Drug and Alcohol Dqmdence, ll(1983) 297307 Elsevier Scientific Publishers Ireland Ltd.

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DRUG ABUSE AND AFFLUENCE IN FIVE COUNTRIES: A STUDY OF ECONOMIC AND HEALTH CON-DITIONS. 1960-1975

REGINALD G. SMART and GLENN F. MURRAY

Addiction Research Foundation, 33 Russell St., Toronto, Ontario (Canada)

(Received January 12th, 1983)

SUMMARY

Studies have reported a positive relationship between alcohol consump- tion and general levels of affluence in society. The present paper suggests that drug use and abuse should also be related to affluence since, to some extent, alcohol and drugs are substitute products. Levels of drug abuse and levels of affluence, in society, change over time. Therefore, indicators of affluence (economic and health conditions) and various types of illicit drug abuse in five countries were examined for the period 1960-1975. The results of our investigation show that officially recorded measures of drug abuse, in each of five countries, were related to improvements in economic and health conditions.

Key words : Drug abuse - Trend - International - Affluence - Health

INTRODUCTION

There seems to be no accepted theory of drug abuse: the literature is characterized by many distinct and incompatible theories. It has been sug- gested that this fragmentation in the literature was created, in part, by the common practice of many researchers focusing ‘exclusively upon a single substance, thus producing separate literatures specific to different drugs, 111. The present paper acknowledges this appropriate criticism and responds by conducting a macro-level analysis of drug abuse based upon an important hypothesis regarding alcohol consumption. Specifically, it is suggested that the positive relationship reported between alcohol consumption and general levels of affluence in society (see citations below) may also be found between drug abuse and affluence.

Studies have shown that alcohol consumption and liver cirrhosis increase when price relative to income decreases (see Refs. 2 and 3 for reviews), and

0 1983 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland

during times of relative affluence. Moreover, alcohol consumption decreases during economic depressions [41 and in areasexperiencing large-scale labour strikes and hence reduced incomes among the populace 151. These data suggest that other things being equal, both drinking and drinking problems are related to economic afIluence. Moreover, drug use and abuse should be related to aflluence since, to some extent, alcohol and drugs are consumer products which perform similar functions and can substitute for each other.

A preliminary study of narcotic drug abuse and affluence [61 in 152 countries showed that countries with low rates of narcotic drug abuse were mainly poor, developing countries. It was more difficult to categorize the so&-economic status of the group composed of countries with a serious drug problem. The data analyzed in that study represented a static view of the problem in the late 1970’s. However, levels of drug abuse and levels of affluence, in society, change over time. There is a need, then, to study these phenomena as they change. In the present paper indicators of affluence (economic and health conditions) and various types of illicit drug abuse in five countries are examined for the period 1960-1975. Since data from a variety of countries involving different drugs of abuse (cannabis, am- phetamines, opiates) are studied over time there should be a good oppor- tunity to determine whether, in general, drug abuse is related to affluence.

METHOD

Indicators of drug abuse The dependent variable in this study (illicit drug abuse) has been

measured in various ways because similar kinds of data were not available in each of the five countries. For example, the data included narcotic drug convictions (mainly cannabis) in Canada, known drug addicts (mostly heroin and opium) in Hong Kong, drug convictions in Sweden (mostly am- phetamines), opiate addicts in the United Kingdom (mostly heroin) and arrests for narcotic drugs (mostly cannabis) in the United States.

The ideal method would have been to obtain data on drug abuse which were strictly comparable from one country to another, such as per capita drug consumption or data derived from national surveys conducted in a consistent manner. However, such data were not available and no measure of illicit drug use or abuse seems to exist for ideal cross-national com- parisons. Data on seizures of specific narcotic drugs were available for four of the countries but these figures were abstracted from international docu- ments which may or may not be less reliable than data taken directly from source countries.*

*It is interesting to note that we found seizures highly correlated with the various measures of drug abuse-Pearson Correlation Coefficients of 0.89 and 0.85 were found for Canada and the United States, respectively, and for the United Kingdom the coa5cient was 0.54. We had no seizure data for Hong Kong and the seizure data for Sweden was inappropriate for comparison with amphetamine conviction data.

Socio-economic indicators A variety of so&-economic data were obtained indicative of aflluence and

‘quality of life’. The list of variables was similar but not identical for all five countries. For all countries data were obtained for each year (1960- 1975) on: (i) economic factors such as income, gross national product, inflation and unemployment and (ii) quality of life and health factors such as life expectancy and mortality, population per physician and population per hospital bed, and government expenditures on health, education, culture and recreation. * *

Data on exactly the same variables were not available for every country for each year. Consequently, each table shows the variables for which data were available over time for each particular country. In some cases, in- formation at annual intervals was not available but all of the variables included in the analysis had information for at least 70% of the intervals. In fact, for most variables complete data was available.

The major sources of statistics used for each country were the following references:

Canada - Statistics Canada (e.g., Canada Year Book; Economic Review)

e

Hong Kong - Statistics prepared and supplied by the Narcotics Division of the Government Secretariat of Hong Kong

Sweden -National Central Bureau of Statistics (e.g., Statistical Abstract of Sweden; Historical Statistics of Sweden)

United Kingdom - Central Statistical OfEce (e.g., Annual Abstract of Sta- tistics)

United States -Bureau of the Census (e.g., Statistical Abstract of the United States; Historical Statistics of the United States).

Statistical tests Pearson Correlations were performed to provide information on the rela-

tionship of each independent variable to the dependent one. A stepwise multiple regression analysis was conducted to analyze the relationship be- tween the dependent variable and the set of predictor (independent) vari- ables for each country. Also, graphs based on a standardized formulation* of. the raw data were prepared for each country. These graphs compared changes over time in the level of drug abuse and changes in certain in- dependent variables. For this purpose one independent variable was selected

**All economic variables and variables representing various government expenditures were adjusted to control for inflation. Population was also controlled for by dividing appropriate variables by the population estimates for each year.

*Each stancland unit along the vertical axis for each figure represents one-tenth of the highest score for each variable. For example, in Fig. 1 (Canada) one unit for health expenditure equals $28.50 and one unit of the population equals 2.27 million people. This is a useful method

for showing varied data over time.

to represent a group of similar variables. For example, gross national produce (GNP) per capita could represent the following kconomic’ variables: GNP per capita, personal income and unemployment. The variable selected was the one which was most highly correlated with the variables in the group.

BESULTS

Correlations between drug abuse and socio-economic variables For each socio-economic variable and the drug abuse indicator Pearson

Correlation Coefficients were computed (Tables I-V). The size of the cor-

TABLE I

CANADA

Relationships of socio-economic variables to the number of narcotic drug convictions.

Pearson correlation

Variables coefficients

Culture and recreation expenditure ($ per capita) 0.96 Personal income per capita (No. of $) 0.93 Gross national product per capita (No. of $1 0.91 Health expenditure ($ per capita) 0.90 Life expectancy (Expectation of life at birth) 0.88 Hospital beds per population (No. per 1000 pop.) 0.86 Population per physician (No.) -0.85 Education expenditure ($ per capita) 0.76 Mortality rate @lo. deaths per 1000 pop.) -0.57 Unemployment (% labour force unemployed) 0.32

TABLE II

HONG KONG Relationships of So&-economic variables to the number of known drug addicts

Pearson correlation

Variables coefficients

Population per hospital bed (No.1 -0.92 Gross domestic product per capita (No. 8 H.K.) 0.87 Health expenditure ($ H.K. per capita) 0.86 Population per physician (No.) -0.84 Education expenditure ($ H.K. per capital 0.83 Police expenditure ($ H.K. per capita) 0.80 Mortality rate (No. of deaths per 1000 pop.) -0.74 Culture & recreation expenditure ($ H.K. per capita) 0.72 Life expectancy (expectation of life at birth) 1.00

“Based on data from only two years out of sixteen

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TABLE III

SWEDEN

Relationships of so&-economic variables to the number of narcotic drug convinctions

Variables

Pearson correlation coefficients

Education expenditure (Crowns per capita) Population per hospital bed (No.) Population per physician (No.) Gross national product per capita (No. of Kronor) Gross national income per capita (No. of Kronor) Life expectancy (Mean expectation of life at birth) Culture & recreation expenditure (Crowns per capita) Health expenditure (Crowns per capita) Mortality rate (No. of deaths per 1000 pop.) Unemployment (% labour force unemployed)

0.87 -0.82 -0.78

0.76 0.75 0.73 0.70 0.67 0.62 0.40

TABLE IV

UNITED KINGDOM

Relationships of so&-economic v.ariables to the number of known opiate addicts

Pearson correlation

Variables coefticients

Police expenditure (.f per capita) 0.93 Education expenditure 0.93 Health expenditure (f per capita) 0.91 Gross national product per capita (No. 6) 0.89 Personal disposable income per capita (No. f) 0.87 Culture & recreation expenditure (f per capita) 0.85 Hospital beds per population (No. per 1000 pop.) -0.75 Unemployment (96 labour force unemployed) 0.73 Population per physician (No.) 0.38 Mortality rate (No. of deaths per 1000 pop.) 0.25

relations varied considerably from one country to another. However, for all five countries there was a very high correlation between the level of drug abuse and: GNP; income (except for Hong Kong which has productivity data); health and education expenditures; life expectancy; and physicians and hospital beds per population. There were usually lower correlations between drug abuse and unemployment, and drug abuse and mortality rate.

The graphs (Figs. l-5) show essentially the same relationships as do the correlation data. For all countries, as indicators of drug abuse increased so

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TABLE V

UNITED STATES

Relationships of socio-economic variables to the number of arrests for narcotic drugs

PearSon correlation

Variables coe5ciente

Health expenditure ($ per capita) 0.97

Education expenditure ($ per capita) 0.97

Population per hospital bed (No.) 0.99

Physicians per population (Rate per 100 000 pop.) 0.95

Personal income ($ per capita) 0.94

Gross national product (8 per capita) 0.91

Life expectancy (Expectation of life at birth) 0.88

Mortality rate (No. of deaths per 1000 pop.) -0.54

Unemployment (% labour force unemployed) 0.49

Fig. 1.

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did economic variables associated with the GNP, income, and government expenditures. The relationship between drug abuse and availability of health services, however, varied from one country to another.

The best predictors of drug abuse Multiple regression analyses were done for each country separately to

select the best predictors of drug abuse. It can be seen from Table VI that

TABLE VI

A MULTIPLE REGRESSION ANALYSIS

Only variablea having a correlation of 0.75 or more with the drug abuse indicator were entered. A maximum of 5 R equaree for each country are reported for convenience; any further listing would be insignificant in terms of cumulative scoree.

Variables Cumulative R Square.

Canada 1. Education expenditure ($ per capita) 0.946 2. Groee national product per capita (No. of $) 0.986 3. Population per phyeician (No.) 0.990 4. Personal income per capita (No. of $) 0.991 5. Hospital beds per population (No. per 100 pop.) 0.992

Hong Kong 1. Grws domestic product per capita @lo. $ H.K.) 2. Education expenditure ($ H.K. per capita) 3. Population per hoepital bed (No.) 4. Police expenditure ($ H.K. per capita) 5. Health expenditure ($ H.K. per capita)

0.868 0.963 0.969 0.972 0.973

1. Population per physician (No.) 0.792 2. Population per hospital bed (No.) 0.797 3. Education expenditure 0owns per capita) 0.808

United Kingdom 1. Police expenditure (& per capita) 0.872 2. Culture Bt recreation expenditure (s per capita) 0.929 3. Hospital bede per population (No. per 1000 pop.) 0.936 4. Health expenditure (& per capita) 0.940 5. Personal dieposable income per capita (No. ;ti) 0.946

United Stata 1. Health expenditure (8 per capita) 0.943 2. Gross national product ($ per capita) 0.951 3. Life expectancy (Expectation of life at birth) 0.963 4. Education expenditure ($ per capita) 0.976 5. Population per hospital bed @Jo.) 0.984

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the rank-ordering of the variables is somewhat different from one country to another. Moreover, the best individual predictors were different in each country. The best predictors for four of the five countries included economic variables or government expenditures. The explanatory values of these variables were extremely high for each country. The high scores could suggest that the relationship between drug abuse and socio-economic con- ditions is very important for all countries. This interpretation, however, should be remembered with some caution. When the independent variables are all highly intercorrelated, there is considerable difficulty in assessing and controlling for confounding effects.

DISCUSSION

The results clearly show that officially recorded drug abuse measures in Canada, Hong Kong, Sweden, the United Kingdom and the United States were all related to improvements in economic and health conditions. There would appear to be considerable generality for the findings because in- creases in drug abuse appeared at somewhat different times and in five different countries, that is, early to mid 1970’s in Canada and the United States; early 1960’s in Hong Kong, and late 1960’s in Sweden and the United Kingdom. This suggests that our knowledge of drug abuse would be facilitated by attention to changes in socio-economic conditions.

The best predictors of drug abuse in individual countries vary somewhat; however, they are all intercorrelated. The best predictors, overall, seem to be those related to the economy: income, productivity and expenditures. These variables indicate that increases in drug abuse are associated with real increases in income and in government spending on education and, less so, on health, police and cultural pursuits. In general, the findings are similar to those for alcohol consumption: both drinking and drug use prob- lems are closely related to changes in economic conditions. The similarity should be expected since, to some extent, both alcohol and drugs are sub- stitute consumer products bought out of disposable income.

The period examined here (1960-1975) is rather short. It would be useful to extend this analysis for a longer period of time, especially to include periods of economic depression or stability, say 1930-1940 or 1976 1980. Also, it would be useful to include more countries, particularly developing ones with traditional drug use problems. Relevant data for such countries are too incomplete for adequate analysis. However, data for the countries examined in the present paper should eventually become available for later years and some analysis of early ‘depression’ years should be possible for some countries.

The present paper allows us to apply the knowledge gained about one substance to the study of others. Specifically, this paper on drug abuse has benefitted from some of the findings derived from studies on alcohol con- sumption. Also, it has shown that several kinds of drug abuse (cannabis, amphetamines, opiates) are closely associated with affluence.

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During the time period studied rapid increases in drug abuse appeared in many countries, including those covered in this paper. A variety of drug abuse ‘epidemics’ have been described in the literature. For example, am- phetamine epidemics occurred in Japan 171 just after the Second World War, in Sweden during the late 1960’s 181 and in England in the early 1970’s 191. An epidemic of ether drinking in Ulster in the late 1800’s has been docu- mented [lo] as have heroin epidemics in Canada 1111 and the United States 1121 in the early 1960’s to late 1960’s 1131 and in Hong Kong 1131 and Thailand [14] in the 1970’s. Although dramatic increases in cannabis use are usually not called ‘epidemics’, such increases have occurred in Canada [15] and the United States 1161 in the late 1960’s and early 1970’s. These ‘epidemics’ do not have an adequate explanation yet, but it would be useful to compare the features common to the various drug epidemics reported in the literature. The data presented here indicate that increases in affuence should be associated with drug abuse epidemics.

REFERENCES

1 D.D. Heckathom and W.L. Lucas, J. Drug Issues, 12 (1982) 443. 2 K. Bruun et al., Alcohol Control Policies in Public Health Perspective, Finnish Foundation of

Alcohol Studies, Helsinki, 1975. 3 D.A. Parker and MS. Harman, in: Normative Approaches to the Prevention of Alcohol Abuse

and Alcoholism, N.I.A.A.A. Monograph No. 3, Washington. 1980.

4 M.H. Brenner, Am. J. Publ. Hlth, 65 (1975) 1279. 5 N. Giesbrecht, G. Markle and S. Macdonald, J. Publ. Hlth Policy, 3 (1982) 22. 6 R.G. Smart and G.F. Murray, Narcotic Drug Abuse in 152 Countries: An Analysis of Social

and Economic Conditions as Predictors, Substudy 1226, Addiction Research Foundation, Toronto, 1982.

7 H. Brill and T. Hirose, Semin. Psychiatry, 1 (19691 179. 8 N. Bejerot. Acta Psychiat. Stand., Suppl., 256 (19751. 9 M.M. Glatt (United Kingdom), in: S. Einstein (Ed.), The Community’s Response to Drug

Use, Pergamon, New York, 1980. 10 K.H. O’Connell, Quart. J. Stud. Alcohol, 26 (19651 629. 11 G. Le Dain, Cannabis, Commission of Inquiry into the Non-Medical Use of Drugs, Ottawa,

1972. 12 J.C. Ball and C.D. Chambers, The Epidemiology of Opiate Addiction in the United States.

C.C. Thomas, Springfield, 1970. 13 Central Registry of Drug Abuse, Ninth Report, Narcotics Division, Government Secretariat.

Hong Kong, 1982.

14 V. Poshyachinda, Hard Drugs in Thailand, Drug Dependence Research Centre, Chulalongkom University, Bangkok, 1979.

15 P.G. Erickson and R.G. Smart (Canada), in: S. Einstein (Ed.), The Community’s Response to Drug Use, Pergamon, New York, 1980.

16 L. Blackford, Summary report, Surveys of Student Drug Use, Department of Public Health and Welfare, San Mateo, California, 1977.