Far
too many Americans are dying from preventable causes, and each time we
make progress it seems like new problems appear. Take the case of opioid
overdoses. As we are beginning to get a handle on misuse of
prescription opioids, fentanyl and synthetic opioids have come to the
fore. Two decades ago, they were linked to fewer than 1,000 deaths each
year. In 2017, fentanyl and synthetic opioids killed more than 28,000
Americans.
The emphasis on opioids is appropriate, but too
narrow. The underlying conditions that often lead to drug misuse can
also lead to alcohol misuse, loneliness, and despair. Even as America is
experiencing surging rates of drug misuse, the nation is also
witnessing an unprecedented rate of suicide deaths, which rose 6 percent
between 2016 and 2017, and with alarming increases among children and
adolescents.
Overall, more than 150,000 Americans — the most
ever — died from alcohol and drug-induced fatalities and suicide in
2017. That’s more than twice as many as in 1999, according to a new analysis released on Tuesday by our organizations, Well Being Trust and Trust for America’s Health.
To truly tackle complex, deeply rooted societal
problems like these, we need to transform fragmented and disjointed
community systems. Deaths from substance misuse and suicide are symptoms
of broader problems. If we treat only the symptoms, more and more
people will be at risk and die needlessly.
To address the underlying causes, we need a comprehensive
approach that includes increasing funding and support for programs that
reduce risk factors for despair and promote resilience in children,
families, and communities. Exposure to trauma and adverse life
experiences at young ages increases the potential
for substance misuse and suicide. Programs that reduce community
violence; address poverty and discrimination; create safe, supportive
schools and quality learning experiences; and promote access to secure
housing and employment opportunities can decrease adverse experiences
and build resilience.For example, the Nurse-Family Partnership works with young, low-income women who are pregnant for the first time. A public health nurse meets with the mother from pregnancy until the child turns 2, establishing a trusted relationship with both. The home visits connect first-time mothers with the care and support they need to ensure a healthy pregnancy and birth. The model has been shown to have dramatic benefits to society. For instance, when Medicaid pays for Nurse-Family Partnership services, the federal government gets a 54 percent return on its investment.
Along that line, the nation should expand substance misuse prevention and mental health programs in schools by increasing the number of schools that get training for, can screen for, and can respond to childhood trauma. Schools should also be supported in scaling up evidence-based life- and coping-skills programs like the Good Behavior Game, and increasing the availability of culturally appropriate mental health and other services.
Schools should also work with other community agencies to assist the families of the children who have experienced trauma. Successful school substance misuse prevention programs return $3.80 to $34 for every $1 invested; social-emotional learning programs provide an $11 for $1 return; and school violence prevention programs (including suicide) have a $15 to $81 return.
The nation will see results only if it addresses the need for a multigenerational response that includes substance use disorder treatment for parents and additional support for all caregivers while also expanding resources for the foster care system.
Model programs have been effective in helping mothers achieve sobriety, reducing state custody placement of children by half and producing a strong return on investment. Sobriety Treatment and Recovery Teams (START), for example, is a Kentucky-based program for families with parental substance use disorders and issues of child abuse and/or neglect. It helps parents achieve sobriety and, when possible, keeps children safely with their parents. Mothers who participated in START achieved sobriety at nearly twice the rate of those not in the program and children in START families were half as likely to be placed in state custody. For every dollar spent on START, Kentucky avoided spending $2.22 on foster care.
