Anthony DiMaggio
Donald Trump has long presented himself as an advocate for the disadvantaged, and this narrative continues to play into his political strategy as he seeks reelection come November. Nowhere is this clearer than in the president’s claims that he’s committed to combating drug addiction. His administration announced in 2019 $1.8 billion “in funding to states” that focused on “expanding access to [drug] treatment,” with “more than $900 million in new funding for a three-year cooperative agreement with states, territories, and localities to advance the understanding of the opioid overdose epidemic and to scale-up prevention and response activities.” Trump bragged about the administration’s achievements in his latest State of the Union address:
“With unyielding commitment, we are curbing the opioid epidemic. Drug overdose deaths declined for the first time in nearly 30 years. Among the states hardest hit, Ohio is down 22 percent, Pennsylvania is down 18 percent, Wisconsin is down 10 percent – and we will not quit until we have beaten the opioid epidemic once and for all.”
Trump has long benefited from the narrative that he speaks for the disadvantaged. In the wake of the 2016 election, academics, reporters, and pundits consistently linked his campaign to the theme of economic decline, echoing his promise to “Make America Great Again” by bringing back manufacturing jobs back to the people. Post-election reporting portrayed Trumpism as a function of working-class whites’ frustration with the economic status quo. One widely reported 2016 study linked Trump support to economic decline, suicide, and drug abuse. The study’s author, sociologist Shannon Monnat, described her findings this way:
“In many of the counties where [Trump] did the best, economic distress has really been building, and social and family networks have been breaking down for several decades…It’s really about downward mobility and the dismantling of the American dream at a larger community level. And Trump has capitalized on and exploited feelings of the people in these communities. In a lot of these places, good-paying jobs and dignity that goes along with those good-paying jobs has been replaced by suffering and hopelessness and the belief that people in power don’t really care about them or their communities.”
The “Trump supporters as economically and physically downtrodden” narrative became a mainstay in American political discourse following Trump’s election. Another 2018 study by researchers from the University of Texas found that Trump averaged 60 percent of the vote in U.S. counties with an “above average rate of opioid prescriptions in 2015,” compared to 39 percent in areas with “below average” opioid use. Reporters were quick to identify a causality at work, as the Washington Post wrote that the relationship between drug abuse and Trump support “could be explained by the prevalence of working-class voters [in depressed areas] and measures of economic distress,” while Newsweek postulated “that the socioeconomic factors that may inspire someone to vote for Trump also may increase the likelihood that he or she would depend on opioids.”
Following these findings, some pundits have echoed the notion that Trumpism is a symptom of neoliberal economic decline. Trump voters, we are told, suffer from “shit life syndrome,” defined by the continued “misery” of “suicide, drug overdose death, and trauma for surviving communities.” But numerous problems exist with the above narrative. For one, there’s little evidence that Trump has been more effective than previous officials in fighting opioid addiction. Government efforts to combat opioid-related overdose deaths predate Trump’s administration. For one, the CDC’s introduction of new prescription guidelines, which were designed to combat opioid over-medication, date back to 2016, prior to Trump’s election. Furthermore, opioid deaths remain high under the Trump administration – higher than in past years. While opioid overdoses fell from 2017 to 2018, CDC statistics demonstrate that they remained higher in 2018 than at any other time in the last 20 years (with the exception of 2017). In other words, the “progress” made under Trump has been extremely limited, compared to the scope of the problem.
Finally, Trump’s claims of progress in fighting addiction ring hollow considering his efforts to strip tens of millions of Americans of their health insurance via the repeal of the Affordable Care Act (ACA). That repeal would have rolled back the expansion of Medicaid, which is the largest source of national funding for mental health programs and substance abuse treatment. As the Washington Post reported, the ACA repeal would have meant the loss access to drug treatments for 1.3 million Americans who gained access to this benefit following the law’s expansion of Medicaid.
Aside from Trump’s poor record in fighting opioid abuse, we should also reject claims that his presidential campaign appealed to the economically less fortunate – particularly those suffering from drug addiction. As I’ve exhaustively documented, a close examination of survey after survey, including dozens of different economic measures, demonstrates there is little to no evidence that Trump supporters were more likely to suffer from economic insecurity or disadvantage. And research examining metropolitan regions throughout the country demonstrates that areas hardest hit by manufacturing job loss were actually less likely to favor Trump in 2016.
To the extent that manufacturing job loss impacted political behavior, available data reveals that the areas hardest hit by outsourcing suffered primarily from demobilization. Which is to say that Americans in these regions became increasingly disillusioned about the value of voting in general. We see this most clearly in the finding that the Democratic Party lost 3.5 times more votes than Republicans gained, when comparing presidential election voter turnout in geographic areas where manufacturing job loss was worst.
But what about the finding that Trump performed better in areas hardest hit by mental health problems and drug addiction? A closer look at available data calls into question the claims of pundits that economic desperation fueled intensifying mental health and drug abuse problems, thereby indirectly fueling support for Trump’s 2016 presidential campaign. To more closely examine such claims, I analyzed the best available survey data measuring individual responses regarding mental illness and drug abuse in the run-up to the 2016 election – the September to October Atlantic/PRRI “white working class” survey. The survey asked Americans about their presidential voting preferences, and about whether respondents (or anyone in their households) had “experienced or struggled with” various problems “in the past 12 months,” including “alcoholism or excessive drinking,” “depression,” and “drug addiction.”
In my statistical analysis, I measured the extent to which depression, alcoholism, and drug addiction were significantly associated with Trump support, controlling for survey respondents’ political party affiliation, ideology, race, income, gender, age, and education level. The results undermine the narrative that economic depression fueled mental health and drug addiction problems, thereby driving voters to support Trump’s campaign. On the one hand, self-reported alcoholism and drug addiction are both statistically unrelated to Trump support in 2016. On the other hand, self-reported problems with depression are significantly associated with Trump support. The findings are similarly mixed when looking only at white respondents. Whites reporting drug addiction problems were no more likely to support Trump, although whites reporting problems with alcoholism and depression were significantly more likely to support Trump.
While mental illness and alcoholism among whites were linked to Trump support, these problems were almost entirely unrelated to poverty and economic desperation. My examination of the 2016 Atlantic/PRRI poll finds that, for whites with depression, whites suffering from alcoholism, and whites facing drug addiction problems, none of these groups were statistically more likely to be economically disadvantaged. Which is to say that none of the three were more likely to report lower incomes, on average, compared to respondents who did not face these problems. This is where the 2016 “Trump as hero of the downtrodden” narrative unravels. These results make it clear that there’s little reason to think that economic desperation is a unique contributor to depression or to drug abuse, or to think that economic disadvantage is indirectly fueling Trump support.
The central lesson from these findings is that we should be careful not to fall into classist attacks on the poor, which pathologize the less fortunate as uniquely suffering from mental illness and drug abuse. There’s little reason to link these factors, considering the failure to identify a relationship between mental illness, drug abuse, and income. Americans of all economic stripes deal with issues of drug addiction and mental illness; these problems are not unique to the poor. A closer analysis of the Atlantic/PRRI poll finds that between 3 to 6 percent of white respondents cited struggles with drug abuse, depending on the specific income group in the survey. Between 3 to 9 percent of whites cited problems with alcoholism, while 16 to 25 percent of whites cited struggles with depression. But in none of these three metrics was income a significant predictor of drug and mental health struggles, controlling for respondents’ race, gender, political party, ideology, age, and education.
It’s become commonplace in U.S. political rhetoric to depict the Trump administration as a champion of the poor, disadvantaged, and dispossessed. This myth originates from Trump himself, who popularized the tall tale that one of the wealthiest plutocrats in American history could somehow be trusted to fight for the interests of the poor and marginalized. American journalists have endlessly reinforced the myth of Trump as a working-class hero, which is unsurprising considering the long-documented official source bias in the news. But there’s no reason that Americans should embrace this propaganda any longer. The president has shown little interest in helping the poor and vulnerable. There’s no reason to think this will change moving forward with an administration that’s consistently devoted itself to plutocratic politics.
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