Poverty, homelessness and social stigma make drug addiction deadlier
A common saying is that “addiction does not discriminate” meaning that it can affect anyone in any sphere of life, from coal miners and truck drivers to executives, doctors and lawyers. I have personal experience of what an equal opportunity destroyer of wellness and happiness addiction can be, as I have 14 years of recovery from a vicious addiction to prescription pain relievers. My addiction didn’t care about my education, medical degree, race, gender, religion (or lack of it), social status, or health.
Social determinants of health and substance abuse
But in another sense, critical, addiction Is discriminate between people, in a way that is unfair and deadly, and in a way that highlights the tears in the socio-economic web that holds our society together. It has long been observed by clinicians that the social determinants of health (SDoH) can tip the scales against people, in their already daunting quest to recover from any type of addiction. According to the World Health Organization, SDoH is defined as “the conditions under which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at the global, national and local levels. levels. “
The profound effect SDoH has on people with addictions is supported by the evidence. In a 2019 study of Drug and alcohol addiction it was found that “in 17 states between 2002 and 2014, opioid overdoses were concentrated in more economically disadvantaged postcodes, indicated by higher rates of poverty and unemployment, as well as lower levels of ‘lower education and median household income’. Other studies have shown that poverty was a risk factor for opioid overdose, unemployment was a risk factor for fatal heroin overdose, and low education was a risk factor for prescription overdose and overdose mortality. Homelessness has also been shown to be associated with overdoses, particularly among veterans. Terrible results are associated with incarceration, especially the period immediately after release from incarceration when overdose deaths skyrocket. Systemic racism contributes to all of these problems.
The research on SDoH mirrors what I see clinically, in the downtown clinic where I practice as a primary care clinician. A patient may be stable for years on buprenorphine or methadone (drugs to manage cravings and help recovery), but if he suddenly loses his home through no fault of his own, he may lose access to the organization and the safety of his life. It becomes much more difficult for them to take care of their families, attend medical appointments or support groups, fill prescriptions or practice any of the personal care that is integral to maintaining health. The healing. As such, they become much more vulnerable to relapse.
Stigma plays a role in addiction
Stigma is defined as “a mark of disgrace associated with a certain quality, circumstance or person”. The contempt with which so many people have long viewed those who suffer from drug addiction, and the fact that we have criminalized drug use in our increasingly unpopular war on drugs, has contributed to a ‘punish, don’t. not treat ”. Fortunately, this destructive attitude has recently evolved, as more and more people have come to understand that addiction is, at least in part, a disease of the brain and that it is not a moral failure on the part of the person. the individual. However, much of the stigma remains and is an additional barrier for people seeking the help they need as they suffer from unnecessary guilt and shame. Many health care providers do not want to care for people with drug addiction because of the stigma. In short, stigma can lead to unnecessary suffering and more overdose deaths.
SDoHs are important factors contributing to addiction, but not the only factors
In the end, with my addiction, I had the chance to go to the other side. I will never know how much of this was due to my own internal resilience, support from my family, resources from work and support from colleagues, genetics, luck, or if it was largely due to my Supportive SDoH putting a useful finger on the scales. Certainly not all doctors are doing well – several of my colleagues have overdosed and are no longer with us. At the same time, many of the apparently depressed patients I have treated in the past lead healthy and stable recovering lives, so SDoH isn’t everything.
But it is clear that SDoH plays a huge role in determining the odds of whether people are able to treat and survive their addictions. As a society and as clinicians, we need to go far beyond the mere perception of drugs as a problem. In order to give all those suffering from drug addiction the best possible chance to enter and recover, we urgently need to start paying attention to the broader issues that allow addiction to escalate, such as housing, housing, employment, poverty, systemic racism and the effects of incarceration (to name a few). By strengthening society’s safety net, so that we all have access to basic human rights to food, shelter and health care, we are not only helping those who suffer from drug addiction, we are also helping everyone.
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