Alcohol and “Deaths of Despair”
Research feature article
Introduction
As reported by economists Anne Case, Ph.D., and Angus Deaton, Ph.D., after decreasing since the end of World War II, rates of death began to increase in the United States for people in some groups. The rise in deaths was driven primarily by drug and alcohol overdoses, suicides, and liver disease. These conditions, in turn, were related to declining quality of life—reduced physical and mental health, increases in chronic pain, financial difficulties, and serious mental illness. Given the nature of these deaths, Drs. Case and Deaton referred to them as “deaths of despair.” They reported that the increase in mortality occurred primarily among 45-54-year-old non-Hispanic, White men and women.
A subsequent study led by researchers at Virginia Commonwealth University found an increase in deaths of despair among people ages 25–64 in a variety of groups, including non-Hispanic Whites, non-Hispanic American Indians and Alaskan Natives, non-Hispanic Blacks, Hispanics, and non-Hispanic Asians and Pacific Islanders. And it appears that the United States is not alone, as deaths of despair are on the rise among middle-aged men and women in England, too.
Alcohol and deaths of despair
Alcohol plays a prominent role in deaths of despair, contributing to overdoses, suicides, and liver disease, as well as to a broad range of other disease states that lead to mortality. Alcohol use is increasing among middle-aged adults in the United States and is more common when people are faced with stressful circumstances, such as job loss, divorce, economic downturns, chronic pain, or psychiatric conditions—all factors related to deaths of despair.
Alcohol use both follows and contributes to mental health conditions that increase the risk of suicide. People with Alcohol Use Disorder (AUD) are
- twice as likely as those without AUD to experience major depression,
- five times as likely to suffer from bipolar disorder,
- three times as likely to experience post-traumatic stress disorder.
People with AUD are much more likely to contemplate suicide, and alcohol often plays a role in suicide attempts. Estimates suggest that nearly 1 in 4 males and 1 in 5 females are intoxicated—with BAC levels of 0.08% or more—at the time of a suicide.
In addition to overdoses, liver disease, and suicides, alcohol contributes to mortality in other ways that might add to deaths of despair. Alcohol plays a role in roughly 3.5% of all cancer deaths in the United States. For women, the risk of breast cancer increases with less than 1 alcohol unit per day. Compared to women who consumed fewer than 60 units of alcohol in a typical year, those consuming 60–229 units of alcohol (about 0.6 units per day, on average) were 20% more likely to develop breast cancer. Research also has shown that people who consume larger amounts of alcohol have a greater risk of cancers of the mouth, esophagus, larynx, pharynx, liver, colon, and rectum.
Alcohol also is a common factor in deaths from injuries. The U.S. Centers for Disease Control and Prevention (2013) estimates that alcohol contributes to 32% of deaths from falls, 42 percent of deaths from fires, 47% of deaths from homicides, and 34% of deaths from drownings.
Alcohol is not the only factor driving the increase in deaths of despair, but raising awareness of the health risks posed by alcohol and the dangers of using alcohol to cope with challenges in life could help reduce the number of such deaths.