Addiction recently posted an editorial suggesting that professionals and media stop using the term “deaths of despair” because it’s inaccurate, it conflates different problems, and it contributes to misunderstandings about the causes and solutions.
The term ‘deaths of despair’ collates deaths caused by substance poisoning, suicide and alcohol-related disease to form a distinct epidemiological phenomenon driven by cumulative economic disadvantage [1, 2]. Socio-economic factors such as high unemployment and a loss of traditional social structures are argued to be responsible for a high level of societal despair. This despair is proposed to be the common factor driving substance poisoning, suicide and alcohol-related disease. Since its postulation in the United States, the terminology has been used across a range of other jurisdictions including Eastern Europe, the United Kingdom and Canada [3-5].
Darke, S., Farrell, M., Hall, W. and Lappin, J. (2025), ‘Deaths of despair’: A term that needs to be retired. Addiction. https://doi.org/10.1111/add.70030
I first shared my skepticism about the term and its framing of the problem in 2018.
What’s most interesting to me is that the term gathered so much currency despite its obvious problems.
Epidemiological studies of population trends are inconsistent with grouping these causes into a distinct epidemiological phenomenon [3, 13–17]. These studies have reported divergent trends between these causes across different countries, and that trends vary by sex, age, birth cohort and spatial location [14, 15, 17]. In the case of heroin overdose, the heroin market appears a stronger predictor than an epidemiological entity driven by despair [16]. Indeed, heroin droughts result in fewer users and overdoses, whereas gluts have the reverse effect, independent of economic circumstances [18].
We believe that talk of ‘deaths of despair’ has given rise to misconceptions about the causal mechanisms that underlie these phenomena and, hence, the policies needed to reduce them. Assuming that ‘deaths of despair’ are driven by a common factor suggests that reducing despair will reduce these fatality rates. It is not clear how one can reduce societal despair apart from broad economic improvements. Although we can all agree on the benefits of a healthier and fairer economy, responses to these three major causes of premature death need to be specific to each.
Darke, S., Farrell, M., Hall, W. and Lappin, J. (2025), ‘Deaths of despair’: A term that needs to be retired. Addiction. https://doi.org/10.1111/add.70030
So, how did such an obviously incomplete or incorrect narrative come to dominate so many discussions in so many spaces? Their conclusion suggests one explanation: “Although it did draw attention to real sociological issues, it has outlived its usefulness.”
It has been useful for drawing attention to real sociological issues, whether or not it actually illuminated anything about addiction or overdose.
We’ve seen similar themes in all sorts of areas related to drug and alcohol problems. One that comes to mind is the disease concept. Most arguments against the disease model focus on what the disease model does or does not accomplish rather than whether addiction is actually a disease. We’ve seen similar examples related to efforts to change and police language. Efforts to abandon language that conveyed incorrect information or had an inherent negative variance have evolved to challenge the use of terms like relapse, sober, addiction, and medication-assisted treatment with rationales tied to expert authority and empiricism
That might explain the why but not the how.
This points to the power of narratives, the power of people in media, and the power of people with authority and expert status conferred by institutions. When narratives are delivered with confidence and are able to dominate spaces in which related discussions take place, they can crowd out other narratives, become orthodoxy, and sideline people who question the orthodoxy (even when they’re right).
The authors point to some potential consequences of working from inaccurate causes and solutions.
I’d also suggest that these patterns contribute to the current crisis of confidence in experts and low institutional trust. Unfortunately, this is a problem without any clear solutions. There’s the loss of confidence in expertise, but there’s also resentment toward orthodoxy as a form of social control, particularly where other motives are suspected.
Over the next couple of days, I’ll repost a couple of related posts.
Recovery Review 