Deaths in the U.S. from alcohol, drugs, and suicide have risen steadily and at alarming rates over the past two decades and accelerated even more during the COVID-19 pandemic – in part leading to a decrease in U.S. life expectancy in 2020 and 2021. The statistics tell a shocking story. Between 2011 and 2021, the total number of deaths from alcohol, drugs, and suicide doubled from 104,379 deaths nationally in 2001 to 209,225 in 2021. Most of the increasing number of deaths were due to sharp increases in drug overdoses, particularly due to opioids, but alcohol-induced deaths have also increased, as have suicide deaths – particularly among young people. The depths of despair crisis is not limited to a specific demographic group or region of the country. Every community is being impacted by the crisis, but some populations groups have experienced more harm than others. Groups suffering higher proportional impacts include young people, racial and ethnic minority groups and LGBTQ people. For example, the suicide rate for young people, ages 10-17, increased by 71 percent between 2010 and 2021. Alcohol-induced deaths are highest among American Indian/Alaska Native people. Drug overdose deaths are highest among adults ages 35 – 54 and males. In addition, the overdose deaths rates within Asian, Black, and Latino communities more than doubled between 2015 and 2020.

Next Steps – What Works?

A comprehensive approach to preventing substance misuse and suicide is badly needed. There are evidence-based programs and policies that are effective in preventing substance misuse and suicide. Those programs need to be expanded so they are put to work in every state, county, city and town within the country. For its part, TFAH will continue to draw attention to the crisis by publishing our annual Pain in the Nation report. Since its inception, the report series has included the latest data and information on model programs. The Pain in the Nation report series includes recommendations that policymakers at the federal and state level should adopt to begin to reverse the heartbreaking deaths of despair trends. These recommendations include:

• Invest in prevention and the community conditions that promote health and support families, including policies and programs that reduce adverse childhood experiences (ACEs) which are associated with later substance misuse and mental health issues. In addition, all youth serving entities, including the juvenile justice system, should adopt trauma-informed service models.
• Transform the nation’s mental health and substance use prevention system and ensure access to services by expanding the size and culturally competency of the workforce and by fully enforcing the Mental Health Parity and Addiction Equity Act. In addition, further investment in continuum of crisis care programs including the 988 suicide and crisis lifeline is needed.
• Strengthen substance misuse and overdose prevention and mental health services programs including in schools and within youth-supporting services. Access to culturally appropriate mental health services should be available in all communities. Within the healthcare arena mental health and substance misuse service programs need to be better integrated into physical healthcare. Funding from opioid litigation settlements should be invested in programs to prevent youth substance misuse.
• Adopt harm reduction policies including increased access to syringe service programs, the overdose reversal drug naloxone, and fentanyl test strips.