Addiction among Socioeconomic Groups
From the beginning, the United States has been founded on principles of social equality and taken pride in its absence of a structured class system. Yet the life experiences of most Americans indicate that one’s financial resources and social standing can make a difference in one’s health, material prosperity, and overall quality of life. Statistics show that socioeconomic status can have a strong impact on one’s risk of abusing drugs and alcohol. By the same token, an individual’s financial standing can help to determine whether the person enters treatment for addiction and the level of care that the person is able to receive.
Cultural Stereotypes about Income and Addiction
There are several pervasive cultural stereotypes about socioeconomic status and addiction in the US. One stereotype holds that drug addiction and alcoholism primarily affect the poor, who use drugs and alcohol as a way to cope with the stress of poverty. Another stereotype states that drug and alcohol abuse are moral failings that create an underclass of impoverished, chronically unemployed individuals who have little hope of ever rising above their miserable circumstances.
There are also negative social stereotypes about substance abuse among the wealthy. The notion of the “idle rich” includes stereotypes about the wealthy as morally weak individuals who are prone to alcohol abuse and drug addiction. Lacking the need to work for a living, they are free to indulge in compulsive behavior and substance abuse without the fear of losing their jobs or social standing.
In reality, addiction crosses the boundaries of wealth and social status, affecting people from all socioeconomic groups. The National Institute on Drug Abuse takes the position that addiction is not a moral failing or a character defect, but a progressive yet treatable brain disease characterized by compulsive substance abuse and repeated relapse. Myths and misconceptions about addiction and socioeconomic status get in the way with developing real solutions for the equal-opportunity problem of substance abuse.
Why does alcohol use increase with an individual’s level of income and education? The answer may be that wealthier individuals are able to afford more alcohol, and they are more likely to attend social activities where alcohol is served, such as parties, fundraisers, and sporting events. However, the exact explanation for this disparity remains unclear.
A study published in the American Journal of Preventive Medicine confirms the results of the Gallup Poll. The journal study revealed that individuals living in higher-income neighborhoods had higher rates of alcohol and marijuana use than those who live in lower-income neighborhoods. These results may indicate that wealthier individuals have easier access to alcohol and marijuana, both because of their financial means and their social activities. On the other hand, this study and the Gallup Poll may also contradict the stereotype that low-income individuals have higher levels of stress, which leads to higher rates of drug and alcohol use. It is possible that the factors causing stress among wealthy and middleclass Americans — such as financial concerns, relationship conflicts, or parenting issues — are as influential and harmful as the factors that cause anxiety or depression among the poor.
Homelessness and Substance Abuse
In mainstream American society, homeless Americans represent the lowest rung of the socioeconomic ladder. The financial instability of these individuals makes it difficult to track their use of drugs or alcohol. The Substance Abuse and Mental Health Services Administration estimates that 34.7 percent of homeless adults living in shelters have drug or alcohol use disorders; however, this number does not account for the thousands of homeless people who live unsheltered in the streets.
Mental illness, which often goes hand in hand with substance abuse, is also common, affecting over 26 percent of sheltered homeless adults. In the homeless, psychiatric disorders like depression, schizophrenia, and bipolar disorder can be a greater barrier to treatment than socioeconomic obstacles. Many homeless adults resist getting treatment because of irrational suspicions about others, low levels of motivation, or fears of social judgment or legal persecution. The National Council for the Homeless points out that for most of these individuals, fulfilling basic survival needs, like the need for food or shelter, takes priority over getting help for substance abuse or seeking treatment for mental illness. In addition, many homeless people lack a support system of family and friends who will motivate or encourage them to get help.
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Is Socioeconomic Status a Barrier to Treatment?
The lack of health insurance and/or financial resources is cited as a barrier to treatment in national surveys. According to the National Survey on Drug Use and Health, 37.3 percent of Americans age 12 and older who did not receive treatment for addiction said they did not seek help because they did not have health insurance or could not afford rehab. The lack of financial resources/insurance was the most commonly reported reason for not receiving treatment; the second most widely reported reason was that the individual was not ready to stop using (24.5 percent).
A study published in the Journal of Substance Abuse Treatment suggests that while drug and alcohol users believe that a lack of financial resources is an obstacle to rehab, it is not necessarily the most important obstacle. In this study, over 300 patients were surveyed at a centralized intake unit to find out what they considered to be the most significant barriers to treatment. Many of the patients who identified themselves as alcoholic stated that the most important reason for avoiding treatment was that they believed they could help themselves rather than seeking help from others. Other barriers cited as more significant than a lack of financial resources were concerns about privacy and the belief that treatment was not necessary. Additional obstacles named by the survey participants were the lack of childcare or convenient transportation.
Statistics on substance abuse in the U.S. indicate that there is clearly a need for more affordable treatment services for all Americans, regardless of their income level. The Affordable Care Act, which includes substance abuse treatment as an essential health benefit, will make rehab more accessible to Americans with low income levels. As of 2014, public assistance programs like Medicaid have historically provided little assistance for drug or alcohol rehab. However, these programs will now receive more reimbursement for substance abuse treatment, which will make it easier for the poor to benefit from recovery services.
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