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American death rate from substance abuse and mental disorders triples since 1980

130 points by upen 10y ago

gesman 10y ago
While these subjects are connected for some individuals - it's not wise to pile them up together into the single stat number. Wrong stats. Which drugs? Top 5-10? Which mental disorders? Top 5-10?
- DanBC 10y ago
  (I upvoted you.) For mental disorders it's something like: 1) Anorexia Nervosa (historically had very high death rate, something like 20%) 2) Body Dysmorphic Disorder (most people don't know that this has a high suicide rate) 3) Major depression 4) Psychotic illness (people with psychosis tend to live 20 years less than the general population) 5) ADHD (I'm not sure of the ordering of the last 3.) As for drugs, far and away the leading cause of death and harm is going to be alcohol.
  - openasocket 10y ago
    So, clearly the anorexic people die because they starve themselves, people with depression commit suicide, but what's killing the people with ADHD? I know ADHD is correlated with greater risk taking, greater likelihood to abuse drugs, but is it severe enough to put it in the top 5 or 10?
andrewguenther 10y ago
I'd be curious to see these numbers separated. Did they both increase proportionally?
- upen 10y ago
  Here is the detailed report: http://ghdx.healthdata.org/us-data http://ghdx.healthdata.org/us-data
deleted 10y ago
[deleted]
Gravityloss 10y ago
Here's the interactive version: http://vizhub.healthdata.org/subnational/usa http://vizhub.healthdata.org/subnational/usa
- AimHere 10y ago
  You can play with this map to see where the changes are biggest and smallest. Interestingly, the strip from Maryland to Georgia - which normally stands out in US political maps, due to issues of slavery and race - stands out as being one big area where deaths due to drugs or substance abuse didn't increase much at all, annually, from a relatively low start.
- zwtaylor 10y ago
  Interesting to see the dramatic rise in deaths related to substance abuse from 1996 onwards, the year Purdue Pharma introduced Oxycontin. It's especially glaring in the most impoverished parts of Appalachia.
- blauditore 10y ago
  Is there any obvious reason for the higher death rate in the "bible belt"? One thing I could imagine is rural exodus, leaving a higher percentage of old people.
  - maxerickson 10y ago
    Poverty.
  - justinlaster 10y ago
    Poverty combined with boredom. And from my personal experience, a complete unwillingness to discuss such problems (i.e, "Not my family").
debacle 10y ago
Regardless of how you feel about legalization, policy, etc, this should prove, at the very least, that we aren't winning the "War on Drugs."
- ListenLinda 10y ago
  Yup. The war on drugs is a waste of everything.
- deelowe 10y ago
  Prohibition really has turned out to be a seriously damaging thing to society. Drugs are classified not based on their potential to cause harm or abuse, but instead by some nebulous concept of morality. We, as a society need to embrace a more scientific based approach.
  - deleted 10y ago
    [deleted]
  - nickff 10y ago
    The value judgments are inseparable from the 'harm or abuse' measurements; there is no value-neutral way to assess harm and abuse. You can say you want to be scientific and come up with numbers, but the selection of the metrics and the 'critical values' will be political and ethical decisions. Having said all that, I am in favor of full legalization of every substance, even though I personally find the use of almost all substances 'distasteful'.
    - deelowe 10y ago
      You can scientifically quantify harm both to individuals and society. For example, potential for abuse, potential for individual harm, and potential for social harm are all factors that could be quantified and considered. Using those metrics alone, the juxtiposition of the classification of marijuana versus alcohol or nicotine is quite interesting. You could perhaps include many other drugs as well such as cocain, mdma, and perhaps even LSD (though this one does pose some concerns socially given that it can cause manic episodes). My point is that the current "war on drugs" has no scientific basis. And, as such, where we've ended up has been very destructive in terms of the cost to society (imprisonment, surge in use of more harmful but easier to source substances, etc...).
icantdrive55 10y ago
Is it a big mystery? Life in certain parts of America is just aweful. Is it suprising certain people turn to a drug to relieve the missery of life, or self-medicate a mental illnesses? A mental illness that doesn't go away yacking/blaming two times a week? We were told how certain wonder drugs(heterocyclic--drugs like Prozac, and older tricyclics type drugs) will make us feel better, relieve certain metal illness, and they when we looked deep into the terrible research; they don't even know if they work. "Oh well--yes--well maybe they work 62% over that huge placebo response--in those dubious studies done in India. You know the ones where the researchers left out the studies that failed. By the way, my fee for today is $350. See you in eight weeks? I might have raised my fees, so bring an extra $50? See yea--close the door on you way out." The one thing that kept me away from heroin, from reliable sources, not Doctors, you do fell better for 3-9 months. (If you don't get busted, go to jail, loose your job, lose what's left of your life now.) Then it stops working. You need more drugs to feel just like you did before the opiate. You spend the next few years, and maybe a lifetime just addicted to a drug that only worked for a few months? What's the point? It's society, and the medical community that failed.
ListenLinda 10y ago
thats because the govt has taken the guns so they can't kill themselves. lol
keylime314 10y ago
Regarding Kentucky cancer stats: https://en.wikipedia.org/wiki/Paducah_Gaseous_Diffusion_Plant#Contamination https://en.wikipedia.org/wiki/Paducah_Gaseous_Diffusion_Plan...
notgood 10y ago
Unless there is evidence to prove the contrary we must be open to the possibility that many of them -as rude as it may sound- are better off dead. Just for example if I got Alzheimer I would kill myself just months later after the diagnosis, I have not a single shred of doubt about it; no need to burden yourself and your friends to see you slowly decay into a memoryless vegetable. I also met a schizophrenic girl once; the way she described the pain she had to endure is alike something out of an horror movie.
- wjnc 10y ago
  Your reply gets flagged / downvoted. Perhaps it's because it is really harsh. The thought experiment is real though. But why would so many more people be better off dead now than a few decades ago? Perhaps mental care was better or more accessible? Or the function of f.e. economic stability helps a mentally unstable pass the most unstable period (20s?) with less chance of derailing?
CoryG89 10y ago
It seems that they are unable or unwilling to separate deaths due to mental disorders from substance abuse. Probably due to the thinking that anyone who dies from a substance abuse issue is dealing with a mental disorder. While this may be true some of the time, I'm not sure that it's clear that it is always the case. And even if it was, substance abuse deaths would just be a subset of deaths from mental disorders, still would seem misleading to lump them together.
- hasbroslasher 10y ago
  Substance abuse is generally regarded as a form of mental illness and is often comorbid with depression or anxiety disorders. It's not totally unfair to lump them, after all it is way easier do die from dangerous drugs than (purely) from a mental illness. That might give the reader some weird impressions or distort the problem to lean more heavily on the typical "War on Drugs" logic. I think it's significantly better for public health policy making to consider substance abuse a mental health issue than it is to consider it a weird personal problem or a social variable that we have no control over.
- draw_down 10y ago
  That's a valid point, but the number tripled. Is that really down to statistical methods, or is there actually a huge problem which, admittedly, may not be measured perfectly?
  - CoryG89 10y ago
    How much wider of a net are we casting when we consider what counts as a "death due to mental illness or substance abuse" compared to 25 years ago? I don't doubt it may have gone up, but I do doubt that these numbers tell us as much as some might think.
- anigbrowl 10y ago
  You make a good point. While drug abuse is often an attempt at self-medication for untreated mental illness (or illness which responds poorly to pharmaceutical industry offerings), it's a mark of the overall social disregard for both mental illness and drug use that this isn't broken down more carefully. On the mental illness side I'd expect to see things get worse from both years of overseas wars (often fought by people from the lowest socioeconomic quintile) and recessionary suffering and subsequent failure to recover. On the drugs side, fentanyl has turned the calculus of dosage, lethality, and morbidity upside down in pursuit of large profits, as much for corporate suppliers as criminal ones. expect all this to get significantly worse rather than better if the incoming administration and Congress pursue their stated goal of repealing the Affordable Care Act aka Obamacare without a clear alternative ready to go. Last discussion I heard suggested that they might need 2-3 years to agree on a replacement health coverage system and that the problem was likely to be thrown back in the lap of the states for the time being.
Alex3917 10y ago
By my count around a third of Americans die from drug misuse and drug-related causes: http://alexkrupp.typepad.com/sensemaking/2014/05/the-one-statistic-you-never-hear-about-drugs.html http://alexkrupp.typepad.com/sensemaking/2014/05/the-one-sta... And that was written before this study came out, which estimated that there may be an additional 60,000 annual tobacco-related deaths that are not being counted by the CDC: http://www.nejm.org/doi/full/10.1056/nejmsa1407211 http://www.nejm.org/doi/full/10.1056/nejmsa1407211
- maxerickson 10y ago
  I think given the way people reason about such things you should probably advertise it as 20% of Americans die from tobacco use and then argue that this should be considered together with other drug related causes. I'm not arguing that tobacco is anything other than a drug, I'm saying that emphasizing it in things like your first paragraph here will reduce the number of people that come to the wrong conclusion.
rm_-rf_slash 10y ago
Make drugs illegal. Lock up drug users in prison with other drug users who get drugs into prison because it's not as hard as you think. Teach prisoners no employable skills. Dump them back outside with the most damming scarlet letter in American society. Give them no public assistance because of drug conviction. Reduce life options to selling drugs or becoming full-blown addict to escape the painful reality. Observe drug use or sale. Arrest again. Change nothing. What a surprise.
jmuguy 10y ago
Take a look at what Reagan did to national mental health services in the 80s. Pretty hard not to draw some correlation there.
- kolbe 10y ago
  drugs have become the new treatment plan. and instead of fixing the mentally ill, they just sedate them until they reach an early death.
- cjensen 10y ago
  That was part of the problem. The other part is that "One Who Flew Over the Cuckoo's Nest" inspired the left to change laws so that it became hard for Psychs to institutionalize people who need help. Both parts need to change. The "they aren't hurting anybody so leave them alone" people need to understand that they are hurting themselves and need to have their freedom of choice taken away. There needs to be strong oversight to prevent abuse. There needs to be sufficient funding to humanely take care of the mentally ill and, when possible, make them better. Addiction needs to be treated as a mental illness since, once the individual becomes addicted, it literally is a chemical abnormality in the physical brain mostly beyond the ability of the individual to address without medical help.
  - m_mueller 10y ago
    Before expanding the process to lock up people I'd have a good look at the current state of me tal health services - see the recent article about UHS about how they're abusing the system and their patient just to milk a bit more profit. Locked wards are fine IMO, but please don't allow this to for-profit institutions - same wrong incentives as for-profit prisons, i.e. current day slavery in the US.
  - maxerickson 10y ago
    What legislation do you think most contributed to deinstitutionalization?
  - thraway2016 10y ago
    it became hard for Psychs to institutionalize people who need help. The prospect of a society in which any psychologist can, on a whim, circumvent due process and imprison anyone against their will indefinitely, is terrifying. It's much, much better this way.
larrik 10y ago
Whenever I see a headline like this, I think "did reality change, or did the reporting methods?"
- kolbe 10y ago
  also worth thinking: did X become a bigger killer, or did we impede all the other killers so much that X is now coming into fruition more often.
tyingq 10y ago
Not mentioned in the article, but I suspect some of this is due to the closing of most state run mental hospitals, which ramped up starting in 1972. https://en.wikipedia.org/wiki/Deinstitutionalisation https://en.wikipedia.org/wiki/Deinstitutionalisation Edit: More in-depth article on the topic: http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html http://www.pbs.org/wgbh/pages/frontline/shows/asylums/specia...
- kolbe 10y ago
  probably, but keep in mind that those places are extraordinarily expensive to run. even though we are seeing massive increases in deaths as a result of their closure, it may still have been the right decision. there's a value to everything, including life.
  - glhaynes 10y ago
    Easier to stomach if the defunding of those programs had been in order to redirect that funding toward better-producing programs.
  - undersuit 10y ago
    It's easy to put a value on someone else's life. How much should we spend on your life before it's ok to consign you to death?
    - kolbe 10y ago
      no, it's not easy or pleasant or anything to put value on someone else's life. but it's a reality. and to your question: i don't think it's your job to spend anything on my life. and i would certainly choose to die if the cost was bankrupting my family, for example.
    - mason240 10y ago
      The flipside of course, is how much extra are you willing to spend to save every preventable death? How much are you you willing spend on someone else's life before it's ok for you to consign their death?
kolbe 10y ago
Is it reasonable to assume that substance abuse deaths are far greater than mental health disorder deaths? As for the increase: no shit. Alcohol, one of the most damaging drugs, plays a central role in our contemporary marketing economy that can scientifically manipulate into engaging with alcohol on a massive scale. On the pharma side, we shove extraordinarily dangerous drugs like Oxy, Klonopin, SSRIs and Adderall on under the guise of them being medication. Thanks to the industry surrounding all these things, people don't even know they are engaging in dangerous, life-threatening drugs until it's too late.
- CoryG89 10y ago
  > Is it reasonable to assume that substance abuse deaths are far greater than mental health disorder deaths? I wouldn't assume that, especially not based on this article. It all depends on how you count up the deaths anyway. For example, considering substance abuse, what counts? Do we only take overdoses? What about accidental poisonings? What if I just smoke cigarettes until I am 85 and then die of heart disease that I was genetically predisposed to anyway? What about eating fatty foods to obesity and then dying from a heart attack?
dasil003 10y ago
Whoah the quantity of subscribe popups, notifications and ads plastered all over the page is a huge turnoff. All this JS interaction seems to have somehow broke the animated gif as well. Protip for publishers: one prominent entry point into "subscribing" with multiple choices is sufficient. I get that you want me to subscribe, but if I don't want to you're surely getting negative returns by creating such an obnoxious UX.
- daxfohl 10y ago
  It's ironic that with all that JS, they couldn't be bothered to come up with something better than a gif to display the actual content.
jjawssd 10y ago
Nobody seems to address the elephant in the room which is that the death rate from substance abuse and mental disorders was possibly underreported in the past
- millzlane 10y ago
  Kinda like how cancer wasn't that big of an issue until we began looking for it.
Bartweiss 10y ago
There's a really interesting result buried in this. "about half of US counties saw increases in suicide and violence" The separation of perceived and actual violent crime rates is a pretty infamous thing. Violent crime has been declining for decades, but at least since ~2000 perceived rates have failed to track that result. People toss around lots of theories, from "the media scares us" to "bigots are scared" to "perception can only go so low". This implies that we might be missing a better answer: people give national answers using local assumptions. If your county and all of the ones nearby have steadily rising rates of assault and homicide, it looks an awful lot like violence is on the rise (and for you, it is). This is especially true since you'll hear about every murder in your town, but only a few from NYC regardless of how many happen there (or don't happen). So violent crime rates have dropped steadily, largely because they're power-law effects and the deadliest regions have gotten much safer. But there are a lot of people looking around at rising violence where they and their families live, and that's getting buried by the data from a handful of cities.
- maxerickson 10y ago
  In many counties the rate of violence is still low enough that it will be difficult to measure accurately, never mind trying to reason about it anecdotally. (a typical year around here includes 0 murders and about 20 aggravated assaults, less than 1/1000 individuals)
- stuckagain 10y ago
  Media scare tactics around violence focus on urban areas, but the counties with high and increasing violence are the rural ones, especially the severely depopulated and very isolated counties. Of course the flip side is, nobody lives there. The ratios are high but the absolute numbers are not. I like to use this site to explore this data, although it cannot produce deep links: https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterface.jsp https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterf...
- anigbrowl 10y ago
  You're correct, but people in rural areas often dismiss the data as lies (egged on by some sectors of the media) rather than asking for better data. So it's an article of faith among rural and semi-rural conservatives that all government data are lies and that the inner cities are some sort of urban-warfare crime zone which is being covered up in the mainstream media. It suits certain political actors to promote this version of events.
DanBC 10y ago
I don't know how US death certificates and coroners work. But things like death by suicide have tricky stats. In the US a death after self injury with the intent to die is counted as suicide. That intent to die bit is hard to know, so some deaths are going to be counted as something else. (Accidental death, maybe.) And because of the strong stigma and taboo around suicide historical data may undercount it. Also, in the UK, for a coroner to rule a death as suicide it has to meet a higher burden of proof. The coroner has to be satisfied beyond all reasonable doubt that the death was suicide. For other deaths (but not murder) the burden of proof is the balance of probabilities. So it's easier (in England) for a coroner to rule something is an accidental death than a death by suicide. I guess the researchers are aware of all of this, and that they'll have mentioned how the cleaned up the data. But it's something to be aware of when reading it.
kafkaesq 10y ago
It would be interesting to see how these morbidity rates correlated with losses in wages and job security, since that magical year 1980. Particularly among middle-aged white males -- which are a pretty large group; and for whom stark rises in suicide rates have been observed by others, e.g.: http://www.nytimes.com/2015/11/03/insider/more-white-men-die-from-suicide-and-substance-abuse-why.html http://www.nytimes.com/2015/11/03/insider/more-white-men-die...
internaut 10y ago
I believe this is connected to stagnant wages (which starts in 1970s for Americans), with a catch. My hypothesis: 1. Counterintuitively, bad economic circumstances don't lead to chronic stress. People in countries with objectively terrible economic conditions are not more stressed or unhappier. It is simply: 'life'. 2. Caveat: Bad economic conditions do cause chronic stress where the media is projecting an illusion of rising success and wealth for the average person. This is because large numbers of people begin to feel left behind, even though most of their 'successful' peers are probably in debt to their eyeballs. Chronic stress is caused by the constant reminders in the form of fraudulent statistics, advertisements and social conditioning by fictional television shows that cause them to compare their circumstances to largely imaginary ideals. My solution, which sounds drastic but I believe it to be meritorious, is to ban television (but we can keep the Nature channels). I believe a large number of social ills shall mostly disappear once this is accomplished. Supporting evidence: http://news.harvard.edu/gazette/story/2009/03/fijian-girls-succumb-to-western-dysmorphia/ http://news.harvard.edu/gazette/story/2009/03/fijian-girls-s...
chinchang1998 10y ago
Yes
sankyo 10y ago
My pet theory is that we are isolated and there are less ways to feel connected to society (suburbs, too much TV) and the over importance of image, wealth, and status. Too many McJobs and lonely suburbs and people start to get depressed and other forms of mental illness. Naturally these people self medicate when their needs are not met anywhere else. Corporations used to feel more obligated to the society that they were in. Churches used to be more popular. Even if the Catholic church did evil things and controlled people, it did/does provide a place for people to feel like they belonged somewhere.
SamUK96 10y ago
I do wonder if they accounted for statistical bias. Death rate is 3x larger, but US population was ~60% of what is was now. That alone means that the death rate is actually only 1.8x times bigger. Additionally, it's been shown that doctors have been bribed and has caused vast over-diagnosis. Why was this clickbait, masquerading as a study, linked on HN?

130 points by upen 10y ago

While these subjects are connected for some individuals - it's not wise to pile them up together into the single stat number. Wrong stats. Which drugs? Top 5-10? Which mental disorders? Top 5-10?

DanBC 10y ago
(I upvoted you.) For mental disorders it's something like: 1) Anorexia Nervosa (historically had very high death rate, something like 20%) 2) Body Dysmorphic Disorder (most people don't know that this has a high suicide rate) 3) Major depression 4) Psychotic illness (people with psychosis tend to live 20 years less than the general population) 5) ADHD (I'm not sure of the ordering of the last 3.) As for drugs, far and away the leading cause of death and harm is going to be alcohol.
- openasocket 10y ago
  So, clearly the anorexic people die because they starve themselves, people with depression commit suicide, but what's killing the people with ADHD? I know ADHD is correlated with greater risk taking, greater likelihood to abuse drugs, but is it severe enough to put it in the top 5 or 10?

andrewguenther 10y ago

I'd be curious to see these numbers separated. Did they both increase proportionally?

upen 10y ago
Here is the detailed report: http://ghdx.healthdata.org/us-data http://ghdx.healthdata.org/us-data

deleted 10y ago

[deleted]

Gravityloss 10y ago

Here's the interactive version: http://vizhub.healthdata.org/subnational/usa http://vizhub.healthdata.org/subnational/usa

AimHere 10y ago
You can play with this map to see where the changes are biggest and smallest. Interestingly, the strip from Maryland to Georgia - which normally stands out in US political maps, due to issues of slavery and race - stands out as being one big area where deaths due to drugs or substance abuse didn't increase much at all, annually, from a relatively low start.
zwtaylor 10y ago
Interesting to see the dramatic rise in deaths related to substance abuse from 1996 onwards, the year Purdue Pharma introduced Oxycontin. It's especially glaring in the most impoverished parts of Appalachia.
blauditore 10y ago
Is there any obvious reason for the higher death rate in the "bible belt"? One thing I could imagine is rural exodus, leaving a higher percentage of old people.
- maxerickson 10y ago
  Poverty.
- justinlaster 10y ago
  Poverty combined with boredom. And from my personal experience, a complete unwillingness to discuss such problems (i.e, "Not my family").

debacle 10y ago

Regardless of how you feel about legalization, policy, etc, this should prove, at the very least, that we aren't winning the "War on Drugs."

ListenLinda 10y ago
Yup. The war on drugs is a waste of everything.
deelowe 10y ago
Prohibition really has turned out to be a seriously damaging thing to society. Drugs are classified not based on their potential to cause harm or abuse, but instead by some nebulous concept of morality. We, as a society need to embrace a more scientific based approach.
- deleted 10y ago
  [deleted]
- nickff 10y ago
  The value judgments are inseparable from the 'harm or abuse' measurements; there is no value-neutral way to assess harm and abuse. You can say you want to be scientific and come up with numbers, but the selection of the metrics and the 'critical values' will be political and ethical decisions. Having said all that, I am in favor of full legalization of every substance, even though I personally find the use of almost all substances 'distasteful'.
  - deelowe 10y ago
    You can scientifically quantify harm both to individuals and society. For example, potential for abuse, potential for individual harm, and potential for social harm are all factors that could be quantified and considered. Using those metrics alone, the juxtiposition of the classification of marijuana versus alcohol or nicotine is quite interesting. You could perhaps include many other drugs as well such as cocain, mdma, and perhaps even LSD (though this one does pose some concerns socially given that it can cause manic episodes). My point is that the current "war on drugs" has no scientific basis. And, as such, where we've ended up has been very destructive in terms of the cost to society (imprisonment, surge in use of more harmful but easier to source substances, etc...).

icantdrive55 10y ago

Is it a big mystery? Life in certain parts of America is just aweful. Is it suprising certain people turn to a drug to relieve the missery of life, or self-medicate a mental illnesses? A mental illness that doesn't go away yacking/blaming two times a week? We were told how certain wonder drugs(heterocyclic--drugs like Prozac, and older tricyclics type drugs) will make us feel better, relieve certain metal illness, and they when we looked deep into the terrible research; they don't even know if they work. "Oh well--yes--well maybe they work 62% over that huge placebo response--in those dubious studies done in India. You know the ones where the researchers left out the studies that failed. By the way, my fee for today is $350. See you in eight weeks? I might have raised my fees, so bring an extra $50? See yea--close the door on you way out." The one thing that kept me away from heroin, from reliable sources, not Doctors, you do fell better for 3-9 months. (If you don't get busted, go to jail, loose your job, lose what's left of your life now.) Then it stops working. You need more drugs to feel just like you did before the opiate. You spend the next few years, and maybe a lifetime just addicted to a drug that only worked for a few months? What's the point? It's society, and the medical community that failed.

ListenLinda 10y ago

thats because the govt has taken the guns so they can't kill themselves. lol

keylime314 10y ago

Regarding Kentucky cancer stats: https://en.wikipedia.org/wiki/Paducah_Gaseous_Diffusion_Plant#Contamination https://en.wikipedia.org/wiki/Paducah_Gaseous_Diffusion_Plan...

notgood 10y ago

Unless there is evidence to prove the contrary we must be open to the possibility that many of them -as rude as it may sound- are better off dead. Just for example if I got Alzheimer I would kill myself just months later after the diagnosis, I have not a single shred of doubt about it; no need to burden yourself and your friends to see you slowly decay into a memoryless vegetable. I also met a schizophrenic girl once; the way she described the pain she had to endure is alike something out of an horror movie.

wjnc 10y ago
Your reply gets flagged / downvoted. Perhaps it's because it is really harsh. The thought experiment is real though. But why would so many more people be better off dead now than a few decades ago? Perhaps mental care was better or more accessible? Or the function of f.e. economic stability helps a mentally unstable pass the most unstable period (20s?) with less chance of derailing?

CoryG89 10y ago

It seems that they are unable or unwilling to separate deaths due to mental disorders from substance abuse. Probably due to the thinking that anyone who dies from a substance abuse issue is dealing with a mental disorder. While this may be true some of the time, I'm not sure that it's clear that it is always the case. And even if it was, substance abuse deaths would just be a subset of deaths from mental disorders, still would seem misleading to lump them together.

hasbroslasher 10y ago
Substance abuse is generally regarded as a form of mental illness and is often comorbid with depression or anxiety disorders. It's not totally unfair to lump them, after all it is way easier do die from dangerous drugs than (purely) from a mental illness. That might give the reader some weird impressions or distort the problem to lean more heavily on the typical "War on Drugs" logic. I think it's significantly better for public health policy making to consider substance abuse a mental health issue than it is to consider it a weird personal problem or a social variable that we have no control over.
draw_down 10y ago
That's a valid point, but the number tripled. Is that really down to statistical methods, or is there actually a huge problem which, admittedly, may not be measured perfectly?
- CoryG89 10y ago
  How much wider of a net are we casting when we consider what counts as a "death due to mental illness or substance abuse" compared to 25 years ago? I don't doubt it may have gone up, but I do doubt that these numbers tell us as much as some might think.
anigbrowl 10y ago
You make a good point. While drug abuse is often an attempt at self-medication for untreated mental illness (or illness which responds poorly to pharmaceutical industry offerings), it's a mark of the overall social disregard for both mental illness and drug use that this isn't broken down more carefully. On the mental illness side I'd expect to see things get worse from both years of overseas wars (often fought by people from the lowest socioeconomic quintile) and recessionary suffering and subsequent failure to recover. On the drugs side, fentanyl has turned the calculus of dosage, lethality, and morbidity upside down in pursuit of large profits, as much for corporate suppliers as criminal ones. expect all this to get significantly worse rather than better if the incoming administration and Congress pursue their stated goal of repealing the Affordable Care Act aka Obamacare without a clear alternative ready to go. Last discussion I heard suggested that they might need 2-3 years to agree on a replacement health coverage system and that the problem was likely to be thrown back in the lap of the states for the time being.

Alex3917 10y ago

By my count around a third of Americans die from drug misuse and drug-related causes: http://alexkrupp.typepad.com/sensemaking/2014/05/the-one-statistic-you-never-hear-about-drugs.html http://alexkrupp.typepad.com/sensemaking/2014/05/the-one-sta... And that was written before this study came out, which estimated that there may be an additional 60,000 annual tobacco-related deaths that are not being counted by the CDC: http://www.nejm.org/doi/full/10.1056/nejmsa1407211 http://www.nejm.org/doi/full/10.1056/nejmsa1407211

maxerickson 10y ago
I think given the way people reason about such things you should probably advertise it as 20% of Americans die from tobacco use and then argue that this should be considered together with other drug related causes. I'm not arguing that tobacco is anything other than a drug, I'm saying that emphasizing it in things like your first paragraph here will reduce the number of people that come to the wrong conclusion.

rm_-rf_slash 10y ago

Make drugs illegal. Lock up drug users in prison with other drug users who get drugs into prison because it's not as hard as you think. Teach prisoners no employable skills. Dump them back outside with the most damming scarlet letter in American society. Give them no public assistance because of drug conviction. Reduce life options to selling drugs or becoming full-blown addict to escape the painful reality. Observe drug use or sale. Arrest again. Change nothing. What a surprise.

jmuguy 10y ago

Take a look at what Reagan did to national mental health services in the 80s. Pretty hard not to draw some correlation there.

kolbe 10y ago
drugs have become the new treatment plan. and instead of fixing the mentally ill, they just sedate them until they reach an early death.
cjensen 10y ago
That was part of the problem. The other part is that "One Who Flew Over the Cuckoo's Nest" inspired the left to change laws so that it became hard for Psychs to institutionalize people who need help. Both parts need to change. The "they aren't hurting anybody so leave them alone" people need to understand that they are hurting themselves and need to have their freedom of choice taken away. There needs to be strong oversight to prevent abuse. There needs to be sufficient funding to humanely take care of the mentally ill and, when possible, make them better. Addiction needs to be treated as a mental illness since, once the individual becomes addicted, it literally is a chemical abnormality in the physical brain mostly beyond the ability of the individual to address without medical help.
- m_mueller 10y ago
  Before expanding the process to lock up people I'd have a good look at the current state of me tal health services - see the recent article about UHS about how they're abusing the system and their patient just to milk a bit more profit. Locked wards are fine IMO, but please don't allow this to for-profit institutions - same wrong incentives as for-profit prisons, i.e. current day slavery in the US.
- maxerickson 10y ago
  What legislation do you think most contributed to deinstitutionalization?
- thraway2016 10y ago
  it became hard for Psychs to institutionalize people who need help. The prospect of a society in which any psychologist can, on a whim, circumvent due process and imprison anyone against their will indefinitely, is terrifying. It's much, much better this way.

larrik 10y ago

Whenever I see a headline like this, I think "did reality change, or did the reporting methods?"

kolbe 10y ago
also worth thinking: did X become a bigger killer, or did we impede all the other killers so much that X is now coming into fruition more often.

tyingq 10y ago

Not mentioned in the article, but I suspect some of this is due to the closing of most state run mental hospitals, which ramped up starting in 1972. https://en.wikipedia.org/wiki/Deinstitutionalisation https://en.wikipedia.org/wiki/Deinstitutionalisation Edit: More in-depth article on the topic: http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html http://www.pbs.org/wgbh/pages/frontline/shows/asylums/specia...

kolbe 10y ago
probably, but keep in mind that those places are extraordinarily expensive to run. even though we are seeing massive increases in deaths as a result of their closure, it may still have been the right decision. there's a value to everything, including life.
- glhaynes 10y ago
  Easier to stomach if the defunding of those programs had been in order to redirect that funding toward better-producing programs.
- undersuit 10y ago
  It's easy to put a value on someone else's life. How much should we spend on your life before it's ok to consign you to death?
  - kolbe 10y ago
    no, it's not easy or pleasant or anything to put value on someone else's life. but it's a reality. and to your question: i don't think it's your job to spend anything on my life. and i would certainly choose to die if the cost was bankrupting my family, for example.
  - mason240 10y ago
    The flipside of course, is how much extra are you willing to spend to save every preventable death? How much are you you willing spend on someone else's life before it's ok for you to consign their death?

kolbe 10y ago

Is it reasonable to assume that substance abuse deaths are far greater than mental health disorder deaths? As for the increase: no shit. Alcohol, one of the most damaging drugs, plays a central role in our contemporary marketing economy that can scientifically manipulate into engaging with alcohol on a massive scale. On the pharma side, we shove extraordinarily dangerous drugs like Oxy, Klonopin, SSRIs and Adderall on under the guise of them being medication. Thanks to the industry surrounding all these things, people don't even know they are engaging in dangerous, life-threatening drugs until it's too late.

CoryG89 10y ago
> Is it reasonable to assume that substance abuse deaths are far greater than mental health disorder deaths? I wouldn't assume that, especially not based on this article. It all depends on how you count up the deaths anyway. For example, considering substance abuse, what counts? Do we only take overdoses? What about accidental poisonings? What if I just smoke cigarettes until I am 85 and then die of heart disease that I was genetically predisposed to anyway? What about eating fatty foods to obesity and then dying from a heart attack?

dasil003 10y ago

Whoah the quantity of subscribe popups, notifications and ads plastered all over the page is a huge turnoff. All this JS interaction seems to have somehow broke the animated gif as well. Protip for publishers: one prominent entry point into "subscribing" with multiple choices is sufficient. I get that you want me to subscribe, but if I don't want to you're surely getting negative returns by creating such an obnoxious UX.

daxfohl 10y ago
It's ironic that with all that JS, they couldn't be bothered to come up with something better than a gif to display the actual content.

jjawssd 10y ago

Nobody seems to address the elephant in the room which is that the death rate from substance abuse and mental disorders was possibly underreported in the past

millzlane 10y ago
Kinda like how cancer wasn't that big of an issue until we began looking for it.

Bartweiss 10y ago

There's a really interesting result buried in this. "about half of US counties saw increases in suicide and violence" The separation of perceived and actual violent crime rates is a pretty infamous thing. Violent crime has been declining for decades, but at least since ~2000 perceived rates have failed to track that result. People toss around lots of theories, from "the media scares us" to "bigots are scared" to "perception can only go so low". This implies that we might be missing a better answer: people give national answers using local assumptions. If your county and all of the ones nearby have steadily rising rates of assault and homicide, it looks an awful lot like violence is on the rise (and for you, it is). This is especially true since you'll hear about every murder in your town, but only a few from NYC regardless of how many happen there (or don't happen). So violent crime rates have dropped steadily, largely because they're power-law effects and the deadliest regions have gotten much safer. But there are a lot of people looking around at rising violence where they and their families live, and that's getting buried by the data from a handful of cities.

maxerickson 10y ago
In many counties the rate of violence is still low enough that it will be difficult to measure accurately, never mind trying to reason about it anecdotally. (a typical year around here includes 0 murders and about 20 aggravated assaults, less than 1/1000 individuals)
stuckagain 10y ago
Media scare tactics around violence focus on urban areas, but the counties with high and increasing violence are the rural ones, especially the severely depopulated and very isolated counties. Of course the flip side is, nobody lives there. The ratios are high but the absolute numbers are not. I like to use this site to explore this data, although it cannot produce deep links: https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterface.jsp https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterf...
anigbrowl 10y ago
You're correct, but people in rural areas often dismiss the data as lies (egged on by some sectors of the media) rather than asking for better data. So it's an article of faith among rural and semi-rural conservatives that all government data are lies and that the inner cities are some sort of urban-warfare crime zone which is being covered up in the mainstream media. It suits certain political actors to promote this version of events.

DanBC 10y ago

I don't know how US death certificates and coroners work. But things like death by suicide have tricky stats. In the US a death after self injury with the intent to die is counted as suicide. That intent to die bit is hard to know, so some deaths are going to be counted as something else. (Accidental death, maybe.) And because of the strong stigma and taboo around suicide historical data may undercount it. Also, in the UK, for a coroner to rule a death as suicide it has to meet a higher burden of proof. The coroner has to be satisfied beyond all reasonable doubt that the death was suicide. For other deaths (but not murder) the burden of proof is the balance of probabilities. So it's easier (in England) for a coroner to rule something is an accidental death than a death by suicide. I guess the researchers are aware of all of this, and that they'll have mentioned how the cleaned up the data. But it's something to be aware of when reading it.

kafkaesq 10y ago

It would be interesting to see how these morbidity rates correlated with losses in wages and job security, since that magical year 1980. Particularly among middle-aged white males -- which are a pretty large group; and for whom stark rises in suicide rates have been observed by others, e.g.: http://www.nytimes.com/2015/11/03/insider/more-white-men-die-from-suicide-and-substance-abuse-why.html http://www.nytimes.com/2015/11/03/insider/more-white-men-die...

internaut 10y ago

I believe this is connected to stagnant wages (which starts in 1970s for Americans), with a catch. My hypothesis: 1. Counterintuitively, bad economic circumstances don't lead to chronic stress. People in countries with objectively terrible economic conditions are not more stressed or unhappier. It is simply: 'life'. 2. Caveat: Bad economic conditions do cause chronic stress where the media is projecting an illusion of rising success and wealth for the average person. This is because large numbers of people begin to feel left behind, even though most of their 'successful' peers are probably in debt to their eyeballs. Chronic stress is caused by the constant reminders in the form of fraudulent statistics, advertisements and social conditioning by fictional television shows that cause them to compare their circumstances to largely imaginary ideals. My solution, which sounds drastic but I believe it to be meritorious, is to ban television (but we can keep the Nature channels). I believe a large number of social ills shall mostly disappear once this is accomplished. Supporting evidence: http://news.harvard.edu/gazette/story/2009/03/fijian-girls-succumb-to-western-dysmorphia/ http://news.harvard.edu/gazette/story/2009/03/fijian-girls-s...

chinchang1998 10y ago

Yes

sankyo 10y ago

My pet theory is that we are isolated and there are less ways to feel connected to society (suburbs, too much TV) and the over importance of image, wealth, and status. Too many McJobs and lonely suburbs and people start to get depressed and other forms of mental illness. Naturally these people self medicate when their needs are not met anywhere else. Corporations used to feel more obligated to the society that they were in. Churches used to be more popular. Even if the Catholic church did evil things and controlled people, it did/does provide a place for people to feel like they belonged somewhere.

SamUK96 10y ago

I do wonder if they accounted for statistical bias. Death rate is 3x larger, but US population was ~60% of what is was now. That alone means that the death rate is actually only 1.8x times bigger. Additionally, it's been shown that doctors have been bribed and has caused vast over-diagnosis. Why was this clickbait, masquerading as a study, linked on HN?