Poverty and substance abuse

DEFINITION: Substance abuse is thought to be closely related to living in poverty, and it is thought that substance abuse may be caused by poverty. However, no evidence exists to show that poverty per se causes substance abuse.

Poverty: Definitions and Dynamics

Living in poverty is defined by the US federal government as living in a family unit with an income that is at or under a specified percentage of the US Census Bureau’s poverty thresholds. With this formula, a family’s income is divided by the appropriate threshold amount. This number is then indexed by the number of family members so that the income is stated per person. In the United States, an estimated 11.1 percent of the population was living in poverty in 2023, according to the US Census Bureau.

Many poor people live their days trying to survive. Low-income individuals often use whatever resources they can muster to feed and clothe their family members. This may include borrowing money from their children or parents and pawning anything of value. Poor people tend to provide for their family one day or week at a time. They often do not have the money to purchase food in advance or to pay their bills. In some low-income homes, there is no money to provide three meals a day, and poor children are often sent to school without breakfast and return home to no dinner.

Some poor people lack the skills to obtain a high-level job, or they are unemployed, underemployed, or inconsistently employed. Some poor parents, particularly single parents, may work more than one minimum-wage job. As a result, they may leave their children with inadequate caregivers, or with the oldest child in charge.

Children in low-income households are often forced to grow up early. Frequently, they are denied the childhood of their peers that extends into the teenage years. Children of poor families may not see much need for education, and they may drop out of high school or get a job after high school rather than going to college or a training school.

Emotional and physical abuse is thought to be common among the poor. Inadequate finances can lead a person to show his or her anger and frustration by harming family members. According to the Fourth National Incidence Study of Child Abuse and Neglect (NIS-4), children who grow up in a household with an income of $15,000 or less are three times more likely to be abused than those in households with higher incomes. Child abuse can lead to low self-esteem and depression for the abuser and the abused. Abuse behaviors are frequently passed from generation to generation, unless an adult gains insight and is able to break the pattern. Both adults and children are likely to feel hopeless in this type of situation. NIS-4 also showed that poor children were seven times more likely to be neglected than their peers in higher-income households.

Poor people are represented in all groups of society. Those living in poverty represent people from all racial and ethnic groups, although according to the US Census Bureau, US poverty rates are disproportionately higher among Black people and Hispanics of any race, with 17.9 percent and 16.6 percent of those populations living in poverty, respectively, in 2023. The poverty rate is the lowest among White and Asian people, at 9.7 percent and 9.1 percent, respectively, in 2023. Mental disorders are more common among the poor, as living in the stressful environment of a low-income household makes it more statistically likely for a person to develop a mental disorder. Additionally, having a mental disorder can make it more difficult for a person to maintain a job, financial stability, and proper medical care. Poverty may last for a short period of time, or it may continue for the long term. This depends on the reason for the poverty. For example, a student may be poor while attending school.

People experiencing homelessness are a subgroup of the poor, and their incomes, financial reserves, and family members are often unknown. Accurate counts of unhoused people are not available, as census workers may not be able to count them because they often tend to limit their social exposure.

Substance Abuse Risk Factors

Many factors can put a person at risk for substance abuse. There may be an inherited genetic susceptibility for abusing drugs. In the absence of an inherited susceptibility, it is likely that substance abuse is passed from generation to generation as a learned behavior. Children tend to perceive their parents’ behavior as the norm, and if a parent abuses a substance, their children are likely to abuse as well. A study by Duke University in 2013 found several important connections between poverty in childhood and the eventual development of substance abuse behaviors. Researchers found that poverty in childhood does not typically allow for the development of good self-control. This lack of self-control can lead to eventual substance abuse. However, while the study found that poor children are more likely to develop cigarette-smoking habits, they are no more likely than high-income children to smoke marijuana and less likely to binge-drink.

Substance abuse is more common in persons with certain mental illnesses, particularly personality disorders, schizophrenia, depression, and bipolar disorder. Certain personality traits can also lead to substance abuse. Some persons are said to have an addictive personality. These persons may be aggressive, thrill-seeking, and rebellious, or they may have low self-esteem. Other personality characteristics thought to lead to substance abuse are impulsiveness, poor ability to deal with stress, lacking goals, and having psychological problems.

Factors in the home can also lead to substance abuse. These factors include living in a home that is not cared for or maintained, having parents who are not nurturing, and having parents who distance themselves from their children. Children and adults who are physically, psychologically, or sexually abused in the home are also at an increased risk for substance abuse. According to NIS-4, children from low-income households are five times more likely to suffer maltreatment than their peers of higher socioeconomic status. These factors can lead to lack of confidence and low self-esteem, which put children and adults at risk for developing substance abuse problems. How a child is socialized to relate to other people also can put a child at risk for substance abuse. The behaviors most commonly associated with substance abuse are poor skills at relating to others, shyness, aggression, involvement with a negative peer group, poor achievement in school, and perceived approval for abusing substances.

Because of the nature of drugs of addiction, it is not possible to simply “try” a drug such as opioids or heroin. These drugs make permanent changes in the brain. Some drugs act like neurotransmitters, which are chemicals in the brain that connect nerve cells and transmit nerve impulses, and they can disrupt the brain’s normal communication patterns. Most drugs of addiction stimulate the production of large amounts of dopamine in the brain, leading to feelings of euphoria. Ongoing use of addictive drugs leads to decreased production of dopamine and a decreased number of dopamine receptors in the brain. As a result, the person needs to continue taking the drug to feel good and needs to take increasingly larger amounts of the drug. Consequently, taking a drug of addiction as an experiment can lead to addiction.

Substance abuse is most common in men. Other risk factors include insecure attachment to parents or other childhood caregivers, difficulty in school, and exposure to chronic stressors. Having multiple risk factors, as often occurs with poverty, drastically increases an individual's chances of problems in adolescence and adulthood; however, these risks can be offset by protective factors such as proper nutrition and exercise, strong parental bond and consistency, school readiness, and healthy peer socialization.

Substance abuse is also more prevalent among homeless people than in the general population. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in the early 2020s about 16 percent of unhoused individuals reported having a substance abuse disorder. Mental health problems are also far more common in this group; SAMHSA reported 21 percent of people experiencing homelessness had a serious mental illness, and they often have little social support from family members or partners.

Does Poverty Cause Substance Abuse?

No clear evidence shows that poverty causes substance abuse. Most of the problems that are thought to characterize low-income individuals and that might lead to substance abuse can also lead to substance abuse in persons with middle- and upper-class backgrounds. These problems include adult and child abuse, hopelessness, parents who abuse substances, low-level job skills, lack of community involvement, feelings of alienation from the rest of society, mental health problems, lack of personal goals, and unemployment.

It does appear, however, that substance abuse can lead to poverty. A substance abuser is more likely to lose his or her job and to spend what money they have on drugs or alcohol. Multiple studies have determined that poverty is a risk factor for opioid overdoses, and homelessness has also been associated with such overdoses, especially among veterans.

Bibliography

Anakwenze, Ujunwa, and Daniyal Zuberi. "Mental Health and Poverty in the Inner City." Health & Social Work 38.3 (2013): 147–57. Social Sciences Full Text (H.W. Wilson). Web. 9 Sept. 2014.

"Current Statistics on the Prevalence and Characteristics of People Experiencing Homelessness in the United States." Substance Abuse and Mental Health Service Admin., July 2011. Web. 9 Sept. 2014.

Duke Medicine News and Communications. "Childhood Economic Status Affects Substance Use Among Young Adults." Duke Medicine. Duke U Health System, 30 July 2015. Web. 30 Oct. 2015.

Grinspoon, Peter. "Poverty, Homelessness, and Social Stigma Make Addiction More Deadly." Harvard Health Publishing, 28 Sept. 2021, www.health.harvard.edu/blog/poverty-homelessness-and-social-stigma-make-addiction-more-deadly-202109282602. Accessed 21 Jan. 2025.

Sedlak, A. J., et al. Fourth National Incidence Study of Child Abuse and Neglect (NIS–4): Report to Congress. US Department of Health and Human Services, Administration for Children and Families, 2010, www.acf.hhs.gov/sites/default/files/opre/nis4‗report‗congress‗full‗pdf‗jan2010.pdf. Accessed 17 Oct. 2017.

Gorski, Paul. “The Myth of the 'Culture of Poverty.'” Poverty and Learning 65.7 (2008). Education Source. Web. 9 Sept. 2014.

Kerr, Peter. “Rich vs. Poor: Drug Patterns Are Diverging.” The New York Times, 30 Aug. 1987, www.nytimes.com/1987/08/30/us/rich-vs-poor-drug-patterns-are-diverging.html. Accessed 21 Jan. 2025.

Principles of Substance Abuse Prevention for Early Childhood: A Research-Based Guide. National Institute on Drug Abuse, Mar. 2016, www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/chapter-2-risk-protective-factors. Accessed 17 Oct. 2017.

Saldua, Mark. "Addressing Social Determinants of Health Among Individuals Experiencing Homelessness." SAMHSA, 15 Nov. 2023, www.samhsa.gov/blog/addressing-social-determinants-health-among-individuals-experiencing-homelessness. Accessed 21 Jan. 2025.

Shrider, Emily A. "Poverty in the United States: 2023." United States Census Bureau, 10 Sept. 2024, www.census.gov/library/publications/2024/demo/p60-283.html. Accessed 21 Jan. 2025.

Thompson, Ronald G., Jr., et al. "Substance-Use Disorders and Poverty as Prospective Predictors of First-Time Homelessness in the United States." American Journal of Public Health 103.S2 (2013): S282–S288. SPORTDiscus with Full Text. Web. 9 Sept. 2014.