1. The Big
  2. Focusing
  3. Addressing
    the Core

A Strategy to Save Lives

More than one million people have died from drugs, alcohol and suicide over the past decade. If these trends continue, the death rate could grow to claim two million more lives by 2025.

This is a wake-up call.

We must expand evidence-based efforts and deploy a full-scale strategy against opioid and alcohol misuse and rising suicide rates.

Band-Aid solutions are not enough.

We need a National Resilience Strategy that takes a comprehensive approach, including prevention, early identification of issues and effective treatment.

Stopgap Measures

In 2019, 156,242 Americans died from drug- or alcohol induced causes or suicide. That equates to 428 deaths per day, 17.8 per hour and one person dying approximately every three minutes. With additional lives handing in the balance, we must act. There are evidence-based solutions that can help slow the crisis.


Accessibility of alcohol

  • Increase pricing
  • Limit hours, density of alcohol sales


Underage drinking

  • Age compliance checks
  • Penalties for hosting parties with underage drinking
  • More recovery high schools


Abuse of prescription opioids

  • Promote responsible prescribing practices
  • Prescription drug monitoring programs
  • Fund safe storage programs
  • Tamper-resistant formulations
  • Improve pain management and treatment


Harm-reduction underused

  • Expand Naloxone access and Good Samaritan laws to curb fatal overdoses
  • Expand sterile syringe access to prevent disease transmission, including HIV & hepatitis


Scarce, outmoded treatment options

  • Recast substance misuse as a health issue to reduce stigma
  • Expand and modernize mental health and substance use disorder treatment services


Dangerous synthetic opioids

  • Curb flow of heroin, fentanyl and carfentanil through enforcement
  • Highlight risks of potent opioids to public


Risky social norms

  • Encourage responsible media reporting about suicide



  • Teach effective life-coping, problem solving and parenting skills
  • Promote and fund anti-bullying and social-emotional learning programs in schools
  • Increase support services for veterans


Limited access to mental health expertise

  • Parity for mental and physical health
  • Access to affordable treatment
  • Expand crisis intervention services
  • Improve suicide risk training
  • Support telehealth delivery models


Easy access to means for suicide

  • Limit access to suicide “hot spots”
  • Promote firearm safety, increase permitting requirements and limit access to lethal means for suicide

The Path to Resilience

No single program or policy will be a cure-all. United in a comprehensive systems approach, policies and interventions can address the underlying causes of these “deaths of despair” — and make even our most vulnerable resilient.


How can we prevent problems before they begin?


multi-sector, place-based partnerships that support community efforts.


adverse childhood events with early childhood and family supports.


school-based policies that pay lasting dividends.


supports for families' core needs and household security.

See These Strategies at Work.

Case Study

Sobriety Treatment and Recovery Teams (Start)

Sobriety Treatment and Recovery Teams is a Kentucky-based program for families with parental substance use disorders, and issues of child abuse and/or neglect, that helps parents achieve sobriety and keep children with parents when it is possible and safe.

Mothers who participated in START achieved sobriety at nearly twice the rate of mothers treated without START (66 percent and 37 percent, respectively). Children in families served by START were half as likely to be placed in state custody as compared with children in a matched control group (21 percent and 42 percent, respectively). For every dollar spent on START, Kentucky avoided spending $2.22 on foster care. In Kentucky, areas have reported that demand for the program is higher than the available services.

Case Study

The Life Skills Training (LST) Program

The Life Skills Training (LST) Program is focused on middle school students and includes a “booster” program for high school students. LST is designed to address a wide range of risk and protective factors by teaching general, personal and social skills, along with drug resistance skills and normative education. The program has been extensively tested over the past 20 years and has been found to reduce the prevalence of tobacco, alcohol and illicit drug use relative to controls by 50 to 87 percent. When combined with booster sessions, LST was shown to reduce the prevalence of long-term substance misuse by as much as 66 percent, with benefits still in place beyond the high school years.

Identification and Early Intervention

How can we keep small problems from escalating into big ones?


programs that identify early warning signs.


those in need of assistance.


people to essential services.

See These Strategies at Work.

Case Study

Prescription Drug Monitoring Programs

Prescription Drug Monitoring Programs (PDMP) are database tools that track dispensed controlled substances in a state. For instance, in Kentucky, mandatory requirements increased use five-fold; multiple prescriptions were reduced by more than half; and opioid prescribing was reduced by around 12 percent. In Tennessee, PDMP use increased by more than 400 percent; opioid prescribing decreased by 7 percent within one year; and patients being able to fill multiple overlapping prescriptions decreased by 31 percent.

Case Study

Garrett Lee Smith (GLS) Memorial Youth Suicide Prevention Program

The Garrett Lee Smith program uses a “gatekeeper” approach, where adults, tweens and teens interact with community group leaders, coaches and faith leaders to help identify concerns — such as risks and signs of mental illness, substance misuse or suicidal thoughts — and connect individuals to appropriate supports. Communities that implemented this program had significantly fewer suicides (1.3 per 100,000 fewer deaths) among 10- to 24-year-olds, and a review found the program helped prevent more than 79,000 suicide attempts from 2007 to 2010.


Healthcare systems are often in a unique place to bring about clinical change that can impact countless individuals seeking care. We need better integration within healthcare so people can have their needs met in a more seamless and timely fashion. Trying harder is not going to be enough – we need systems-level change.
Benjamin F. Miller, PsyD
Chief Strategy Officer, Well Being Trust

How do we care for people in pain?


on whole health, the interconnections between physical and mental health, and the outside factors that influence well-being.


pain management and treatment.


substance use disorder treatment services.


medication-assisted treatment.


stigma, a major barrier to mental-health reform.

See These Strategies at Work.

Case Study

Head Start-Trauma Smart (HSTS)

Crittenton Children’s Center at Saint Luke’s Health System in Kansas City, Missouri, developed Head Start-Trauma Smart (HSTS) to help children, ages 3 to 5, handle complex trauma — violence, arrest/incarceration, substance misuse, homelessness, death and others. HSTS therapists provide training for all of the people (caregivers, Head Start staff, daycare providers, neighbors, grandparents, etc.) who are part of a child’s life to help the child identify and share feelings; and classroom consultation to teachers and children, during which the therapist is able to bring skill-based training into the classroom. The model also includes intensive individual trauma-focused intervention, short therapy sessions and peer-based mentoring for teachers and others to help sustain progress.

Case Study

Recovery High Schools

Recovery High Schools are designed for students recovering from a substance use disorder as part of the continuum of recovery care. These schools offer programs that uniquely meet the education and therapeutic challenges faced by those in recovery and who were struggling to succeed in traditional school settings. They provide an alternative to the justice system and delinquency, and are a way to reduce school violence while improving education attainment, typically by providing intensive therapeutic and peer-recovery support and an academic curriculum with structured recovery-focused programming. A study found that complete avoidance of alcohol or other drugs increased from 20 percent during the 90 days before entering the school to 56 percent after.

Support After

If we can strengthen family and social relationships, improve the social-emotional development of America's young people, and reduce early childhood trauma in our nation, we can reverse many of the dynamics fueling the rise in despair deaths.
John Auerbach,
President and CEO of TFAH

How do we ensure progress continues?


silos between health, mental health, social services, and the education and child care sectors.


trauma-informed systems to provide respectful, sensitive and culturally-competent care to people who have experienced trauma.

See These Strategies at Work.

Case Study

Recovery-oriented Systems of Care (ROSC)

Recovery-Oriented Systems of Care (ROSC) focus on addressing disorders through a chronic care management model that includes longer-term, outpatient care, recovery housing, and recovery coaching and management checkups. These systems are meant to be “easy to navigate for people seeking help, transparent in their operations and responsive to the cultural diversity of the communities they serve.”

Case Study


“Navigators,” such as the Accountable Health Communities (AHC) pilot model, focus on bridging the gap between clinical medical care and community services. They do this by systematically identifying and addressing beneficiaries’ health-related social needs, and assessing whether establishing these linkages can reduce healthcare costs and improve quality of care and outcomes. AHCs address housing instability and quality, food insecurity, utility needs, interpersonal violence and transportation needs.

Pain in the Nation

It's time for a strategy to save lives.

Drugs, alcohol and suicide have wracked our communities for far too long. We must adopt comprehensive, evidence-based solutions that address those who are most at-risk. Read the full report to learn more about the critical need for a National Resilience Strategy.

For more information about the report, please contact Rhea Farberman, [email protected].