Addiction and its consequences have driven up the death rate among middle aged working-class white people to unprecedented levels, a study published yesterday by the National Academy of Sciences reported.
While death rates among nonwhites and among all other age brackets have been falling, mortality among whites in the 45 to 54 year age group who have no more than a high school education have been rising substantially. The leading causes of death are not the traditional ones such as heart disease and diabetes, but afflictions stemming from substance use: alcoholic liver disease, overdoses of heroin and prescription opioids, and suicides.
The trend reversed a previous long-term mortality decline in this demographic. If the previous decline had continued, study authors Anne Case and Angus Deaton of Princeton wrote, half a million deaths would have been avoided. This figure is comparable to losses in the AIDS epidemic, they write.
The researchers’ report, together with commentaries in The New York Times and the Wall Street Journal, speculates that lowered economic opportunities led to the everyday stresses that drove victims to seek relief in alcohol and other drugs, or to end their lives.
While these inferences are certainly plausible, the rising death rate also throws a spotlight on the shortcomings of our addiction treatment system. By and large, this is dominated by a religious and moralistic approach that has no scientific grounding. As studies have shown, even when this kind of treatment is available, most people don’t want it. Referral to twelve-step groups remains the knee-jerk reaction among treatment providers, despite clear evidence that these groups retain less than five per cent of those who try them. Reliance on this paradigm alone is costing thousands of lives. It is high time for the medical profession and others concerned with addiction to recognize and promote additional approaches that supplement the legacy paradigm with secular and non-moralistic approaches. We need more roads out of addiction so that more people may live.
My book, Empowering Your Sober Self.