Deaths of Despair: The Connection Between Drugs, Alcohol, Suicide, and Religion

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Thanks for joining us this week for Family Policy Matters. Deaths resulting from suicide, alcohol, and drug use are on the rise in American society. At the same time, Americans are less religious than ever. Is it possible that these two opposing trends are somehow related? Or is that a connection that is oversimplification of a vast and complex web of problems facing American society? Charles Fane Lehman, a fellow at the Manhattan Institute, has been studying this.

And he wrote an article recently entitled, Did the Decline in Religiosity Cause Deaths of Despair? Charles Fane Lehman, thanks for joining us. Absolutely.

Thanks for having me on the show. All right. So first of all, let's just talk about what you mean by deaths of despair.

Sure. So deaths of despair is a sort of a catch-all term for three different kinds of what we might refer to as self-inflicted death, usually meaning drug overdose death, death by suicide, and death by alcohol, either alcohol poisoning or liver cirrhosis, which comes from long-term alcohol consumption. The term has sort of been popularized in part because it connotes a relationship between these deaths and a particular effective state, which is to say this is a byproduct of rising despair, unhappiness, sense of disconnectedness. Why do you include drug overdoses and things that we might consider to be accidental in with suicide? Conventionally, death data differentiates accidental drug overdoses. It is from, you know, it's a little harder to talk about any drug that is intentional, but ones which were the product of deliberate action as opposed to consuming drugs unintentionally.

I've said, you know, it has gotten a little harder. People don't always necessarily know what they're consuming. But I think the commonalities that they were distinguished from both medical causes of death and also external causes of death and acting on a person which, say, car crashes or homicide. And is there a sense then that this drug use and alcohol abuse are connected to despair, I guess?

There's certainly a story to be told there that I think is coherent. We see significant increases in both categories. There are more drug overdose deaths last year than almost any year on record, going back over 120.

We've seen a significant uptick in alcohol-associated deaths as well. And, you know, I think there's a very straightforward story to tell about an increase in drug use, an increase in alcohol consumption that is attendant to rising despair. I suspect that's not the whole story. I can sort of dive into the details. But, you know, I do think it's likely part of the story.

All right. So this term, deaths of despair, is this a term that you like? Do you think it works? I think that there is a subset of the population of people who are dying in these categories for whom it is descriptively useful. It is almost certainly the case that some people are dying who might not have because of a sense of alienation, because of a decline in social capital.

I think that is part of the story. To some extent, I think it downplays other changes which are driving this. So the most obvious one is much more straightforwardly the case that there's been a dramatic increase in drug overdose deaths because the drug supply has gotten much deadlier because of the introduction of synthetic opioids like fentanyl, which are much more potent than other opioids, heroin, prescription opioids.

I think we should not miss that component of the story or, you know, reduce it to an increase. You know, there has been some increase in the number of people using drugs. There's been some increase in the intensity of drug use. There's a much larger increase in the potency of drugs. So I think it drives a lot of the increase. That's a really technical answer. But, you know, I think it's a component of the problem, but not all of the problem.

Oh, I think that's a great answer. So talk about the factors that you think are foundational to this alarming upward trend of deaths. On the one hand, there are supply side factors.

I alluded to changes in the drug supply. I think there is some likelihood that suicide has been made easier either by great availability of guns, great availability of information associated with suicide online. That's hard to tell a story about alcohol consumption deaths that fits the same narrative. You know, look, I think that there is, across a variety of measures, a decline in what we might call social capital, human relationships that conduce to successful lives in certain segments of American society, particularly post-industrial, white, non-urban, less educated populations.

And those are the people whom this crisis struck first. It's sort of expanded outside of those demographic groups, but it is hard not to see a connection between that decline in social capital and their subsequent increased risk for self-inflicted death. You're talking about social capital. Your article talks about religiosity and is there some connection. Talk a little bit about how all of these things interplay.

Sure. You know, I think when we talk about religiosity, there are lots of different things that we mean by that. So, you know, one example is if somebody is religious, well, does that person believe in God? Another example is if somebody is religious, well, does she pray daily?

Another example is if somebody is religious, well, does she go to church on a weekly or more than weekly basis? Those are all different indexes of religiosity, but they mean different things. You know, I think across those measures, we've seen declines in religiosity, particularly that last one in church attendance.

You've seen substantial declines in church attendance over the past 30 to 40 years. And, you know, I think that is a substantial portion of the social capital story, again, particularly church attendance. America remains by many measures a highly religious country. My favorite statistic on this topic is that 75 percent of Americans, 80 percent, somewhere in there, believe in, profess to believe in angels, which is not true of many other, quote unquote, developed countries. But on the other hand, our religion has gotten much less organized, which I mean in the descriptive sense of being involved in sort of mainline, highly structured traditions.

We've become much less engaged in religion as an organized institution, and that has implications for our social connections and therefore for our social capital. You're listening to Family Policy Matters, a weekly radio show and podcast of the North Carolina Family Policy Council. This is just one of the many ways NC Family works to educate and inform citizens across North Carolina about policy issues that impact North Carolina families. Our vision is to create a state and nation where God is honored, religious freedom flourishes, families thrive, and life is cherished. For more information about NC Family and how you can help us to achieve this incredible vision for our state and nation, visit our website at ncfamily.org. Again, that's ncfamily.org, and be sure to sign up to receive our email updates, action alerts, and, of course, our flagship publication, Family North Carolina Magazine.

We'd also love for you to follow us on Facebook, Instagram, and Twitter. Why is there such a connection between social capital and involvement in a religious institution? Some of the reasons are intuitive. If you go to a place where there are lots of other people and you all have a common project, you will likely form relationships there. I imagine any relationship that goes to church on a regular basis will intuitively say, oh, yeah, I have friends from church, I'm able to rely on them, if I need something in my day-to-day life, I might make a business connection, a professional connection through church. But I do think it's important that religious communities are, they're quote, unquote, thick in a sense. They don't just entail sort of incidental commercial relations, they entail ongoing connection, which means that you can build, you know, there's an assumption of long-term reciprocity. My wife gets pregnant and I can go to my fellow parishioners and I can say, I need your help, you know, we have a new baby, can you be part of the meal training? And then somebody else gets pregnant and has a new child, and you give back to them. So there's sort of that relationship of mutual understanding, obligation that's made possible by that kind of structure.

All right. Do you think involvement in a church or a religious institution is a lot different from how many people might look at social capital? Because they might think, well, I have a lot of friends on Instagram or, you know, I work, you know, with a lot of people that I like. Is it much different from that? Almost certainly. Part of what characterizes religious involvement is that there's an explicitly ethical component, but you don't have any moral obligations to your friends.

I mean, maybe you do on Instagram, but like probably not. I'll be very thin in relationship to them. You know, work is a little more fuzzy, but churches are one of the social spaces where, you know, people are explicit, you know, part of what structures and determines the nature of involvement in the space of membership in a church is a sense that you have an obligation to your fellow, you have an obligation to your neighbor. You are bound together in an ethical relationship.

And so, you know, there's sort of a tawdry material interpretation. We say, like, you get more out of it. But I think what you're really saying is that the strength of the interdependence is greater.

And so, you know, when you need something, it's more likely to be there. What are the supply side factors in this conversation that you think might need more attention? I think we don't talk enough about the change in potency of the drug supply. Look, all the best estimates we have suggest that there have been increases in the people who are abusing drugs, but they are not nearly on the magnitude of the increases we have seen in drug overdose deaths. And that suggests to me that the changes in the drugs that people are consuming matters are getting more. Producers of illicit drugs, cartels, etc., have access to much more potent materials than they did 20, 30 years ago.

That has to do with a whole host of changes in what the internet and access to the internet, access to chemical producers in China. But the reality is that the stuff that's coming over the border is just much stronger than it used to be. That means more people are dying.

I think that's an unintended problem. And then I alluded to very briefly earlier, sort of changes in one of the sort of odd things about the increase in suicides. We really are at one of the highest rates of suicide on record. We actually have gone down a little bit, but we're still close to the highest rates of suicide on record. You know, across groups, you don't necessarily find an increase in what you call suicidality, thinking about planning, attempting suicide. We have measures and reports of that. Those have gone up much less, which suggests to me that the frequency of people, the, you know, sort of complete suicide has increased, which suggests to me that there's been some change in methods.

Again, I think there's potentially an internet-associated story there that, you know, knowledge about how to go through with a suicide has changed. When we consider the astounding increase in drug overdose deaths, are you satisfied or frustrated or beyond frustrated at the reaction or response from our federal government and other policy makers? I mean, look, nobody's found the solution. You know, I think the most recent, the Biden administration has said, well, they want to bring O.D. deaths down fairly substantially, but it's not obvious that they're doing anything novel.

They've sort of pushed some critical harm reduction stuff I'm kind of skeptical of. But this is a, you know, this is an inter-party problem. The Trump administration, you know, made some steps, but the problem kept increasing. The Biden administration made some steps, but the problem kept increasing. The drug use has increased exponentially over the past 20 years.

It looks nothing like anything we have ever recorded. Clearly, we just don't have the tools or if we do have the tools, we're not using them to address the problem. Well, it does occur to me that many, most probably of these people are taking these drugs willingly.

Obviously, they're not aware of the consequences that are about to befall them. But what can we do? So maybe it's not a policy solution. What can we do in our communities?

What can we do as individuals to try to address this problem? There are two different concerns. One is people who know what they're taking and the other is people who don't know what they're taking. There really is a problem with drugs being purchased that, you know, are advertised as one thing and actually turn out to be fentanyl. And so, you know, I think particularly young people need to be taught, you know, say what you like, just say no. Really, the drugs now can kill you.

And they quite likely will. There's a real threat to drug use that just didn't exist 50, 60 years ago. On the other hand, you know, look, people with long-term substance use disorders, chronic compulsive drug use, they need access to treatment. That's ultimately a policy problem, but it's a thing that you can support, that your community can support. That is a thing that nonprofits work towards as much as the government does. When you talk more broadly about substance use, look, suicide, alcohol use, there are often signs. I think awareness of those signs and being correct about trying to intervene can have some impact, can have some benefit. You know, being aware of how your friends might be suffering, I think is to their benefit yours. Where can our listeners go to read your article?

Did the decline in religiosity cause deaths of despair and to follow your other good work? So that was published by the Institute of Family Studies over on their blog. I'm primarily a fellow at the Manhattan Institute.

You can find my work there and at MI's in-house publication, City Journal, that's city-journal.org, where I write all the time. I'm also on Twitter, at Charles F. Lehman. Charles Fane Lehman, thank you so much for being with us today on Family Policy Matters.

You've been listening to Family Policy Matters. We hope you enjoyed the program and plan to tune in again next week. To listen to this show online and to learn more about NC Family's work to inform, encourage, and inspire families across North Carolina, go to our website at ncfamily.org. That's ncfamily.org. Thanks again for listening and may God bless you and your family. .