How Self-Interest and Partisanship Affect Public Opinion about Opioid Treatment Policy

In the APSA Public Scholarship Program, graduate students in political science produce summaries of new research in the American Political Science Review. This piece, written by Maryann Kwakwa, covers the new article by Michael Hankinson, Harvard University,Concentrated Burdens: How Self-Interest and Partisanship Shape Opinion in Opioid Treatment Policy.”

Every day, more than 130 people in the United States die after overdosing on opioids. Drug overdose is now the leading cause of death for Americans under age 55, and policymakers across the country are searching for ways to combat the opioid epidemic. Although most Americans agree that drug addiction is a major problem , they disagree about how to address it. We might think that these differences are purely political – between Democrats and Republicans – but a new article in the American Political Science Review suggests that it’s not that simple. Political scientists Justin de Benedictis-Kessner and Michael Hankinson argue that in the case of the opioid crisis self-interest plays a key role in shaping support for policy solutions. This poses a challenge to policymakers’ efforts to address this crisis, but as the authors demonstrate, self-interest may also present us with some promising paths forward.

Currently, communities with high overdose rates bear a large share of the financial burden of the opioid crisis. Their municipal and county governments are expected to cover the increased costs of emergency call volumes, ambulance services, and coroner bills.  In addition to the financial costs, there are other costs associated with opioid addiction. Although those struggling with addiction need health care services, people often fear that the construction of addiction treatment infrastructure will undermine public safety, decrease property values, and lower overall quality of life. These are significant costs, and Benedictis-Kessner and Hankinson suggest that they might make self-interest particularly influential in shaping opinions of opioid policy.Currently, communities with high overdose rates bear a large share of the financial burden of the opioid crisis. Their municipal and county governments are expected to cover the increased costs of emergency call volumes, ambulance services, and coroner bills.

To find out if they’re right, the authors survey a representative sample of 2,000 U.S. residents. They ask survey participants to express their level of support (from “strongly support” to “strongly oppose”) for different policies funding opioid treatment. The sample of residents were shown one of two policies: the first was an “income-based” or “redistributive” funding option. Under this policy, people who have a household income higher than their state’s median income would pay more than those with a lower household income. The second was an “overdose rate-based” or “needs-based” funding option. Under this policy, those living in areas with a higher opioid overdose rate relative to their state’s median rate would pay more than those in areas with a lower overdose rate. It is similar to existing policies that require cities and counties with high rates of opioid use to shoulder the financial burden for the resources necessary to combat opioid addiction. In addition to financial self-interest, the authors also consider what they call “spatial self-interest.” To evaluate how people’s policy attitudes change based on the nearness of a treatment facility, they ask respondents to express their level of support for a clinic that is a 40-minute versus 5-minute walk from the their home.

Does self-interest shape people’s preferences on contentious policies? At least in the case of addiction policy, the answer is clearly yes. The authors find that higher income respondents were less supportive of policies where they paid far more than lower-income individuals. Survey participants living in areas with high overdose rates were less likely to support policies that required them to pay higher taxes than those living in lower-overdose rate areas. And survey participants were less likely to support the building of at treatment facility when they were told the facility would be near their own home.

Voters whose self-interest might influence their policy preferences may also have different partisan preferences towards health policy. Although self-interest plays a significant role in shaping policy preferences, the authors find that political affiliation has almost double the effect on support for particular policies. While Republicans are less supportive of treatment policies than Democrats, the authors find that financial self-interest pressures lower-income Republicans to support policy that is more in line with the preferences of Democratic partisans. To read more about how partisanship and ideology affects support for opioid treatment click here.Although self-interest plays a significant role in shaping policy preferences, the authors find that political affiliation has almost double the effect on support for particular policies.

For those invested in finding policy solutions to the opioid crisis, this research offers two important implications. First, the popularity of redistributive funding—and its support among low-income Republicans—suggests that policymakers may be able to leverage self-interest (specifically among lower-income conservative voters) to build broad coalitions of policy support for opioid treatment. Second, because wealthy communities are more able to act on their self-interest and block nearby clinic construction, Benedictis-Kessner and Hankinson warn that policymakers must actively resist the pressure to concentrate treatment centers in low-income and minority neighborhoods.

Given the widespread nature of opioid addiction in America, it’s no surprise that 54% of the respondents in this study reported personally knowing someone who had struggled with addiction. And this experience made a big difference. Survey participants who had personal experience with addiction were more supportive of each of the three opioid addiction policies compared to those without. Thus, while new policies are key to combatting the opioid crisis, it appears that empathy and self-interest may determine whether Americans support them.


  • Maryann Kwakwa is a Ph.D. candidate (A.B.D.) in American Politics and Constitutional Studies at the University of Notre Dame. Her research interests include civic engagement, education, race/ethnic politics, and democratic citizenship. In her dissertation, Maryann uses a mixed-methods approach to analyze the effect of undergraduate college experiences on civic engagement in the United States. Maryann graduated from Oberlin College in 2014 with a Bachelor of Arts in Law and Society and a minor in Politics. At Notre Dame, Maryann has served on numerous departmental committees, led discussion sections for introductory American Politics courses, and taught a senior seminar, “Politics in Cyberspace,” as the instructor of record. She has also published a virtual review article for the American Political Science Association and two, co-authored journal articles, which appear in Politics, Groups, and Identities.
  • Article details: American Political Science ReviewFirst ViewConcentrated Burdens: How Self-Interest and Partisanship Shape Opinion on Opioid Treatment Policy, Published online 25 July 2019
  • About the APSA Public Scholarship Program.

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