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Deaths from alcohol, drugs, and suicide occur so often — 1 million in the last decade — that there’s a name for them: deaths from despair. And the situation may get worse. According to a study that the Berkeley Research Group did for our organizations, the Trust for America’s Health and the Well Being Trust, deaths from despair could total 1.6 million between 2016 and 2025, a 60 percent increase over the previous decade. And that might be a conservative estimate.

The only good thing about these numbers? They’re projections. They’re what happen if nothing changes and we sit idly by.


These deaths touch every part of society. No family, no child is immune. But we can change things. This generational crisis calls for big, bold action. Simply creating new programs to address one piece of the problem is not enough — incrementalism is insufficient. We need true systemic reform.

Deaths of despair are directly related to pervasive issues with how the country views and manages issues like mental health and pain. While there’s no question that the availability of drugs and alcohol contribute to their use, many other factors also contribute to substance misuse and risk for suicide. These include family and social relationships, adverse childhood experiences, trauma, depressed communities, and lack of opportunity and social capital.

To stop these epidemics, the Trust for America’s Health and the Well Being Trust call for the creation of a National Resilience Strategy that takes a comprehensive approach and focuses on prevention, early identification of issues, and effective treatment. Whole-person solutions require whole-health strategies. As described in our report, “Pain in the Nation,” these include:


  • Improve pain management and treatment by helping people heal physically, mentally, and emotionally. Approaches must acknowledge that there are different types of pain and experts from mental health, medical care, and other disciplines must develop team-based solutions that focus on proactively addressing pain before it gets worse.
  • Stem the opioid crisis with a full-scale approach that includes promoting responsible opioid prescribing practices (such as provider education and best practices for prescription drug monitoring programs); public education about misuse and safe disposal of unused drugs; “hotspot” intervention strategies; anti-trafficking to stop the flow of heroin, fentanyl, and other illicit drugs; and expanding the use and availability of rescue drugs, sterile syringes, and diversion programs.
  • Address the impact of the opioid epidemic on children using a multi-generational response that includes substance use disorder treatment for parents; wraparound services for children and families, including grandparents and other relatives who help care for children; and expanded support for the foster care system. Model programs for families struggling with opioid and other substance misuse disorders have been twice as effective in helping mothers achieve sobriety, have reduced placement of children in state custody by half, and had a return on investment of $2.22 for every $1 spent on child welfare programs.
  • Reduce excessive alcohol use through evidence-based policies, such as increasing pricing, limiting hours and density of alcohol sales, enforcing underage drinking laws, and holding sellers and hosts liable for serving minors. For example, a 10 percent increase in the price of alcoholic beverages is shown to reduce consumption by 7.7 percent.
  • Prevent suicide by expanding crisis-intervention services; anti-bullying and social-emotional learning in schools; support systems for veterans; and better integrating mental health into primary care. As an example, the Zero Suicide model program has shown 80 percent reductions in suicides.
  • Expand and modernize mental health and substance use disorder treatment services toward a goal of focusing on the whole health of individuals by prioritizing innovative integrated delivery models for rural and underserved urban areas and expanding the provider workforce, including those who can deliver medication-assisted treatment. Some effective substance use treatment programs have a return of $3.77 per $1 invested.
  • Prioritize prevention, reduce risk factors, and promote resilience in children, families, and communities by limiting trauma and adverse experiences, which have the biggest long-term impact on later substance misuse, and promoting better mental health. Nurse home visiting programs have a return of $5.70 for every $1 invested, and early childhood education programs have a $4 to $12 return for every $1 invested.
  • Reboot in schools substance misuse prevention and mental health by scaling up evidence-based life- and coping-skills programs and inclusive school environments and increasing the availability of mental health and other services. Top school substance misuse prevention programs have a $3.80 to $34 return for every $1 invested; social-emotional learning programs have an $11 for $1 return; and school violence prevention (including suicide) programs have a $15 to $81 for $1 return.

We know what works. “Pain in the Nation” highlights more than 60 research-based policies, practices, and programs that address deaths of despair. Local, state, and federal governments — particularly Congress — need to be dauntless in their response. We can prevent needless deaths and spare our next generation from a lifetime of suffering.

Now is the time to improve resilience across the nation by increasing our investments in proven approaches that prevent deaths from drugs, alcohol, and suicide where we live, learn, work, and play.

John Auerbach is president and CEO of Trust for America’s Health, a nonprofit, non-partisan organization dedicated to making disease prevention a national priority. Benjamin F. Miller, is chief policy officer for Well Being Trust, a national foundation advancing the mental, social, and spiritual health of the nation and founding director of the Eugene S. Farley Jr. Health Policy Center in Aurora, Colo., where he remains a senior adviser.

  • One has to wonder if these various Wellbeing organizations are really obscuring these problems. So many of these egotistical do gooders believe they have an answer. They think there is simple top down approach, that will magically fix it all. There is a list of experts at Wellbeing Trust, who give the mistaken impression that smart people with expertise are looking at these problems, so they create a smokescreen as the problems become more entrenched and more invisible.
    These types of groups create nice jobs, and put out really compelling grant proposals. They are always top down, ignoring significant issues, while patronizing the people experiencing these issues. The people who are making a nice living and getting attention pointing out these problems, are quite comfortable, never knowing a sleepless night or going a day without eating. It is easy for them to promote some viral nonsense about “Thankfulness” while people go without medical care, are constantly desparaged or even die form exposure.

    Groups like this will never call out the hypocrisy, or even demand fact based data on these issues. They rely on corporate funding, government grants or the occasional good billionaire. Their position require that they remain silent on how we got here. They would not want to point out any kind of facts, or systemic issues. Any mention of a systemic issue or the profiteering from poverty, despair could mean less funding from corporate donors.

    This country is experiencing a silent epidemic of despair, the seriousness is offset by these heartwarming PR pieces, which are advertorials for fund raising purposes. The system is broken, yet we have not seen any of these types of groups, identify the problem. Here they put out facts about the broken mental health system, and insurance reimbursement. Certain insurance makes no difference, when people on Medicaid are forced to go to religious non profits for mental health care . There is no accountability, no tracking of outcomes or any meaningful measurement at these faith based organizations. There have been no improvements in mental health in decades, yet there has been silence from these experts. Since there was no tracking or accountability, these problems are now generational. Low Income clinics giving out random pharmaceuticals is not really mental healthcare. People with serious mental illnesses are worse off then they were 30 years ago, as are most things. None of these nice sounding groups offered any more than cover for the failing system.

    What we are really dealing with is a slow genocide, while these fundraisers, use the despair to generate income. They also spend a lot of time with movers and shakers who continue to profit from the epidemic of despair.
    These self described experts stood by while media outlets re-framed all of this. None of these experts looked at how the media misinforms us all on these issues, while groups like this give out platitudes and false hope. These groups filled a niche, giving the public the false idea that there are experts capable of identifying the problem. Their publicity and fundraising only obscures the extent of it. This is a group that thinks a platitude about Gratitude, is a remedy for the many suicides in America. A lot of those suicides are due to the continuous Gas Lighting of sick people, the poor and those in despair.

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