Over the last several years, there has been a significant increase in what has been termed “deaths of despair” – suicide, alcohol, and drug overdose induced deaths. At the same time, there has been a stark decrease in religious affiliation. Is there a connection between the two?
This week on Family Policy Matters, host Traci DeVette Griggs welcomes Charles Fain Lehman, a Fellow at the Manhattan Institute, to discuss the increase in deaths of despair and how it connects to the decrease in religiosity in America.
TRACI DEVETTE GRIGGS: 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. Well, is it possible that these two opposing trends are somehow related? Or is that a connection that is over simplification of a vast and complex web of problems facing American society.
Charles Fain 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 Fain Lehman, thanks for joining us.
CHARLES FAIN LEHMAN: Absolutely. Thanks for having me on the show.
TRACI DEVETTE GRIGGS: All right. So, first of all, let’s just talk about what you mean by deaths of despair?
CHARLES FAIN LEHMAN: Sure. So deaths of despair is sort of a catch-all term of 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 been sort of popularized in part because it connotes a relationship between these deaths and a particular effect of – – which is to say that it is a biproduct of rising despair, unhappiness, sense of disconnectedness.
TRACI DEVETTE GRIGGS: Why do you include drug overdoses and things that we might consider to be accidental in with suicide?
CHARLES FAIN LEHMAN: Conventionally, death data differentiates accidental drug overdoses. It is from — you know, it’s a little bit hard to talk about any drug overdose as intentional, but ones which were the product of deliberate action as opposed to consuming drugs unintentionally. 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 accidents on a person, which is to say car crashes or homicide.
TRACI DEVETTE GRIGGS: And is there a sense then that this drug use and alcohol abuse is connected to despair, I guess?
CHARLES FAIN LEHMAN: There’s certainly a story to be told there that I think is coherent. We see significant increases in both categories. There were 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. 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, and I can sort of dive into the details, but I do think it’s likely part of the story.
TRACI DEVETTE GRIGGS: Right. So this term “deaths of despair,” is this a term that you like? Do you think it works?
CHARLES FAIN LEHMAN: 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’s part of the story. To some extent I think it downplays other changes, which are driving this. 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 medical opiates like fentanyl which are much more potent than other opioids, heroin, and prescription opioids. I think we sometimes miss that component of the story or reduce it to — there has been some increase in the number of people using drugs and some increase in the intensity of drug use, but there’s a much larger increase in the potency of drugs, which I think drives a lot of the increase. That’s not really a technical answer, but I think it’s a component of the problem but not all of the problem.
TRACI DEVETTE GRIGGS: No, I think that’s a great answer. So talk about the factors that you think are foundational to this alarming upward trend of deaths.
CHARLES FAIN LEHMAN: 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 greater availability of guns, greater availability of information associated with suicide on-line. It’s not hard to sort of tell a story about alcohol consumption deaths that fits the same narrative. You know, look, I think that there is, of course, a variety of measures of decline in what we might call social capital, human relationships that conduce to successful lives in certain segments of American society, post-industrial, white, non-urban, less-educated populations. And those are the people whom this crisis struck first. It sort of expanded outside of those demographic groups, but it is hard not to see a connection between that decline in social capital and the subsequent increased risk for self-inflicted death.
TRACI DEVETTE GRIGGS: 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.
CHARLES FAIN LEHMAN: Sure. You know, I think when we talk about religiosity, there are lots of different things that we mean by that. So one example is, “Is somebody religious? Well, does that person believe in God?” Another example is, “Is somebody religious? Well, does she pray daily?” Another example is, “Is somebody 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. I think across those measures we’ve seen declines in religiosity, particularly that last one in church attendance. We’ve seen sustained declines in church attendance over the past 30 to 40 years, and I think that is a substantial portion of the social capital story, particularly church attendance. American 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 “developed countries”. But on the other hand, 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.
TRACI DEVETTE GRIGGS: Why is there such a connection between social capital and involvement in a religious institution?
CHARLES FAIN LEHMAN: Some of the reasons are intuitive. If you go to a place where there are lots of other people and you both have a common project, you will likely form relationships there. I imagine any religion institution — or if you go to church on a regular basis, will intuitively say, oh, yeah, you know I have friends from church, I am 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, you know, I do think it’s important that religious communities are “thick” in a sense. They don’t just entail sort of incidental or commercial relations. They entail ongoing connection, which means you can build — there’s an assumption of long-term reciprocity. If 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 a meal train? 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.
TRACI DEVETTE GRIGGS: 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 with a lot of people that I like. Is it much different from that?
CHARLES FAIN LEHMAN: Almost certainly. Part of what characterizes religious involvement is that there is an explicitly ethical component. You don’t have any moral obligations to your friends on — maybe you do — on Instagram, but probably not. You have a very thin relationship to them. Work is a little more fuzzy, but churches are one of the social spaces where people have explicit — the portable structure determines the nature or involvement in the space. 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 there’s sort of a – – where you get more out of it, but what you’re really saying is that the strength of the interdependence is greater, and so when you need something it’s more likely to be there.
TRACI DEVETTE GRIGGS: What are the supply side factors in this conversation that you think might need more attention?
CHARLES FAIN LEHMAN: I think we don’t talk enough about the changing potency of the drugs. Look, all of the best estimates that we have suggest that there have been increases in the number of 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 a great deal more. Producers of illicit drugs, cartels, etcetera, 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, access to the Internet, access to chemicals produced in China, but the reality is the stuff that’s coming over the border is just much stronger than it used to be. And that means more people are dying. I think that’s an unintended problem, and I alluded to it 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, across groups.
You don’t necessarily find an increase in what you call suicidality, thinking about planning attempting suicide, as we’ve measured reports of that. And those have gone up much less, which suggests to me that the frequency with which people 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 knowledge about how to go through with a suicide has changed.
TRACI DEVETTE GRIGGS: 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?
CHARLES FAIN LEHMAN: I mean, look, nobody’s found the solution. I think the most recent — the Biden Administration has sort of said, well, they want to bring OD deaths down fairly substantially. But it’s not obvious to me that they’re doing anything novel. They’ve sort of pushed some “harm reduction” stuff I’m kind of skeptical of, but this is an interparty problem. The Trump Administration made some steps, but the problem kept increasing. The Obama Administration made some steps, the problem kept increasing. The drug – – death has increased exponentially over the past 20 years. I mean 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.
TRACI DEVETTE GRIGGS: Well, it does occur to me that many — most, probably, of these people are taking these drugs willingly. Obviously, they are 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?
CHARLES FAIN LEHMAN: 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 I think particularly young people need to be taught, 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, 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 deaths of despair, suicide and alcohol use are — there are often signs, I think awareness of those signs and being proactive about trying to intervene can have some impact, can have some benefit. Being aware of how your friends might be suffering, I think is to their benefit and yours.
TRACI DEVETTE GRIGGS: 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?
CHARLES FAIN LEHMAN: 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 city-journal.org, where I write all the time. I’m also on Twitter at Charles F. Lehman
TRACI DEVETTE GRIGGS: Charles Fain Lehman, thank you so much for being with us today on Family Policy Matters.