A few months ago, The Economist it had an article about the drug problem in Scotland. This figure caught my eye:
Scots in the poorest areas are 16 times more likely to die drug-related than those in the wealthiest areas.
The difference between the excess death rates of the rich and the poor is too great to be attributed to mere accident. This contradiction cries out for some kind of explanation.
Another possibility is that lack of money makes people depressed, and depressed people often abuse drugs to ease the pain of poverty. Another possibility is that both poverty and drug abuse are caused by a third factor. How can we separate these different ideas?
A similar article in the Economist has a graph that shows equally striking differences in drug overdose rates across countries:
There appears to be little or no correlation between the wealth of nations and the level of drug abuse. Scotland’s GDP per capita is right on average for the European Union, the US is richer than the European average, while Portugal is poorer than the average. And yet it is Portugal that has the lowest drug overdose death rate.
So how can we reconcile the fact that drug abuse in a country like Scotland is highly correlated with income, while at an international level one sees little evidence of poverty driving drug abuse? Another possibility is that both drug abuse and poverty are caused by a third factor.
Suppose that both poverty and drug use are associated with some personality trait. And consider that all countries have a mix of people, some more vulnerable to drug use than others. And finally, consider that international differences in per capita income are not due to differences in national personalities. I am not suggesting that any of these assumptions are entirely true, rather that they allow us to understand why drug use and country may be strongly related to poverty, but not in all countries.
If we assume that in both poor and rich countries a stable percentage of people have personalities that make them vulnerable to drug abuse, then we should not expect more drug abuse in poor countries than in rich countries. If we also assume that the same personality trait that leads to drug abuse also leads to poverty (i.e. lack of self-control), then we can explain both the intra-country correlation and the lack of international correlation.
Case closed? Not really. This does not explain why there is such a huge difference in drug deaths between different countries (even between different regions, as we see in the UK.) There is something else going on, but poverty alone does not seem to be the problem. definition.
Another possibility is that some countries have legal systems that tolerate drug use. But that also doesn’t seem relevant, as both Switzerland and Portugal rely heavily on a soft “harm reduction” approach, while the US and Scotland have strong anti-drug laws. Indeed, it is possible that strict enforcement of drug laws has increased overdose deaths, by creating an underground market where the quality of the drug is highly unreliable.
Rather, I suspect that drug use is related to two factors—personality and regional culture. Regions of the world where people lack social support systems may have higher rates of substance abuse, and people with certain personality types within any given area are more likely to abuse drugs. The worst case scenario of all would be people with no self-control and living alone in countries without strong support systems for people struggling in life.
In the US, these two regions have the lowest rates drug overdose deaths is Nebraska and South Dakota. Both states have many small rural towns with a strong sense of community. North Dakota used to be traditionally homogenous, but the growth of fracking in the Bakken region has brought many young workers separated from their families and communities. North Dakota still has a low rate of drug overdoses, but it is now worse than its two neighbors to the south. And yet no one would argue that the oil boom has made North Dakota poor—indeed, the opposite is true.
In conclusion, poverty is probably not directly responsible for drug deaths. But in any given region, the factors that cause poverty are likely to be related to the factors that cause drug abuse.
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