drug problems, which almost always become aggravated after immigration. Nine of the participants report experiencing this trajectory. The second trajectory is typical of younger users who immigrate in late childhood and early adolescence, and start using drugs after immigration (and usually in proximity to it). Six of the participants belong to this category. Additional trajectory, that represents a transitional phase between the first and second trajectories and is characteristic of users who immigrate during adolescence and emerging adulthood, was found. This group already has experience with “soft” drugs, alcohol, and mild criminal behavior, which rapidly deteriorates immediately after immigration. Four participants report experiencing this path. As this path shares many characteristics with the first trajectory, it is not addressed separately, but rather as a part of it. Distinct factors characterize each trajectory, and they are described in detail in this section.

Trajectory 1: Drug Abuse Development Among Older Users

The participants report that in their experience, the majority of immigrant drug addicts started using drugs prior to immigration. Most of the participants (13) belong to this group. Nine of them used to consume “hard” drugs in the FSU and came to Israel already addicted. Their age at immigration ranged between 18 and 37, with the majority immigrating in their early 20s: “Guys that started using there are usually a bit older” (Misha). Four participants in this group did not use “hard” drugs prior to immigration but had an experience with “soft” drugs, alcohol, or mild criminal behavior. They represent a kind of transitional phase between the older and the younger users, and share many of the characteristics typical of both groups. They immigrated during adolescence and emerging adulthood (aged 14, 15, 18, and 22), and after their immigration, their drug abuse deteriorated rapidly and severely. Vitaly puts it this way: “The majority began using there, or at least came with some unfulfilled potential. They drank alcohol and did all kinds of stuff, except drugs. But they were ready to use drugs as soon as they had an opportunity.”

Immigration as a solution

The majority of users in this group perceive their immigration as a chance to change their lives: “I was sure that if I leave to another country this will stop. It was a solution” (Roman); “I thought: That’s it. I go to the Holy Land. No drugs, no junkies, new life” (Dima). Sometimes the user’s family initiates the immigration in a desperate attempt to save their child: “My parents believed that if I stayed there (in the FSU) I would die. They tried to save me” (Pavel).

However, after immigration, the anticipated change mostly does not occur: “The salvation doesn’t come just because you move” (Pavel). In fact, the user finds drugs very soon after arriving at the new place, mostly through immigrant social networks: “The day we arrived my cousin introduced me to Russian guys that smoked and cooked (prepared drugs)” (Sasha); “It was easy. You feel it, you see it in people’s eyes, you pick it up like a radar . . . in a few days I had drugs” (Evgeny).

Further aggravation of the abuse

Not only is the drug problem unsolved with immigration, it usually deteriorates rapidly. According to the study participants, drugs in Israel are more accessible: “It’s easier to get drugs here. You have sellers literally everywhere” (Roman). There is a greater variety of substances: “We used mainly opium and hashish there. Here I heard about drugs I didn’t know and felt an urge to use them, to feel the difference” (Marat). Moreover, Israeli law enforcement is less strict compared with the FSU: “Russian law is much more severe. You get caught—you go to prison. Here you can have 17 records and still walk free. You don’t feel afraid” (Semyon). These reality-specific factors create a basis for further use and deterioration. Moreover, other immigration-related variables are reported as closely connected to this process.

Immigration stress

Stress associated with immigration is perceived as a crucial factor that aggravates the addiction: “There, many users had some degree of control over the abuse. Here it’s different—there is a lot of stress in immigration—money, work, relationships. Some manage to cope with it, but others don’t. This stress intensifies the deterioration” (Vladimir). Immigration exposes the user to new, unfamiliar challenges. The pattern of self-medicating that had already been established before immigration is brought into play and is perceived by the user as an escape route from the difficulties of the new life. Semyon, who immigrated at age 20 with an existing drug problem, puts it this way:

Immigration brought new things with it. I had to rent an apartment, to find work, to study—I was a student, or at least supposed to be. And I struggled with the addiction. These difficulties crushed me. I tried to fight but I felt desperate. I sank into self-pity, felt miserable and stuck. I had no coping habits, no mechanisms of managing myself, no decision-making abilities, nothing. The only thing that was clear and stable in my life was the drugs.

Semyon immigrated by himself, without his family, and thus lacked a support network: “There, I was on home ground that I could always count on—food, laundry, bed. Here—nothing. I had to manage on my own.” Yet even if the user immigrates together with his family, they are usually stressed and do not support him the way they did before immigration, and in some cases are even pushed away and alienated by drug use:

Your parents are trying to cope with immigration, it’s hard for them to get along, and they work hard for peanuts. So when they find out you’re stealing from them they say “goodbye.” In Russia they wouldn’t do it, but here they understand there is no choice. (Dima)

Loneliness and isolation

A crucial factor in the fall-off process is the immigrant user’s sense of loneliness:

When you are absolutely alone, don’t understand people and they don’t understand you, you realize you are just a little bolt. When I realized that, I wanted to commit suicide, but I couldn’t do it. So I kept using more and more, I just sank deeper and deeper and it didn’t matter anymore. (Dima)

The peer group of other immigrant users actually alleviates this sense of loneliness:

The loneliness was awful. There was a terrible lack of human relationships. I was looking for belonging—for acceptance, human warmth, and intimacy. I was looking for it in this terrible place—I was surrounded by junkies, but it gave me some momentary illusion of belonging. (Semyon)

Many immigrant users feel isolated and alienated in the new Israeli milieu, and at the same time they do not really try to integrate in it: “I didn’t want to come here in the first place. I didn’t connect to the Israelis, didn’t speak Hebrew. I didn’t even accept the weather—it was too hot. I was negative about everything” (Nikolai). Furthermore, many users actively reject Israeli society:

This tendency to unite against the host society, to create this situation of “us versus them,” to nurture this feeling that they are different and to reject their culture, is a very strong element in the addicts’ culture. It exists in a normative society as well, but among addicts it is exaggerated. (Semyon)

Trajectory 2: Drug Abuse Development Among Younger Users

A smaller proportion of immigrant drug users immigrate to Israel during childhood and early adolescence with no prior experience of substance use or criminal behavior. In this study, six participants represent this group. They immigrated between the ages of 8 and 15 and started using drugs within 2 years on average after immigration. All attribute the onset of abuse at least partially to immigration: “My addiction has its roots in my childhood; I would probably have ended like this anyway. But immigration definitely contributed its share and accelerated the process” (Igor); “At that age the addiction is often connected to immigration. In Russia I didn’t even hear about drugs. I can say this definitely about myself and my friends who did drugs with me” (Tolik).

Peer rejection

The onset of drug abuse in this population is mainly attributed to the social exclusion experienced by young immigrants. The participants report a lack of belonging and a sense of inferiority in their new social milieu. This feeling is intensified by rejection on the part of their local peers: “It was a very difficult phase in my life. I was the only immigrant in my class. They had their language, their humor. They were laughing at me. I felt different and deficient” (Igor); “The local kids came to school in their parents’ cars, wearing Nike and Adidas. We couldn’t afford it. You always felt inferior” (Vitaly).

Some immigrant youngsters experience overt hostility that results in their sense of disappointment and alienation:

“Smelly Russian” . . . I don’t want to be smelly, I’m not smelly. I came to my homeland as I was promised, as I fantasized . . . and they call me “smelly.” It was very hard for me, with all my expectations of this country. (Mark)

The young immigrants’ feelings of inferiority and alienation often result in violent behavior that serves to restore their social status: “Some kids accepted this rejection and offense. I didn’t. I was willing to pay the price—I got into fights, I was beaten, I took the risk. This was my choice” (Mark); “I got into fights. This was my way to prove myself, to show them they shouldn’t mess with me” (Igor).

Grouping with other immigrant youth and taking part in group violence also provide immigrant teens with a sense of control and power: “When more Russian children came to the school there was an immediate click. Suddenly we became a force; we had the power, like some mini-mafia. This brought us respect” (Garik).

Beyond violence, some immigrant groups promote other antisocial behaviors: “Instead of going to school we were going to the mall, stealing clothes and cigarettes” (Tolik); “We were smoking, stealing, doing some stupid stuff” (Vitaly). Substance abuse soon becomes a common pastime: “We were drinking during the school breaks. Later we started using other staff” (Grigori).

Ineffective adult figures

While many young immigrants suffer from rejection and feel pushed toward violence and substance abuse, often the adults around them do not provide them with needed assistance and support. The participants report their teachers and other educational staff being highly ineffective in dealing with their stress. In some cases, the system totally ignores the immigrant students’ needs, thus making them feel transparent:

I hardly attended school for 4 years. There was a period I didn’t come to school for 4 months! No one asked why! They just didn’t want to deal with me. And when I was finally caught for stealing, they just expelled me . . . I just needed someone to see me, just to be there for me. (Tolik)

Some teachers fail to realize the stress of the immigrant students and adopt a negative attitude toward them:

In the beginning the teachers tried to be patient, but soon I became the “problematic Russian.” They didn’t try to find out what was really happening, so I always was the guilty one. I became the scapegoat and soon I felt comfortable in this role. (Grigori)

Garik shares his negative experience with the school counselor as follows:

On my first day in school my nose was broken (in a fight). I remember standing there, bleeding, when the counselor came. She started screaming at me. I told her in Russian: “I didn’t do anything!” but she continued screaming. I remember her face—how much anger was there. I wanted to punch her, she was so nasty to me!!! (Garik)

Insufficient parental involvement

According to the participants, many immigrant parents are not available and fail to provide their children with the support they need. Garik continues describing the situation in which he was physically assaulted at school: “They (the parents) asked me how was it at school. I said: ‘OK. My nose is broken.’ They didn’t know what to do, they didn’t try to defend me.”

Immigrant parents have to contend with the challenges of immigration and invest most of their time and energy in work, which do not leave them enough space for being available to their children: “My mother had to work, she couldn’t control me. She was sure I attended school and stayed home at nights. For me it felt like freedom, like I can do anything” (Vladimir).

Parental overload enables the adolescents to escape the oversight that otherwise would keep them safe:

My parents were busy with surviving. In Russia they protected me; here I was alone trying to find my way outside where I was exposed to all kind of things, and my instincts took over . . . These kids don’t intentionally search for drugs; they search for attention. Some, like me, find drugs. (Grigori)

Low parental involvement deepens the sense of loneliness of some immigrant children who in any case feel rejected and unwanted by their peers and teachers: “I had parents but they were not there. I woke up in the morning, went to school, came back, and ate—all alone. They came in the evening, tired; I had no one to talk to” (Mark).

The study participants believe that FSU immigrant families do not encourage their children to express emotions and try to avoid addressing emotionally laden issues:

Russian families don’t talk about feelings, hardships, weakness, anger. It’s not accepted, it feels awkward. The parents are either very critical and yell a lot till the kid gets immune to their criticism, or act like there’s no problem and don’t talk about it at all. (Mark)

Parental involvement is primarily directed at the functional domains of children’s lives, especially academic performance: “I don’t ever remember someone asking me: ‘How do you feel? Why are you sad?’ It was only: ‘Have you done your homework?’ Everything that was going on inside me was mine only, nobody knew” (Gennady). Some families put excessive pressure on the child to succeed in school, while ignoring his other difficulties.

Drug abuse as a way of dealing with loneliness

Loneliness is a crucial factor in initiating drug abuse among younger immigrant users (similar to its role in abuse deterioration among older addicts). Social rejection, parental unavailability, and ineffective school staff involvement leave some immigrant children alone in coping with the hardships of immigration and the developmental challenges of adolescence. These children manage by seeking inclusion and attachment to youngsters in a similar situation: “These kids feel alone and connect to others who share this loneliness. The abuse has a social nature—they drink together, use drugs together, and they believe it strengthens their bonds” (Roman); “The group made me feel a sense of belonging. In Russia I was rejected for being Jewish, and here I was rejected for being Russian. And these guys accepted me” (Grigori). Thus, immigrant peer groups serve as a solution to loneliness and social exclusion. In many cases, these groups turn to antisocial activities that provide their members with a sense of superiority and power, along with substance abuse that serves as a bonding facilitator and a way of fleeing difficult emotional states: “They can’t talk about what they feel, so they need a substitute, and alcohol and drugs do the work” (Roman).

Apparently, the first trajectory of addiction development among FSU immigrants has its roots in earlier, preimmigration stages of users’ lives. It is largely shaped by such experiences as transition to other society characterized by distinct drug-related reality and policy, coping with money, employment and housing problems, loss of familial and social support networks, and sense of loneliness and isolation. The second trajectory is set in motion after the immigration by immigrant youth’s experience of peer rejection, inability (or unwillingness) of educational staff and parents to meet their needs, and, like in the first trajectory, sense of loneliness.

Shifting Away From Abuse Trajectory: Treatment as an Alternative Path to Integrating and Belonging

The issue of shifting away from drug abuse trajectory was not included in the research questions; however, it was raised by the participants in context of their ongoing social and cultural integration. The participants believe that Russian-speaking users are generally reluctant to seek help with their addiction. Main reasons for avoiding treatment are the lack of reliable information regarding treatment methods available in Israel, negative experience with the drug treatment system in the FSU, and criminal values that condemn behaviors that are reinforced in treatment (e.g., informing on other patients and performing cleaning tasks). Interestingly, although the participants attribute the onset of drug abuse and its deterioration to immigration experience, immigrant addicts’ decision to eventually seek help is perceived by them as related to other, more personal, reasons, primarily physical and mental exhaustion: “I felt I couldn’t do it anymore: the stealing, the pain, the fear. I was really tired” (Pavel); “One morning I saw my reflection in a mirror. I saw an old man. Then I finally realized I should get some help” (Roman).

Notably, participating in treatment and drug rehabilitation provides most of the participants—irrespective of age—with a way to integrate in Israeli society and feel being a part of it. A prominent indicator of this process is their acquisition of fluency in Hebrew. Prior to entering a treatment program, many of the participants—especially the older ones—did not speak Hebrew and only began learning the language in therapy: “I learned Hebrew in the community. Before that I didn’t speak Hebrew at all—I didn’t need it to get drugs, so I wasn’t interested in learning it” (Yefim). After rehabilitation, most of the patients experienced a heightened sense of belonging. Yefim continues, “I always told my parents that if I stayed in Ukraine I would be all right. I don’t believe that anymore. I don’t want to go back, don’t want that life. I like it here (in Israel).”

Users in rehabilitation have an opportunity to connect with Israeli patients with similar difficulties and to feel an affinity with them:

Being clean really changed my sense of belonging here. Suddenly I understood my place in this society. I met great people—social workers, counselors. I visited in other patients’ homes and saw how they live. We celebrated our graduation from the community together. I even have an Israeli girlfriend. Before that I thought they were no good for me. Now I understand that this perception was detached from reality. My heart belongs here. (Tolik)

This gradual integration in Israeli society also stems from the nature of the rehabilitation process based on encouraging the patients’ feeling of belonging to the normative society:

Ingraining openness and acceptance of others and of yourself is a crucial part of treatment. Now I’m an Israeli—in my perceptions and in my mentality. I can criticize them, but in the end I’m one of them, for better and worse. (Semyon)

Stopping drugs includes changing your attitude toward the society. When you are a user, you believe the society is against you and you live to prove this is so: they are cruel to me, thus my behavior is justified. In treatment, you break this sense of alienation. (Vitaly)

The participants in the study believe that the treatment of addiction should be inclusive and should stress the commonality between immigrant and nonimmigrant patients: “We want them to realize that society is not their enemy. Segregating them would prove the contrary” (Vitaly).

The majority of the participants are highly appreciative of the help they received in Israel regarding their addiction, a factor that has brought them close to Israeli society:

I rejected this country and these people. But now I’m in a different place. If I had stayed there I would be buried somewhere in Ukraine, like all my friends. I call this place my home. I was rebirthed here. I’m really grateful to this country. (Evgeny)

Discussion

The study aimed to explore the trajectories of addiction development among FSU immigrant addicts in Israel. The analysis of the interviews held with the recovering counselors yielded two main narratives: one of abuse deterioration and the other of abuse initiation in the context of coping with immigration difficulties. Notably, drug addiction is a chronic disorder. It usually begins with occasional drug-taking (Chuan-Yun et al., 2008; Winger et al., 2005), often initiated during adolescence and young adulthood, and has a tendency to progress and intensify over time (Tucker et al., 2005). Thus, the immigrants’ initiation of drug-taking during adolescence, as reported in this study, as well as its deterioration through young adulthood, may partially reflect a natural course of abuse and addiction development. However, all the participants interviewed in the study stress the specific and crucial role of the immigration experience in shaping their own as well as other immigrant users’ drug-taking behavior, beyond the common tendency of abuse aggravation.

Tucker and his colleagues (2005) identified two important periods of vulnerability for substance use: early adolescence and late adolescence/emerging adulthood. Based on the present study, it appears that the risk of developing drug use disorders among immigrant adolescents and youngsters is highly related to common characteristics of these developmental periods (e.g., the search for social belonging and status and the significance of friends). Young immigrants may be at greater risk of initiating use upon arrival because they are more likely to be influenced by a peer environment and face stronger stress due to their need to be recognized by their peers, side by side with their ambiguous cultural identities (Li & Wen, 2013).

Apparently, the core issue that characterizes abuse development trajectories among both younger and older immigrant users is the sense of loneliness. Loneliness is considered a subjective, unpleasant, and emotionally distressing experience. Late adolescence and young adulthood are the two life stages during which loneliness is most prevalent, due to the prominent role of peer relationships at this age (Lee & Goldstein, 2016; Qualter et al., 2015). Loneliness is often closely related to emotional problems and drug abuse (Olmstead, Guy, O’Mally, & Bentler, 1991; Rokach, 2002). Rokach (2002) found that adolescents and young adults who use drugs score significantly higher on personal as well as situational antecedents of loneliness. Social isolation and sense of loneliness are viewed as both risk factors and possible results of relapse (Ames & Roitzsch, 2000; Barrick & Connors, 2002; Lev-El, Lichtentrit, & Teichman, 2013). Moreover, the drug user’s sense of loneliness may affect his or her willingness to seek help (Lev-El et al., 2013). Feelings of loneliness may be induced during immigration by immigrant’s loss of social relations and challenges related to acculturation in the new country (Madsen, Damsgaard, Jervelund, et al., 2016). Madsen, Damsgaard, Jervelund, and her colleagues (2016) reported immigrant adolescents to have an increased risk of loneliness compared with nonimmigrant adolescents. Moreover, not belonging to the ethnic majority in the school class was found to increase schoolchildren’s odds for loneliness (Madsen, Damsgaard, Rubin, et al., 2016).

Older and younger immigrant drug users’ experiences of loneliness have certain common features as well as substantial differences. It appears that among older users, who often perceive immigration as a chance to change their lives, the anticipated separation from a familiar social environment is largely viewed as positive thing. However, their expectation of recovery is generally unfulfilled, partially due to the high accessibility and variety of substances, and relatively flexible law enforcement in Israel. Very soon after their arrival, they connect with other immigrant users and return to drugs. Although dealing with repeated failures, or relapses, is an essential part of coping with addiction, it often leads the addict to self-blame, social seclusion, and further setback (Lev-El et al., 2013). Maarefvand and his colleagues (2015) argued that relapse may undermine the drug addict’s trust in treatment programs and his hope for recovery. When the immigrant user is exposed to drugs in the new country, and eventually lapses, he understands that his hope for salvation is not realistic. He sinks back into abuse and finds solace in the immigrant users’ social network. In retrospect, the participants realize that their perception of immigration as a solution to their drug problems was unrealistic and served as an escape mechanism rather than an effective coping strategy (Endler & Parker, 1993).

The stress of immigration, furthermore, aggravates the abuse. Faced with multiple adaptation challenges, the user turns to the familiar pattern of self-medicating. However, drug abuse as a coping strategy may actually increase the user’s risk of exposure to additional stress, and interfere with his ability to manage related negative emotions (Abraido-Lanza et al., 2005). Indeed, the immigrant users’ ability to effectively cope with “standard” challenges of immigration (e.g., housing, language) is hindered by their lack of coping mechanisms and behavior patterns associated with the abuse. This process is further aggravated by the burnout and the exhaustion of immigrant users’ familial networks. The immigrant family, whose resources are often depleted, may not find enough strength to provide their addicted child with a sufficient support (Ranz et al., 2012; Yakhnich, 2016b). Lack of familial support is accompanied by the user’s social isolation, as he feels estranged from the host society and in many cases rejects it. This rejection of the host society is consistent with the finding that immigrants who perceive their immigration as unsuccessful are often characterized by a marginalization orientation (rejection of the culture of the larger society as well as one’s own minority normative culture; Benish-Weisman & Horenczyk, 2010). The perceived lack of familial and social support increases distress and the sense of loneliness, especially in younger individuals (Segrin, 2003), thus leading the immigrant user toward relapse (Lev-El et al., 2013) and aggravated drug abuse.

The trajectory of loneliness and drug-taking develops somewhat differently among younger users. This population has no experience with substance use prior to immigration and is pushed toward experimentation with drugs by immigration-related familial and social factors. According to the participants in the present study, their immigration status subjected them to peer exclusion and rejection, prompting reactions of alienation, violence, and antisocial behavior. Snyder and his colleagues (2005) argued that peer rejection is often accompanied by peer coercion—a social interactional process that involves mutually escalating coercive and counter-coercive interactions. Whether the reported rejection was a product of the participant’s immigrant status alone, or of a combination of immigration and personal characteristics, is unclear. Many drug addicts are characterized by baseline antisocial behavior (Hamil-Luker et al., 2004) and conduct problems (Fergusson et al., 2007), and they might be rejected because of these characteristics. With this, multiple studies show that rejection and discrimination of immigrant youngsters is a widespread phenomenon (Unger et al., 2014; Walsh et al., 2015). Chen, Drabick, and Burgers (2015) viewed peer rejection as a product of an individual–environmental transaction in which initial aggression contributes to peer rejection, which then contributes to persisting conduct problems. This is congruent with the study participants’ acknowledgment that some though not all immigrant youth react to peer rejection with counterviolence. In light of reduced opportunities for positive peer interactions, rejected children may interact with other rejected children and imitate their undesirable behaviors, thus heightening their conduct problems (Chen et al., 2015). Information gathered in the current study showed that experiencing rejection and hostility resulted in immigrant youngsters forming social networks that sustained and exacerbated their aggressive behavior patterns.

Many immigrant adolescents have no adult figures on whom they can rely during this difficult phase in their lives. The participants in the study report perceiving their teachers’ behavior as ranging from ignoring their difficulties, to blaming and scapegoating them, thereby facilitating their deterioration further. Their parents, who were burdened with long working hours and emotional exhaustion, did not provide them with needed support either. Low parental involvement is perceived as deepening the sense of loneliness of immigrant children who in any case feel rejected by their peers and their teachers. The change in the family dynamic following immigration, along with unfamiliarity with the cultural norms and language, can prevent immigrant parents from fulfilling their parental responsibility and impair their involvement in their children’s lives, leading to parent–child distancing and failure to address the child’s difficulties (Berry, 1997; Yakhnich, 2016b). Moreover, it may prevent parents from providing their children with support, monitoring, and communication, which have been found to limit the development of risk behaviors among adolescents generally and immigrant adolescents in particular (Darwish Murad, Joung, Verhulst, Mackenbach, & Crijnen, 2004; Stevens, Vollebergh, Pels, & Crijnen, 2007; Walsh et al., 2015).

Parents putting excessive emphasis on academic achievement, which is highly characteristic of FSU Jewish immigrants (Lerner, Rapoport, & Lomsky-Feder, 2007), is perceived by the participants as further intensifying the pressure on the immigrant child instead of alleviating his stress. In addition, culturally specific child-rearing practices, accepted in families of Russian origin based on education toward self-discipline, self-restraint, and control of emotions (Chirkov & Ryan, 2001; Ranz et al., 2012; Slonim-Nevo et al., 1999; Yakhnich, 2016b), may prevent the child from sharing his distress and create an illusion of positive and successful adaptation.

The sense of loneliness that is created by peer rejection, parental unavailability, and ineffective involvement by the educational staff may prompt immigrant children to seek the company of other young immigrants in a similar situation. Their need for social support to maintain a sense of well-being results in low relationship standards and an eagerness to join any social group that enables them to feel whole (Segrin, 2003). In this context, delinquent groups may provide marginalized immigrant adolescents with a yearned-for sense of belonging and acceptance (Walsh et al., 2015). Drug use in these groups may serve as a shared ritual that enhances this sense of belonging and facilitates bonding (Guarino et al., 2012).

It appears that sense of loneliness and drug abuse create a snowball effect in both younger and older immigrant user populations. The initial sense of loneliness that originates in the immigration experience—whether due to unfulfilled expectations, immigration stress, and low family support among older addicts, or peer rejection and adult figures’ inadequacy among younger users—prompts drug-taking as a way of self-medicating and enhancing a sense of belonging. However, this same behavior further magnifies the sense of loneliness by undermining the user’s hope for recovery, heightening social withdrawal, and escalating coercive social interactions. Notably, the highly negative experiences described by the participants in the study may be largely characteristic of immigrant youth already at risk for delinquency and drug abuse. Other immigrant youngsters, who also have to contend with multiple difficulties during their adaptation, may experience them at a more moderate level due to a broader base of social support (Ames & Roitzsch, 2000) or personal factors that promote their resiliency (Varga, 2014).

Unlike the processes of entering and moving along the abuse trajectories that are strongly related to the challenges of immigration, the process of leaving these trajectories is perceived by the participants as linked primarily to users’ sense of decline and exhaustion. It is possible, however, that as immigrants’ drug abuse and its deterioration are accelerated by adaptation difficulties, this exhaustion, at least partially, results from factors associated with the immigration.

Apparently, the decision by users to seek help and participate in treatment not only assists them in overcoming their addiction but also promotes their inclusion in the host society. The participants admit that before entering treatment, they felt alienated from Israeli society, were not interested in learning Hebrew, and had no significant interactions with nonimmigrant Israelis. In treatment, they got to know Israelis (patients and staff) and experienced positive, supportive, and empowering relations with them. Furthermore, the rehabilitation programs that encourage the patients’ sense of belonging to the normative society, and the patients’ appreciation of the help they receive, significantly lessen their antagonism and enable them to begin the ongoing process of integration. The participants’ posttreatment integration in the host society may well reflect their sense of successful adaptation. Benish-Weisman and Horenczyk (2010) reported that immigrants who perceive their immigration as successful show high levels of Israeli identity as compared with immigrants who do not perceive their immigration as successful. Moreover, immigrants who define success in terms of belonging might be more eager to adopt the new Israeli identity. In line with these findings, Madsen, Damsgaard, Jervelund, and her colleagues (2016) reported identification with the host society’s majority being protective against loneliness among immigrant youth. The participants strongly believe that treatment should be inclusive and should stress the commonality between immigrant and nonimmigrant patients, thus alleviating their sense of loneliness. This is compatible with the assertion that effective treatment of addiction and relapse prevention should include the reintegration of drug-dependent patients into society (Maarefvand et al., 2015).

The findings may be interpreted within the framework of acculturation model (Berry, 1997, 2005), with the trajectories reflecting immigrant users’ process of acculturation. In that way, older users, who have already started the process of marginalization due to drug abuse and criminal behavior, may be further pushed to the margins by their sense of disillusionment, failure, and loneliness. Drug abuse may offer them a means of expressing their anger and obtaining a sense of belonging, a social status, and an alternative culture (Edelstein & Bar-Hamburger, 2007). This may explain their unwillingness to learn Hebrew and attach to the host society, as well as their sense of not belonging to the normative immigrant community (e.g., familial and social networks). Among younger users, the process of marginalization may be initiated by social exclusion (Amit, 2010; Kurman et al., 2005); as their attempts to integrate are encountered with rejection and hostility, and their parents fail to provide them with the needed support and protection, they feel alienated and seek company of other marginalized youngsters. Thus, both trajectories of drug abuse may be conceptualized as a manifestation of marginalization acculturative strategy.

Conversely, the rehabilitation process, that encourages significant relationships with native Israeli users and staff, and is aimed at restoring immigrant users’ ties with their families and broader society, may serve as a turning point in their acculturative process. In this sense, shifting away from the abuse trajectory promotes an ongoing process of integration and psychological and sociocultural adjustment (Berry, 1997; Walsh et al., 2015).

Limitations and Implications

The study has several limitations. As it is based on the personal and professional experience of recovering addict counselors (which constitutes one of the advantages of the study), it focuses on their perceptions rather than on those of current users and thereby might not grasp all the issues under discussion. It would be interesting to explore the trajectories of drug abuse development as viewed independently by users and by treatment professionals, and compare these perceptions. Another limitation is the small number of participants who represent the third trajectory of abuse development among users who have experience with “soft” drugs prior to immigration. Consequently, and due as well to several similarities between this trajectory and the other two, it (the third trajectory) was not addressed separately. This issue might be dealt with by conducting a study with a larger sample which would allow for clearer boundaries between the different trajectories. Last, no female counselors participated in the study. An exploration of the interaction between gender and the development of substance abuse might promote prevention and treatment strategies aimed at immigrant youth at risk regardless of gender.

The study has a number of implications. In particular, the findings emphasize the importance of loneliness and marginalization in the deterioration of young immigrants. Preventive practices should involve alleviating the sense of loneliness by promoting positive social interactions between young immigrants and their local peers, as well as encouraging social bonding among the young immigrants through positive and constructive activities (e.g., youth movements, volunteering, evening schools). Education toward greater multicultural awareness and acceptance at school could help immigrant adolescents feel a greater sense of belonging (Walsh et al., 2015). Strengthening young immigrants’ original cultural identity may promote their access to such protective factors as familial and community support and positive self-image.

A critical factor in preventing drug abuse is the availability and sensitivity of the school staff toward immigrant adolescents who suffer from social rejection. Providing these youngsters with support in school may help them cope with multiple social and familial challenges and promote their school attachment.

Special effort should be made in locating youngsters already involved in moderate antisocial activities or showing a predisposition for violent behavior. Establishing a stable foundation of familial and professional support may prevent their involvement in destructive social interactions. Empowering immigrant families appears as a crucial issue in preventing the initiation of abuse and its exacerbation among young immigrants. Specially adjusted activities for youth and families both on a personal and a group level may prevent youngsters’ risky behaviors and help families give support to their children. However, because drug abuse is largely perceived as a taboo subject in FSU immigrants’ community, young users, as well as their families, might fear stigmatization and thus be reluctant to participate in such activities (Guarino et al., 2015). Therefore, special emphasis should be made on developing culturally adjusted prevention strategies and involving Russian-speaking practitioners who may be more sensitive to family’s concerns and manage the intervention in a culturally appropriate way. Community-level education about drug use may help address the drug-related stigma within the FSU community and make it easier for young users to get assistance.

Special emphasis should be placed on assisting young adults, who, in contrast to adolescents, are not present in educational settings, and whose difficulties may remain unnoticed. For this population, local authorities should construct self-assistance groups, which will be used as a social network on one hand, and as a platform for education and guidance in coping with stress and providing adjustment skills on the other hand. Reaching this population requires promoting greater awareness of drug abuse issue among physicians, teachers at Hebrew classes (“Ulpans”), social workers, and other professionals who are involved in immigrants’ absorption.

The findings reported here shed light on the trajectories of addiction development among FSU immigrant drug users in Israel, and positioned their sense of loneliness as a core issue underlying these trajectories for both older and younger addicts. Using qualitative methodology enabled an in-depth understanding of the themes being explored, while the participants’ personal and professional experience allowed a more thorough observation of these themes.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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