Preserving Progress in Reducing Substance Misuse Deaths Requires Continued Investment and Addressing the Roots of Community Trauma
By J. Nadine Gracia, M.D., MSCE, President and CEO, Trust for America’s Health (TFAH), and John A. Rich, M.D., MPH, Director, RUSH BMO Institute for Health Equity, Rush University System for Health, Member, TFAH Board of Directors
Substance use, overdose, and suicide send ripples of pain through many communities, often without regard for station in life. At the root of too many of these tragedies are the scars of past physical, emotional, or sexual trauma.
Trust for America’s Health (TFAH) recently published our annual Pain in the Nation: The Epidemics of Alcohol, Drug, and Suicide Deaths report. The report is a comprehensive analysis of national, state, and population group substance use and suicide data and trends. It spotlights successful prevention programs and includes recommendations for action by federal, state, local, tribal, and territorial policymakers to reduce such deaths.
This is the ninth report of the Pain in the Nation series which opened with a comprehensive overview of the data in 2017. We continue to be dedicated to working on these issues not only because they have tragic impacts for so many families but because they are preventable.
In the early years of my medical practice at Boston City Hospital, I saw patients in distress often turn to substances to self-medicate the pain of their past trauma, only to stumble into addiction, and potential overdose. Their distress was compounded by lack of access to healing resources, like ongoing mental health support and medication-assisted treatment, to ease their pain in a more enduring way.
John Rich, M.D., MPH
There has been some recent progress in reducing the scourge of substance misuse – the combined rate of alcohol, drug, and suicide deaths was down nationally in 2023 for the second straight year, and provisional data show an unprecedented 27 percent drop in overdose deaths in 2024. Still, over 200,000 Americans died due to alcohol, drugs, and suicide in 2023, twice the rate of such deaths 20 years ago.
While the reduction in deaths at the national level is encouraging, it is concerning that these decreases are not happening in every community. White people were the sole racial/ethnic group to experience a decrease in drug overdose rates in 2023, and overdose rates continue to be highest among American Indian/Alaska Native people and Black people. In addition, while other regions of the country experienced decreases in drug overdose deaths, the West saw an 8 percent increase.
What’s needed to sustain and grow the progress?
Healing as a strategy has been undervalued. While we recognize that there are many roots to the pain that leads to substance use disorders, healing is critical, whether through behavioral treatment, medication, or integrative approaches, like mindfulness. We must also address community trauma by addressing poverty, hopelessness, unemployment, and other salient drivers of despair.
Increasingly in healthcare and public health settings, patients are being screened for exposure to trauma and tailored solutions are being created to meet their needs. Depression, trauma, stress, and despair are often at the root of chronic disease, it is therefore incumbent on the healthcare system and public health to find integrative ways of addressing these challenges.
Extend the progress across all population groups – The reduced overall rate of alcohol, drug, and suicide deaths in 2022 and 2023 is welcome news, but it is also vitally important to make the investments necessary to extend this progress across all population groups.
Address non-medical drivers of health – Increasing evidence suggests that social and economic factors such as lack of access to adequate nutrition, communities without safe places to be physically active, and excess stress may fuel metabolic disruptions that also contribute to depression and other mental health conditions.
Real-time data save lives – The availability of timely data allows public health officials to understand what’s happening on the ground and tailor appropriate responses in a timely manner. Data answer questions about such issues as who is at risk and what drug types (or additives) are leading to overdose so information can be shared, and interventions can quickly be put to work.
Role of health disparities – American Indian/Alaska Native people have the highest rates of alcohol, drug, and suicide deaths compared to other population groups. In addition, Black people and men typically have higher rates of deaths due to drug overdose, alcohol, and suicide as compared to the overall population. The next steps are clear. We need to identify barriers to good health and well-being. Doing so will require addressing health disparities, community disadvantage, adverse childhood experiences, and racial trauma – all of which impact rates of substance use and suicide deaths.
Structural racism is itself a driver of the burden of health inequities. The social and economic drivers of poor health, including such fundamental challenges as lack of access to healthy food, green space, and healthcare, contribute to ill health. When structural racism is built into communities in the form of disinvestment, lack of services, lack of transportation, lack of safety, and opportunities are structured by the color of one’s skin, community trauma erodes community well-being.
We know what works.
Recent progress shows what can be accomplished with investment, data, and federal, state, and local leadership, but continued progress is not guaranteed. We know what works, now is the time to sustain and increase investment in prevention, not reduce it. Doing so will support community stability, reduce healthcare spending, and save lives.
The report’s policy recommendations are designed to spur action within key areas including:
- Protect and bolster investment in prevention programs and public health infrastructure.
- Focus on the underlying drivers of substance use disorder and suicide.
- Maximize overdose prevention and intervention Naloxone access is one of the key drivers of lower rates of drug overdose, but such programs could be on the chopping block due to proposed federal budget recissions and cuts.
- Build community capacity to ensure culturally appropriate access to mental health and substance use services for anyone needing them.
The current and proposed cuts to federal prevention programs and workforce will put lives at risk.
- The Injury Center at the Centers for Disease Control and Prevention (CDC) plays a critical role in helping state and local health departments access data, work with experts, understand emerging threats in the drug supply, and implement prevention programs that will meet the needs of communities. The expertise of the Injury Center saves lives, yet the Center is proposed for elimination in the President’s FY 2026 Budget.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) has experienced significant staffing reductions including staff working on the 988 Suicide & Crisis Lifeline, and a potential $1.07 billion funding cut for FY 2026.
- These actions followed the Administration’s clawback of billions of dollars in public health funding already at work in states and communities across the country, including for suicide prevention.
Continuing to apply a public health lens to the diseases of despair is critical to envisioning solutions to these complex problems. Moving from data to action by including the voices of communities, and leveraging data collected in partnership with communities, will create a holistic, long-term approach to ensure a public health system that is equipped to prevent substance misuse and suicide deaths.
The progress we are making in reducing alcohol, drug and suicide deaths shows that public health interventions including investments in primary prevention, mental health, and overdose prevention and intervention programs work. But this progress is fragile. We can’t ensure health if we are cutting the very programs that save lives. The recent and proposed cuts to federal budgets, experts, and programs aren’t just numbers. They will translate into lost lives and grieving families.
