ABSTRACT

Drug problems, like many other ills that afflict modern societies, are problems of inequality. Rates of violence, ill-health and early death are all higher where inequality is greatest (CSDH 2008; Wilkinson & Pickett 2008; Wilkinson 1996; Working Group on Inequalities in Health 1988 [1980]). As countries develop out of generalized poverty towards industrialized affluence, they initially see widespread improvements in health. But, past a certain point, increases in average wealth do not produce any more health benefits. And where inequality is deeper, so is ill health, with the poorest always suffering the most harm. This chapter asks whether drug use and drug dependence belong among the ‘afflictions of inequality’ that Richard Wilkinson (1996) has identified. It examines the nature of inequality. It presents evidence which suggests that drug use is more equally spread through society than dependence is. It examines the social patterning of the harms that are related to drug use and criticizes narrow, atheoretical analyzes of them. It argues for an understanding of drug use, dependence and harms that incorporates the social contexts of drug use.