Abstract
BackgroundThe relationship between economic conditions and substance abuse is unclear, with few studies reporting drug-specific substance abuse. The present study examined the association between economic conditions and drug-specific substance abuse admissions.MethodsState annual administrative data were drawn from the 1993–2016 Treatment Episode Data Set. The outcome variable was state-level aggregate number of treatment admissions for six categories of primary substance abuse (alcohol, marijuana/hashish, opiates, cocaine, stimulants, and other drugs). Additionally, we used a broader outcome for the number of treatment admissions, including primary, secondary, and tertiary diagnoses. We used a quasi-experimental approach -difference-in-difference model- to estimate the association between changes in economic conditions and substance abuse treatment admissions, adjusting for state characteristics. In addition, we performed two additional analyses to investigate (1) whether economic conditions have an asymmetric effect on the number of substance use admissions during economic downturns and upturns, and (2) the moderation effects of economic recessions (2001, 2008–09) on the relationship between economic conditions and substance use treatment.ResultsThe baseline model showed that unemployment rate was significantly associated with substance abuse treatment admissions. A unit increase in state unemployment rate was associated with a 9% increase in treatment admissions for opiates (β = 0.087, p < .001). Similar results were found for other substance abuse treatment admissions (cocaine (β = 0.081, p < .001), alcohol (β = 0.050, p < .001), marijuana (β = 0.036, p < .01), and other drugs (β = 0.095, p < .001). Unemployment rate was negatively associated with treatment admissions for stimulants (β = − 0.081, p < .001). The relationship between unemployment rate and opioids treatment admissions was not statistically significant in models that adjusted for state fixed effects and allowed for a state- unique time trend. We found that the association between state unemployment rates and annual substance abuse admissions has the same direction during economic downturns and upturns. During the economic recession, the negative association between unemployment rate and treatment admissions for stimulants was weakened.ConclusionThese findings suggest that economic hardship may have increased substance abuse. Treatment for substance use of certain drugs and alcohol should remain a priority even during economic downturns.
Highlights
The relationship between economic conditions and substance abuse is unclear, with few studies reporting drug-specific substance abuse
In Model 1, a unit increase in unemployment rate was associated with a 9% [(exp (0.087)-1)*100%] increase in opioid treatment admissions (β^ =0.087, p < .001)
In Model 2, which adjusted for state fixed effects instead of division effects as in the first model, a similar association was found between state unemployment rate and substance use treatment admissions, except the association was not significant for opiates admissions ( β^ =0.002, p = 0.84)
Summary
The relationship between economic conditions and substance abuse is unclear, with few studies reporting drug-specific substance abuse. The present study examined the association between economic conditions and drug-specific substance abuse admissions. The harmful or hazardous use of psychoactive substances, remains a significant public health problem. The United States has experienced an increase in the prevalence of illicit drug use, from 8.3% in 2002 to 11.2% in 2017 [2, 3]. There has been a recent rise in the use of marijuana from 14.5 million (5.8%) in 2007 to almost 41 million (15%) in 2017 [2, 3]. In 2017, almost 17 million persons (6.1%) reported heavy alcohol use in the past month, and nearly 67 million (24.5%) reported binge alcohol use, a slight increase from 2016 [2]
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