I have spent years searching for answers to one question: what causes addiction?
It’s deeply personal. I’m a triplet, and one of my sisters has lived with chronic alcohol dependence for more than a decade. We grew up together, in the same middle-class home, with loving parents, a happy school life and, on the face of it, every opportunity to flourish.
Yet our adult lives have taken very different paths.
My sister developed alcohol dependence around the age of 40. I’ve often wondered why her and not me. Was it nature or nurture? Genetics, the breakdown of relationships, isolation, despair or mental ill health? Or some combination of them all?
We shared a childhood, but not the same experiences of adulthood.
The more I’ve tried to understand addiction, the more questions I’ve accumulated. Despite advances in neuroscience, including our understanding of dopamine and the brain’s reward and stress systems, we still cannot fully explain why some people develop a devastating dependence while others do not.
Having recently moved to the North East, I attended a networking event at the Baltic Centre for Contemporary Art in Gateshead. During a presentation, someone mentioned, almost in passing, that the region consistently records England’s highest rates of drug and alcohol-elated deaths.
The statistic stopped me in my tracks.
I’d spent years looking for answers within the individual: genetics, brain chemistry, relationships and trauma. But what if I’d been overlooking something else?
What if where we live also influences our vulnerability to addiction, and our chances of surviving it?
In 2024, 429 people died from drug poisoning in the North East. The region recorded 167.6 deaths per million people, compared with an England average of 91.1. In the East of England, the rate was just 66.3.
The North East has occupied the top of this grim regional league table for 12 consecutiveyears.
Alcohol tells a similar story. In 2024, the region recorded 21.1 alcohol-specific deaths per 100,000 people, compared with 13.8 across England and 10.9 in London.
These figures reveal a persistent geographical inequality. Mortality rates reflect not only patterns of substance use and dependence, but also differences in health, vulnerability and access to support.
Why should someone living in Middlesbrough or Hartlepool face such different risks from someone in a more affluent part of southern England?
Dr Tim Price, a researcher at Newcastle University, has been investigating the geographical inequalities surrounding what academics call deaths of despair - deaths associated with suicide, drugs and alcohol.
He challenges the idea that the North East’s disproportionately high mortality rates can be explained by individual behaviour alone.
“There is simply no compelling reason to believe that people in the North East are just inherently more likely to make poor choices than people elsewhere in the country,” he says.
“It’s not the people who live in the North East that make it unique in this regard, it’s the conditions in which they live.”
For decades, the region has carried the consequences of industrial decline. Coal mining, shipbuilding, steelmaking and heavy manufacturing once provided more than employment. They helped define communities, identities and a sense of purpose.
Their disappearance shaped subsequent generations, growing up in places where secure employment, financial stability and opportunities had been profoundly altered.
Price’s research suggests that economic decline, poverty, poor health and the erosion of community support are closely intertwined.
In one study, published in the International Journal for Equity in Health, he and his colleagues drew on interviews and a focus group involving 54 residents and stakeholders in Middlesbrough and South Tyneside.
The findings highlighted the impact of economic hardship, reduced mental health provision, diminished addiction treatment capacity and the loss of local services.
“Communities in the North East have been subjected to decades of deindustrialisation, economic deprivation, austerity and social disinvestment,” Price explains.
These conditions, he argues, increase vulnerability to harmful substance use while weakening the support that might otherwise protect people.
Poverty does not inevitably lead to addiction, any more than wealth provides immunity. My own family’s experience is evidence enough that alcohol dependence can devastate lives regardless of social class.
But as Price puts it, people are not making choices “under equal circumstances, with equal opportunities, or with equal access to support.”
One of the most revealing aspects of Price’s research is the importance of what might be called the social scaffolding of a community.
The North East’s former industrial towns once had extensive networks of working men’s clubs, miners’ welfare halls, youth clubs, sports teams, libraries and community centres.
These weren’t simply buildings. They were places where friendships formed, generations mixed and people found a sense of belonging.
Over time, many have disappeared or struggled to survive. Successive rounds of public spending cuts, particularly during the austerity years, placed enormous pressure on local authorities, with youth services and community facilities among those affected.
Price believes these more recent political decisions have compounded the problems inherited from industrial decline.
“Deindustrialisation (and the policies of the Thatcher government), underinvestment, austerity, responses to COVID-19, and more have all helped create the lived conditions in which people are more vulnerable to substance use related harms, while also weakening the services and support networks that might otherwise protect them.”
The consequences are difficult to measure.
A closed youth club doesn’t appear on a death certificate. Yet these places can provide precisely the relationships, activities and informal support that help people navigate difficult periods in their lives.
For young people, they can offer trusted adults, opportunities to develop confidence and a sense of possibility beyond their immediate circumstances. For adults, community spaces provide friendship, routine and connection.
Their loss may be particularly damaging in places already struggling with unemployment, poor health and isolation.
Price’s research highlights how residents and stakeholders perceived the disappearance of these institutions alongside reductions in specialist support.
It doesn’t prove that closing youth clubs directly causes addiction. But it raises important questions about the cumulative effects of removing the things that protect people from adversity.
We have spent decades measuring the economic consequences of industrial decline. But have we ever properly counted the cost of losing the places that held communities together?
Alcohol presents a revealing contradiction. Britain has a well-established drinking culture, from affluent dinner parties to city-centre bars. Yet its consequences are anything but evenly distributed.
Public health researchers describe an alcohol harm paradox: people in disadvantaged communities can experience significantly greater alcohol-related harm than more affluent drinkers, even when their overall consumption is similar.
Poor physical health, chronic stress, smoking, insecure housing and barriers to healthcare can increase vulnerability. Differences in drinking patterns may also play a role.
The issue isn’t necessarily that everyone in poorer communities drinks more, but that the consequences can be considerably more damaging.
This brings me back to my sister.
Her experience cannot be explained by the industrial history of the North East, nor by a simple equation linking poverty to addiction.
There is no single cause. Biology, psychological distress, trauma, relationships and environment interact in ways that are difficult to predict.
Geography doesn’t explain every individual story. But when thousands of individual stories produce such a consistent regional pattern, we have to ask what wider forces are at work.
For Price, reducing addiction-related deaths requires a fundamental shift in approach. “I think we need to move beyond treating addiction as an individual problem and start addressing the social and economic conditions that make people vulnerable to it in the first place.”
That means reducing poverty, improving access to secure employment and housing, investing in public services and rebuilding community resources.
Properly funded drug and alcohol treatment services remain essential, but treatment alone cannot resolve the underlying inequalities.
“We definitely need more properly funded and accessible drug and alcohol treatment services to support people struggling now, but treatment alone won’t resolve the underlying inequalities that lead to these problems.”
It challenges us to think differently about prevention. Could investing in youth services, secure housing, mental health care and opportunities for social connection be as important to long-term recovery as clinical treatment?
These aren’t alternatives to medical care. They’re part of creating the conditions in which recovery becomes possible.
For families living with addiction, the search for explanations can become all-consuming.
I’ve spent years wondering why my sister developed alcohol dependence, looking for a tipping point that might explain everything that followed.
I will never have an answer.
Price reminds us that behind the statistics are people, families and communities experiencing profound loss.
“We are talking about real people who are suffering and dying, leaving behind families, friends and communities who are deeply affected by their loss.”
I began this investigation looking for answers about my sister. Instead, I found myself asking a much bigger question about the communities in which we live and the inequalities we have come to accept.
Perhaps addiction will never have a single, simple explanation. But if we want to understand why so many people are dying in particular parts of the country, we cannot look only at the individual.
We must also look at the world around them.
What’s geography got to do with it?
Quite possibly, a great deal.
Header image: Hazel Plater
