Many forms of addiction start as a means to escape the psychological and socioeconomic costs of poverty. For the ﬁnancially fortunate, addiction acts as a medium for self-fulfillment and instant gratification. Addicts, when intoxicated with their substance of preference, think that only they are aﬀected on a personal level. But substance abuse has significant direct and indirect costs, not just for the individual, but also for the family, the community, and society as a whole.
Substance abuse is a global malady. It has a negative impact on human development, health, and socioeconomic status. The repercussions of addiction are far-reaching, and include poverty, homelessness, lack of education, unemployment, loss of work productivity, a proliferation of addiction-related diseases, social dysfunction and neglect, higher rates of accidents, violence, crime, suicide, and degradation of quality of life. On an extensive level, an addiction epidemic may also have a ripple effect on a country’s per capita income.
The highest rate of substance use disorders (SUD) are found in wealthy countries like the United States: 3.06% in 2017, according to charts published by brainfacts.org. In the same year, more than 351,000 deaths from substance abuse occurred worldwide. Three quarters of these were males and 81,598 were Americans. The SUD death rate had increased to 400% since 1990 due to the opioid epidemic. Of the 175 million-plus people worldwide with SUDs, more than 120 million are men.
Why don’t enough people get treatment for addictions?
Two major factors contributing to the avoidance of treatment are the price of treatment programs and the stigma associated with the disease. These have a direct effect on all other reasons. Even if many want to change, they are unable to aﬀord treatments, or they are not covered by insurance. Some are not ready to quit, even in the face of an intervention. Others are afraid of the repercussions of admitting to having the disorder: they are scared of losing their jobs or they are wary of how others will view or judge them.
Others lack the resources for treatment or consultation. Some are too busy, they don’t want what’s currently on oﬀer, or they don’t think rehabilitation will help. Some are daunted by demographics: location, logistics, and transport challenges deter them.
Eﬀective treatments for SUDs
Methadone is one of the most eﬀective drugs that help with substance withdrawal, especially the physical and mental cravings and the ﬂu-like symptoms. Another medicine to combat the eﬀects of SUDs is buprenorphine. As eﬀective as methadone, it is administered sublingually daily or every other day. But the hero of the opioid antidotes is naloxone.
Doctors prefer to have heroin and fentanyl addicts taper oﬀ these drugs instead of making them quit abruptly, because of the withdrawal symptoms. Opioid maintenance is normally combined with psychosocial therapy to determine the triggers and causes of addiction.
US President Donald Trump declared the opioid epidemic as a public health emergency, but the question remains how health authorities and opioid addicts will get greater access to the above medications. Medicaid, Medicare, and most insurers cover the cost of similar opioid antidotes like suboxone and naltrexone, but for those without health insurance, these can cost from $600 to $1,200 a month.
This aspect is one of the topics that the Appalachian Addiction & Prescription Drug Abuse Conference will address. This event will be held from tomorrow, October 17, to October 19 at the Waterfront Marriott in Morgantown, West Virginia.
Studies and national surveys examine the link between familial socioeconomic status (SES) and substance abuse. One of these is the Hanson and Chen study in 2007 . Health, antisocial behaviour, cognition, and educational attainment play a role in SES too, but researchers are more interested in how family SES as a concept can determine the risk factors for substance abuse in adulthood. Being able to identify children susceptible to substance abuse will help clinicians and counsellors present the appropriate prevention methodology.
Researchers based their ﬁndings on three indicators of family SES: wealth, income, and parental educational attainment. The Luthar, Latendresse, and Goldstein study  found that children and youth from families with higher income levels are at greater risk for substance use disorders, particularly those stemming from anxiety and great depression. This refutes the popular belief that “addicts only come from poor neighbourhoods or uneducated groups or immigrant families.”
Luthar suggested that the ﬁnding may be attributed to the pressure prevalent in wealthier families to achieve more, because the parents have high-powered careers. This parental demand is not as strictly imposed, or even expected, in families from a lower socioeconomic background. Since the study focused on the three factors, ethnicity wasn’t a priority. Researchers didn’t consider that some ethnic groups, mostly from Southeast and South Central Asia, have the same demand for stellar academic output from their offspring, if not more. And yet, addiction does not rate highly in these communities.
Socioeconomic status aside, though, abnormal behaviour arising from substance abuse aﬀects all family members, whether they live with the addict or not. Often, when immediate family members have difficulty adjusting to, or can no longer tolerate, the addicted loved one, they reach out to extended family for help. This may be in the form of ﬁnancial aid, assistance during emergencies, post-detox medical care, or taking the addict in because he or she is no longer welcome at home.
In an addicted household, children and spouses are usually the targets of domestic violence. Addiction, poverty, and sexual and physical abuse are linked. Statistics from the National Institute on Drug Abuse (NIDA) show that children from low-income households are more likely to be abused. Children of alcoholic parents are four times more likely to be abused, and 80% of cases involving child abuse and neglect stem from substance abuse. Studies have shown that youth who go through these adverse childhood experiences are likely to develop substance abuse problems in adulthood. They also have an increased risk of mental illness.
Pregnant women who abuse alcohol are likely to deliver babies with fetal alcohol spectrum disorders (FASD). Those who misuse other substances, especially illegal ones, have a high risk of having infants with brain damage. Symptoms of both conditions may be permanent. So these women should be informed early. One repercussion to this, though, is that fear of stigma or negative consequences may make them resort to legal abortions after learning the diagnosis.
Addiction in its varied forms impairs normal functioning, aﬀects decision-making, and inﬂuences the addict to shirk responsibilities. Extreme substance addiction can cost the addict most of his income to the point where it pushes him to the poverty line. Economic effects such as this increase insurance premium costs (especially after a DUI arrest), produces bills that didn’t exist before the addiction—like lawyers’ fees from arrests or other legal problems—and leaves the addict with debts, rendering him unable to cover household, educational, medical, and other important expenses.
The true cost may be higher on an intangible level. Examples include underemployment as a result of dropping out of college, loss of opportunity from negative life experiences brought about by the addiction, and the incapacity to provide for one’s dependents.
The Substance Abuse and Mental Health Services Administration (SAMHSA) cites $600 billion annually as the cost of substance abuse to the US health care system. Alcohol abuse alone is responsible for more than 88,000 deaths annually. Binge drinkers are not necessarily dependent on alcohol, but in the US, they contribute to a major portion of excessive alcohol consumption (70 to 75%). In 2000, about $185 billion annually was set as the cost of alcohol-related expenses . Treatment and management of alcohol-related illnesses and injuries account for about $28 billion annually. In 2004, the Oﬃce of National Drug Control Policy [ONDCP] quoted $181 billion for other drug use and consequences .
The Centers for Disease Control and Prevention (CDC) estimates that the cost of excessive alcohol consumption is more than $200 billion per year, and all levels of government shoulder 40% of this. This aﬀects tax revenues, among other factors. A cost estimate of $25 billion annually to the criminal justice system is attributed to alcohol-related crime.
As for the cost of illegal drug abuse in the United States, the ONDCP cited around $180.9 billion in 2002. This amount was to manage the repercussions of crime and health care. A portion of this was from absenteeism and productivity loss due to disability, death, and resignation from the labour force. An additional cost of $36.4 billion was for expenses related to addiction with regard to criminal justice, social, and child welfare systems. The actual costs quoted were more than what was projected. Regardless, the drug abuse-related component to these is one of the more expensive medical problems in the United States.
In 2004, SAMHSA recommended an increase in spending on treatment to lower health care costs. Even with the cost increase in treatment and recovery support for substance use disorders, this will be better than the cost of sending addicts to prison, more serious health repercussions resulting from their addiction, and caring for those they left behind.
The abuse of, and dependence on, opioid painkillers, whether prescribed or illicit, have contributed to a full-blown epidemic in North America. The arrival of fentanyl in the market has contributed greatly to the opioid crisis in recent years. Many opioid abusers have graduated to using heroin or fentanyl to cut costs or when they couldn’t get more opiate medications the legitimate way (through their doctors). The result? A tremendous increase in opioid-related medical conditions and overdose deaths.
Alcohol also features in many chronic ailments, both psychological and physiological. Some of these are cardiac diseases, cancer, gastrointestinal ailments, diabetes, neurological conditions, and overdoses. It is not easy to pinpoint the exact extent of the role addictive substances play in injury, illness, and death, because information is not always reported or available.
The economic impact of substance abuse in the workplace does not only affect the addict’s employment or business status. It also extends to family members missing work because of the addict’s aﬄiction. In extreme cases, addiction has a domino eﬀect: it promulgates joblessness, which evokes hopelessness, which compels the addict to turn to crime, which may lead to incarceration.
In a study of the occupational status of drug addicts in Sylhet City, Bangladesh , psychologists cite permanent unemployment as a real threat to mental health. The study depicted that the highest percentage of drug addict participants were unemployed.
Studies have shown alcohol and drug consumption’s correlation to violence and criminal acts. Excessive substance use alters the chemical makeup of the brain, causing users to behave differently than they normally would. For example, some people who are soft-spoken and timid by nature may act the opposite when under the inﬂuence.
The Bangladesh study revealed that the highest number of drug addicts lived in their own houses, while 66.66% of participants were extended family members. Most of the participants bought drugs from money either obtained from family or criminal activities.
Factors related to age and marital status
The Bangladesh study showed that there are deﬁnite correlations between substance abuse and the age of the addict. Results show that 31% are in the 22-25 age range, 24% are 26-29 years old, and 12% are in the 34-37 age group.
In terms of educational attainment, 30.81% studied up to the primary level of education and 39.34% had completed secondary education. The same study also considered marital status. Results showed that 60.14% of the participants were single, 37.48% were married, and 2.38% were divorced, suggesting that marriage may have a positive eﬀect on substance abusers.
In acceptance lies the solution
The first step to resolving addiction-related difficulties is to overcome the fear of stigma, and acknowledge that there is a problem in the ﬁrst place. This is especially true for those suffering from gambling addiction. Habitual gamblers will justify their casino or online betting website visits as occasional fun activities, just as alcoholics will tell intervention specialists that they are merely social drinkers.
Once the acknowledgement is established, this opens the door to support and appropriate addiction treatment, including psychotherapy, group and family therapy, and medical intervention for alcohol and opioid addictions . Recent innovations to addiction treatment modalities and partnerships among medical authorities, related organisations, and the government boost chances of recovery.
 Hanson, MD and Chen, E. “Socioeconomic status and health behaviors in adolescence: a review of the literature”. Journal of Behavioral Medicine, 30, 263-285. 2007.
 Luthar, SS and Goldstein, AS. “Substance use and related behaviors among suburban late adolescents: The importance of perceived parent containment”. Development and Psychopathology, 20, 591–614. 2008.
 Harwood, H. “Updating estimates of the economic costs of alcohol abuse in the United States: Estimates, update methods, and data”. Lewin Group for the National Institute on Alcohol Abuse and Alcoholism. 2000.
 “The economic costs of drug abuse in the United States, 1992–2002”. Oﬃce of National Drug Control Policy. Publication #207303. Washington, DC: Executive Oﬃce of the President. 2004.
 Ahad et al. “Socioeconomic Status of Young Drug Addicts in Sylhet City, Bangladesh”. IOSR Journal of Humanities and Social Science, vol 22, # 6, ver 2. June 2017.
Statistics: “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, Executive Summary”. US Department of Health and Human Services (HHS), Oﬃce of the Surgeon General, Washington, DC. November 2016.
Photo credit: davitydave. This picture has a Creative Commons attribution license.