Is drug use mainly in deprived areas?

If we use a broad definition of drugs –  including alcohol, cigarettes, illegal drugs and other socially unacceptable substances – it is clear that drug use is nearly everywhere. However, different people living in different areas may have different drug use patterns.

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Deprivation

Deprivation can involve many things such as poverty, inadequate housing, poor education and lack of job or social opportunities. Although deprivation is often concentrated in particular areas, such as inner-cities, it is also to be found in smaller towns and rural areas.

Cigarettes and vaping

Cigarette smoking has been in decline since 1974. According to ONS bulletin Adult smoking habits in the UK: 2021, in the UK, in 2021, 13.3% of people aged 18 years and over smoked cigarettes, which equates to around 6.6 million people in the population, the lowest proportion of current smokers since records started in 2011. 

The ONS report Deprivation and the impact on smoking prevalence, England and Wales: 2017 to 2021 found that approximately one-third (33.1%) of all smoking adults in England lived in the two most deprived deciles in 2021, 10.9% of all smoking adults in England lived in the two least deprived deciles in 2021. And, of people aged 18 years and over in England, 23.8% living in the most deprived neighbourhoods were current smokers in 2021, compared with 6.8% living in the least deprived neighbourhoods

Adult smoking habits in the UK: 2021 found those who had no qualifications were more likely to be current smokers (28.2%) than those whose highest level of education was a degree or equivalent (6.6%) in 2021. The previous publication Adult smoking habits in the UK: 2019 reported 23.4% of those working in routine and manual occupations said they currently smoked, significantly higher than those in managerial and professional occupations where 14.1% reported they were current smokers.

Though, according to report Vaping in England: an evidence update including vaping for smoking cessation, February 2021, there may also have been a past-year increase in smoking prevalence among people classified as ‘high or intermediate managerial, administrative or professional’. Gov.uk publication Local tobacco control profiles for England: short statistical commentary, December 2021 also showed that smoking-related mortality rates were highest in the most deprived areas. Vaping in England: an evidence update including vaping for smoking cessation, February 2021 commissioned by Public Health England found that vaping prevalence varied between socioeconomic groups, ranging from 4.6% in group AB to 8.2% in group D (Where group AB is considered more advantaged than D). However vaping was more prevalent in advantaged groups when looking at young people. Based on the socioeconomic status of 11 to 18 year olds, the estimates for vaping (and smoking) prevalence were higher among more advantaged groups in social grades A, B and C1 (7.1% for smoking, 5.3% for vaping) than for more disadvantaged groups in social grades C2, D and E (5.7% for smoking, 3.5% for vaping).

Alcohol

According to a 2021 report by the Local Government Association there are 10 million adults in England who drink above the guidelines, including more than two million who drink at higher risk and an estimated 587,000 who are dependent on alcohol.

Alcohol-specific deaths are higher in more deprived areas. The ONS’s quarterly report on alcohol-specific deaths showed that the alcohol-specific death rate in 2020 for males was 4.2 times higher in the most deprived quintile (34.1 deaths per 100,000) compared with the least deprived quintile (8.1 deaths per 100,000), and the rate for females was 3.0 times higher in the most deprived quintile (15.0 deaths per 100,000) compared with the least deprived quintile (5.0 deaths per 100,000). In 2020 the relative difference between the most deprived and least deprived areas had increased for males and decreased for females on the previous year. 

As for alcohol use, the most deprived areas had more non-drinkers than the least deprived areas, but drinkers are more likely to be at risk drinkers in more deprived areas. Drinkaware’s report Drinking through the pandemic’ showed that in 2021: 

  • 58% of adults in the least deprived quintile drink at least once a week, compared to 41% in the most deprived quintile 
  • 19 in every 100 adults in the top 20% most deprived areas of the country never drink alcohol.
  • Drinkers in the most deprived areas were more likely to have had a drink alone in the last week 
  • 10% of drinkers in the most deprived areas drink to forget about their problems most or all of the time, compared to 5% of those in the least deprived quintile.
  • 19% of drinkers in the most deprived areas also smoke.

Furthermore, according to National Statistic’s Adult substance misuse treatment statistics 2019 to 2020: report, almost half the people in treatment for alcohol only (45%) were living in areas ranked in the 30% most deprived areas.

Illegal drugs

The relationships between deprivation and illegal drug use have been highlighted in a number of research studies. Although problematic use of these drugs is not exclusively related to deprivation it is more common among poorer people.

ONS data shows that the rate of deaths related to drug poisonings is highest in the most deprived quintile and lowest in the least deprived for both men and women.

Opiate and crack use are also strongly linked to deprivation, the National Statistic’s Adult substance misuse treatment statistics 2019 to 2020: report shows that 56% of people in treatment for crack and/or opiates live in areas ranked in the 30% most deprived areas in England. And people with opiate problems accounted for 69% of deaths in treatment, 33% of opiate deaths were people living in the most deprived 10% of areas in England.

Moreover, deprived people living in overcrowded and substandard accommodation are more likely to share injecting equipment and more likely to get hepatitis, HIV and Tuberculosis.

Homelessness and drugs

According to a recent bulletin – Deaths of homeless people in England and Wales: 2021 registrations – from ONS, almost two in five deaths of homeless people were related to drug poisoning in 2021 (259 estimated deaths; 35% of the total number), which was consistent with previous years. There were an estimated 99 suicide deaths (13.4% of the deaths) and 71 alcohol-specific deaths (9.6%). 

Updated April 2023