January 25, 2024

By Shriti Pant, Gillings Communications Fellow

Research has found that food insecurity, defined as not having access to enough healthy food to live a good quality of life, is associated with an increased risk of developing substance use disorders and engaging in risky substance use behaviors. 

A recent study from the UNC Gillings School of Global Public Health has shown that state adoption of policies to expand eligibility for the State Supplemental Food Nutrition Program (SNAP) could potentially help reduce substance use disorders and overall substance misuse in the United States. SNAP provides a monthly benefit to help purchase food for lower-income households. 

Currently in the U.S., more than 33 million people live in a household that experiences food insecurity. 

Based on past findings, researchers think that substance use may be a coping mechanism associated with not having consistent access to food. Past research has also suggested that people experiencing food insecurity may use substances with psychoactive properties, such as opioids, to suppress hunger and curb their appetite. 

Dr. Anna Austin

Dr. Anna Austin

When asked about why it was important to explore the connection between state expansion of SNAP eligibility and substance use, Anna E. Austin, PhD, assistant professor in the Department of Health Behavior and one of the authors of the paper, said: “Given the ongoing and worsening overdose crisis in the U.S., it is critically important to understand broader social and structural interventions, such as economic support policies, that can contribute to reductions in substance use disorders and other substance use behaviors.”  

“At the federal level, there is a lifetime disqualification on participation in SNAP for people with a felony drug conviction. However, states can opt out of this disqualification, allowing people with felony drug convictions to receive SNAP benefits with no restrictions,” she added. “Given demonstrated associations between food insecurity and various substance use behaviors and outcomes, we wanted to examine whether state expansion of SNAP eligibility through policies such as opting out of the federal felony drug conviction [disqualification] was associated with changes in substance use disorders and behaviors.” 

The new paper, published in the American Journal of Preventative Medicine, studied how substance use may change when 1) states adopt policies that do not deny people with a felony drug conviction from using SNAP and 2) adopt policies under SNAP’s broad-based categorical eligibility policies (BBCE) to expand SNAP eligibility.  

Under these BBCE policies, states can increase the income limit up to 200% of the federal poverty level and remove the asset test altogether to allow for broader SNAP eligibility. Asset tests require that assets, such as land ownership and money in savings, fall below pre-specified levels. At the federal level, households must have incomes less than 130% of the federal poverty level and less than $2,750 in assets to be eligible to participate in SNAP.

The study team used 2015-2019 data from adults 18 years and older from the National Survey on Drug Use and Health and information they collected on state SNAP policies.

The study findings highlight that states that allowed individuals with a felony drug conviction to participate in SNAP and/or expanded SNAP eligibility under BBCE had reduced rates of alcohol use disorder, substance use disorder and illicit opioid misuse compared to states that did not implement either of those policies.  

When asked why she thinks this study is important in helping influence future studies, Austin said, “Answering the question [of whether] these policies have beneficial impacts just beyond addressing food insecurity is critically important. Hopefully, this study will inspire others to consider the potential implications of economic support policies for a variety of health-related outcomes.” 

Austin’s co-authors on the study are: Rebecca B. Naumann, PhD, assistant professor in the Department of Epidemiology and core faculty at the Injury Prevention Research Center; Madeline Frank, dual Master of Social Work and Master of Public Health student in the Department of Maternal and Child Health; Meghan E. Shanahan, PhD, associate professor and associate chair of MCH and research scientist at IPRC; H. Luz McNaughton Reyes PhD, associate professor in the Department of Health Behavior; Alice S. Ammerman, DrPH, Mildred Kaufman Distinguished Professor in the Department of Nutrition and director of the Center for Health Promotion and Disease Prevention; and Giselle Corbie, MD, Kenan Distinguished Professor of Social Medicine and professor of internal medicine at UNC’s School of Medicine, director of the Center for Health Equity Research and vice provost for faculty affairs. 

Read the full article online.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

Visit our communications and marketing team page.
Contact sphcomm@unc.edu with any media inquiries or general questions.

Communications and Marketing Office
125 Rosenau Hall
CB #7400
135 Dauer Drive
Chapel Hill, NC 27599-7400