Weed, Whiskey, And ZIP Codes: The Psychology Of Legal Substances In Unequal Communities
As an outpatient psychiatrist, I’ve seen the psychological toll that environment plays in shaping substance use, coping behaviors, and long-term mental health. It’s hard to ignore how alcohol and cannabis businesses often cluster in working-class neighborhoods. In many cities, liquor stores line the streets of lower-income communities, while cannabis dispensaries—once a promise of reparative justice—are similarly overrepresented. Meanwhile, in more affluent areas, access to these substances tends to be less frequent, more regulated, and—critically—more expensive.
A 2021 study published in Preventive Medicine found that neighborhoods with lower median incomes had significantly higher alcohol outlet density. Similarly, a 2020 JAMA Psychiatry analysis reported that high cannabis outlet density is associated with increased adolescent use and greater mental health strain in those same communities. Yet, paradoxically, during the COVID-19 pandemic, liquor stores were deemed essential businesses. While therapy centers closed or went virtual, access to substances that can worsen depression, anxiety, and trauma remained uninterrupted.
This disparity becomes even more striking when compared to the number of community resources in these areas. A 2022 report in Health & Place found that predominantly low-income, minority neighborhoods had more liquor stores and cannabis dispensaries than grocery stores with fresh produce, public playgrounds, or libraries. Access to green space and healthy food is linked to lower rates of depression and anxiety—but instead, these communities are often oversaturated with substances and underserved by preventive health infrastructure.
Then there’s the economic justice angle. Decriminalization of cannabis was marketed as a step toward righting the wrongs of mass incarceration. Yet, as of 2023, fewer than 2% of cannabis business owners nationwide are individuals formerly convicted of marijuana-related crimes. Licensing laws, startup capital requirements, and background checks have all but shut out the very people this movement was supposed to empower. We decriminalized the product—but not the pathway to ownership.
The mental health implications are far-reaching. Substance availability, especially in overburdened communities, is not just a public health concern—it’s a psychiatric one. Higher exposure increases normalization, self-medication, and intergenerational trauma. If we truly care about healing communities, we must examine not just who’s using, but who profits, who’s targeted, and who’s left to treat the consequences.
References:
Karriker-Jaffe, K. J., et al. (2021). Neighborhood income and alcohol outlet density: Their influence on harmful drinking. Preventive Medicine, 148, 106582.
Firth, C. L., et al. (2020). Association between cannabis retailer proximity and adolescent cannabis use. JAMA Psychiatry, 77(4), 400–406.
Zenk, S. N., et al. (2022). Built environment inequities: Mapping disparities in access to food, parks, and mental health-supportive spaces. Health & Place, 75, 102781.
Marijuana Business Daily (2023). Racial disparities persist in cannabis industry ownership.
Becker, W. C., et al. (2021). COVID-19 and the prioritization of substance access. Journal of Substance Abuse Treatment, 130, 108495.
