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Key points
- Addiction is created by numerous factors that are both innate/biological (nature) and social/environmental (nurture).
- Drugs are blamed for countless social problems, and we largely ignore how those same social problems are actually risk factors for addiction.
- Many risk factors for addiction could be reduced by public policies and programs that reduce poverty.
- We can’t punish and scare our way out of the public health crises of addiction, overdose deaths, and drug-policy-related disenfranchisement.
Americans are often so focused on individual aspects of substance use, addiction, and recovery that we overlook ways that public policies could harness social and environmental initiatives to reduce addiction risk and improve recovery success.
The Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health proposes viewing food as medicine, with a focus on bettering people's diets and reducing diet-related health problems. Numerous medical associations and healthcare centers have committed funding to this initiative—but I argue that there was a significant missed opportunity to highlight how the proposed policies would reduce drug-related deaths, fatal overdoses, and addiction, which are major public health concerns with bipartisan support.
In the 50 years of the U.S. War on Drugs, drugs, drug users, and drug dealers have been blamed for countless social problems. We continue to ignore how those same social problems are actually risk factors for substance abuse and addiction. The U.S. spends less than $3 billion annually on federal substance abuse prevention programs while over $17 billion goes to federal enforcement of drug laws and drug interdiction.
Despite consistent congressional support for “anti-drug” legislation and funding, rates of drug use and addiction have remained unchanged. The U.S. leads the world in rates of addiction, drug-related deaths, and drug-related incarcerations. Americans convicted of drug felonies, who are disproportionately racial minorities, are routinely and legally denied access to social support like food and housing subsidies, Medicaid, equal employment opportunities, gun ownership, voting rights, and student loans.
Many politicians stoke “drugs are the cause” narratives while avoiding meaningful changes to public policies and services that could actually reduce drug use, addiction, overdose deaths, and related social issues. Whether borne from ignorance, miseducation, greed, or intentional malice, the result is the same: Many people who claim to care about addiction, substance abuse, and overdose deaths often dispute proposals that could reduce those very things.
It makes no sense, in my view, to enthusiastically support legislation to curb drug overdose deaths, substance abuse, and addiction while also opposing policies that reduce poverty, hunger, and healthcare disparities. If people truly understood the causes of addiction, it would be impossible to continue this inconsistent policy support.
I’ve spent 20 years studying addiction, providing evidence-based addiction treatment, and teaching about the risk and protective factors that influence addiction and recovery. Despite common misconceptions, addiction is not a character flaw; addiction is not entirely a brain disease; addiction isn’t even really caused by alcohol or drugs.
Looking beyond political rhetoric, the research and clinical evidence show that addiction is created by numerous factors that are both innate/biological (nature) and social/environmental (nurture). About 50 percent of a person’s risk for developing an addiction is related to genetic and biological factors—that’s the “brain disease” part. But the other 50 percent of addiction risk is related to sociocultural and environmental factors, many of which could be reduced by public policies and programs like those discussed at the 2022 White House Conference on Hunger, Nutrition, and Health.
- A permanent Advanced Expanded Child Tax Credit and higher minimum wage would reduce the addiction risk factors of poverty, chronic stress, food insecurity, malnutrition, housing instability, and insufficient parental engagement. Poverty and food insecurity raise levels of ongoing stress and place demands on parents/caregivers that can impede their ability to spend quality time with their children. Reliable financial support could be a more effective substance abuse prevention program than anything we currently provide.
- Expanding SNAP eligibility to college students and formerly incarcerated individuals would increase access to sufficient healthy food and reduce the substance use and addiction risk factors of food insecurity, unhealthy diet, obesity, overall poor health, chronic pain, and chronic health problems.
- Lower education and fewer employment opportunities are risk factors for addiction. Free school meals for all students would decrease the stigma and marginalization of financially disadvantaged families, improve students’ ability to focus, improve students’ health, reduce school-based violence/bullying, and increase student engagement, achievement, and readiness for the workforce.
Preventing child hunger, reducing children living in poverty, reducing food-related health problems, and increasing access to childcare and healthcare are important issues in themselves—and these same policies could directly reduce substance use, addiction, and overdose deaths.
It’s become increasingly clear that we can’t punish and scare our way out of the overlapping public health crises of substance abuse, overdose deaths, and drug-policy-related disenfranchisement. Our communities will never be “drug-free.” But maybe we can legislate our way toward increased addiction resistance by acknowledging that anti-poverty policies are likely the most effective anti-drug policies of all.
Copyright 2022 Kelly E. Green, Ph.D.
