Unemployment rate, opioids misuse and other substance abuse: quasi-experimental evidence from treatment admissions data

Abstract

Background The relationship between economic conditions and substance abuse is unclear, with few studies reporting drug-specific substance abuse. The present study examined the association between economic conditions and drug-specific substance abuse admissions. Methods State annual administrative data were drawn from the 1993–2016 Treatment Episode Data Set. The outcome variable was state-level aggregate number of treatment admissions for six categories of primary substance abuse (alcohol, marijuana/hashish, opiates, cocaine, stimulants, and other drugs). Additionally, we used a broader outcome for the number of treatment admissions, including primary, secondary, and tertiary diagnoses. We used a quasi-experimental approach -difference-in-difference model- to estimate the association between changes in economic conditions and substance abuse treatment admissions, adjusting for state characteristics. In addition, we performed two additional analyses to investigate (1) whether economic conditions have an asymmetric effect on the number of substance use admissions during economic downturns and upturns, and (2) the moderation effects of economic recessions (2001, 2008–09) on the relationship between economic conditions and substance use treatment. Results The baseline model showed that unemployment rate was significantly associated with substance abuse treatment admissions. A unit increase in state unemployment rate was associated with a 9% increase in treatment admissions for opiates (β = 0.087, p < .001). Similar results were found for other substance abuse treatment admissions (cocaine (β = 0.081, p < .001), alcohol (β = 0.050, p < .001), marijuana (β = 0.036, p < .01), and other drugs (β = 0.095, p < .001). Unemployment rate was negatively associated with treatment admissions for stimulants (β = − 0.081, p < .001). The relationship between unemployment rate and opioids treatment admissions was not statistically significant in models that adjusted for state fixed effects and allowed for a state- unique time trend. We found that the association between state unemployment rates and annual substance abuse admissions has the same direction during economic downturns and upturns. During the economic recession, the negative association between unemployment rate and treatment admissions for stimulants was weakened. Conclusion These findings suggest that economic hardship may have increased substance abuse. Treatment for substance use of certain drugs and alcohol should remain a priority even during economic downturns.

Evaluation of Substance Use Disorder Readmission and Length of Hospital Stay in a Major Rehabilitation Center in the Gulf States: a Retrospective Cohort Study

“…Including nationally representative data, the Drug and Alcohol Services Information System has documented low employment rates among adult individuals undergoing SUD treatment: less than onethird of the sample (31%) were employed (Substance Abuse and Mental Health Services Administration Office of Applied Studies, 2008). A recent experimental study on the economic condition and admission among patients with SUD has concluded that economic hardship may increase the number of SUD admissions (Azagba et al, 2021). The coronavirus disease (COVID-19) pandemic resulted in economic downturns worldwide, including in Saudi Arabia.…”

Problem drinking as intentional risky behavior: Examining the association between state health insurance coverage and excessive alcohol consumption

“…We tested whether the association between health insurance and heaving-drinking rates differed between economic downturns and upturns. Following previous studies, we replaced health insurance variables in Model 1 with two decomposed variables – insurance coverage during economic downturns and insurance coverage during economic upturns -- in order to capture potential asymmetric effects ( Azagba et al, 2021 , Carpenter et al, 2017 , Mocan and Bali, 2010 ). We define downturns and upturns as periods when the unemployment rate is higher or lower, respectively, than the prior period and zero otherwise.…”

Matrix‐variate time series modelling with hidden Markov models

“…The second change (March 2010) is closely related to an overall increase in hydrocodone MME (solid blue lines switch to black ones). This regime change is probably due to the economic crisis that commenced in 2008, which has contributed to the increased illegal use of opioid drugs (Azagba et al 2021). The last change (April 2012) is again related to hydrocodone.…”