Few months ago, The Economist had an article on the drugs problem in Scotland. This statistic caught my attention:
Scots in the poorest areas are 16 times more likely to die a drug-related death than those in the richest areas.
The difference between overdose death rates among the rich and poor is too great to be attributed to mere coincidence. This discrepancy calls for some kind of explanation.
One possibility is that lack of money makes people depressed, and depressed people are more likely to abuse drugs in order to alleviate the suffering of poverty. Another possibility is that poverty and drug addiction are both caused by a third factor. How might we distinguish between these alternative theories?
The same article from The Economist presents a graph that shows equally surprising differences in rates of drug overuse between countries:
There appears to be little or no correlation between the wealth of nations and drug addiction rates. Scotland’s GDP per capita is exactly on average for the European Union, the United States is much richer than the European average, while Portugal is much poorer than the average. And yet, it is in Portugal that the rate of deaths from drug overdoses is the lowest.
So how do we reconcile the fact that drug misuse in a country like Scotland is highly correlated with income, while internationally there is little evidence that poverty is the cause of it? drug abuse? It is possible that both substance abuse and poverty are caused by a third factor.
Suppose that poverty and drug use are correlated with certain aspects of personality. Let’s also assume that all countries have a mix of personalities, some more likely than others to use drugs. And finally, suppose that international differences in per capita income are not caused by differences in national personalities. I do not claim that any of these hypotheses are entirely true, but rather that they help us understand why drug use within a country may be strongly correlated with poverty, but not between countries.
If we assume that, in both poor and rich countries, a fairly stable percentage of the population has a personality that makes them susceptible to drug abuse, then we would not necessarily expect greater drug use in poor countries than in rich countries. If we also assume that the same personality aspect that leads to drug abuse also leads to poverty (e.g. a lack of self-control), then we can explain both the within-country correlation and l lack of international correlation.
Case closed? Not enough. This doesn’t explain why there is such a big difference in drug overdose deaths between different countries (and even between different regions, as we see in the UK). There’s something else going on, but poverty alone doesn’t seem to be a problem. explanation.
Some countries may have legal systems that are more tolerant of drug use. But that doesn’t seem to fit the data either, as Switzerland and Portugal rely more on a gentler “harm reduction” approach, while the US and Scotland enforce laws against drug use. Indeed, it could be that strict enforcement of drug laws increases the number of overdose deaths by creating an underground market where the quality of drugs is very unreliable.
Instead, I suspect that drug use is correlated with two factors: personality and regional culture. Areas of the world where people lack community support systems may have higher rates of drug abuse, and people with certain personality types in a given area are more likely to abuse drugs. The worst situation would be people lacking self-control and living in relative isolation in countries without strong support systems for people struggling with life.
In the United States, the two states with the highest rates of drug overdose death are Nebraska and South Dakota. Both states have many small, rural towns with a strong sense of community. North Dakota was once quite similar culturally, but the fracking boom in the Bakken region attracted many young workers isolated from their families and communities. North Dakota still has a fairly low drug overdose rate, but it is now much worse than its two southern neighbors. And yet no one would dispute that the oil boom has impoverished North Dakota – quite the contrary.
In conclusion, poverty is probably not directly responsible for drug overdose deaths. But in a given region, the factors that cause poverty are likely to be correlated with the factors that cause drug abuse.
