It works both directions. I'll give you a pretty common example for my neck of the woods. A good friend of mine worked in a machine shop and had a great job for rural America ran his own small lawn-care business on his days off. One day he hurt his back bad, he didn't have time or money for physical therapy (who else would pay the bills) which would've probably been best instead the doctor prescribed opioids and insurance paid. So he went for a few months and it got worse, which was probably just him building up a tolerance, rinse and repeat a few times and he was a fully burned out addict. Couldn't hold his job because of how fried he was.

This isn't an isolated incident it's an all too common pattern I've seen. The cycle works: you go to work and work as hard as you can, you get hurt, you can't afford the best care option, you take the cheaper meds so you can continue working, tolerance builds up, you can't perform, then you're let go. In the end you're left broke, hurting, unemployed, and addicted.