Poverty, loneliness, helplessness, hopelessness, lack of other healthcare options, lack of community, overwork, hate by others (racism, sexism, etc.), lack of any say in government, getting fucked over by companies over and over again, etc. I bet all those are top reasons for self-medicating in America. When you're one accident away from being homeless, alone, and have no hope of changing anything about your life, it's likely you'll self-medicate. When you can't get treatment for your work injury and have to work in pain all the time to keep from being homeless, you're likely to self-medicate. Do I really need to keep going? I think the causes of self-medication in America are incredibly obvious but most people choose to put their heads in the sand and not see them.