My mom died of cancer in her 40's. My mom also died an addict. Two of her sisters also had cancer, found because of her diagnosis. Both became addicts as well. I don't see how they couldn't have. Chemo is rough. It is a long and painful treatment that we _should_ be giving painkillers to those receiving it. But it is shame that makes it difficult for people to get treatment. It is shame that prevents people from even admitting they need treatment in the first place.
The hard truth is that grandma is an addict and she needs to be unashamed of going to the methadone clinic.
So it was truly, truly all income levels interacting in our public schools (which are pretty highly rated).
I graduated in 2009. Close to 10% of my graduating class (~400), all income levels, died of opioid overdoses or suicide. The shame of talking about our town's problem and wanting keep up appearances killed scores of people.
BBC did a documentary on our town, called Smack in Suburbia, focussed on my age group. 30 minute watch, but, it really drives this point home https://www.youtube.com/watch?v=j7ynJ5S9c58
All of this tragedy was the direct consequence of shame as public health policy.