[acb-hsp] Addiction Discriminates?

[peter altschul]

Addiction Discriminates? What That Means in Today's Troubled 
Economy
  Maia Szalavitz, The Fix November 7, 2011
  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 smokingband nearly one third 
less likely to end a cocaine addictionbthan 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 IRA's 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.
  These differences relate not to overall amount of wealth in 
industrialized countries but to how the money is distributed 
among the population.  So why does inequality per se have such a 
profound impact on health, including addiction?
  Like other primates, humans are hierarchical creatures: there 
are alphas and betas and so on down the line for both males and 
females.  However, humans also have an innate desire for 
fairness.  The reason children are so quick to say, "That's not 
fair," when their siblings get what seems to be a bigger piece of 
cake is not because parents teach them to measure their portions 
but because our brains predispose us to prefer at least some 
degree of equality-or at the very least rational explanation of 
unfair distributions.
  Numerous studies demonstrate this preference.  A major study 
conducted by the noted Duke University economist and author Dan 
Ariely found that Americans would favor a system of wealth 
distribution closer to the one found in Sweden (one of the 
world's most egalitarian countries) than the current status quo 
in the United States.  The 5,522 participants surveyed tended to 
believe that our existing wealth distribution was much closer to 
equitable than it is-before the crash made us much more aware of 
the reality.
  Study after study has also found that people will pay to punish 
others who treat them unfairly, even when it isn't in their own 
economic interest to do so.  While people obviously often 
selfishly seek their own individual advantages, the idea that we 
prefer a Darwinian bdog eat dogb world over one in which people 
have a fair chance at winning through hard work is simply not 
supported by the data.  We're hierarchical, but we also crave 
justice.
  This is probably related to the fact that we evolved in 
tight-knit, highly egalitarian groups in which selfishness was 
highly discouraged because survival required cooperation.  
Whatever the case, even in the most egalitarian societies, there 
is a survival difference between those on top and those on the 
bottom.  But that difference is greatly magnified when economic 
inequality is high.  A stress abuse of mortality among all human 
beings is stress, which is the primary factor in a long list of 
fatal illnesses.  By and large, wealthier people are more 
equipped to insulate themselves from the stressors of daily life.  
But people in poverty suffer through much the greater degree of 
uncertainty and insecurity, both of which exacerbate chronic 
stress.  Even at the top of the financial pyramid, however, 
competition, responsibility, and fear of failure take a constant 
toll.
  Meanwhile, chronically elevated stress hormone levels increase 
the risk of virtually every illness you can name: not just 
addictions, obesity, diabetes and cardiovascular disease, but 
also infectious diseases, infant mortality and most cancers.
  In one famous study of British civil servants, people on the 
bottom rung of the hierarchy suffered mortality rates three times 
higher than those on the top at every age-and the difference was 
graded sequentially from top to bottom.  Only about one third of 
the difference in death rates was accounted for by factors like 
smoking and obesity-the rest was caused by the stress itself, not 
self-medication to try to cope with it.
  Keep in mind that those on the bottom weren't unemployed or 
even poor: they were working class, and because Britain has a 
national health care system, their worse health was not due to 
lack of access to medical services.  Further, the US is even more 
unequal than the UK: in America, the ratio of CEO to worker pay 
is now 185 to one; in Great Britain, that figure is 28 to one 
(and they're considered one of the most inequitable countries in 
Western Europe).
  Although direct comparisons between countries on rates of drug 
problems are hard to make, one 2003 study contrasted rates of 
active drug dependence (the DSM diagnostic term for "addiction") 
among Americans to that of Brits.  It found a drug dependence 
rate of 1.5% in the U.S.  and 0.5% in the UK: three times lower.
  America, as many of us may remember, used to be far less 
unequal: in the postwar years from 1948 to 1985, on average, 
annual American income grew by $21,162.  Some 60% of that growth 
went to the bottom 90% of earners.  In contrast, between 1986 and 
2008, average yearly take-home grew by a mere $6,894-and 100% 
went to the top 10%.  In fact, on average, the income for 90% of 
Americans declined.
  If we want to fight addiction, these numbers and trends are 
unsustainable.  Reducing inequality isn't just a boon to the 
middle class and poor-it could help every level of society by 
raising educational achievement, cutting health costs, crime, 
criminal justice expenditures and stress.
  Obviously, this would require more taxes on the wealthy and on 
corporations and greater spending on schools, particularly early 
childhood care.  It would require a commitment to genuine 
equality of opportunity-not of outcome, but of real options.
  Alternatively, we can continue to self-medicate with food, 
cigarettes, alcohol, heroin, coke, meth, oxy, sex, the 
Internet-the list of consumer goods employed in a failing attempt 
to alleviate stress without getting to its root causes keeps 
growing-and go on fighting an endless, equally failing, war on 
drugs-and on ourselves.
  Maia Szalavitz is a columnist at The Fix She is also a health 
reporter at Time magazine online, and co-author, with Bruce 
Perry, of Born for Love: Why Empathy Is Essentialband Endangered 
(Morrow, 2010), and author of Help at Any Cost: How the 
Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 
2006).
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