The link between poverty and problem substance use is clear. This is borne out in statistics but also in the experience of those working with people with substance use problems and in the personal experiences of hundreds of thousands of people in Scotland.

A few statistics paint enough of the picture to confirm the link. In 2017/18, an estimated 49% of the patients with a drug use related GP consultation lived in an area classed as in the 20% most deprived areas as opposed to the 4% of patients who were living in the 20% least deprived areas. Approximately half of the patients with a drug-related general acute or psychiatric hospital stay lived in the most deprived areas in Scotland.

Problem alcohol use is similarly linked to poverty. For example in 2015 in the most deprived areas of Scotland rates of alcohol-related death were six times higher than in the least deprived areas, while rates of alcohol-related hospital stays were nine times higher. (Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) NHS Health Scotland 2017)

And yet the root cause of poverty is denied in notions of problem substance use being a personal or moral failing or a wilful choice (see lifestyle choice). These can be regarded as moralistic arguments which are based on religious perspectives that substance use is essentially sinful i.e. evil. There are also political perspectives that deny the role of poverty and the role of the state in inducing and addressing problem drug use. The evidence clearly contradicts any assertion that poverty and indeed class are not relevant.

There are people who have no experience of poverty but who develop substance use problems – these are largely linked to trauma and mental health issues.
(See adverse childhood experiences; see trauma; see self medicating)

It should also be noted that people who experience poverty and have a substance use problem may well also have experienced trauma and mental health issues.

Poverty is a stigmatised state and people do not readily self-identify as being or having been in poverty. Poverty is also closely linked to class which is an issue many people can find it difficult to discuss or describe. For these reasons, poverty is not mentioned in many personal narratives (see personal narratives). It may also be excluded from personal narratives because people feel that they are blaming their community for their personal problems (which the poverty analysis does not do, of course). They may also feel that poverty is irrelevant because a substance use problem ‘could happen to anyone’ – which is not borne out by the evidence. (See could happen to anyone). Poverty is also perhaps excluded from personal narratives because it is taken for granted; a ‘given’.