
American death rate from substance abuse and mental disorders triples since 1980 - upen
http://sciencebulletin.org/archives/8077.html
======
Bartweiss
There's a really interesting result buried in this.

"about half of US counties saw increases in suicide and violence"

The separation of perceived and actual violent crime rates is a pretty
infamous thing. Violent crime has been declining for decades, but at least
since ~2000 perceived rates have failed to track that result. People toss
around lots of theories, from "the media scares us" to "bigots are scared" to
"perception can only go so low".

This implies that we might be missing a better answer: people give national
answers using local assumptions. If your county and all of the ones nearby
have steadily rising rates of assault and homicide, it looks an awful lot like
violence is on the rise (and for you, it is). This is especially true since
you'll hear about every murder in your town, but only a few from NYC
regardless of how many happen there (or don't happen).

So violent crime rates have dropped steadily, largely because they're power-
law effects and the deadliest regions have gotten much safer. But there are a
lot of people looking around at rising violence where they and their families
live, and that's getting buried by the data from a handful of cities.

~~~
at-fates-hands
>> the deadliest regions have gotten much safer.

Not so sure I agree with that.

\- St. Louis, MO

\- Detroit, MI

\- New Orleans, LA

\- Baltimore, MD

\- Chicago, IL

All have had incredibly high murder rates since 2002. That's over a decade of
violent crime that hasn't slowed down at all and continues to remain steady to
this day.

~~~
dionidium
I'm from St. Louis, so I happen to be familiar with those numbers.

Here are the homicide rates in St. Louis in the early 90s (per 100k people):

    
    
        1991	65.0
        1992	57.4
        1993	69.0
        1994	63.5
        1995	54.9
    

And here's 2002-2014:

    
    
        2002	31.4
        2003	21.8
        2004	33.7
        2005	37.9
        2006	37.2
        2007	39.6
        2008	46.9
        2009	40.3
        2010	45.1
        2011	35.3
        2012	35.5
        2014	49.9
    

Homicides here started falling in the late 1990s and remained (relatively) low
throughout the 2000s. The rate did jump in 2014 and has remained higher since,
but it's still lower than it was in the early 90s.

Which, I think, is to say that your narrative isn't correct, at least
regarding St. Louis. It's much messier than that (and mostly good news
(relatively)).

~~~
grecy
Wow. In the mean time, Toronto has a homicide rate of around 2.0 (in 2012
[1]), making it almost 18x lower than St. Louis.

Genuine question, why do you continue to live there? Why wouldn't you move
somewhere safer?

[1]
[https://en.wikipedia.org/wiki/Crime_in_Toronto](https://en.wikipedia.org/wiki/Crime_in_Toronto)

~~~
dionidium
There are (at least) three things to understand about those numbers:

1\. The City of St. Louis occupies a very small portion of what any reasonable
person would call "St. Louis." And those numbers include only the City
portion. The rest of the area is _much_ safer. St. Louis County, which
surrounds St. Louis on three sides and contains three times as many people
(over 1 million), had 15 homicides in 2014 for a homicide rate of 1.5 (lower
than Toronto) [0]. _Most_ people living in the St. Louis area are living in
very safe places.

2\. Not all cities occupy such a small portion of their region. Toronto, to
keep your example, is 243.33 sq mi. St. Louis is 66 sq mi. If St. Louis's
borders were extended to match Toronto's reach, then it would include a whole
bunch of the safe areas in St. Louis County, which would considerably soften
the numbers. (Note that nothing on the ground would actually _change_.) This
is why reasonable regional comparisons should be done at the level of the MSA.
Arbitrary borders are, well, arbitrary and produce misleading comparisons.

3\. Even when looking only at the City of St. Louis, you have to understand
that many neighborhoods have 1 or 2 or 0 homicides each year. [1] Most of the
violence is concentrated on the city's Northside and in the Southeast. Extreme
violence is not a part of the everyday lived experience for most citizens.

The way outsiders talk about crime in places like St. Louis _very sloppy_.

(Bonus #4: Crime and safety and law and order aren't the only metric by which
to choose where to live.)

[0] This number is almost certainly too low, because of how crime is reported
in the County. I got that number here:

[http://www.kmov.com/story/29948033/homicides-on-the-rise-
in-...](http://www.kmov.com/story/29948033/homicides-on-the-rise-in-st-louis-
county)

Some other sources suggest it may be around twice that for the entire County,
meaning the rate is likely closer to 3.0 per 100,000 (which is still
considerably lower than in the City).

[1] [https://nextstl.com/2013/01/understanding-st-louis-
homicides...](https://nextstl.com/2013/01/understanding-st-louis-
homicides-2005-2012/)

~~~
Bartweiss
This is a very good list, and I'd like to expand on point four: even among
city-life-specific dangers, murder generally ranks fairly low.

Where I live, the annual pedestrian and bicyclist death count is is comparable
to the St. Louis murder rate. And, of course, far more evenly distributed
across neighborhoods. Add in car crashes and I'm probably at far more risk
here than I would be in St. Louis.

I'm at more risk from smog and water pollution just by living in a city, and
to fight that I should move not to Toronto but to a ritzy suburb. But dense
populations mean good emergency response times, which argues for city again!

The list continues - you're absolutely right that safety isn't the only goal,
but even on that basis it's not clear that murder is the statistic to observe.

------
CoryG89
It seems that they are unable or unwilling to separate deaths due to mental
disorders from substance abuse. Probably due to the thinking that anyone who
dies from a substance abuse issue is dealing with a mental disorder. While
this may be true some of the time, I'm not sure that it's clear that it is
always the case. And even if it was, substance abuse deaths would just be a
subset of deaths from mental disorders, still would seem misleading to lump
them together.

~~~
draw_down
That's a valid point, but the number tripled. Is that really down to
statistical methods, or is there actually a huge problem which, admittedly,
may not be measured perfectly?

~~~
CoryG89
How much wider of a net are we casting when we consider what counts as a
"death due to mental illness or substance abuse" compared to 25 years ago?

I don't doubt it may have gone up, but I do doubt that these numbers tell us
as much as some might think.

------
jjawssd
Nobody seems to address the elephant in the room which is that the death rate
from substance abuse and mental disorders was possibly underreported in the
past

~~~
millzlane
Kinda like how cancer wasn't that big of an issue until we began looking for
it.

------
tyingq
Not mentioned in the article, but I suspect some of this is due to the closing
of most state run mental hospitals, which ramped up starting in 1972.

[https://en.wikipedia.org/wiki/Deinstitutionalisation](https://en.wikipedia.org/wiki/Deinstitutionalisation)

Edit: More in-depth article on the topic:
[http://www.pbs.org/wgbh/pages/frontline/shows/asylums/specia...](http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html)

~~~
kolbe
probably, but keep in mind that those places are extraordinarily expensive to
run. even though we are seeing massive increases in deaths as a result of
their closure, it may still have been the right decision. there's a value to
everything, including life.

~~~
undersuit
It's easy to put a value on someone else's life. How much should we spend on
your life before it's ok to consign you to death?

~~~
mason240
The flipside of course, is how much extra are you willing to spend to save
every preventable death?

How much are you you willing spend on someone else's life before it's ok for
you to consign their death?

------
Gravityloss
Here's the interactive version:
[http://vizhub.healthdata.org/subnational/usa](http://vizhub.healthdata.org/subnational/usa)

~~~
blauditore
Is there any obvious reason for the higher death rate in the "bible belt"?

One thing I could imagine is rural exodus, leaving a higher percentage of old
people.

~~~
justinlaster
Poverty combined with boredom. And from my _personal_ experience, a complete
unwillingness to discuss such problems (i.e, "Not _my_ family").

------
kolbe
Is it reasonable to assume that substance abuse deaths are far greater than
mental health disorder deaths?

As for the increase: no shit. Alcohol, one of the most damaging drugs, plays a
central role in our contemporary marketing economy that can scientifically
manipulate into engaging with alcohol on a massive scale. On the pharma side,
we shove extraordinarily dangerous drugs like Oxy, Klonopin, SSRIs and
Adderall on under the guise of them being medication. Thanks to the industry
surrounding all these things, people don't even know they are engaging in
dangerous, life-threatening drugs until it's too late.

~~~
CoryG89
> Is it reasonable to assume that substance abuse deaths are far greater than
> mental health disorder deaths?

I wouldn't assume that, especially not based on this article.

It all depends on how you count up the deaths anyway. For example, considering
substance abuse, what counts? Do we only take overdoses? What about accidental
poisonings? What if I just smoke cigarettes until I am 85 and then die of
heart disease that I was genetically predisposed to anyway? What about eating
fatty foods to obesity and then dying from a heart attack?

------
DanBC
I don't know how US death certificates and coroners work.

But things like death by suicide have tricky stats. In the US a death after
self injury with the intent to die is counted as suicide. That intent to die
bit is hard to know, so some deaths are going to be counted as something else.
(Accidental death, maybe.) And because of the strong stigma and taboo around
suicide historical data may undercount it.

Also, in the UK, for a coroner to rule a death as suicide it has to meet a
higher burden of proof. The coroner has to be satisfied beyond all reasonable
doubt that the death was suicide. For other deaths (but not murder) the burden
of proof is the balance of probabilities.

So it's easier (in England) for a coroner to rule something is an accidental
death than a death by suicide.

I guess the researchers are aware of all of this, and that they'll have
mentioned how the cleaned up the data.

But it's something to be aware of when reading it.

------
Alex3917
By my count around a third of Americans die from drug misuse and drug-related
causes:

[http://alexkrupp.typepad.com/sensemaking/2014/05/the-one-
sta...](http://alexkrupp.typepad.com/sensemaking/2014/05/the-one-statistic-
you-never-hear-about-drugs.html)

And that was written before this study came out, which estimated that there
may be an additional 60,000 annual tobacco-related deaths that are not being
counted by the CDC:

[http://www.nejm.org/doi/full/10.1056/nejmsa1407211](http://www.nejm.org/doi/full/10.1056/nejmsa1407211)

~~~
maxerickson
I think given the way people reason about such things you should probably
advertise it as 20% of Americans die from tobacco use and then argue that this
should be considered together with other drug related causes.

I'm not arguing that tobacco is anything other than a drug, I'm saying that
emphasizing it in things like your first paragraph here will reduce the number
of people that come to the wrong conclusion.

------
jmuguy
Take a look at what Reagan did to national mental health services in the 80s.
Pretty hard not to draw some correlation there.

~~~
cjensen
That was part of the problem. The other part is that _" One Who Flew Over the
Cuckoo's Nest"_ inspired the left to change laws so that it became hard for
Psychs to institutionalize people who need help.

Both parts need to change. The "they aren't hurting anybody so leave them
alone" people need to understand that they are hurting themselves and need to
have their freedom of choice taken away. There needs to be strong oversight to
prevent abuse. There needs to be sufficient funding to humanely take care of
the mentally ill and, when possible, make them better. Addiction needs to be
treated as a mental illness since, once the individual becomes addicted, it
literally is a chemical abnormality in the physical brain mostly beyond the
ability of the individual to address without medical help.

~~~
thraway2016
_it became hard for Psychs to institutionalize people who need help._

The prospect of a society in which any psychologist can, on a whim, circumvent
due process and imprison anyone against their will indefinitely, is
terrifying.

It's much, much better this way.

~~~
DanBC
>> it became hard for Psychs to institutionalize people who need help.

> The prospect of a society in which any psychologist can,

You've mixed up psychologist and psychiatrist.

It's easy to find ways that psychiatrists can detain people against their
will, and force them to undergo medical treatment against their will, that
don't rely on a single doctor and that have strong protections against abuse.

Something like two doctors - one of which knows the patient, plus an approved
MH professional who's role is to protect the legal rights of the patient, plus
free advocacy during all stages of detention to protect the legal rights, with
powers of a close relative to ask for the detained person to be released; with
a default position that people have capacity to make decisions about
themselves, and that any limitations of capacity are limited to a single
domain (I might not be able to say what happens to my money, but you should
not use that to assume my capacity chose my medication is limited); with a
recognition from all involved that this is a significant interference with my
human rights and that we only tolerate this because it's in my best interests.

~~~
tptacek
Same problem with psychiatrists. The psychiatrists associated with large-scale
direct intake at hospitals are also extremely overworked and often not
particularly sophisticated (psychiatrists who keep up with research and are
effective practitioners can make more money outside the hospital system).

In the very worst case, which is unfortunately common, you have chains like
UHS operating mental health hospitals in numerous states with what appear to
be quotas. You don't have to drive yourself to a UHS hospital to end up in
one. Most hospitals, even the very good ones, don't do on-site psych; in many
of them, if you show up for _any_ psych reason, you'll be held and then
transported to an affiliated mental health hospital.

So, yes, there are very significant due process concerns with acute mental
health care.

------
larrik
Whenever I see a headline like this, I think "did reality change, or did the
reporting methods?"

~~~
kolbe
also worth thinking: did X become a bigger killer, or did we impede all the
other killers so much that X is now coming into fruition more often.

------
sankyo
My pet theory is that we are isolated and there are less ways to feel
connected to society (suburbs, too much TV) and the over importance of image,
wealth, and status. Too many McJobs and lonely suburbs and people start to get
depressed and other forms of mental illness. Naturally these people self
medicate when their needs are not met anywhere else.

Corporations used to feel more obligated to the society that they were in.
Churches used to be more popular. Even if the Catholic church did evil things
and controlled people, it did/does provide a place for people to feel like
they belonged somewhere.

------
kafkaesq
It would be interesting to see how these morbidity rates correlated with
losses in wages and job security, since that magical year 1980. Particularly
among middle-aged white males -- which are a pretty large group; and for whom
stark rises in suicide rates have been observed by others, e.g.:

[http://www.nytimes.com/2015/11/03/insider/more-white-men-
die...](http://www.nytimes.com/2015/11/03/insider/more-white-men-die-from-
suicide-and-substance-abuse-why.html)

------
dasil003
Whoah the quantity of subscribe popups, notifications and ads plastered all
over the page is a huge turnoff. All this JS interaction seems to have somehow
broke the animated gif as well.

Protip for publishers: one prominent entry point into "subscribing" with
multiple choices is sufficient. I get that you want me to subscribe, but if I
don't want to you're surely getting negative returns by creating such an
obnoxious UX.

~~~
daxfohl
It's ironic that with all that JS, they couldn't be bothered to come up with
something better than a gif to display the actual content.

------
SamUK96
I do wonder if they accounted for statistical bias.

Death rate is 3x larger, but US population was ~60% of what is was now. That
alone means that the death rate is actually only _1.8x times bigger_.

Additionally, it's been shown that doctors have been bribed and has caused
vast over-diagnosis.

Why was this clickbait, masquerading as a study, linked on HN?

------
keylime314
Regarding Kentucky cancer stats:
[https://en.wikipedia.org/wiki/Paducah_Gaseous_Diffusion_Plan...](https://en.wikipedia.org/wiki/Paducah_Gaseous_Diffusion_Plant#Contamination)

------
debacle
Regardless of how you feel about legalization, policy, etc, this should prove,
at the very least, that we aren't winning the "War on Drugs."

~~~
deelowe
Prohibition really has turned out to be a seriously damaging thing to society.
Drugs are classified not based on their potential to cause harm or abuse, but
instead by some nebulous concept of morality. We, as a society need to embrace
a more scientific based approach.

~~~
nickff
The value judgments are inseparable from the 'harm or abuse' measurements;
there is no value-neutral way to assess harm and abuse. You can say you want
to be scientific and come up with numbers, but the selection of the metrics
and the 'critical values' will be political and ethical decisions.

Having said all that, I am in favor of full legalization of every substance,
even though I personally find the use of almost all substances 'distasteful'.

~~~
deelowe
You can scientifically quantify harm both to individuals and society. For
example, potential for abuse, potential for individual harm, and potential for
social harm are all factors that could be quantified and considered.

Using those metrics alone, the juxtiposition of the classification of
marijuana versus alcohol or nicotine is quite interesting. You could perhaps
include many other drugs as well such as cocain, mdma, and perhaps even LSD
(though this one does pose some concerns socially given that it can cause
manic episodes).

My point is that the current "war on drugs" has no scientific basis. And, as
such, where we've ended up has been very destructive in terms of the cost to
society (imprisonment, surge in use of more harmful but easier to source
substances, etc...).

~~~
nickff
If you are going to do a cost/benefit analysis of drugs, what do you include
in the costs? Do you include direct medical care, counselling, crime, and/or
insurance? Do you count the financial or emotional costs borne by family
members? Do you count lost income? Do you count lost taxes? How do you account
for positive outcomes from drug use, such as potential improvements in
productivity, or creativity? Do you count benefits to happiness, emotional
well being, sense of belonging, or fellow-feeling? How do you count all these?
Do you evaluate risks from a straight expected-value or do you use some risk-
aversion factor? What is your time preference (i.e. 'interest rate'), and how
do you derive it?

I am not aware of any government policy based on science; the ones that
reference scientifically derived evidence are mostly justifying
intuitive/emotional judgments. It may be a Hume-ian perspective, but I am not
aware of any compelling evidence to the contrary.

~~~
deelowe
You can use whatever you'd like. It's comparative analysis, so it doesn't
matter too much. E.g. Marijuana versus Alcohol versus Oxycodone versus meth.

------
rm_-rf_slash
Make drugs illegal. Lock up drug users in prison with other drug users who get
drugs into prison because it's not as hard as you think. Teach prisoners no
employable skills. Dump them back outside with the most damming scarlet letter
in American society. Give them no public assistance because of drug
conviction. Reduce life options to selling drugs or becoming full-blown addict
to escape the painful reality. Observe drug use or sale. Arrest again. Change
nothing.

What a surprise.

------
andrewguenther
I'd be curious to see these numbers separated. Did they both increase
proportionally?

~~~
upen
Here is the detailed report: [http://ghdx.healthdata.org/us-
data](http://ghdx.healthdata.org/us-data)

------
gesman
While these subjects are connected for some individuals - it's not wise to
pile them up together into the single stat number.

Wrong stats.

Which drugs? Top 5-10?

Which mental disorders? Top 5-10?

~~~
DanBC
(I upvoted you.)

For mental disorders it's something like:

1) Anorexia Nervosa (historically had very high death rate, something like
20%)

2) Body Dysmorphic Disorder (most people don't know that this has a high
suicide rate)

3) Major depression

4) Psychotic illness (people with psychosis tend to live 20 years less than
the general population)

5) ADHD

(I'm not sure of the ordering of the last 3.)

As for drugs, far and away the leading cause of death and harm is going to be
alcohol.

~~~
openasocket
So, clearly the anorexic people die because they starve themselves, people
with depression commit suicide, but what's killing the people with ADHD? I
know ADHD is correlated with greater risk taking, greater likelihood to abuse
drugs, but is it severe enough to put it in the top 5 or 10?

------
chinchang1998
Yes

------
internaut
I believe this is connected to stagnant wages (which starts in 1970s for
Americans), with a catch.

My hypothesis:

1\. Counterintuitively, bad economic circumstances don't lead to chronic
stress. People in countries with objectively terrible economic conditions are
not more stressed or unhappier. It is simply: 'life'.

2\. Caveat: Bad economic conditions _do cause_ chronic stress where the media
is projecting an illusion of rising success and wealth for the average person.
This is because large numbers of people begin to feel left behind, even though
most of their 'successful' peers are probably in debt to their eyeballs.
Chronic stress is caused by the constant reminders in the form of fraudulent
statistics, advertisements and social conditioning by fictional television
shows that cause them to compare their circumstances to largely imaginary
ideals.

My solution, which sounds drastic but I believe it to be meritorious, is to
ban television (but we can keep the Nature channels). I believe a large number
of social ills shall mostly disappear once this is accomplished.

Supporting evidence:

[http://news.harvard.edu/gazette/story/2009/03/fijian-
girls-s...](http://news.harvard.edu/gazette/story/2009/03/fijian-girls-
succumb-to-western-dysmorphia/)

