Pain in the Nation Report


Pain in the Nation: The Drug, Alcohol, and Suicide Crises and the Need for a National Resilience Strategy is produced through collaboration between Trust for America’s Health, Robert Wood Johnson Foundation, and Well Being Trust. The report is designed as a resource for policy makers at all levels, health care providers, health insurers/payers, advocacy organizations, journalists, and anyone interested in their own—and the nation’s collective—health and well-being. The report details recent trends and projections related to each of three crises: deaths related to drugs, alcohol, and suicide. So too does it codify the evidence base for solutions to address these issues.

The scale of the challenge requires solutions that are equally formidable. We need integrated, community-driven solutions that work upstream to address the drivers of disease and pain. This report lays the foundation for a National Resilience Strategy to do just this.

The attached report is meant for everyone’s use. We can look at this data; apply them to our own states; begin a discussion with friends, family, and co-workers about the steps we can take; and most importantly, commit to being part of the solution. While the report’s projections are tragic, they are just that—projections. It’s up to us to address these trends. It will require all of us working together to advance the programs, policies, and investments needed to save lives.

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How to use this report

Access the latest data on the suicide, opioid, and alcohol crises
Explore the latest, most comprehensive national data on deaths by drug, alcohol, and suicide over the past 10 years. Additionally, state-level data and supporting graphics are available online.

See 10-year projections for “despair deaths”
Modeling indicates that in 10 years’ deaths due to drugs, alcohol, and suicide will grow to 1.6 million—a 60 percent increase over current numbers, with some states surging by 77 percent or more. If the nation continues along recent trajectories, death rates from these causes would double to 2 million by 2025.

And while these projections may prove conservative. The rise of highly potent narcotics such as heroin, fentanyl (which is 100 times more powerful than morphine), and carfentanil (which is 100 times more powerful than fentanyl and 10,000 times more powerful than morphine) leave no margin for error.

Explore underlying causes
Many efforts to curb drug and alcohol misuse focus on limiting access to those substances without addressing underlying causes. Comprehensive approaches are needed to address upstream drivers of despair deaths, such as mental health, substance use disorders, chronic pain, adverse childhood experiences, and prolonged stress. For example, we must reconsider how we pay for care. Barriers between how we address mental health and substance misuse make it difficult for clinicians to provide care in a timely manner.

Understand the costs
One of the biggest drivers of the health care system is cost. About 3.8 percent of the population had a diagnosis related to drugs, alcohol, or suicide risk in 2014—and combined, these patients had annual health care costs of $249 billion. To begin to control costs, we must more proactively address the underlying causes of pain and disease.

Consider policy implications
Public policy solutions—while well-meaning—typically focus on health care coverage and ways to reduce drug and alcohol misuse. Pain in the Nation reviews current policies and their effectiveness and lays out new policy considerations for federal, state, and local policymakers. Advocacy organizations should seek ways to align with and scale up these evidence-based policies and approaches.

Learn strategies to reduce risks of misuse, addiction, and overdoses
Many states and communities have established policies, programs, and practices to reduce drug and alcohol misuse. Pain in the Nation details evidence-based approaches to consider implementing now, including initiatives to reduce opioid misuse. 


  • Opioid prevention (page 38): The National Governors Association’s 2016 Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States, is a tool to help states respond to the growing crisis of opioid misuse and overdose by assessing their current capacity to address the problem, selecting evidence-based and promising strategies, and evaluating their work. More than 40 governors have signed a 2016 compact agreeing to fight opioid addiction.
  • Alcohol misuse prevention (page 66): The National Institute on Alcohol Abuse and Alcoholism emphasizes the importance of increasing public awareness about the problems associated with underage drinking and social pressure to drink. For example, one opportunity is to counter the inaccurate perceptions minors have about how much their peers drink. The Surgeon General’s 2016 report and other expert sources further reinforce the importance of addressing cultural norms and messages around underage drinking, excessive drinking, and drinking and driving—including through peer, parental, school-based, and community-based efforts.

Review research-based practices for suicide prevention
Suicides are the 10th leading cause of death in the United States, and they are preventable. There are numerous research-based programs, policies, and practices available to enhance how our nation prevents suicide and self-harm. 


  • The Zero Suicide Model (page 77) has shown an 80 percent reduction in suicides. The approach illustrates the power of integrating depression care and suicide prevention into primary and behavioral health care. The model requires primary care doctors to screen every patient during every visit with two questions: How often have you felt down in the past two weeks? How often have you felt little pleasure in doing things? High scores lead to further questions about sleep disturbances, changes in appetite, and thoughts of hurting oneself. Providers must indicate on each patient’s medical record that they completed the screening—and when they recognize a mental health problem, they must assign patients to appropriate care, such as cognitive behavioral therapy, medication, group counseling, new care models (such as same-day psychiatric evaluations and drop-in group therapy visits), and if necessary, hospitalization.

Scale up school-based approaches to support children, youth, and families
The education sector and school-based health centers have central roles to play in assessing and addressing drug and alcohol misuse, promoting health and well-being, destigmatizing mental health issues, and preventing suicide among teens. Pain in the Nation highlights approaches that merit enhanced investment to help ensure the next generation is healthy and well. 


  • The Jed Foundation (page 78) promotes emotional health and prevents suicide among teens and young adults through a comprehensive suite of strategies: partnering with high schools and colleges to strengthen their programs and systems for mental health, drug and alcohol misuse, and suicide prevention; campaigns that directly engage young people; and resources for individuals, families, communities, and institutions on how to enhance access to help. To date, their resources have been used by nearly 3,000 colleges and universities, and more than 500,000 young people are engaging with Jed’s social media and other content.

Join Well Being Trust in advancing whole-person health
The National Resilience Strategy* should be designed to put prevention first to address the drivers of disease and pain. Human health is the foundation for achievement and is influenced by a variety of factors—biological, social, economic, political, and more. Solutions to address whole-person health must be no less systematic and integrated. The National Resilience Strategy should lay the foundation for comprehensive approaches to promote health. However, effecting change will require far more than a political agenda. It begins at home. It begins with you. 

It will take all of us doing our part—reducing mental health stigmas, advancing social support networks, and scaling up evidence-based models for care—to reduce projected increases in despair deaths and promote a society where everyone can achieve their fullest potential. Here are sample of ways that you can get involved:

  • Support loved ones over the holidays: During this holiday season, some of us will be with family and friends; others will be alone. The holidays may offer joy for some, but their social and financial pressures are vexing for others. This holiday season, let’s promote connection—with family, friends, neighbors, and others in our communities. Ask “How are you?” and create the space for them to truly answer. You might be surprised by what you learn, and in the process, you will help establish one of the key ingredients for a healthy society: personal relationships with those in your proximity.
  • Turn knowledge into action: Talk with co-workers, family, fellow students, and others in your community about what matters most to them, about their own health and wellness, and about how they’re feeling. Ask what we can do to reduce the rise in drug, alcohol, and suicide deaths in our community.
  • Share what you learn with us: As you work to promote resilience where you work, learn, pray, and play, find out what is working. What are you learning that can help others try new approaches? Join the conversation at #beheard to share your questions, stories, findings, and ideas.

For media inquiries, please contact
Albert Lang at or 301-512-8379.

 *We define resilience as the process of adapting well in the face of adversity—whether a traumatic event or a daily stressor—and how well we maintain a stable trajectory of healthy functioning after a highly adverse event.