Issue Category: Substance Misuse and Mental Health

Deaths Due to Drug Overdose and Alcohol Are Down Nationally, But Progress is Uneven Across Population Groups and at Risk Due to Cuts in Federal Health Programs

How can progress be sustained and extended to all communities?

(Washington, D.C. – May 28, 2025) – Deaths due to drug overdose and alcohol misuse were down in the United States in 2023 according to Centers for Disease Control and Prevention (CDC) data and newly released CDC 2024 provisional data predict an unprecedented 27 percent one year drop in overdose deaths. These reductions are encouraging and were likely related to a number of factors including investments in primary prevention, mental health, harm reduction, and overdose prevention programs. However, current and proposed federal budget cuts, public health workforce reductions, and proposed federal agency reorganizations are likely to undermine this progress, according to a new report.

Pain in the Nation 2025: The Epidemics of Alcohol, Drug, and Suicide Deaths, released today by Trust for America’s Health, reports that the combined number of deaths from alcohol, drugs, and suicide in the United States declined in 2023 for the second straight year—after two decades in which such deaths increased at an alarming pace.  Still over 200,000 Americans died due to alcohol, drug overdose, or suicide in 2023, twice the rate of such deaths 20 years ago.

The new data highlight the value of investment in mental health and substance use prevention programs – such as ensuring adequate mental health, substance use disorder, and crisis intervention services, access to overdose reversal drugs, and investing in children’s mental health and resilience. The data however also show that much more needs to be done to ensure that the progress against alcohol, drug overdose, and suicide deaths is sustained and that reductions in such deaths are occurring in every community and among all population groups.

“Data show that decades of investment and capacity building in substance use prevention, harm reduction programs, and mental health services have helped reduce associated deaths. The challenge now is to build on these investments and sustain this progress. These programs save lives; their funding should not be cut,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health.


Drug overdose rates are declining but still at tragic levels.

In 2023, 105,007 Americans across died from drug overdoses. After precipitous increases in the rate of drug overdose deaths in 2020 and 2021, the 2022 overall overdose mortality rate was virtually unchanged and the 2023 mortality rate was 4 percent lower. Provisional mortality data for 2024 show an unprecedented one-year 27 percent decrease in overdose deaths nationally. Seven states (Louisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, and Wisconsin) and Washington D.C. saw the greatest reductions, with declines of 35 percent or more in overdose deaths for the year.

According to public health experts, improved data systems which allow for real-time tracking of substance use and its impacts, the expansion and effectiveness of overdose prevention strategies such as programs to ensure access to naloxone, buprenorphine, and drug-checking tools all played a significant role in bringing down mortality rates.

The improvement was, however, not consistent across all population groups or regions of the country. In 2023, white people were the only racial/ethnic population group that experienced a statistically significant decrease in drug overdose deaths; other population groups had nonsignificant changes or increases. Drug overdose death rates in 2023 were highest among American Indian/Alaska Native people (AI/AN) (65.0 deaths per 100,000 people), adults ages 35 to 54 (57.3 deaths per 100,000 people), Black people (48.5 deaths per 100,000 people), and males (45.6 deaths per 100,000 people).

Alcohol-induced deaths are down.

In 2023, 47,938 Americans died from alcohol-induced causes. The overall age-adjusted alcohol-induced mortality rate decreased by 7 percent from 2022 to 2023 (from 13.5 to 12.6 deaths per 100,000 people). This decrease built on a 6 percent reduction the year prior and crossed nearly all demographic and geographic groups, but such deaths still disproportionately impact some groups. Alcohol-induced death rates in 2023 were highest among AI/AN people (61.5 deaths per 100,000 people), adults ages 55 to 74 (32.5 deaths per 100,000 people), adults ages 35 to 54 (20.2 deaths per 100,000 people), and males (18.1 deaths per 100,000 people).

Suicide deaths unchanged.

The U.S. overall suicide mortality rate remained virtually identical from 2022 to 2023 (14.2 and 14.1 deaths per 100,000 people, respectively). In 2023, 49,316 Americans died from suicide. Age-adjusted suicide rates in 2023 were highest among AI/AN people (23.8 deaths per 100,000 people), males (22.7 deaths per 100,000 people), and adults ages 75 and older (20.3 deaths per 100,000 people).

Budget rescissions and future cuts to prevention programs will cost lives.

While these data demonstrate real progress, the public health community is united in its concern about progress reversals due to cutbacks in federal investment in health promotion, crisis intervention, and overdose prevention programs. For example, staff and funding for the CDC Injury Center have been drastically reduced, and the Center is proposed for elimination in the Administration’s budget request for fiscal year (FY) 2026. The Injury Center conducts research and collects data. Approximately 80 percent of its funding goes to states and other entities for prevention of overdoses, suicide, and adverse childhood experiences (ACEs). Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has experienced major staffing reductions including staff working on the 988 Suicide & Crisis Lifeline, and a potential $1.07 billion funding cut for FY 2026. The Administration has proposed folding some remaining SAMHSA and Injury Center programs into a new Administration for a Healthy America.  These actions followed the Administration’s claw-back of billions of dollars in public health funding already at work in states and communities across the country, including for suicide prevention.

The Pain in the Nation report calls for sustained investment in prevention and harm reduction programs and includes recommendations on actions federal and state policymakers should take including:

  • Protect and bolster investment in public health and behavioral health systems and injury and violence prevention programs to improve mental health and well-being for all Americans.
  • Continue to improve programs, like CDC’s Overdose Data to Action, to track emerging trends by geographic, demographic, and drug type metrics to guide local, state, and national responses and to prevent overdoses and deaths in real time.
  • Focus on underlying drivers of substance use disorder through early intervention and prevention policies including expanding resiliency and substance use prevention programs in schools and increasing access to social and mental health services for children and families.
  • Maximize harm reduction strategies and substance use disorder treatments to reduce overdose risk, and support efforts to limit access to lethal means of suicide.
  • Bolster the continuum of crisis intervention programs and expand the mental health and substance use treatment workforce. Build community capacity to ensure access to mental health and substance use treatment for anyone needing such services.

Read the full report

 

Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Trust for America’s Health (tfah.org)

 

 

Las muertes a causa de sobredosis por drogas y alcohol disminuyen a nivel país, pero el avance es desigual entre los grupos poblacionales y está en riesgo por los recortes en los programas sanitarios a nivel federal

¿Cómo se puede mantener y ampliar el avance para todas las comunidades?

(Washington, D.C., 28 de mayo de 2025). Las muertes a causa de sobredosis por drogas y abuso de alcohol disminuyeron en los Estados Unidos en 2023, según datos de los Centros para el control y prevención de enfermedades (CDC) y de los últimos datos provisorios publicados por los CDC en 2024, en donde que estima una baja sin precedentes del 27 % en un año en las muertes por sobredosis. Estas disminuciones son alentadoras y probablemente se relacionaron con una serie de factores, entre los que se incluyen las inversiones en prevención primaria, la salud mental, la reducción de riesgos y los programas de prevención de sobredosis. No obstante, los recortes presupuestarios actuales y propuestos a nivel federal, la reducción de la fuerza laboral de la salud pública y la reorganización propuesta de las agencias federales probablemente perjudiquen este avance, según un nuevo informe.

El informe Pain in the Nation 2025: the Epidemics of Alcohol, Drug, and Suicide Deaths (Dolor en el país 2025: la epidemia de muertes por alcohol, drogas y suicidio), que hoy publica Trust for America’s Health, expone que la cantidad conjunta de decesos a causa del alcohol, las drogas y los suicidios en los Estados Unidos disminuyeron en 2023 por segundo año consecutivo, tras dos décadas en las cuales tales decesos aumentaban a un ritmo alarmante. Aun así, más de 200.000 estadounidenses murieron a causa de sobredosis por alcohol, drogas o suicidio en 2023, el doble de la tasa por tales causas de muerte de hace 20 años atrás.

Estos nuevos datos ponen de manifiesto el valor de la inversión en salud mental y en los programas de prevención de consumo de sustancias como, por ejemplo, garantizar el acceso a los servicios correspondientes de salud mental, trastorno por consumo de sustancias e intervención por crisis, acceso a medicamentos que revierten la sobredosis, y la inversión en la salud mental y la resiliencia de los niños. No obstante, en los datos también se observa que se necesita hacer mucho más para garantizar que el avance contra las muertes a causa del alcohol, las drogas y el suicidio se mantengan, además de que las disminuciones logradas respecto a tales decesos están produciéndose en cada una de las comunidades y entre todos los grupos poblacionales.

“Los datos demuestran que en las décadas de inversión y desarrollo de capacidades con respecto a la prevención del consumo de sustancias, los programas de reducción de riesgos y los servicios de salud mental ayudaron a disminuir las muertes relacionadas con este flagelo. Actualmente, el desafío consiste en basarse en estas inversiones y mantener este avance. Con estos programas se salvan vidas, y no se debería recortar su financiamiento”, declaró Nadine Gracia, M.D., MSCE, presidenta y directora general de Trust for America’s Health.

 

Las tasas de sobredosis por drogas disminuyen, pero aún estamos en niveles trágicos.

En 2023, 105.007 estadounidenses en todo el país murieron a causa de sobredosis por drogas. Tras los aumentos precipitados en la tasa de muertes por sobredosis en 2020 y en 2021, la tasa general de mortalidad por sobredosis en 2022 no se modificó prácticamente y la tasa de mortalidad en 2023 fue un 4 por ciento menor. Los datos de mortalidad provisorios durante 2024 indican una disminución sin precedentes en un año del 27 por ciento en las muertes por sobredosis a nivel nacional. Se observaron en siete estados (Luisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, y Wisconsin) y en Washington D.C. las disminuciones más importantes al tener bajas del 35 por ciento o más en muertes por sobredosis durante el año.

Según expertos en salud pública, los sistemas de datos mejorados que permiten hacer un seguimiento en tiempo real del consumo de sustancias y sus efectos, la ampliación y la eficacia de estrategias de prevención de sobredosis como los programas que garantizan el acceso a la naloxona y a la buprenorfina, o herramientas de control de drogas, tuvieron en conjunto un papel importante en la baja de las tasas de mortalidad.

No obstante, la mejora no fue uniforme en todos los grupos poblacionales ni regiones del país. En 2023, la población blanca fue el único grupo poblacional que tuvo una disminución estadísticamente significativa con respecto a las muertes por sobredosis de drogas; otros grupos poblacionales tuvieron cambios poco significativos o aumentos. Las tasas de muerte por sobredosis de drogas en 2023 fueron las más altas en los grupos poblacionales indoamericano y nativos de Alaska (AI/AN) (65 muertes por cada 100.000 habitantes), en adultos de 35 a 54 años (57,3 muertes por cada 100.000 habitantes), en la población de color (48,5 muertes por cada 100.000 habitantes), y en los hombres (45,6 muertes por cada 100.000 habitantes).

Disminución de las muertes inducidas por el alcohol

En 2023, 47.938 estadounidenses murieron por causas inducidas por el alcohol. La tasa general de mortalidad inducida por el alcohol ajustada por edad disminuyó en un 7 por ciento de 2022 a 2023 (de 13,5 a 12,6 muertes por cada 100.000 habitantes). Esta reducción se acumuló a un 6 por ciento de disminución del año anterior y atravesó a casi todos los grupos demográficos y geográficos, aunque dichas muertes aún afectan de manera desproporcionada a determinados grupos. Las tasas de muerte inducidas por el alcohol en 2023 fueron las más altas en los grupos poblacionales IA/NA (61,5 muertes por cada 100.000 habitantes), en adultos de 55 a 74 años (32,5 muertes por cada 100.000 habitantes), en adultos de 35 a 54 años (20,2 muertes por cada 100.000 habitantes), y en los hombres (18,1 muertes por cada 100.000 habitantes).

Sin cambios en las muertes por suicidio

La tasa de mortalidad general por suicidio en los Estados Unidos sigue prácticamente igual de 2022 a 2023 (14,2 y 14,1 muertes por cada 100.000 habitantes, respectivamente). En 2023, 49.316 estadounidenses murieron por causas del suicidio. Las tasas de muerte por suicidio ajustada por edad en 2023 fueron las más altas en los grupos poblacionales AI/AN (23,8 muertes por cada 100.000 habitantes), en los hombres (22,7 muertes por cada 100.000 habitantes), y en los adultos de 75 años o más (20,3 muertes por cada 100.000 habitantes).

La cancelación de presupuestos y los recortes futuros en los programas de prevención costarán vidas

Si bien con estos datos se demuestran avances reales, la comunidad de la salud pública se encuentra unida en esta preocupación con respecto a los cambios en los avances debido a los recortes en la inversión federal relacionados con la promoción de la salud, la intervención en situaciones de crisis y los programas de prevención de sobredosis. Por ejemplo, el personal y la financiación del Centro de Lesiones de los CDC sufrieron una reducción drástica y se ha propuesto eliminar al Centro en la solicitud de presupuesto del gobierno para el año fiscal 2026. El Centro de Lesiones lleva a cabo investigaciones y recopila datos. Aproximadamente, el 80 por ciento de su financiación se destina a los estados y demás entidades para la prevención de sobredosis, suicidios y experiencias infantiles negativas (ACE).

Asimismo, la Administración de Servicios de Salud Mental y Abuso de Sustancias (SAMHSA) ha sufrido importantes reducciones en su dotación de personal, lo que incluyó personal que trabajaba en la Línea 988 de atención al suicidio y situaciones de crisis y un potencial recorte de presupuesto de 1,07 mil millones para el año fiscal 2026. El gobierno propuso incorporar a los programas que queden de la SAMHSA y del Centro de Lesiones en la nueva Administración para unos Estados Unidos Saludables. Estas acciones siguieron a la recuperación del gobierno de miles de millones de dólares de financiación a la salud pública que ya estaban en marcha en los estado y comunidades de todo el país, incluida la prevención del suicidio.

En el informe Pain in the Nation, se llama a una inversión constante en los programas de prevención y reducción de riesgos y se incluyen recomendaciones sobre medidas que los representantes políticos a nivel federal y estatal deberían tomar, entre las que se incluyen:

  • Proteger y apoyar las inversiones en los sistemas de salud pública y conductual y en programas de prevención de lesiones y violencia a fin de mejorar la salud mental y el bienestar de todos los ciudadanos de los Estados Unidos;
  • Seguir mejorando los sistemas de datos, como Datos de sobredosis para la acción de los CDC, para hacer el seguimiento de las tendencias emergentes según las métricas geográficas, demográficas y por tipo de droga con el fin de orientar las respuestas a nivel local, estatal y nacional y prevenir casos de sobredosis y muertes en tiempo real;
  • Enfocarse en las causas subyacentes de los trastornos por consumo de sustancias por medio de la intervención temprana y políticas de prevención incluidos los programas de ampliación de resiliencia y prevención de consumo de sustancias en las escuelas y aumento del acceso a servicios sociales y de salud mental para los niños y sus familias;
  • Maximizar las estrategias de reducción de riesgos y los tratamientos de trastornos por consumo de sustancias a fin de disminuir el riesgo de sobredosis, y dar apoyo a las iniciativas para limitar el acceso a medios fatales de suicidio;
  • Respaldar la continuidad de los programas de intervención de crisis y ampliar la dotación de personal para que brinde tratamiento de salud mental y por consumo de sustancias; Desarrollar la capacidad en la comunidad para garantizar el acceso a los servicios de salud mental y consumo de sustancias para todos los que necesiten estos servicios.

Lea el informe completo en: https://www.tfah.org/report-details/pain-in-the-nation-2025/

 

Trust for America’s Health es una organización sin fines de lucro no partidaria relacionada con políticas, investigación y defensa de la salud pública que fomenta la salud óptima para cada una de las personas y comunidades, y prioriza la prevención de enfermedades y lesiones a nivel nacional. Trust for America’s Health (tfah.org)

2024 Year in Review and Looking Ahead to 2025

During 2024, Trust for America’s Health (TFAH) continued its work to create a more resilient, trusted, and equitable public health system, and a healthier nation.

TFAH continued its work in a number of critical issue areas to improve the nation’s health, including emergency preparedness, public health funding, chronic disease prevention, the role of food and nutrition policy in stemming the nation’s obesity crisis, preventing substance misuse and suicide, supporting healthy aging, and addressing the health impacts of climate change and other environmental health risks.

Progress and Risks

The nation’s public health system is at an inflection point; progress has been made in many areas but there are also continuing and potential new risks to the nation’s health. The following are examples of areas of progress and areas of risk.

Areas of progress:

  • Drug overdose deaths, including from fentanyl, are down. The reduction can be credited in part to the increased availability of treatment options and the adoption of harm reduction strategies such as readily available naloxone, the overdose reversal drug, in many communities. However, disparities persist, with overdose rates increasing in many Black and Native American communities.
  • COVID-19 infection rates are currently low across the country, a testament to what can be achieved when the public health community rallies and has the funding and resources necessary to meet an immediate challenge.
  • Investments in public health data modernization, wastewater surveillance, and the Centers for Disease Control and Prevention’s (CDC) Center for Forecasting and Outbreak Analytics have improved the nation’s ability to identify and track emerging health threats. The Center has awarded more than $100 million to partners who are technologically advancing the use of outbreak data to control infectious disease spread.
  • Fifty-nine state and local health departments have earned Age-Friendly Public Health Systems Recognition Status through TFAH’s Age-Friendly Public Health Systems initiative by making healthy aging a core function of the department. In addition, four public health organizations and 154 individual public health practitioners have been recognized as public health champions.
  • Fifteen states and D.C. have adopted paid sick leave laws which require private employers to provide paid sick leave to employees attending to their own or a family member’s health. Alaska, Missouri, and Nebraska will require employers to provide paid sick leave beginning in 2025. Paid sick leave has been a long-standing TFAH policy recommendation.

Areas of risk:

  • Public health faces a serious funding cliff as monies infused into the public health system as part of the pandemic response are expiring or in some cases rescinded. The loss of such funding returns the public health system to the state of underfunding it experienced for decades prior to the global pandemic. TFAH’s annual report, The Impact of Chronic Underfunding on America’s Public Health System 2024: Trends, Risks, and Recommendations called attention to the critical need to increase investment in public health on a sustained basis.
  • The COVID-19 pandemic exposed serious gaps in the nation’s emergency infrastructure that have not been fully addressed. Furthermore, misinformation about the pandemic, particularly about lifesaving COVID-19 vaccines, contributed to an uptick in mistrust of public health officials that could lead to more vaccine hesitancy and challenges to important public health authorities, all of which could make containing future disease outbreaks more difficult.
  • New disease outbreaks such as the H5N1 Bird Flu could grow.
  • Rates of recommended childhood vaccinations are down.
  • Health disparities continue to impact the nation. Rates of chronic disease are on the rise in every community but are higher, for example, among many communities of color and in rural communities, due to structural barriers to health like access to healthy and affordable food, secure housing, and opportunities for physical activity in those communities.
  • Health risks are also increasing due to an increase in the number and severity of weather-related incidents including extended periods of extreme heat and extreme heat in regions of the country unaccustomed to such weather.

Working With Partners and Providing Leadership to Strengthen the Nation’s Public Health Ecosystem

TFAH released its Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress in October, after consultation with more than 45 experts, practitioners, organizations, and community members. The Blueprint provides the incoming Administration and Congress a policy roadmap for improving the nation’s health, economy, and national security within six priority areas: 1) invest in public health infrastructure and workforce, 2) strengthen prevention, readiness, and response to health security threats, 3) promote the health and well-being of individuals, families, and communities across the lifespan, 4) advance health equity by addressing structural discrimination, 5) address the non-medical drivers of health to improve the nation’s health outcomes, and 6) enhance and protect the scientific integrity, effectiveness, and accountability of agencies charged with protecting the health of all Americans.

Working with partners across multiple sectors is central to TFAH’s work. TFAH staff led or participated in a number of coalitions during 2024, including the Coalition for Health Funding, the CDC Coalition, the Common Health Coalition, the Well-Being Working Group, the Injury and Violence Prevention Network, National Alliance for Nutrition and Activity, the Coalition to Stop Flu, the Adult Vaccine Access Coalition, the Age-Friendly Ecosystem Collaborative, the National Alliance to Impact the Social Determinants of Health, the National Commission on Climate and Workforce Health, and the National Council on Environmental Health & Equity.

Advocating for Evidence-Based Solutions

A healthy community supports the health of individuals and families by creating access to non-medical drivers of health such as secure housing, transportation, quality healthcare, high-quality childcare and educational opportunities, and jobs that pay a living wage. Such health security supports individuals, families, communities, and the nation’s economy.

Throughout the year, TFAH convened partners to strategize ways to effectively advance health promoting policies and programs at the federal and state levels. In addition, TFAH staff worked with numerous federal agencies and offices, like CDC, FDA, and SAMHSA, as well as public health organizations such as the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), Big Cities Health Coalition, and the National Governors Association to advance policies and garner support for programs that will improve Americans’ health. Among TFAH’s legislative goals for 2024 and moving into 2025 are increased and sustained investment in public health agencies, infrastructure, and programs; passage of a new Farm bill that provides access to nutrition support programs; reauthorization of the Pandemic and All Hazards Preparedness Act and the Older Americans Act; and passage of the Public Health Infrastructure Saves Lives Act and the Social Determinants of Health Act.

These advocacy efforts earned numerous policy wins, including the U.S. Department of Agriculture’s (USDA) updates to school meals formulas and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefit food packages that aligns with TFAH recommendations.

TFAH’s core annual reports, which track data and recommend policy solutions in the areas of emergency preparedness, public health funding, preventing substance misuse and suicide, and addressing the nation’s obesity crisis, continue to be a critical source for data trends and evidence-based policy and program solutions for health officials, policymakers, other decision-makers, and advocates across the country.

Making Healthy Aging a Core Function of Local Health Departments

Through its Age-Friendly Public Health Systems Initiative (AFPHS), TFAH continues to provide guidance and resources to state and local health departments to help them promote healthy aging in their communities. During 2024, AFPHS co-hosted the 2024 National Healthy Aging Symposium with the U.S. Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion. The symposium brought together speakers from sectors across all levels of government, philanthropy, academia, nonprofits, community-based organizations, tribal representatives, and others who shared their perspectives on important topics related to healthy aging including caregiving, brain health, the caregiving workforce, transportation, housing, and social engagement. TFAH also launched the Age-Friendly Ecosystem Collaborative to continuously engage organizations and sectors central to healthy aging.

Supporting Public Health Communicators

TFAH continues to be a managing partner of the Public Health Communications Collaborative (PHCC). PHCC provides no-cost messaging resources and communications training to state and local health departments to help the field effectively address the public’s information needs on public health issues. The Collaborative was first established during the COVID-19 pandemic and now works across the public health sector on such issues as H5N1 Bird Flu, Mpox, protecting health during periods of extreme heat, and vaccine confidence. Its training materials include resources on strengthening public health through community engagement, responding to misinformation, and using social media in health communications. The PHCC newsletter is shared with over 38,000 opted-in subscribers, and its website has earned over 1.2 million page views since its launch in 2020.

Looking Ahead

The 2025 calendar year promises to be pivotal for the nation’s health. TFAH looks forward to bringing evidence-based policy recommendations to the new Administration and Congress, particularly on issues such as emergency preparedness, chronic disease prevention, mental health, veterans’ and rural health, and investing in prevention to reverse the pattern of increasing healthcare spending without better health outcomes. We are committed to making the case for policies and programs that address the non-medical drivers of health in order to promote the nation’s health and economic security.

Over 50 Public Health Advocacy Organizations Support Robust Investment in CDC Suicide Prevention

(November 1, 2024 – Washington, DC)  – According to data from the Centers for Disease Control and Prevention (CDC), the number of suicides increased in 2022 to historic peak levels—over 49,000 deaths—after slight declines in 2019 and 2020. Suicide is the second leading cause of death among Americans between the ages of 10-14 and 25-34, and suicide rates increased by 36 percent between 2000 and 2021. The complex nature of suicide requires a comprehensive approach to prevention that focuses on disproportionately affected populations, uses data to understand risk factors associated with suicide in these groups, and applies the best available evidence to decrease risk and increase protective factors.

In a recent letter to key Congressional leaders, TFAH and the American Foundation for Suicide Prevention (AFSP) led more than 50 public health advocacy organizations in urging increased investment in these approaches through the CDC Comprehensive Suicide Prevention Program (CSP). Established in 2020, the CSP currently funds 24 initiatives nationwide through cooperative agreements designed to implement and evaluate a comprehensive public health approach to suicide prevention, with a special focus on populations that are disproportionately affected by suicide. These CSP initiatives have led to significant benefits, including decreases in suicide rates and increased training, awareness, and data collection. For example, the veteran and servicemember population that CSP initiatives served saw a 6.5% reduction in suicide rates from 2019-2021.

As the letter explains, “[b]y promoting mental health awareness, encouraging early intervention, and supporting individuals in crisis, the CSP plays a pivotal role in addressing one of the most serious public health challenges of our time.” TFAH and AFSP urge Congressional leaders to provide robust funding for the CSP to save lives and foster hope for Americans in crisis.

Pain in the Nation 2024: The Epidemics of Alcohol, Drug, and Suicide Deaths

Trust for America’s Health (TFAH) hosted a national webinar on our report, Pain in the Nation 2024: The Epidemics of Alcohol, Drug, and Suicide Deaths.

TFAH’s report found that a decrease in the alcohol-induced mortality rate led to a slightly lower combined rate of all U.S. deaths due to alcohol, drugs, and suicide in 2022, but the long-term trend of such deaths is still alarmingly high. Between 2002 and 2022, combined deaths due to alcohol, drugs, and suicide have increased by 142 percent from 74,003 deaths in 2002 to 207,827 deaths in 2022. For 2022, the alcohol-induced mortality rate decreased by six percent to 13.5 deaths per 100,000 people, the first decrease in the rate after more than a decade of increases, but death rates for drug overdose and suicide remained unchanged. The report also includes a special feature on polysubstance misuse and overdose.

The webinar discussed steps policymakers should take to begin to reverse these crises.

 

U.S. Deaths Due to Alcohol, Drugs, and Suicide Down Slightly After Years of Growth

Data Show First Improvement in Combined Substance Misuse and Suicide Mortality Rate in Five Years but Multidecade Trends Remain Alarmingly High

(Washington, DC – July 31, 2024) – A decrease in the alcohol-induced mortality rate led to a slightly lower combined rate of all U.S. deaths due to alcohol, drugs, and suicide in 2022, but the long-term trend of such deaths is still alarmingly high, according to a report released today by Trust for America’s Health.

The report, Pain in the Nation 2024: the Epidemics of Alcohol, Drug, and Suicide Deaths, includes data showing that between 2002 and 2022, combined rate of deaths due to alcohol, drugs, and suicide have increased by 142 percent from 74,003 deaths in 2002 to 207,827 deaths in 2022.

For 2022, the alcohol-induced mortality rate decreased by six percent to 13.5 deaths per 100,000 people, the first decrease in the rate after more than a decade of increases, but death rates for drug overdose and suicide remained unchanged.

Rates and trends for deaths due to substance misuse and suicide vary across population groups and states and regions of the country. While all population groups have experienced increases in substance misuse and suicide deaths over the last two decades, American Indian and Alaska Native people, Black people, and white people have higher than average combined rates for alcohol, drug, and suicide deaths.

In 2022, states with the highest rates of deaths due to alcohol, drugs, and suicide were New Mexico (124.3 deaths per 100,000 people), West Virginia (115.7 deaths per 100,000 people), and Alaska (104.1 deaths per 100,000 people).

Substance use and drug overdose

The overall age-adjusted drug overdose mortality rate was virtually unchanged from 2021 to 2022 (32.4 deaths per 100,000 people and 32.6 deaths per 100,000 respectively), but despite the flat trend, 107,941 people died in the U.S. due to a drug overdose in 2022.

According to data collected by the U.S. Substance Abuse and Mental Health Services Administration, in 2022 approximately 70 million people in the U.S. aged 12 and older – about one-quarter of the adolescent and adult population – reported using one or more illegal drugs and just under 10 percent of people aged 12 and over in the U.S. had a drug use disorder.

Drug overdose rates were highest among American Indian/Alaska Native people at 65.2 deaths per 100,000 people, adults ages 35 to 54 (59.4 deaths per 100,000), Black people (47.5 deaths per 100,000), and males (45.6 deaths per 100,000).

Alcohol Misuse

Despite the decrease in alcohol-induced deaths in 2022, 51,191 people in the U.S. died from alcohol-induced causes during the year. Alcohol-induced deaths were highest among American Indian and Alaska Native people (78.4 deaths per 100,000 people) and adults ages 55 to 74 (34.9 deaths per 100,000 people).

Suicide Deaths

In 2022, 49,476 people in the U.S. died from suicide. Overall mortality due to suicide was virtually unchanged between 2021 and 2022: 14.1 deaths per 100,000 people and 14.2 deaths per 100,000, respectively.

The highest rate of suicide was among American Indian/Alaska Native people (27.1 deaths per 100,000 people), males (23 deaths per 100,000), older adults (21 deaths per 100,000), and people living in rural areas (20.5 deaths per 100,000). Suicide mortality between age groups moved in different directions with suicide deaths among young people (ages 0-17 and 18 – 34) decreasing while increasing for all older age groups.

“While the stabilization in the combined rate of alcohol, drug, and suicide deaths in 2022 is promising news, it is overshadowed by decades of tragically increasing numbers of such deaths and spotlights the need to continue to apply evidence-based solutions in order to save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO, Trust for America’s Health. “We have strategies that we know work, including early prevention and harm reduction strategies, creating safe and supportive schools, ensuring access to mental and behavioral healthcare, and creating community conditions that support children and families. We need to invest in these policies and programs.”

Report Recommendations

The report includes recommendations for steps that federal, state, local government and other stakeholders should take to address the substance misuse and suicide crisis, including:

Invest in prevention and community conditions that promote health, including programs to reduce adverse childhood experiences and those that support families and offer trauma-informed and culturally appropriate services for youth.

Reduce overdose risk and access to lethal means of suicide through harm reduction programs including syringe services programs, access to overdose prevention medications like naloxone, and promoting safe storage of all firearms.

Strengthen the mental health and substance use prevention system by continuing to build a continuum of crisis intervention programs, ensuring access to mental health and substance use services, and growing the mental health workforce while increasing its diversity and offering more culturally and linguistically responsive services.

Read the full report

Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.

 

Ensuring Culturally and Linguistically Appropriate Mental Health Services Will Reduce Health Disparities and Promote Well-being

In 1966, Dr. Martin Luther King, Jr. famously condemned injustice in health as the most shocking of all forms of inequality.  As TFAH recognizes Mental Health Awareness Month almost 60 years later, populations of color and other underserved groups in the United States continue to experience disparities in behavioral health outcomes and the availability and quality of care.  By supporting and promoting culturally and linguistically appropriate services (or CLAS), however, policymakers can reduce these disparities and promote well-being for all Americans.

The Office of Minority Health at the U.S. Department of Health and Human Services (HHS) defines CLAS as services that are respectful of and responsive to cultural and communication needs, including through consideration of cultural health beliefs, health literacy levels, and preferred languages.  By incorporating CLAS, providers can ensure individuals and families receive respectful, understandable, effective, and equitable care.  Among other features, CLAS can involve recruiting and supporting a culturally and linguistically diverse workforce, offering language assistance to individuals with limited English proficiency, and collecting and maintaining accurate data to evaluate impacts on health equity and outcomes.

The U.S. mental health care system, specifically, has struggled to address the needs of culturally and linguistically diverse populations; as a result, racial and ethnic minority populations have historically been less likely to receive necessary mental health care and more likely to receive low-quality care.  In addition, these groups are more likely to use hospitals and inpatient facilities to address mental health needs instead of community-based services.  Across the healthcare system, non-white patients report lower quality patient-physician interactions, less participation in medical decision making, and lower overall satisfaction with care. Other social and economic factors like lack of health insurance, limited income, transportation barriers, and experiences of racism and bias also contribute to these outcomes. In addition, a recent report found that 50 percent of LGBTQ+ young people who wanted mental healthcare could not get it due, in part, to a lack of affordable options and fears of negative reactions or other consequences.

Racial and ethnic health disparities impose a high burden in the United States—one study found $451 billion in costs, including medical expenses, lost productivity, and premature death, for 2018 alone—but CLAS can significantly improve quality of care and advance equity.  One study found that the single most important factor for increasing use of mental health services for individuals with limited English language proficiency was access to providers speaking their native languages.  In addition, the use of peer support specialists and other lay health workers with community-specific experience can promote access to care and help to reduce dropout rates and boost attendance rates for patients during mental health treatment.  In Native communities, for example, these workers can help overcome practical barriers to mental healthcare like lack of transportation and reduce symptoms of depression and suicide-related outcomes.  An integrated care approach that coordinates a variety of services can also improve mental health outcomes for patients from racially and ethnically diverse populations.

The Biden-Harris Administration has undertaken significant efforts to support and enhance CLAS across the spectrum of behavioral healthcare.  The 988 Suicide and Crisis Lifeline, which launched in July 2022, for example, has implemented specialized services for the LGBTQ+ population, and the Substance Abuse and Mental Health Services Administration announced the addition of Spanish language text and chat services in July 2023.  In November 2023, the White House also released the U.S. Playbook to Address Social Determinants of Health.  This document outlines strategies to “support equitable health outcomes by improving the social circumstances of individuals and communities,” including the structural inequities that “often disproportionately impact historically underserved individuals.” The 2023 HHS Equity Action Plan similarly outlined measures to improve access to behavioral healthcare coverage for underserved populations, including by developing an inclusive workforce, promoting behavioral health integration, and enhancing language services.  Relatedly, in January 2024, the Centers for Medicare & Medicaid Services (CMS) announced the Innovation in Behavioral Health (IBH) Model, which will comprehensively address health-related social needs of Medicaid and Medicare populations with moderate to severe mental health conditions and substance use disorder.  Importantly, this model requires participating Medicaid agencies to develop a health equity plan to address disparities in the populations they serve.

Several recent Congressional initiatives have also focused on promoting CLAS in the behavioral health system.  The PEER Support Act, for example, would strengthen the peer support specialist workforce by ensuring accurate data reporting on the profession, supporting best practices on training and supervision, and addressing barriers to certification and practice.  In addition, the Pursuing Equity in Mental Health Act would help establish behavioral healthcare teams in areas with underserved populations, improve training and best practices for addressing mental health disparities, and enhance outreach to populations of color to promote mental health and reduce stigma.  Finally, the Health Equity and Accountability Act would help reduce health disparities by improving data reporting, supporting workforce diversity, and increasing access to CLAS.

TFAH encourages Administration officials and Congressional leaders to continue to bolster CLAS to improve behavioral health outcomes for populations of color and other underserved groups. These improvements will not only help address the high cost of health disparities in the United States but will also support foundational changes to improve access and outcomes in the future.