Short communicationUnemployment and substance outcomes in the United States 2002–2010☆,☆☆
Introduction
The connection between economic stress, substance use, and addiction is complex. Substance use and addiction can be both the cause and outcome of economic stresses (Davalos et al., 2012, French et al., 2011). For alcohol, results have been conflicting, suggesting either increased alcohol problems in response to economic stress (Arkes, 2007, Crawford et al., 1987, Davalos et al., 2012, Dee, 2001, Hammer, 1992, Janlert, 1997, Merline et al., 2004, Peck and Plant, 1986; Kriegbaum et al., 2011; Merline et al., 2004; Mossakowski 2008; Peck and Plant, 1986) or a moderating income effect (Ettner, 1997, Freeman, 1999, Johansson et al., 2006, Ruhm, 1995, Ruhm and Black, 2002). Studies highlighting the relationship between illicit drug use and employment, though few in number, have generally shown an inverse association of drug use to employment (De Simone, 2002, French et al., 2001; Platt, 1995). Studies have also addressed the implications for drug treatment (Platt, 1995) and have focused on the relationship between drug availability and employment (Gascon and Spiller, 2009).
In 2008 the world's economies, including that of the United States, collapsed (Hurd and Rohwedder, 2010; Mishel et al., 2012). The U.S. unemployment rate rose from 5.8% in 2008 to 9.3% in 2009 (Bureau of Labor Statistics, 2014). This economic shock provided a unique opportunity to study the impact of macroeconomic stressors on substance use and addiction. Thus, the present study used annual cross-sectional national surveys to estimate the statistical association of unemployment and problematic substance use during a period of high unemployment compared to earlier times of nearly full employment. The study examined the relationship of past month heavy alcohol use, use of illicit drugs, tobacco use, and past year DSM-IV alcohol and illicit drug abuse and dependence to unemployment during 2002 through 2010. We hypothesized strong associations between unemployment and substance use outcomes. Consistent with the observation that higher prevalence can be associated with lesser influence of a risk factor (Helzer et al., 1992) we further hypothesized that the association between unemployment and problematic substance use would be moderated in 2009–2010. Finally, while the data in this study did not allow for prospective examination of the order of events, retrospective self-report information was available on the timing of both marijuana use and recent unemployment. Using these data, we conducted exploratory work on the timing of marijuana use and job loss.
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Data
Data were from the Substance Abuse and Mental Health Services Administration (SAMHSA)’s 2002–2010 U.S. National Survey on Drug Use and Health (NSDUH), an annual national survey of civilian, non-institutionalized individuals (SAMHSA, 2013). Items in the NSDUH survey have good reliability and validity (Substance Abuse, 2010, Jordan et al., 2008, Grucza et al., 2007). The nine years analyzed included data from approximately 405,000 respondents age 18 or older. Primary variables related to current
Results
Consistent with official U.S. rates (BLS, 2014), study subjects had markedly higher (p < .0001) rates of unemployment in 2009–2010 compared to earlier years (Table 1). For every time period, each category of problematic substance use was more prevalent among the unemployed (Table 1). Heavy alcohol use, illicit drug use, tobacco use, alcohol abuse or dependence, and illicit drug abuse or dependence were more prevalent among the unemployed before, at the start of, and during the 2009–2010 period of
Discussion
Consistent with prior literature, unemployment is associated with higher rates of tobacco use, heavy alcohol use, illicit drug use, alcohol use disorders, and illicit drug use disorders. Inconsistent with our hypothesis, we found that during a period of macro-economic distress, when the unemployment rate soared, the relationship of unemployment to problematic substance use persisted.
Findings were consistent across most subgroups with one exception: unemployment was not associated with higher
Role of Funding Source
Support for this work was through Contract Number HHSS283201000003C by the Center for Behavioral Health Statistics and Quality (CBHSQ), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), with RTI International, Research Triangle Park, North Carolina. The co-authors planned and supervised all data analysis and drafted the manuscript as part of their official work at SAMHSA (JG) and the National Institute on Drug Abuse (WC, KC,
Contributors
Compton, Gfroerer and Conway designed the research. Gfroerer supervised the data analysis and statistical analysis. Finger and Compton produced final tables for publication. Finger conducted literature searches for the background. Compton produced the first full draft of the manuscript. All authors provided critical editing and contributed to the final manuscript. All authors approve the final manuscript.
Conflict of interest
All authors affirm that there are no conflicts of interest with any people or organizations that could be perceived to have influenced this work. This research was conducted as part of official work at SAMHSA (JG) and the National Institute on Drug Abuse (WC, KC, MF).
Acknowledgements
We gratefully acknowledge Sarah Duffy, Ph.D. of NIDA who provided encouragement and suggestions regarding the direction for this work. In addition, an early version of this work was presented at the International Federation of Psychiatric Epidemiology.
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Note: The opinions and conclusions here represent those of the authors, and do not represent the National Institutes of Health, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, or the US Government.
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Supplementary material can be found by accessing the online version of this paper at http://dx.doi.org and by entering 10.1016/j.drugalcdep.2014.06.012.