A recent study showed that increases in clinical diagnoses related to alcohol misuse, substance misuse, and suicide ideation/behavior between 2009 and 2018 largely mirror the broader mortality trends from these three causes (Brignone et al., 2020). The rise in drug poisoning deaths is well studied, and scholars have offered plausible explanations for this phenomenon. Explanations for recent trends in alcohol-related deaths have been less extensively debated; however, the factors that influence both sets of trends are similar. Compared with 2019, death rates involving alcohol as an underlying or contributing cause of death increased during the first year of the COVID-19 pandemic in 2020, including among adults aged 20 to 64 years.8 Therefore, the proportion of deaths due to excessive drinking among total deaths might be higher than reported in this study. Nevertheless, these study findings are consistent with the epidemiology of excessive drinking.

U.S. Alcohol-Related Deaths Have Doubled, Study Says

CDC’s Alcohol-Related Disease Impact application was used to estimate the average annual number and age-standardized rate of deaths from excessive alcohol use in the United States based on 58 alcohol-related causes of death during three periods (2016–2017, 2018–2019, and 2020–2021). Average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016–2017 to 178,307 during 2020–2021; age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population. During this time, deaths from excessive alcohol use among males increased 26.8%, from 94,362 per year to 119,606, and among females https://ecosoberhouse.com/ increased 34.7%, from 43,565 per year to 58,701. Implementation of evidence-based policies that reduce the availability and accessibility of alcohol and increase its price (e.g., policies that reduce the number and concentration of places selling alcohol and increase alcohol taxes) could reduce excessive alcohol use and alcohol-related deaths. They first examine life expectancy from 1959 to trace when it started to change and, recognizing that fatal overdoses started to rise in the nineties, next look at cause-specific mortality between 1997–2017. They note that U.S. life expectancy first diverged from other wealthy countries in the ‘80s.

EXPLANATIONS FOR THE RISE IN WORKING-AGE MORTALITY FROM DRUG POISONING AND ALCOHOL-INDUCED CAUSES

It would be valuable to understand the extent to which changes in the types of alcohol consumed by Americans (e.g., greater consumption of hard liquor) or the quantities consumed during drinking sessions (e.g., binge drinking) have increased the toxicity of the behavior and contributed to rising alcohol mortality rates among Whites. Geronimus and colleagues (2019) examined years of life lost by sex and education among Whites and Blacks ages 25–84 from 1990 to 2015. They found that drug overdoses, but not suicides or alcohol-related deaths, contributed substantially to growing educational inequities in life expectancy among White males and, to a lesser extent, White females. Case and Deaton’s 2015 article resulted in massive media coverage and public attention (Cassidy, 2015; Douthat, 2015; Fox News, 2017; Krugman, 2015; Rugaber, 2017; Saslow, 2016; Tavernise, 2016), as well as commentary by scientists (Auerbach and Miller, 2018; Diez Roux, 2017; Erwin, 2017; Scutchfield and Keck, 2017). The notion that the recent rise in midlife mortality was due to increasing psychological distress among working-class Whites accorded with economic, cultural, and societal trends in the United States.

TRENDS IN MORTALITY DUE TO DRUG POISONING AND ALCOHOL

The most recent Florida data suggests that 1 out of 3 opioid overdose deaths, and an even greater share of cocaine deaths, are not reported.15 So, deaths of despair, may be occurring more frequently than we have thought. Americans smoke less than we used to, but smoking more decades ago could still kill more people today. And, Americans are often more obese than their peer country counterparts, so could that account for the differences? This review points to research on other countries, like Australia, that resemble the U.S. in smoking and obesity but haven’t followed our marked life expectancy divergence. There’s “inconclusive evidence” that depression and anxiety, which can also harm physical health, rose over the relevant time period, and, the authors say, it’s also hard to figure out the link between conditions like depression and all the rising specific causes of death.

• Other research has found no or only limited evidence of the relationship between short- or medium-term economic decline and drug overdoses.
• America has a drinking problem, but our nation’s overdose crisis has shifted attention away from our national hangover.
• Like the medical model, the psychological model does not emphasize individual choice but highlights the influence of learned reinforcement on the development of such behaviors.
• In large part, alcohol doesn’t attract consistent attention as a killer because it’s legal, easily available and socially acceptable.

Historical perspective on alcohol consumption

Relative to drug poisoning, the extended period of consumption before the onset of many diseases caused by alcohol provides greater opportunity for intervention before alcohol-induced mortality occurs, as well as greater opportunity for deaths from other causes. In contrast, drug poisoning mortality may be more likely to track contemporaneous trends in the supply of particularly lethal drugs. For these reasons, although the overall trends in mortality from these causes of death differ, it is possible that these trends are the result of common underlying vulnerabilities to drug and alcohol use within certain population groups and geographic areas. In a subsequent study, Ho (2017) conducted a thorough analysis of changes in U.S. death rates due to drug poisoning between 1992 and 2011, stratified by educational attainment.

Deaths from alcohol use disorders

At pill mills, physicians wrote prescriptions for OxyContin and other opioids, often with little diagnosis or follow-up. Several investigative books and docuseries describe how patients would line up, pay cash, and leave with prescriptions for high-dosage opioids and other drugs, which they sometimes used themselves but often sold or diverted to family and friends (Quinones, 2015; Temple, 2016; Willoughby Nason and Furst, 2020). This egregious prescribing could not have happened without the willful help of pharmaceutical distributors. In the space of just 2 years, for example, the giant pharmaceutical distributor McKesson Corporation shipped nearly 9 million opioid pills to a single pharmacy in tiny Kermit, West Virginia (population 400) (Kristof and WuDunn, 2020). First, population-attributable fractions were calculated based on data including only persons who currently drank alcohol. Because some persons who formerly drank alcohol might also die from alcohol-related causes, population-attributable fractions might underestimate alcohol-attributable deaths.

Alcohol-related deaths in U.S. jumped 29 percent in 5 years. Here’s why, according to experts

As this report was being written, data for 2018 were released, so the most up-to-date death counts for deaths due to drugs and alcohol are presented here. However, these surveys and systems have several critical gaps that need to be addressed. The collapse of local economies, social institutions, and family structures experienced by working-class Whites since the 1990s appears similar to the decline experienced by their Black counterparts in the 1970s–1990s. As alluded to earlier, the crisis among Blacks was treated primarily as a criminal justice problem, while the crisis among Whites has been treated primarily (though not exclusively) as a public health crisis—a contrast often cited as an example of systemic racism (see Chapter 11).

Drinking Alone as a Teen May Foreshadow Future Alcohol…

As overdoses from prescription opioids and heroin began to level off, fentanyl overdoses surged to become the primary contributor to overdose deaths. In some ways, the drug overdose crisis can be considered a national crisis, as drug poisoning mortality rates increased in every U.S. state over the study period (Figure 7-3). However, drug mortality rates were disproportionately higher and increased more in some parts of the country than others, with the highest rates concentrated in Appalachia, New England, Florida, eastern Oklahoma, and the desert Southwest (Monnat, 2018, 2019, 2020b; Monnat et al., 2019; Rigg et al., 2019; Rossen et al., 2017). The committee’s analysis showed that working-age drug mortality rates increased for both males and females in all states from 1990 to 2017, but the increases were most pronounced in West Virginia (more than 2000% for both males and females).

Public health policies treat substance use as a health problem, while criminal justice policies treat it as a moral failure. The criminal justice approach has been misguided and largely ineffective (Neill, 2014). In contrast with a punitive zero-tolerance, War on Drugs approach, a public health or social determinants approach emphasizes integrating clinical care with efforts to improve structural environments and targeting both supply and demand factors at multiple levels (Dasgupta, Beletsky, and Ciccarone, 2018; Scutchfield and Keck, 2017). Some of the studies discussed above found drug-related mortality effects of economic decline/distress for Whites but not Blacks or Hispanics (Hollingsworth, Ruhm, and Simon, 2017; Pierce and Schott, 2020). This finding might call into question the explanatory power of economic decline for drug mortality trends, given that Blacks and Hispanics have long faced more precarious economic conditions relative to Whites.

An important report on the frequency of and trends in various mental illnesses was produced for the United States for the period 1990–2016 (U.S. Burden of Disease Collaborators, 2018), but a full specification of the range of mental conditions was not available. It is important to note, however, that Masters and colleagues did not disaggregate trends by educational attainment, which would be essential for undermining Case and Deaton’s cohort thesis. As Case and Deaton (2017, 2020) show, nearly all of the increase in drug poisoning over the prior three decades was among those without a 4-year college degree. While the difference between drugs and alcohol rates increased slightly among those with a bachelor’s degree, these increases pale in comparison with the surge in drug overdoses and other “deaths of despair” among Whites without a 4-year college degree. It is among the less-educated group of Whites that Case and Deaton (2020) show that the risk of dying from drugs, alcohol, and suicide increased with each subsequent birth cohort. For example, they found that among those ages 45 without a bachelor’s degree, the birth cohort of 1960 faced a risk 50 percent higher than that of the cohort born in 1950, and the cohort of 1970 faced a risk more than twice as high.