Middle-aged white men are dying from “diseases of despair” like suicide and overdose

White men are dying of diseases of despair. What are we doing about it?

On July 20, 2017, a middle aged white man who had struggled with drug addiction killed himself.

Probably more than one middle-aged white man did that on July 20, 2017, but since the one in question was Chester Bennington, the front man of the wildly successful and influential band Linkin Park, the world pays attention and asks “why”.

 In the 1990s there was a “war on drugs”, with opiates playing a major role. Rising stars in the music industry like Andy Wood, Kurt Cobain, and Shannon Hoon were all affected by addiction. Andy and Shannon fatally overdosed, Kurt’s suicide was related to failure to achieve long-term sobriety and the likelihood this failure would break up his family.

Gradually, the “war on drugs” lost momentum, heroin was supplanted by methamphetamine and pills, and the nation’s attention focused elsewhere.

But the problem didn’t go away. The numbers of suicides in the country has increased. Opiate deaths have skyrocketed. And Chester’s suicide, on the heels of Chris Cornell’s, and so shortly after Scott Weiland’s overdose, has forced us to re-think some of our favorite myths about suicide and drug addiction. When men in their 40’s and 50’s are dying from these things, en masse and in the spotlight, we need to accept the fact that addiction and suicide are not artifacts of youth culture, and that the passage of time alone does not cure the pain that fuels these plagues.

Opiate addiction is one of the major reasons that the death rate for middle-aged white males is increasing in the country, while the death rate for every other demographic is declining. Suicide is another reason, and cirrhosis of the liver makes up much of the rest of the balance. Deaths caused by people trying to cure chronic pain at any cost.

The one thing that has changed since the mid-nineties is that we understand more about the roots of depression, suicide, and addiction than we ever have.

The Adverse Childhood Experiences (ACE) study, the first iteration of which was published in 1997, demonstrated that ten childhood traumas have a profound, cumulative, lifelong impact on their victim’s physical, mental, emotional, and financial health.

What does that mean? If you experience one ACE, your chances of being chronically depressed are double what they are if you don’t. If you experience two ACEs, your chances of being chronically depressed double again. And so on and so forth. Someone with an ACE score of four is 1122% more likely to attempt suicide than someone with an ACE score of 0, and someone with an ACE score of 4 has a 3900% increased likelihood of using IV drugs.

The link between ACEs and addiction is so strong and well known among professionals that a leading addiction specialist has started referring to addiction as “ritualized compulsive comfort-seeking” and says “Ritualized compulsive comfort-seeking is a normal response to the adversity experienced in childhood, just like bleeding is a normal response to being stabbed.”

The first ACE study was conducted primarily on middle-class, mostly white people born in the 1930s, 1940s, and 1950s. What it showed is that back then, child abuse, neglect, exposure to domestic violence, addiction, and mental illness was very common. About ⅔ of participants had a score of one or higher, and 12.5% experienced 4 or more, which is clinically high and the point where increased risks of the seven leading causes of death become significantly higher.

We know that Kurt Cobain had an ACE score of 4, probably higher. We know Layne Staley’s was at least three. Scott Weiland and Chester Bennington both survived child sexual abuse; until their trauma caught up with them.

Before the ACE study, child abuse and maltreatment were linked to bad things, the link was strong enough that there was interest in preventing it. By the 1990s there was a solid body of evidence proving that Maternal Home Visiting programs like Nurse Family Partners and Healthy Families America prevent or reduce most ACEs. Twenty years later, there is strong peer evidence that they work. And how they reduce taxpayer burdens. They are only available to about 5% of eligible families.

The ACE study proved 1 in 5 children are sexually abused. Politicians trip over themselves to pay lip service to child sexual abuse, but they are rarely willing to do anything significant to make a difference. Differences like eliminating the statute of limitations for child sexual abuse, and wholesale efforts to educate parents and stakeholders about the crime. Experts estimate that 90% of child sex abusers never see a day behind bars*. In a divorce or custody dispute, if a parent is alleged to have sexually abused their child that parent will almost always be given full custody or unsupervised access.

We can be shocked by the rising death rates of middle-aged white men. We can, and should, grieve when it affects us personally. But we cannot say we don’t understand why so many Americans are self-medicating. We should be shocked by our collective unwillingness to prevent it.

Forgiving yourself and moving forward after relapse was the theme of some of Linkin Park’s most beloved songs. The world a little quieter and a little more pessimistic without Chester Bennington singing about that anymore. If we use the quiet to reflect on a way forward from the “diseases of despair” that blight our children for the rest of their lives, we can solve this problem.

But we need to choose to.

* Robert Baker of the Massachusetts Sex Offender Registry Board, Massachusetts Office of Public Safety. 2008.