Poverty, homelessness, and social stigma make addiction more deadly

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Poverty, homelessness, and social stigma make addiction more deadly

“Addiction doesn’t discriminate,” as the proverb goes, meaning that it may impact people from all walks of life, from coal miners and truck drivers to executives, doctors, and lawyers. Someone who has spent 14 years recovering from a nasty prescription opioid addiction, I know how much of an equal-opportunity destroyer of well-being and happiness addiction can be. My addiction was unconcerned with my educational background, medical degree, race, gender, religion (or lack thereof), social standing, or health.

Social determinants of health and addiction

However, addiction does discriminate between people in a way that is unjust and dangerous. It does so in a way that highlights tears in the socioeconomic web that holds our society together. Clinicians have long known that social determinants of health (SDoH) might work against persons in their already difficult journey to recover from any addiction. SDoH, as defined by the World Health Organization, is “the circumstances in which individuals are born, grow, live, work, and age. The global, national, and local distributions of money, power, and resources influence these circumstances.”

The research supports SDoH’s tremendous impact on persons who are battling with addictions. According to a 2019 study published in Drug and Alcohol Dependence, “opioid overdoses were concentrated in more economically disadvantaged zip codes throughout 17 states in 2002–2014, as indicated by greater rates of poverty and unemployment, as well as lower education and median household income.” Poverty has been linked to opioid overdoses, unemployment has been linked to deadly heroin overdoses, and a lack of education has been linked to prescription overdose and overdose mortality in other research. Homelessness has been linked to overdoses in the past, particularly among veterans. Incarceration has terrible consequences, especially in the period immediately following release, when overdose deaths are at an all-time high. All of these problems are exacerbated by systemic racism.


The SDoH research reflects what I see in the inner-city clinic as a primary care practitioner. A patient on buprenorphine or methadone (medications to manage cravings and aid recovery) may be stable for years. Still, if they lose their housing due to no fault of their own, they may lose access to the organization and stability that they have come to rely on. It becomes far more difficult for them to care for their family, attend medical appointments or support groups, fill prescriptions, or engage in any other self-care activities that are so important for staying in recovery. As a result, they are far more likely to relapse.

Stigma plays a role in addiction.

“A mark of dishonor linked with a given quality, incident, or person,” according to the dictionary. The low esteem in which many people have held those who have struggled with addiction for so long, as well as the fact that we have criminalized drug use in our increasingly unpopular war on drugs, have contributed to a “punish, don’t treat” mentality. Thankfully, this detrimental mindset is changing, as more people realize that addiction is, at least in part, brain disease and that it isn’t a moral failure on the side of the individual. However, there is still a significant stigma, which creates an additional barrier to people seeking treatment, as they are burdened with unwarranted guilt and shame. Because of the stigma, many healthcare providers avoid dealing with persons who are addicted. In short, stigma can cause unneeded suffering and increase the number of overdose deaths.

SDoH is a significant factor contributing to addiction, but not the only factor.

Finally, with my addiction, I was fortunate enough to make it to the other side. I’ll never know how much of this was due to my internal resilience, family’s support, work resources, and colleagues’ support, genetics, luck, or my favorable SDoH tipping the balances in my favor. Not all doctors survive – several of my colleagues overdosed and are no longer with us. Simultaneously, many seemingly hopeless patients I’ve treated in the past are now living healthy, stable lives in recovery, proving that SDoH isn’t everything.

SDoH, on the other hand, obviously plays a significant part in framing the odds of people being able to treat and overcome their addictions. As a culture and as professionals, we must look beyond the medications as the source of the problem. We must begin to pay attention to the broader issues that allow addiction to fester, such as housing, employment, poverty, systematic racism, and the effects of incarceration, to provide everyone suffering from addiction the greatest chance possible to enter and stay in treatment (to name only a few). Not only do we help individuals who are addicted, but we also help everyone else by enhancing society’s safety net so that we all have access to essential human rights like food, shelter, and healthcare.



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Wednesday, 06th July 2022
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