One of the most popular stereotypes about drug use is that it is more prevalent among the poor. In fact, a lack of moneyn itselfoes not seem to be associated with drug use. Empirical research has found, however, that in the United States, a number of attitudes, behaviors, and conditions linked to drug use also are linked to poverty, thus creating a situation that encompasses more than a lack of money. The study of poverty and drugs in the United States is complicated by the complexity of poverty as a conceptual category and by methodological problems in the measurement of drug use.
Merriam-Webster's Collegiate Dictionary, Tenth Edition defines poverty as "the state of one who lacks a usual or socially acceptable amount of money or material possessions." The sociological definition focuses on the relational aspect of poverty: Poor people are those who are at the bottom of a hierarchy of social stratification. Such a system is marked by unequal distribution of resources and income and also by differences in prestige, lifestyle, and values. In one review of the literature about poverty, authors listed the "critical features" of povertyttitudes, behaviors, or conditions that are believed to distinguish poor from people who are not poor. Poor people often are categorized by unemployment or intermittent employment, low-status and low-skill jobs, unstable family and interpersonal relationships, low involvement in the community, alienation from the larger society, low aspirations, and individual feelings of helplessness. Poverty was also correlated with divorce and unhappy marriage, illegitimacy, low rates of voting, dropping out of school, high arrest rates and incidence of mental disorders, poor physical health, and high mortality rates. The literature concluded that poor people differed quantitatively, but not qualitatively, from people who were not poor; that is, the differences in their attitudes, their behaviors, and their conditions were differences of degree, not kind. Interestingly, however, extreme poverty is not necessarily linked to a lack of education. Some research has shown that drug users with little education were less likely to be homeless than those with considerably more education, perhaps because those with less education look for and easily find unskilled labor jobs, and they earn enough to keep them in stable housing.
When studying the relationship of poverty to drug use, some of the literature is devoid of attempts to use the multidimensional conception of poverty. Instead, researchers have tended to choose one critical feature and look at its relationship to the use of specific drugs. Such studies have examined the association of U.S. drug use with income; educational attainment; educational success; employment; mental health; HOMELESSNESS; and neighborhood. The results of these studies are largely inconclusive, thereby pointing not to a simple correlation between poverty (or poverty-linked attitudes, behaviors, and conditions) and drug use, but to more subtle pathways of direct and indirect effects.
Some of the sociological literature on poverty since the 1980s has focused on the concept of an American underclass population caught in an intergenerational cycle of poverty, isolated from mainstream society, living in an urban ghetto, and at risk for a number of social ills, including drug use. It should be noted that only a small proportion of poor people lead lives fitting this description. Many poor people are poor for only a short time. Poor people are also a highly heterogeneous group. They live in all regions of the United States, in both rural and urban areas, and they are represented in all age and ethnic groups.
Collecting valid information about poverty and drug use has proved to be methodologically problematic. For example, for various reasons, some individuals misrepresent the severity of their drug use or their level of poverty. In addition, some surveys of drug use are based on household samples. Those who are poor are less likely to live in stable households and more likely to live in extended or amorphous householdsoth situations that would result in their being excluded from such a survey. Some reporting of drug use also comes from testing of arrestees, and this may introduce a bias in the estimation of the amount of drug use by people who are poor. Some statistical information on the drug-using population also comes from treatment programs or outreach services and not all individuals with drug abuse problems seek such programs or services. A number of individuals avoid treatment programs because problems with mental health interfere with their ability to desire or seek treatment. Finally, many studies focus on certain drugs (e.g., crack-cocaine, HEROIN) and not others (e.g., MARIJUANA, COCAINE), and this may tend to misrepresent the extent of drug use among poor people as compared to its extent among people of the middle and upper classes.
Regardless of these many obstacles, researchers have reached some conclusions about drug use among the poor, especially the extreme poorhe homeless. The homeless do appear to be at higher risk for drug abuse, and some findings suggest that drugs may have displaced alcohol as an important precursor of homelessness for many people. Researchers have also found that the homeless population is no longer primarily older, white males, but that women now make up a large portion of the homeless and that among them are many drug users.
One area in the study of drug use among the poor that has recently received much attention is the prevalence of mental health problems among the drug-using, homeless population. Researchers have found that this is a heterogeneous population in which not all individuals have the same health problems or severities of drug abuse, but studies have found a high incidence of mental health problems among homeless substance abusers. Some of the disorders seen in connection with this population include mood disorders, conduct and antisocial personality disorders, and anxiety disorders. Researchers have speculated that individuals with mental health problems use drugs as a means of self-medicating. Studies have also suggested that dealing with the mental health of drug-abusing homeless individuals may take first priority in the treatment of these individuals because mental health problems can prevent people from finding stable housing situations, getting a job, connecting with family, and staying with a drug-treatment program.
The risk of HIV infection among impoverished drug users is also an issue of increasing concern. Youths with mental illness are at particular risk for HIV infection as they have been found more likely to engage in such risky behavior as prostitution and unprotected sex, drug dealing, and drug use by injection.
Perhaps the greatest impact of poverty on the life of a drug user is how it can make prevention and treatment efforts inaccessible to that person. With private inpatient and outpatient treatment costing thousands of dollars and the long waiting lists for admission to publicly funded programs, impoverished drug users are less likely to obtain access to treatment. The heterogeneity of the poor and the lack of an empirical association between income level and drug use imply that making the poor the object of a targeted prevention and treatment effort might not be successful. Instead, the extant research on poverty and drug use suggests that policy efforts be directed at ensuring that lack of money does not become a barrier to participation in prevention and treatment programs.
Researchers have also suggested that special efforts must be made to target homeless youths due to their high risk of drug abuse. The range of services needed included outreach and sheltering services, substance abuse treatment, counseling, and HIV prevention programs. Unfortunately, many youths who engage in risky behavior do not seek traditional services or programs, and consequently those most in need may be underserved.
We wish to acknowledge the contribution of Karen Clarke, who helped review the literature.
(SEE ALSO: ; Ethnicity and Drugs; Families and Drug Use; ; Vulnerability As Cause of Substance Abuse)
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MARGARET E. ENSMINGER
REVISED BY PATRICIA OHLENROTH
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