The emotional, financial, and societal costs of substance use disorder are bigger than we realize.
A recently published research report, entitled An Overlooked Emergency: More Than One in Eight US Adults Have Had Their Lives Disrupted by Drug Overdose Deaths, caught my eye.1 I’ve underappreciated the enormous toll that addiction, substance use disorder, and overdose deaths have had. Its negative effects ripple through families, communities, and our society. And stigma and shame fuel it.
The Emotional Toll
For the individual suffering from SUD, feelings of shame and guilt are common. We know that stigma is a major driver of the addiction crisis, and it discourages people from seeking help or even talking about their illness. It’s telling that many will avoid attending a 12-step support group where they might encounter a co-worker or neighbor. They might feel regret for the pain they have caused loved ones and for the mistakes they have made under the influence. Suicide is all too common.2
Family members often must bear witness to their loved one’s self-destruction, and this causes significant emotional distress.3 They can live in a constant state of worry and fear for the well-being of their loved ones. The unpredictable nature of SUD can lead to a chaotic and unstable home environment, which can be particularly damaging for children who suffer emotional turmoil and psychological damage.
Family members also experience addiction stigma and shame. Parents are often reluctant to admit that their child has a substance use disorder. Children actively hide a parent’s addiction, knowing that it is socially unacceptable. When a loved one dies of an overdose, family members often must grieve in silence and isolation.1
Witnessing an overdose or discovering a loved one who has died from an overdose is traumatic. Millions of Americans experience a devasting sense of loss that can linger for years.1 Overdose loss survivors, friends and family as well as people who use drugs, have few resources available to them to process their experience.
The Economic Toll
Similar to other prevalent chronic diseases, like diabetes, cancer, and heart disease, the economic burden of substance use disorder is huge. Individuals dealing with SUD often face financial difficulties. The cost of sustaining the substance use, coupled with the potential loss of employment due to the inability to function effectively at work, leads to financial instability. At the same time, medical treatments and rehabilitation programs for SUD are costly, further exacerbating the financial strain on individuals and their families.
The direct medical cost to treat substance use disorder is more than $15k per person per year and totals more than $35 billion.4 But that pales in the face of the broader, indirect costs. In the United States, the estimated economic cost of opioid use (alone) was 1.5 trillion dollars in 2020. In addition to direct medical costs, substance use disorder leads to lost work productivity, increases the risk of withdrawing from school, and contributes to the high cost of running our criminal justice system. Dropping out of school affects not only the individual’s future prospects but also the community’s productivity and long-term economic growth.
The Societal Toll
The cycle of addiction perpetuates a cycle of poverty and disenfranchisement, trapping individuals, families, and communities in a downward spiral with limited avenues for escape. Communities affected by high rates of SUD can experience collective emotional distress. Higher crime rates and a deterioration in social cohesion can lead to feelings of fear and mistrust. The strain on public services such as law enforcement can create a sense of frustration and helplessness.
The negative social impacts of substance use disorder permeate every facet of society, underscoring the need for comprehensive prevention and intervention strategies.
If you put shame in a petri dish, it needs three ingredients to grow exponentially: secrecy, silence, and judgment. If you put the same amount of shame in the petri dish and douse it with empathy, it can’t survive.
–Brené Brown
References:
Athey A, Kilmer B, Cerel J. An Overlooked Emergency: More than One in Eight US Adults Have Had Their Lives Disrupted by Drug Overdose Deaths. Am J Public Health 2024; 114 (3): 276-279.
Lynch FL, Peterson EL, Lu CY, et al. Substance use disorders and risk of suicide in a general US population: a case control study. Addict Sci Clin Pract 2020; 15: article 14.
Landers L, Howsare J, Byrne M. The Impact of Substance Use Disorders on Families and Children: From Theory to Practice. Soc Work Public Health 2013; 28 (3-4): 194-205.
Li M, Peterson C, Xu L, et al. Medical Costs of Substance Use Disorders in the US Employer-Sponsored Insurance Population. JAMA Netw Open. 2023;6(1):e2252378. doi:10.1001/jamanetworkopen.2022.52378