Unemployment and Substance Use: A Review of the Literature (1990-2010)
Institute of Addiction Research, University of Applied Sciences, Frankfurt a.M., Germany. Current Drug Abuse Reviews
04/2011; 4(1):4-27. DOI: 10.2174/1874473711104010004
The current article summarizes the results of a comprehensive review of the international research published between 1990 and 2010. The research was focused on the prevalence of substance use/disorders among the unemployed and employed, the impact of substance abuse on unemployment and vice versa, the effect of unemployment on alcohol/ drug addiction treatment and smoking cessation, and the relationship between business cycle, unemployment rate and substance use. Over hundred-thirty relevant studies were identified investigating these issues. The main results are as follows: (1) Risky alcohol consumption (associated with hazardous, binge, and heavy drinking) is more prevalent among the unemployed. They are also more likely to be smokers, to use illicit and prescription drugs, and to have alcohol and drug disorders (abuse, dependence). (2) Problematic substance use increases the likelihood of unemployment and decreases the chance of finding and holding down a job. (3) Unemployment is a significant risk factor for substance use and the subsequent development of substance use disorders. However, the current research provides only limited information about which individuals are more likely to be affected. (4) Unemployment increases the risk of relapse after alcohol and drug addiction treatment. (5) The exact nature of the relationship between unemployment and the probability of smoking cessation remains unclear due to the mixed results observed in the literature review. (6) Drinking and smoking patterns appear to be procyclical. We see a decrease in both when the economy declines and the unemployment rate increases. In contrast, a countercyclical trend was observed amongst adolescent drug users. However, these studies do not provide any convincing or additional information about substance use amongst the unemployed. This paper discusses the merits, limitations and problems of the research, proposes numerous future research questions, and outlines important implications for policy makers and practitioners, especially with regard to prevention and vocational promotion and rehabilitation.
Available from: harmreductionjournal.biomedcentral.com
- "This also means that drawing on existing familial resources is of great importance for social and health-related care. In contrast to international research where high rates of unemployment of PWUD are often described, e.g.,[10,32], our study revealed a different picture: In Kazakhstan, where PWUD are generally younger, their employment situation was even more advantageous (more than 50 % in regular employment) than among Kyrgyzstan's rather older PWUD (around one third in regular employment).The results regarding drug use showed that both groups consisted of mainly long-term opioid-dependent persons who usually consumed intravenously. Further, we surveyed polyvalent consumption patterns with high proportions of (additional) cannabis and alcohol use. "
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In Central Asia, there is a need to update information about the situation of people who use (opioid) drugs (PWUD), especially regarding their access to and utilization of health care services. The aim of the study was to gather information about two different groups of drug users in Kazakhstan and Kyrgyzstan.
In 2013, two groups of PWUD were recruited in Kazakhstan and in Kyrgyzstan in order to gather quantitative data via interviewer-administered questionnaires. PWUD registered with the Narcological Register were allocated to group A while non-registered PWUD were allocated to group B. Interviews were conducted in the office of the Narcological Register as well as in low-threshold facilities. Participants reported about their drug use patterns, health status, and utilization of health services as well as barriers to utilization.
The sample consisted of N = 600 PWUD (301 registered and 299 non-registered PWUD) from Kazakhstan and N = 900 PWUD (450 registered and 450 non-registered PWUD) from Kyrgyzstan. Both groups—registered (group A) and non-registered (group B)—consisted of mainly male long-term intravenous opioid users. We found high rates of current (last 30 days) opioid use (group A up to 70 %; group B up to 84 %). Most PWUD were burdened with poor physical and mental health. The prevalence of infectious diseases added up to 19 % (group A) or 13 % (group B) regarding HIV, 56 % (group A) or 30 % (group B) regarding HCV, and 24 % (group A) or 20 % (group B) regarding tuberculosis. Registered and non-registered PWUD reported high rates (95 or 82 %) of lifetime use of health services for PWUD. Drug-related services were utilized less often, especially among the non-registered PWUD (13 %). The most important barriers preventing PWUD from accessing services were the belief not to need treatment, doubts about the effectiveness of treatment, mistrust of treatment regime/staff, and fear of being registered with the Narcological Register (mainly group B).
Results show that access to the health care system for non-registered PWUD is realized mainly through low-threshold facilities. Opioid substitution treatment, which is an important pillar in the treatment of PWUD, is normally only available for those registered with the Narcological Register. Instead, access to opioid substitution treatment (especially in Kazakhstan) should be expanded and granted without prior registration, as this poses an important barrier for PWUD’s utilization of drug treatment services. Further, there seems to be a need for the provision of specific and target group-related information about drug treatment services in order to reduce existing reservations among PWUD as to the necessity and effectiveness of modern drug treatment.
Available from: Dieter Henkel
- "Longitudinal studies examining the causal relationship between addictive behaviours and SES are missing in the current research in Germany. For example, binge drinking can be seen as both the cause and the consequence of unemployment. Being able to clarify and differentiate cause and consequence is particularly important for preventative efforts as these should target the causes, rather than the consequences, of a problematic behaviour. "
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ABSTRACT: The current review provides an overview of socioepidemiological research in Germany about the prevalence of addictive behaviours (smoking, binge and hazardous drinking, consumption of cannabis and other illegal drugs, the non-medical use of prescription drugs and problematic gambling) among adolescents (11-17 years) and young adults (18-25 years), also differentiating between different socioeconomic status (SES) indicators (attended school type, family affluence, parental occupational status, parental SES, employment status) and migration background. The authors evaluated data from ten national surveys and one regional survey conducted between 2002 and 2012, which included different samples. The trends over this time frame reveal that the proportion of adolescents who smoke tobacco, show problematic patterns of alcohol consumption, use cannabis or other illegal drugs has generally declined over the investigated time span in Germany. The results nevertheless suggest that some strong associations still exist between social inequalities and the prevalence of substance use. The detailed results are summarised in twelve tables. The main results are as follows: 1) Low SES (school type, em¬ploy-ment status) was consistently associated with more cigarette smoking, and, where such data was available, this pattern was observed in both males and females. 2) With regard to family affluence, two surveys show that boys with low and middle FAS are significantly less likely to have binge drinking experience compared to boys with high FAS. There were no significant associations between problematic alcohol use and parental SES, and not all results of the surveys show that binge drinking is more prevalent among HS-students. Employment status was associated with gender differences; problematic patterns of alcohol consumption were significantly more prevalent among young unemployed males compared to GY-students (secondary high school/grammar school) of the same age. The opposite was true for females. Another consistent finding was that among adolescents and young adults with a Turkish/Asian migration background, a problematic use of alcohol was significantly less common compared to adolescents and young adults of the same age without a migration background. 3) In terms of the consumption of cannabis, the unemployed and students with low educational level (`Hauptschule´) emerge as high-risk groups. 4) The results concerning problematic gambling significantly overlap with and reflect the findings of international research: being male, of low educational attainment, unemployed, receiving social welfare, and having a migration background significantly increased the risk of problematic gambling habits. 5) The highest lifetime prevalence rates for the consumption of illegal drugs (other than cannabis) were observed among students with low educational level. It should be noted that other SES indicators, in addition to school type, have not been examined to date. The review concludes by outlining gaps and future research areas, as well as presenting several implications for prevention initiatives.
- "Our multivariate analysis confirms this result, also adding new data: (i) a negative trend in the mortality rate in relation to the time interval from registration; and (ii) being employed was associated with a lower mortality rate. In fact, it is well-known that being unemployed may play a crucial role as a risk factor for persistent heavy drinking and for alcohol relapsesand for an increased risk in developing some specific cancers[28,29]. This study presents some limitations. "
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ABSTRACT: Introduction and aims:
The aim of this study was to investigate the mortality risk and to explore the presence of subjects more at risk of dying in a cohort of alcoholic individuals treated for alcohol dependence over a lengthy follow-up period.
Design and methods:
A total of 2363 subjects attending 10 centres for addiction treatment for alcohol dependence were recruited.
During the 17 year follow-up period, 14.7% of the entire cohort died. Total standardised mortality rates (SMR) were higher in women (SMR = 5.94) as compared with men (SMR = 4.65). Higher SMRs were found for several diseases, for traumatic episodes (SMR = 6.65) and in younger patients (18-44 age group) (SMR = 8.16). Alcoholic women showed a higher survival rate as compared with men. In addition, a higher risk of death for men and unemployed subjects, with a progressive increase of risk in line with the increase of the age of admission to treatment, and with a progressive decrease of risk after 1 year from the beginning of the treatment, was also found.
Discussion and conclusions:
This study confirms that mortality risk in alcoholic individuals in treatment is higher in comparison with the general population. Moreover, alcoholics men, unemployed, >40 years at time of admission and during the first year of treatment are more at risk to die. Thus, much more attention to patients with these characteristics should be planned by the professional staff working in centres for addiction treatment. [ Pavarin R M, Caputo F, Zoli G, Domenicali M, Bernardi M, Gambini D. Mortality risk in a cohort of Italian alcoholic individuals treated for alcohol dependence Drug Alcohol Rev 2015;00:000-000].
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