Who are the victims when it comes to “deaths of despair”? Recent research has focused on the racial makeup of these tragedies — drug overdoses, alcohol-related deaths and suicides. According to a recent study, the number of Black people and Native Americans in this category has been growing while the number of white people has been going down. A study published in the journal JAMA Psychiatry found that between 2013 and 2022, the number of Black deaths of despair rose from 36 deaths per 100,000 people to 104 deaths per 100,000. For Native Americans, it was 242.
The drug crisis, it seems, comes for everyone. But there are some protective factors. Having connections — to family, to work, to religious institutions — all serve to help people stay off of drugs or support them in a fight against addiction. And now there is a new piece of evidence to support that idea. New research from Hangqing Ruan at the University at Buffalo and his colleagues finds that not only were the death rates of those who are unmarried higher than the rates of those who are not, but also that the difference was enough to make up for other factors. For instance, while higher rates of education are usually correlated with fewer deaths of despair, the research found that less educated married people had similar outcomes to the more educated unmarried.
Writing for the Institute for Family Studies website, Rosemary Hopcroft of the University of North Carolina at Charlotte notes that “this is one more reason the decline of marriage has been catastrophic for poorly educated white men.” Indeed, it is not just that having a close connection to another human being for many years prevented people from sinking into despair. It is also that women used to act as gatekeepers or at least civilizing influences when it came to substance use. Women were at the forefront of the temperance movement, for instance, not because they were prudes, but because they understood that for the sake of their family’s economic prospects and safety, it was important to have a man who was sober most of the time. He would support his family and he would be less likely to engage in violent behavior toward them as well.
While the gender gap in substance drug use has narrowed significantly over the years — thanks, in part, to the sexual revolution telling women they should behave more like men, and growth in the marketing of alcohol to women — typically women are still subject to the worst excesses of substance abuse. Whether they or their children are subject to violence or men who can’t help to support their children because they are too incapacitated, women are disproportionately at risk in these scenarios. But it is more likely men who are the victims of deaths of despair in part because they are less likely to have social connections when they are not married.
And while a stable marriage can clearly be a protective factor for men and women, alcohol and drug use can also undermine relationships, forcing partners to choose whether to stay when a partner is not changing their behavior. In some cases, sadly, a partner’s addiction can prevent someone from getting sober themselves. Do you have to put on your own oxygen mask before you can help someone else with theirs? Indeed, even if a partner does decide to engage in treatment for addiction, some research suggests that the process of withdrawal can increase the frequency of intimate partner violence.
The connection between relationship instability and substance use is complicated and can feel a little bit like a chicken-and-egg problem. Does a person’s susceptibility to drug use also make them less likely to enter stable relationships? Does a relationship decline because of substance use? Can drug users kick their habits if they don’t have stable relationships with people who can help them? Will they have an incentive to get clean if they don’t have relationships they are working to rebuild? The problems of the drug crisis and family breakdown are often discussed separately, but the truth is it is impossible to disentangle them.
