Pain in the Nation 2026: the Epidemics of Alcohol, Drug, and Suicide Deaths
After two decades of rising deaths from alcohol, drugs, and suicide, the United States is at a turning point. Recent declines in mortality suggest meaningful progress, but that progress is fragile. Over the past year, the federal behavioral health and injury prevention systems that support prevention, surveillance, and crisis response have experienced leadership upheaval, funding disruptions, and workforce reductions. Whether recent gains continue will depend on sustained investment in the public health infrastructure that makes prevention possible.
After peaking in 2021, this year’s report finds that the combined age-adjusted rate of deaths from alcohol, drugs, and suicide declined by 16 percent in 2024, building on a decrease of 4 percent in 2023. Specifically, alcohol-induced mortality declined by 4 percent, drug overdose mortality by 26 percent, and suicide mortality by 3 percent.
“Sustaining and building on recent progress requires the federal government to invest even more in programs that reduce and prevent harm—not cut them—while also investing in the skilled workforce and modern data systems necessary to deliver and evaluate those programs effectively,” said Dr. J. Nadine Gracia, President and CEO of TFAH. “We are also seeing specific groups of people not experiencing the same progress, especially when it comes to deaths from suicide, meaning we need to do even more to build strong policies and programs that help to improve everyone’s mental health and well-being,”
Drug overdose rates are declining but still at concerning levels.
In 2024, 79,384 Americans of all ages died from drug overdoses. The overall age-adjusted drug overdose rate was 26 percent lower in 2024 (23.1 deaths per 100,000) as compared with 2023 (31.3 deaths per 100,000). This was the second year in a row that the drug overdose death rate declined, after a long-term rise over the last two decades and precipitous increases in 2020 and 2021.
All groups had lower rates of drug overdose deaths in 2024 compared with 2023, with particularly large decreases among youth ages 0–17 and young adults ages 18–34 (-34 percent), Black Americans (-31 percent), and people in the Northeast (-30 percent), Midwest (-30 percent), and South (-29 percent). Synthetic opioids remained the subtype of drug with the highest overdose death rate (14.3 deaths per 100,000) in 2024. It also had the highest decrease in overdose rate (-36 percent) in 2024, though cocaine (-27 percent) and other psychostimulants (-20 percent) also declined markedly.
Alcohol-induced deaths are down for third year in a row.
In 2024, 46,714 Americans of all ages died from alcohol-induced causes. (Note: alcohol-induced deaths include alcohol poisoning, liver diseases, and other diseases; it does not include alcohol-attributable deaths, such as alcohol-related violence, accidents, or vehicle fatalities.) The overall age-adjusted rate of U.S. deaths from alcohol-induced causes was 4 percent lower in 2024 (12.1 deaths per 100,000) compared with 2023 (12.6 deaths per 100,000 people). After two decades of increases (since 2002), this was the third year in a row with a decline in the alcohol-induced death rate. All groups had lower rates of alcohol-induced deaths in 2024 compared with 2023, except for multiracial people.
Suicide deaths are down.
In 2024, 48,824 Americans of all ages died from suicide. The overall age-adjusted suicide rate was 3 percent lower in 2024 (13.7 deaths per 100,000) as compared with 2023 (14.1 deaths per 100,000). Over the last decade, there has been fluctuations with lows in 2015/2016 and 2020 (13.3-13.5 death per 100,000), and peaks in 2018 and 2022 (14.2 deaths per 100,000). All groups had lower rates of suicide deaths in 2024 compared with 2023, except for multiracial people. Firearm suicides make up more than half of suicides every year and the rate (7.6 deaths per 100,000) remained the same in 2023 and 2024. Suicide rate by suffocation/hanging and poisoning/overdose methods were lower in 2024.
Budget rescissions and future cuts to prvention programs will cost lives.
As the United States faces the ongoing epidemics of alcohol, drug, and suicide deaths, the federal behavioral health system has undergone substantial organizational and policy changes. Throughout 2025 and 2026, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Center for Injury Prevention and Control (Injury Center) at the Centers for Disease Control and Prevention (CDC) experienced drastic workforce reductions — with SAMHSA losing roughly half of its workforce and the Injury Center reportedly losing more than 200 staff. These staff tracked emerging trends in behavioral health, provided expertise and technical assistance to states and localities, and administered critical programs focused on mental health and well-being.
Congress provided full funding for SAMHSA and CDC’s Injury Center. The legislation also required agencies to maintain the minimum staffing necessary to carry out the funded programs. However, abrupt terminations of already-approved funding throughout 2025 and 2026 have generated uncertainty among state and local grantees surrounding the stability of these investments. Amid these actions and evolving federal landscape, the following recommendations for policymakers represent TFAH’s research into the programs and policies that are needed to improve the nation’s behavioral health outcomes.
Policymakers should act on these recommendations.
The Pain in the Nation report calls for a sustained commitment to primary prevention programs and investments, and includes recommendations on actions the Administration, Congress and federal agencies should take, such as:
- Investing in prevention and conditions that promote health
- Spend behavioral health funds and carry out investments as directed by Congress.
- Provide robust funding for CDC’s Injury Center and maintain the vital workforce necessary to fulfill the Center’s activities.
- Support policies and programs that reduce adverse childhood experiences and the impact of trauma and promote positive childhood experiences.
- Reducing overdose risk and access to lethal means of suicide
- Support policies to reduce overdose and bloodborne infection.
- Support efforts to limit access to lethal means of suicide, such as safe storage of medications and firearms.
- Transforming the mental health and substance use prevention system
- Maintain SAMHSA’s funding and critical workforce and bolster the continuum of crisis intervention programs and supports, such as the 988 Suicide and Crisis Lifeline.
- Restore Medicaid funding and eligibility to prevent losses in mental health and substance use healthcare.
- Promote equity in mental health, with a specialized workforce and targeted services to reduce disparities in access and outcome.
