Addiction among Socioeconomic Groups


When addiction information and data is broken down by socioeconomic status, we can learn more about how certain groups of people are using substances. Often, socioeconomic status is measured by a combination of education, income, and occupation.

A further look into socioeconomic groups and how they use substances also can provide valuable insights into understanding how treatment resources are divvied up, and where there might be inequities in the system.

The life experiences of most Americans indicate that a person’s financial resources and social standing can make a difference in their 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

example of socioecomic differencesThere are several pervasive cultural stereotypes about socioeconomic status and addiction in the U.S.

For example, 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. School and education seem to institutionalize social-class distinctions, and social-class stereotypes can lead to a reinforcement of inequality.1

In reality, addiction crosses the boundaries of wealth and social status, affecting people from all socioeconomic groups. A seriously outdated misunderstanding of addiction states that drug and alcohol abuse are moral failings that create an underclass of impoverished, chronically unemployed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. Instead, experts have defined addiction as a disease that impacts the brain and a person’s behavior that has nothing to do with “moral failing”.2

Alcohol Abuse and Income Level

Income level can affect drug or alcohol use in many ways. People might assume that individuals in a poor or lower-middle-class neighborhood would be more likely to abuse alcohol and drugs because of financial stress, lack of education about substance abuse, and insufficient resources for treatment.

Among the socioeconomically disadvantaged, increases in alcohol use, heavy drinking, and alcohol use disorder have led experts to consider this alcohol use a public health crisis.3 A lower socioeconomic status can increase alcohol-related death by 66% for men, and by a whopping 78% for women.4

Other socioeconomic groups are also affected by alcohol use.

Statistics indicate that alcohol use can increase in higher income groups. Alcohol use is more common among upper-class, highly educated Americans:5

  • About 80% of upper-income survey respondents reported drinking alcohol, compared with approximately 50% of lower-income respondents.
  • Approximately 78% of individuals with an income of $75,000 or more reported that they drink, compared with 45% of individuals with an income of $30,000 or less.
  • About 80% of college graduates reported that they drink, compared with 52% of those who had a high-school education or less.

Altogether, 64% of American adults from all income categories reported that they use alcohol.5

Among American adolescents, heavy alcohol use is more widespread in individuals whose families have higher levels of income and education. Teens whose parents had a higher education and a higher household income were more likely to engage in heavy drinking episodes than young people from lower-income homes whose parents were less educated.6

However, individuals with a history of belonging to a lower-income socioeconomic group were more likely to engage in heavy drinking or binge drinking (the consumption of five or more drinks in one sitting), while individuals in higher-income groups were more likely to engage in light or social drinking. Individuals from a working-class background were more likely to indulge in heavy drinking; however, they were also more likely to be completely abstinent from alcohol than the white-collar Americans who were studied.7

Opioid Addiction and Socioeconomic Status

Although opioid-related death rates have diminished in the last decades in most categories, nearly 70% of all overdose deaths in the U.S. involved an opioid in 2018. And synthetic opioid-involved death rates have increased 10%.8

Abuse of illegal or prescription opioids may be highest among the poor and continues to affect people in Appalachia and those living in poverty at disproportionate rates. Research has also shown that Americans who are on Medicaid are more likely to:9

  • Be prescribed opioids.
  • Receive higher doses for opioids.
  • Take opioids for a longer period of time.

This can increase Medicaid’s users’ risk for addiction. Unfortunately, this socioeconomic subset is also less likely to have access to appropriate addiction treatment.9

Middle-aged white Americans who have less education, experience poverty, and increased stress due to their financial situation have increased mortality related to substance use.9

Other communities and demographics, including Black Americans, that experience high poverty and a lack of local economic investment also experience opioid use at increased levels, as well as polysubstance use.10

Homelessness and Substance Abuse

In mainstream American society, homeless Americans are the most vulnerable and socioeconomically disadvantaged. 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% 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.11

Mental illness, which often goes hand in hand with substance abuse, is also common, affecting over 26% 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.11

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.12

Is Socioeconomic Status a Barrier to Treatment?

In 2018, common reasons for not receiving substance use treatment among people aged 12 or older who needed treatment and perceived a need for treatment but did not receive treatment at a specialty facility:13

  • Were not being ready to stop using (38.4%)
  • Had no healthcare coverage and were not able to afford the cost of treatment (32.5%).
  • Did not know where to go to get treatment (21.1%).
  • Felt that getting treatment would have a negative effect on their job (16%).
  • felt that getting treatment would cause their neighbors or community to have a negative opinion of them (14.9%).

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.

Since the Affordable Care Act was passed into law, substance use disorder treatment had expanded in the U.S., offering states a larger arsenal of tools to address all manner of substance use. Major coverage expansions, regulatory changes requiring coverage of SUD treatments in existing insurance plans, and requirements for SUD treatments to be offered on par with medical and surgical procedures have helped fight addiction and aid recovery, specifically with opioid use disorder.14

How Americans Pay for Treatment

No matter what their income or social position may be, the majority of Americans who need substance abuse treatment wonder how they will pay for rehab. The National Survey of Substance Abuse Treatment Services (NSSATS) for 2018 listed the following forms of payment, along with the percentage of treatment facilities that accepted those payment options:15

  • Cash or self-payment: 90%
  • Private health insurance: 71%
  • Medicaid: 66%
  • State-financed health insurance: 48%
  • Medicare: 36%
  • Federal military insurance: 36%
  • IHS/Tribal/Urban funds: 10%

In general, privately funded treatment centers were less likely to accept payment through federal or state assistance programs, like Medicare, while federally funded programs were less likely to accept cash payment. Out of the facilities surveyed, 58% reported that they had a sliding scale option, which allows clients to pay for treatment based on their financial resources. Treatment at no charge or for a lesser payment was offered by 45% of facilities.15

No matter where a person falls in socioeconomic groups or trends, they are deserving of quality, compassionate, evidence-based treatment for addiction. If you or a loved one are ready to make that step into recovery, give us a call at 973-862-4820.

 

References:

  1. Durante, F. & Fiske, S.T. (2017). How social-class stereotypes maintain inequality. Current Opinion in Psychology 18, 43-48.
  2. National Institute on Drug Abuse. (2014). Drugs, brains and behavior: the science of addiction.
  3. Grant, B.F., Chou, S.P., Saha, T.D., et al. (2017). Prevalence of 12-month alcohol use, high-risk drinking, and SDM-5 alcohol use disorder in the United States, 2001-2002 to 2012-2013. JAMA Psychiatry 74(9), 911-923.
  4. Collins, S.E. (2016). Associations between socioeconomic factors and alcohol outcomes. Alcohol Research Current Reviews 38(1), 83-94.
  5. Jones, J.M. (2015). Drinking highest among educated, upper-income Americans.
  6. Patrick, M.E., Wightman, P., Schoeni, R.F., & Schulenberg, J.E. (2012). Socioeconomic status and substance use among young adults: a comparison across constructs and drugs. Journal of Studies on Alcohol and Drugs 73(5), 772-782.
  7. Cerdá, M., Johnson-Lawrence, V., & Galea, S. (2011). Lifetime income patterns and alcohol consumption: investigating the association between long- and short-term income trajectories and drinking. Social Sciences & Medicine 73(8), 1178-1185.
  8. Centers for Disease Control and Prevention. (2020). Understanding the epidemic.
  9. National Institute on Drug Abuse. (2017). Addressing the opioid crisis means confronting socioeconomic disparities.
  10. Substance Abuse and Mental Health Services Administration. (2020). The opioid crisis and the Black/African American population: an urgent issue.
  11. Substance Abuse and Mental Health Services Administration. (2011). Current statistics on the prevalence and characteristics of people experiencing homelessness in the United States.
  12. National Coalition for the Homeless. (2009). Substance abuse and homelessness.
  13. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  14. Abraham, A.J., Andrews, C.M., Grogan, C.M., et al. (2017). The Affordable Care Act transformation of substance use disorder treatment. American Journal of Public Health 107(1), 31-32.
  15. Substance Abuse and Mental Health Services Administration. (2019). National Survey of Substance Abuse Treatment Services (N-SSATS): 2018. Rockville, MD: Substance Abuse and Mental Health Services Administration.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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