Elsevier

Drug and Alcohol Dependence

Volume 142, 1 September 2014, Pages 350-353
Drug and Alcohol Dependence

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Unemployment and substance outcomes in the United States 2002–2010,☆☆

https://doi.org/10.1016/j.drugalcdep.2014.06.012Get rights and content

Abstract

Background

The economic shock of 2008–2009 provided an opportunity to study the robustness of observed statistical associations between unemployment and problematic substance use.

Methods

Data from 405,000 non-institutionalized adult participants in the 2002 to 2010 U.S. National Survey on Drug Use and Health were used to compare substance outcomes among unemployed and employed persons. Association of unemployment with substance outcomes was examined for the years 2002–2004, 2005–2007, 2008, and 2009–2010, corresponding to periods prior to and after the economic downturn of 2008. Multivariate logistic regression models adjusted for age, sex, race/ethnicity, education, urban/rural residence, current DSM-IV Major Depression, and local county unemployment rates.

Results

Higher rates of past month tobacco and illicit drug use, heavy alcohol use, and past-year drug or alcohol abuse/dependence were found among the unemployed. Markedly increased unemployment in 2009–2010 did not moderate the association between substance outcomes and employment. This association was not confounded by sex, age group, or race/ethnicity for tobacco and illicit drugs, although it varied for alcohol outcomes among 18–25 year-olds. Results based on retrospective data regarding marijuana use in the period prior to unemployment suggest its use was associated with future job loss.

Conclusions

Employment status was strongly and robustly associated with problematic use of substances. Prevention and treatment interventions are warranted for a group whose employment and resulting insurance status may impair access to much needed health care.

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.

Section snippets

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.

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