The despair epidemic started before opioids—and it's still spreading

The story of deaths of despair in America usually begins with OxyContin. A pharmaceutical company floods the market with addictive painkillers in the late 1990s, and mortality spikes among working-class white Americans. Case closed. Except the research suggests the case opened years earlier.

A new study from Ohio State University found that states which saw the steepest drops in church attendance between 1985 and 2000 later experienced the largest increases in deaths from drug overdoses, suicide, and alcoholic liver disease. The timing matters. These deaths were already rising before opioids arrived—the prescription epidemic didn't create the vulnerability, it exploited it.

The Decline Was Already Underway

Morality rates for middle-aged white Americans without college degrees had been falling steadily from the late 1970s through the early 1990s. Then something shifted. The downward trend stalled, reversed, and began climbing just as religious participation was collapsing and blue laws—regulations that had restricted Sunday commerce—were being repealed.

When Minnesota, South Carolina, and Texas eliminated their blue laws in 1985, weekly church attendance in those states dropped by 5 to 10 percentage points. Years later, those same states saw measurable increases in deaths of despair. After OxyContin entered the market in 1996, the mortality curve spiked sharply. "OxyContin and the opioid crisis made a bad situation worse," said Tamar Oostrom, an economist at Ohio State and one of the study's authors, "but the deaths of despair were already on the rise."

The researchers used data from the General Social Surveys and CDC mortality records to track these patterns. What emerged was a portrait of a population losing its moorings before the pharmaceutical crisis hit.

What Church Actually Provided

The obvious explanation is social connection. People who attend church regularly have built-in relationships, community, a sense of belonging—all things research has linked to better health outcomes. When church attendance fell, those ties frayed. But the study found something more specific was happening.

Other forms of social activity didn't decline at the same rate during this period. Bowling leagues, clubs, volunteer work—these weren't disappearing. What was unique about religious participation was something harder to measure: a framework for making sense of the world, an identity rooted in something larger than yourself, a narrative that held meaning even when circumstances were difficult.

"Religion may provide some way of making sense of the world, some sense of identity in relation to others, that can't easily be replaced by other forms of socialization," Oostrom explained. The loss wasn't just social—it was existential.

The Harder Question

If the problem runs this deep, can it be solved? The study offers a sobering answer: probably not easily. Researchers found no evidence that overall community participation is reversing, and the positive effects of religious involvement on life satisfaction have proven difficult to replicate through secular alternatives. The rise of social media in the 21st century has only made the problem more entrenched—people are more isolated, more algorithmically sorted, less likely to encounter the kind of binding community that churches once provided.

Oostrom's final observation carries weight: "People are less religious now, and there hasn't been a substitute that provides what religion provided to many people. And our paper suggests this could have long-term impacts on health and mortality." The opioid crisis didn't create deaths of despair. It arrived in a landscape already destabilized by the loss of meaning and belonging. Understanding that distinction matters for anyone thinking about how to actually reverse these trends—because treating the symptom (addiction) without addressing the underlying wound (disconnection) may leave the vulnerability intact.