People still talk about certain drugs as gateways to others. These are often Class C drugs such as steroids, benzodiazepine and other opioids, or legal highs. But therapists and mental health specialists have always known that these are not the root cause of addiction issues, or of wider substance abuse.

We’ve delved deep into UK government figures, public health reports and other research, to put the spotlight on the real gateway drugs affecting people in the UK right now.

• Mental health issues and financial insecurity are two of the biggest issues connected with substance misuse.
• Figures show that housing issues, domestic violence and other socio-political factors fuelling poverty are also ‘gateway drugs’ that continue to drive addiction and ruin lives.
• Among all substances, alcohol is the most damaging; 64% of adults entering treatment for substance issues in 2022 had a problem with alcohol.

With the cost of living crisis plunging more and more people into poverty, and the country already struggling after a decade of government cuts to addiction services, the UK has become an ideal breeding ground for substance addiction as growing numbers of people struggle to cope with the untreated social issues affecting their lives.

“Economic downturns are associated with increases in suicide rates. They also increase the risk of depression, anxiety and alcohol use”. - WHO 2022 World Mental Health Report

Poverty and inequality feed addiction

When we look at the relationship between poverty and addiction, we don’t have to dig deep to find studies which show that alcohol and substance abuse are far more common among individuals of ‘lower economic status’.

“Among adults living in high-income countries, drug use disorders tend to be more prevalent among those who experience socioeconomic disadvantage, which is most frequently measured in terms of low educational level, low income level or unstable employment status, or a combination of these factors” – UN World Drug Report

Recent ONS data show that people in the most deprived communities in Scotland are 18 times more likely to experience problem drug use than those in the least deprived communities. Director of The Poverty Alliance, Peter Kelly, states “We can’t tackle drug deaths without tackling poverty”.

According to research compiled by the Joseph Rowntree Foundation, in 2021 one in five people in the UK (20%) was living in poverty, the equivalent of 13.4m people.

You only need to look at the data to begin to correlate drug and alcohol use with poverty. In England, four of the five cities with the highest rates of alcohol dependency are also severely deprived areas, according to government figures published in January 2023. For comparison, the national average is a rate of 1.37 per 1000 people.

1. Blackpool: 3.5 per 1000
2. Southampton: 2.65 per 1000
3. Liverpool: 2.53 per 1000
4. Middlesbrough: 2.5 per 1000
5. Sunderland: 2.48 per 1000

According to a new report, Blackpool is a town plagued by too many preventable fatalities linked to alcohol, drug abuse and suicide - collectively described by the bleakly poetic phrase "deaths of despair" by health researchers.

A study of deaths recorded at coroners' courts across England suggests that between 2019 and 2021, about 46,200 people lost their lives in this way - the equivalent of 42 people every day.

In Blackpool the rate is 83.8 for every 100,000 people.

Compare that to the area with the lowest rate, Barnet in Greater London, where the figure stands at 14.5 deaths per 100,000 people.

The Living Wage Commission notes that 6 of England’s 20 poorest areas are in Blackpool. Meanwhile, ONS data finds that Middlesborough is the most income-deprived area in England, with Blackpool and Liverpool 3rd and 4th most deprived, and 1 in 5 Sunderland residents said to be ‘income deprived’.

So, why does poverty increase the likelihood of substance addiction?

Housing problems & healthcare access

Homelessness and housing issues are problems that occur more frequently among those on low or unstable incomes. These issues are closely linked to substance misuse. A 2023 report from the Office for Health Improvement & Disparities looks at adult substance misuse treatment in England throughout 2022, finding that:

• 16% of all adults starting addiction treatment in 2022 had housing problems. Almost one third of these were classified as having ‘No Fixed Address’.
• 30% of opiate users had housing problems, and of these 43% were people with no fixed address.

The USA’s National Coalition for the Homeless notes that while addiction can be the trigger that causes housing insecurity or homelessness, substance abuse often arises as a result of people losing their housing, rather than the other way round. Studies in Australia, Canada and other regions have found that as many as two thirds of homeless individuals with addiction problems only developed those addictions as a result of their housing issues.

“This population is vulnerable to complex mental illnesses due to the constant worrying about their future housing status and the struggles of navigating through harsh living situations. Accessing comprehensive psychiatric care is often a challenge for people experiencing housing problems.” - BLA Report

A report from the Health Foundation found that the UK’s poorest areas are also the worst-off when it comes to health inequality, due to a combination of poverty-driven pre-existing health conditions and difficulty accessing health care. People living in deprived areas face a perfect storm of financial insecurity, housing instability and poor access to both mental and physical health support, all of which play a part in triggering and perpetuating addiction.

Domestic violence

Women in low-income households are 3.5 times more at risk of suffering domestic violence than those women in higher income households.

This statistic is part of a vicious cycle, as men with substance use disorders are six times more likely to abuse their partners than those without – but women who have experienced abuse are three times more likely to go on to use alcohol and drugs themselves than those who have not.

One study carried out at Drake Hall Prison found that 64% of female inmates had a history of brain injury, with 62% of those sustaining the brain injury as a result of domestic violence. Wider research notes that this type of injury can make a person more likely to take risks, and to struggle to differentiate between good choices and bad ones.

• There were 64,807 domestic abuse incidents recorded by Scottish police in 2021-22.
• Police in Northern Ireland recorded 33,186 domestic abuse incidents in the same year.
• In England and Wales, 5% of UK adults aged 16+ experienced domestic abuse in 2021-22 - estimated to be roughly 1.7 million women and 699,000 men.

Of course, cycles of addiction and violence in the home also affect children and young people living alongside these issues. According to the British Association of Social Workers “Children who grow up with domestic abuse and substance use in the home are at greater risk of substance use and in adulthood”.

A recent report by the Children’s Commissioner for England identified that 50,000 children aged zero to five were living in households where domestic violence, alcohol or drug dependency and severe mental health issues were all present.

Untreated trauma from mental health issues fuel the fire

• Recent data shows that 70% of adults starting addiction treatment in 2022 had mental health needs, compared to a national average of 30%
• 22% of these were not receiving any kind of treatment
• ONS data notes that 21% of adults who report low levels of happiness day to day tried drugs in 2021/22, compared to 8% of those whose happiness was ‘very high’
• 16% of those whose satisfaction with life was low had used drugs in 2021/22, compared to 5% who said it was ‘very high’

At Rehabs UK, we see first-hand that some of the biggest underlying issues in people who misuse alcohol or other substances are a lack of mental health support and/or unresolved trauma. Dual-diagnoses and co-occurring disorders with addiction are common, and it’s well known that there is a direct link between substance and alcohol abuse and mental health conditions such as depression. One US study revealed that people seeking treatment for PTSD are 14 times more likely to be diagnosed with a substance abuse disorder.

Sadly, a combination of inadequate funding in addiction services and ever-growing waiting lists for NHS mental health support means more people will continue to suffer.

“This government, and those before it, fail to see the damage they cause. Not to mention the strain these cuts place on those of us who are left to pick up the pieces. We and other rehab services do what we can, but the government must do more. The figures speak for themselves, the cuts have destroyed lives.” - Lester Morse, Director, Rehabs UK

Childhood trauma

Of course, a number of those who experience trauma are those who have lack of mental health support, and it is important to nip this in the bud as early as possible. Childhood trauma fuels substance abuse issues later in life and there are various factors that make it more prevalent such as poverty and low socio-economic standing.

UK government figures show that there were 49,748 UK children with parents in substance misuse treatment in 2022, and that 65% of these were not receiving any early help. That’s almost 50,000 vulnerable children being let down in the UK, all experiencing trauma and are at risk of increasing their chances of mental health and substance abuse later in life.

Research as part of The Adverse Childhood Experiences (ACE) Study says that: “experiencing childhood abuse, neglect or other traumatic stressors, known as adverse childhood experiences, increases the individual’s risk for a variety of health problems as an adult, including alcoholism, heart disease, obesity, drug use, liver disease, and depression, among others”.

“Many problems in the area of substance use and mental health begin early in life and that children who come from less advantaged backgrounds are at higher risk. Those problems also influence their education and socio-economic situation in the longer term, often fueling a vicious circle” - Maria Melchior, Senior Researcher, Pierre Louis Institute of Epidemiology and Public Health

Why is the media so focused on the wrong things?

Organisations like the UN have repeatedly noted that it is poverty and inequality which sit at the root of addiction issues. So why does the media so often focus on the idea of “entry-level” drugs, and blame trends like “heroin chic” fashion rather than pointing the finger at decades of government cuts to health and housing services?

“Substance use disorders are symptoms of a systemic, socioeconomic type of disease. We cannot hope to eradicate addiction until we treat the deeper issues affecting our society, and until we provide meaningful and comprehensive mental health care to everyone that needs it.” - Lester Morse, Director, Rehabs UK

If any one substance was to be scapegoated in place of pointing the finger at poverty wages or a lack of affordable housing, figures shine that spotlight directly on alcohol rather than on opioids or other street drugs. 64% of new addiction treatment entrants in 2022 had alcohol problems, compared to ‘only’ 25% with opioid problems. But as with other addictions, misuse of alcohol is not the gateway from one addiction to another – it is just another symptom of the broader societal illness.

What can be done to break the cycles?

The government strategy on treating addiction is not good enough, focusing on the symptoms, and not the causes of addiction. 20% of the UK population were already living in poverty before the energy crisis began, with this figure estimated to be much higher now – which we believe could take us from the precipice of an addiction epidemic to skyrocketing rates of substance misuse, trauma and violence.

The Joseph Rowntree Foundation charity in Northern Ireland recently released a report calling on the government to:

• Focus on the adequacy of the social security system
• Invest more in social housing
• Take action to provide targeted employability support (with a focus on disabled people and single parents)
• Work with employers and the education system to ensure that people are able to secure the skills that they need (with an emphasis on jobs of the future)

At Rehabs UK, we agree that all this and more is needed from the government, including:

• Increasing funding to drug and alcohol intervention services
• Improving funding for other health and social care provisions to prevent and tackle harm

The past ten years of cuts to addiction services and a reluctance to treat the symptoms and not the root causes are leading to avoidable deaths. How much more trauma related to drug use do people need to endure before things truly start to change? The government and NHS statistics only give us a snippet of how serious this issue is.

Rehabs UK is committed to continuing to support those battling alcoholism, drug addictions and behavioural addictions. If you need help, reach out to one of our empathetic specialists today.