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Pathways between urbanization and harmful substance use

Morgan, Nirvanaa; Mall, Sumayab

Current Opinion in Psychiatry: May 2019 - Volume 32 - Issue 3 - p 218–223
doi: 10.1097/YCO.0000000000000488

Purpose of review Epidemiological literature suggests that urbanization is potentially linked to a number of stressors that could be associated with harmful substance use and mental disorders. This may vary by country. This review gives attention to emergent literature examining the pathways between urbanization and harmful substance use.

Recent findings Studies examining the links between urbanization, mental health and substance use suggest complex pathways between urbanization and substance use as well as a range of modifying variables that could contribute to these associations. Such variables include increased supply of illicit and licit substances brought about by economic development, globalization and technology as well as an increased demand for particular substances. Rural areas may also have unique factors associated with harmful substance use but these are beyond the scope of this review.

Summary We have presented evidence to suggest potential associations between urbanization and harmful substance use. We acknowledge that data are limited because of a paucity of longitudinal studies elucidating these relationships.

aDepartment of Psychiatry

bDivision of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa

Correspondence to Nirvana Morgan, MBBCh, MMed, FCPsych, Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. Tel: +27767538051; e-mail:

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