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For years, the world has understood climate change as an environmental problem—melting glaciers, rising seas, extreme weather. But what happens in people's minds when their world becomes unstable? What do they do when the only life they've known—farming, herding, providing for their families—becomes impossible?

These questions drove our team of psychiatrists and public health researchers to conduct one of the largest studies of its kind in West Africa. We interviewed 20,000 adults across 40 communities in Kano, Kaduna and Katsina states, a region that sits in the semiarid Sahel belt. Agriculture is a major source of employment and livelihood in an area that is among the most climate-vulnerable in Nigeria.

We applied a number of research measures. We used a multidimensional poverty index to measure deprivation, the Kessler psychological distress scale to assess anxiety and depression, and the alcohol, smoking and substance involvement screening test to identify harmful substance use. We also asked participants about their coping strategies: how they deal with stress.

What we found is alarming. A vast majority of the people we surveyed are multidimensionally poor. Nearly half reported high levels of psychological distress. And almost one in five engaged in substance abuse.

Our findings underscore that substance use disorder in northwest Nigeria can't be understood in isolation. It's part of a system—climate stress, poverty, mental distress—and must be addressed as such.

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