Addiction does discriminate: it hits hardest those who are already down or feel that they will never be able to rise.
In the late 1980s and early 1990s, crack cocaine, which was prevalent and visible in poor black communities, was said to be a great threat to the white middle class. In many black communities, before crack took off, unemployment rates had been high and rising, driven by the decline in manufacturing jobs and biased hiring and firing practices.
But where jobs had more stability, and where drug users weren’t victims of the “war on drugs” policing push, the long-predicted spread to the leafy suburbs never happened. While white youth took plenty of cocaine, addiction rates didn’t skyrocket. And when middle-class youths did get hooked, their recoveries were quicker.
Now, another drug epidemic is afoot, and white America looks economically a lot more like black America in the 1990s: stable, well-paying jobs are disappearing, replaced by lower-wage positions with far more uncertainty. And criminalizing drug use, while proven not to work, remains the default.
But our response to today’s opioid crisis cannot be effective if it ignores the socioeconomic aspects of the problem. Though advocates like to claim that addiction is an equal opportunity destroyer, in reality, it is far less likely to hit people who have stable, structured lives and decent employment than it is those whose lives are marked by uncertainty and lack of work.
Research shows that when a country has a healthy middle class – and low or at least moderate levels of economic inequality – addiction rates are lowest among the middle class and at least half of them (excepting tobacco) end by age 30, even without treatment. However, when unemployment, tenuous employment and inequality are high and the middle class shrinks, more people are at high risk. And their odds for early-life recovery decline.
Abundant data support the connection between socioeconomic factors, addiction and recovery.
For one, heroin addiction is more than three times as common in people making less than $20,000 per year compared to those who make $50,000 or more, and higher levels of education are also linked with lower rates of addiction. The relationship between addiction rates and inequality has long been noted by researchers who study its health effects: countries and states with higher levels of inequality tend to have worse mental health and addiction problems than those with less dramatic differences between the 1% and everyone else.
Further, decades of survey data also show that the addiction rate among the unemployed is usually around twice as high as among those who have jobs. Some of this unemployment, of course, is addiction-related job loss. But a review of this literature suggests that in many cases, unemployment precedes addiction and that either way, it reduces the odds of recovery.
So what explains these connections? It’s important to understand that 90% of all addictions begin in the teen and young adult years, a time when most people – especially in the middle class – are in school. Binge drinking and drug use are one way that teens separate themselves from their parents and declare independence.
Moreover, in the high school and college years, not only are teens developmentally primed to move away from their families, their brains are also especially sensitive. The regions that push youths to take risks and seek romantic relationships are the same ones that drive desire for drugs during addiction – and these areas mature long before the regions that exert maximum control do. The prefrontal cortex, which is the seat of judgment and restraint, does not fully develop until the mid 20s, which is typically when excessive drinking and other drug use tends to recede.
This healthy maturation is not only driven by genes, however; it is also reliant to some extent on environmental experience. For example, in a typical, modern middle-class life, people are completing college and starting careers alongside as their prefrontal cortex matures. And it’s not as easy to get away with not showing up or showing up hungover or stoned at work as it is to college classes.
The routine and requirements of working life work against addictive behavior and, for many people, they are what allows it to be outgrown. Getting married is also a turning point into recovery for many people: being accountable to a spouse often makes binging harder. Finally, having a child is also a major spur to quitting or cutting back dramatically: the demands of a baby and the love and purpose that parenting engenders tend to work against a lifestyle of frequent intoxication, to say the least.
Combined, these social and developmental factors work to keep all but the most severe addictions time-limited to adolescence and young adulthood.
But when decent jobs are not available, all of the social aspects of this process can be blocked because economic opportunity influences not only employment, but also coupling and childrearing. Accordingly, recovery without treatment is far less common among the poor and unemployed.
For over 100 years, we’ve relied on attempting to cut the drug supply by locking up dealers or restricting access to certain chemicals – and this has never remotely come close to solving the problem. If we want to fight addiction, we’ve got to look at what drives people to despair. And to do that, we can’t ignore inequality.