Far too many Americans are dying from preventable causes, and each time we make progress it seems like new problems appear. Take the case of opioid overdoses. As we are beginning to get a handle on misuse of prescription opioids, fentanyl and synthetic opioids have come to the fore. Two decades ago, they were linked to fewer than 1,000 deaths each year. In 2017, fentanyl and synthetic opioids killed more than 28,000 Americans.
The emphasis on opioids is appropriate, but too narrow. The underlying conditions that often lead to drug misuse can also lead to alcohol misuse, loneliness, and despair. Even as America is experiencing surging rates of drug misuse, the nation is also witnessing an unprecedented rate of suicide deaths, which rose 6 percent between 2016 and 2017, and with alarming increases among children and adolescents.
Overall, more than 150,000 Americans — the most ever — died from alcohol and drug-induced fatalities and suicide in 2017. That’s more than twice as many as in 1999, according to a new analysis released on Tuesday by our organizations, Well Being Trust and Trust for America’s Health.
To truly tackle complex, deeply rooted societal problems like these, we need to transform fragmented and disjointed community systems. Deaths from substance misuse and suicide are symptoms of broader problems. If we treat only the symptoms, more and more people will be at risk and die needlessly.
To address the underlying causes, we need a comprehensive approach that includes increasing funding and support for programs that reduce risk factors for despair and promote resilience in children, families, and communities. Exposure to trauma and adverse life experiences at young ages increases the potential for substance misuse and suicide. Programs that reduce community violence; address poverty and discrimination; create safe, supportive schools and quality learning experiences; and promote access to secure housing and employment opportunities can decrease adverse experiences and build resilience.
For example, the Nurse-Family Partnership works with young, low-income women who are pregnant for the first time. A public health nurse meets with the mother from pregnancy until the child turns 2, establishing a trusted relationship with both. The home visits connect first-time mothers with the care and support they need to ensure a healthy pregnancy and birth. The model has been shown to have dramatic benefits to society. For instance, when Medicaid pays for Nurse-Family Partnership services, the federal government gets a 54 percent return on its investment.
Along that line, the nation should expand substance misuse prevention and mental health programs in schools by increasing the number of schools that get training for, can screen for, and can respond to childhood trauma. Schools should also be supported in scaling up evidence-based life- and coping-skills programs like the Good Behavior Game, and increasing the availability of culturally appropriate mental health and other services.
Schools should also work with other community agencies to assist the families of the children who have experienced trauma. Successful school substance misuse prevention programs return $3.80 to $34 for every $1 invested; social-emotional learning programs provide an $11 for $1 return; and school violence prevention programs (including suicide) have a $15 to $81 return.
The nation will see results only if it addresses the need for a multigenerational response that includes substance use disorder treatment for parents and additional support for all caregivers while also expanding resources for the foster care system.
Model programs have been effective in helping mothers achieve sobriety, reducing state custody placement of children by half and producing a strong return on investment. Sobriety Treatment and Recovery Teams (START), for example, is a Kentucky-based program for families with parental substance use disorders and issues of child abuse and/or neglect. It helps parents achieve sobriety and, when possible, keeps children safely with their parents. Mothers who participated in START achieved sobriety at nearly twice the rate of those not in the program and children in START families were half as likely to be placed in state custody. For every dollar spent on START, Kentucky avoided spending $2.22 on foster care.
Policymakers should create, and clinicians should support, policies that limit access to the lethal means of suicide by promoting safe storage of medications and firearms — completed suicides with a firearm have increased 22 percent over the last decade. The Counseling on Access to Lethal Means model has improved medication and firearm storage behavior through parental counseling. One Colorado study, focusing on parental counseling for suicidal youth in the emergency department, found 100 percent of firearms locked up at follow-up.
These more upstream approaches should be seen as essential elements of a comprehensive approach that includes the more downstream availability of treatment. While the continuum of services is essential for all populations, we must place focused attention on access to programs for communities and population groups at the highest risk for substance misuse and suicide.
Every American — from policymakers and public health advocates to parents, caregivers, clinicians, and counselors — should demand that community leaders develop and fund a comprehensive strategy that includes the elements laid out above and so much more.
Continually rising deaths from despair and trauma are unacceptable and, perhaps most importantly, they are preventable. America’s leaders need to direct resources toward comprehensive solutions that truly integrate physical health, mental health, and substance-use disorder services in a way that prioritizes prevention and more adequately addresses community demand.
Let’s not wait for the next crisis, or ride out this one for another decade, to decide that now is the time to invest in prevention.
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. John Auerbach is president and CEO of Trust for America’s Health, a nonprofit, nonpartisan organization dedicated to making disease prevention a national priority.