The role of despair in the opioid crisis: Lessons from the science of well-being

A 41-year-old man found unconscious after overdosing on opioids in the driver's seat of a car, with the engine running and the transmission in drive, puts his hands over his head in the back of a Cataldo Ambulance at a gas station in the Boston suburb of Malden, Massachusetts, December 2, 2017. A used syringe was found in the car with the victim, who was revived with 10mg of naloxone. REUTERS/Brian Snyder  SEARCH "SNYDER OPIOIDS" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. - RC13F461C890
Editor's note:

This paper comes from the paper series “The opioid crisis in America: Domestic and international dimensions.”

Deaths of despair—suicides, drug overdose, and alcohol-related deaths—claimed the lives of over 1 million Americans between 2006-2015. Some cohorts, particularly less than college educated whites, have lost faith in the American Dream, have little hope for the future, and low levels of resilience and coping skills. This is the population that is most vulnerable to opioid overdose and other deaths of despair, while minorities, who still face objective disadvantages and discrimination, are much more hopeful and resilient.

In this paper, I first explore the new metrics for understanding and addressing the role of despair in the opioid crisis. There is now established best practice for implementing well-being surveys, with consensus on the importance of measuring three distinct dimensions of well-being: hedonic, evaluative, and eudaimonic.

I then show how well-being metrics track with America’s divisions, exploring the extent to which trends in well-being and ill-being match those of the deaths of despair, at the level of individuals, race, and place. Geographically, these trends reflect two Americas, with one group displaying resilience and optimism about the future, and the other high levels of despair and poor objective health indicators.

In response to this complex crisis, federal policymakers have focused on saving addicts from overdose deaths by increasing the supply of “opioid antagonist” medications. What is missing is an approach that addresses the epidemic’s root causes by dealing with both demand and supply issues. I review some examples of local level interventions that have been successful and provide generalizable lessons. For such interventions to be effective over the long run, they must help address the underlying causes of despair, such as lack of employment, sense of purpose, and hope for the future. This is an instance where we have much to learn from the informal safety nets and community support common in African American and Hispanic communities.

In conclusion, I propose ideas for new and expanded federal level efforts, including providing collective evidence to policymakers, providing federal funds to support efforts to enhance well-being, and building well-being metrics into national statistics collection.

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