A research team I’m part of just published data looking at the ‘diseases of despair’ crisis over the last decade (full article is free and available online). A brief summary of our findings below, and some thoughts.... bmjopen.bmj.com/content/10/10/…
Diseases of despair are the *clinical* manifestations of substance abuse, suicidal thoughts/behaviors & alcohol dependency that precede despair-related *deaths* that have been in the news in recent years 
We looked at 12 million people enrolled in a Highmark health insurance plan between 2009-2018 (including Medicare/ACA), focusing intensively on Pennsylvania, W. Virginia, & Delaware & extracting diagnoses related to alcohol use, substance use, and suicide ideation/behaviors.
We found that last decade, 1 out of every 20 carriers (n=515,830) was diagnosed with at least one disease of despair. The overall rate of DoD diagnoses increased by 68%, with rate of alcohol-, substance-, & suicide-related diagnoses rising by 37%, 94%, and 170%, respectively.
With regard to alcoholism, the most dramatic increases were seen among men, and those 55–74. Suicide-related Dx among those <18 increased 287%, and 210% among 18-34 y.o.’s. Neonatal abstinence syndrome linked to maternal drug abuse (eg, opioid addiction) rose by 114%.
[Seeing these data for the first time was one hell of a gut punch...]
While we didn’t collect income/wealth data, people with Medicare had 1.5x higher odds of having a DoD Dx, followed by those with ACA plans (1.3x higher odds). Clearly class-position & greater relative precarity is playing a role in mediating risk for despair-related illness.
Our findings join other recent studies in establishing that the DoD crisis & rising mortality—originally characterized in poor rural non-Hispanic whites w/ low educational attainment—is crossing demographic/geographical boundaries.
This implies we’re dealing w/a crisis systemically linked to material changes in US political economy that have broadly affected working class over last several decades. It’s not a “loss of virtue” in a particular ethnic group or “diseases of disproportionate opportunity” (smdh)
Simply put, the US isnt presently organized to support people living materially secure, fulfilled lives. Hyper-capitalism/globalization, stagnant wages, weak unions, austerity, loss of soc safety nets, soc media, have produced pervasive alienation, anxiety, depression, loneliness
People are seeking escape from pain, esp in econ-declining regions, & when you mix in deadly & accessible drugs like opioids/fentanyl, cheap alcohol, broad access to guns, high levels of uninsured/underinsured citizens, lack of mental healthcare, it is a deadly combination.
And we have a political system incapable of dealing w/ any facet of our underlying structural problems. This isn’t just an opioid problem, or a gun problem. It wouldn’t even be solved by M4A, though that would certainly help.
Health systems can do better screening for despair and ensure resources & proper Tx for those at risk. But ultimately there has to be a reckoning at the level of political-economy. Tough to envision a way forward as we careen into another decade of grinding neoliberal austerity…
(Goes without saying that the editorializing bit is my opinion & doesn’t necessarily reflect views of Penn State College of Medicine, Highmark Health, etc., etc.)
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