Addiction Discriminates? What That Means in Today's Troubled Economy

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For decades now, we've branded addiction “an equal opportunity disease.” And judging from the largely white, middle-class people who populate most AA meetings and rehabs, it is.

But while no sector of society is immune from substance abuse, addiction does discriminate. Examples abound: "drug problems" among college grads is nearly a third lower than those for high school dropouts, according to the National Household Survey on Drug Abuse and Health. Unemployed people are twice as likely to be addicts as people with jobs. With America facing the greatest income gap since the Great Depression, the largely unpublicized link between financial inequality and drug addiction suggests big trouble ahead.

Of course, the causal connection between poverty and substance use runs both ways. People who are suffering from alcohol or drug problems are obviously more likely to drop out of school or lose their jobs, while those who don't have the education and skills to find a job in this fast-changing, increasingly high-tech economy not only increase face increased odds of addiction but also dramatically lower odds of recovery.

Stigma keeps addiction low on the list of "causes"; if, for purposes of raising funds and sympathy, the public face of recovery looks most like the people who have the resources to donate—with a celebrity or two thrown in—what's the beef?

For example, Americans earning less than $20,000 a year are half as likely to successfully quit smoking—and nearly one third less likely to end a cocaine addiction—than those making $70,000 a year or more.

The recovery community has typically shied away from acknowledging these inconvenient truths. For one thing, addiction is so painful and destructive—and sobriety so difficult and one-day-at-a-time—that distinctions based on class or race can seem churlish. For another, stigma keeps addiction low on the list of "causes"; if, for purposes of raising funds and sympathy, the public face of recovery looks most like the people who have the resources to donate—with a celebrity or two thrown in—what's the beef? Still, among ourselves, we need to admit the truth: addiction is disproportionately concentrated among the poor, and, consequently, among blacks and Hispanics.

Social problems plaguing the poor are largely ignored as intractable, a given of the invisible “underclass.” But as more and more Americans in the middle class become poorer, if not impoverished, by our ongoing economic crises—the implosion of the financial industry (goodbye IRAs and retirement funds), the raft of foreclosures and 10% unemployment (farewell to the bedrock American belief in a house and a job)—denying the link between income and addiction keeps us from finding workable solutions for the explosion in addictive behavior all around us. The most potent anti-craving medications in the world won’t prevent relapse among people who lack skills, job opportunities and hope.

It's important to emphasize that drawing attention to the increased vulnerability to addiction that poverty poses is in no way meant to pit addict against addict or to sew discord. There are all too many middle-class and rich people in this country battling various addictions. But if we continue to ignore the special role that the lack of education and employment play in fermenting the growing drug problem, we are likely to leave them out of the solution when it comes to crafting treatment and prevention.

Instead, we need to address the specific social and economic problems that have made the US one of the most drugged-out countries in the world. The magic-wand policy answer would be, of course, to cut economic inequality. Almost without exception, nations, and even US states, where the concentration of wealth is greatest have not only more addictions but also more obesity, heart disease, stroke, mental illness and other major health problems than those with less inequality. The greater the inequality, the higher the murder rate, too.