How substance abuse is killing middle aged white Americans

The New York Times reported recently that a disturbing uptick in premature deaths in a particular demographic group has been occurring in recent years. Two Princeton economists, Angus Deaton, and Anne Case, examined data from the Centers for Disease Control and Prevention, among other sources. They concluded that middle-aged, white Americans are dying at a greater rate than previous years. More importantly, middle-age whites in America are dying more than middle-aged whites in other countries, where the death rate is declining.

Middle-aged white Americans dying from complications of substance abuse

At first glance, one would think that the obesity epidemic is driving deaths from heart attacks and the complications of diabetes among men in this age group. However, the primary causes of death include suicides and conditions related to substance abuse. Men between the ages of 45 and 56 are dying of heroin and prescription painkiller overdoses and alcohol liver disease.

Middle-aged white Americans who have a lower education die at a higher rate

The researchers found that the cluster of deaths among middle-aged white Americans tended to be those with a lower education. Deaths of middle-aged white Americans with a high school education increased by 133 per 1,000 from 1999 to 2014. The death rate for middle-aged white Americans with a college education declined during the same period.

Middle-aged African Americans and Hispanic Americans

The death rate for middle-aged African Americans is still higher than that of middle-aged white Americans but is on a steady decline. The death rate for middle-aged Hispanic Americans is lower than that of middle-aged white Americans and is also declining. The death rates for all older and younger Americans are also on the decline.

Factors in the increase of death rate for middle-aged white Americans

No one factor can explain the steady uptick of deaths of middle-aged white Americans.

One factor seems to be a steady decline in income and hence a rise in financial anxiety among middle-aged white Americans with a high school education. Middle age is a time when men frequently take stock of their future and, more often than not, find it to be less promising than they had hoped it would be when they were younger.

Another factor seems to be an increase in chronic pain among middle-aged American whites with a limited education. Men in that age group have been reporting increases in lower back pain and joint pain that affect their ability to work and socialize. Chronic pain not only increases mental stress but can lead to substance abuse.

Men with chronic pain are being over-prescribed opioid painkillers

The researchers theorize that middle-aged white men are being prescribed opioid painkillers such as Vicodin and OxyContin to manage their pain. The combination of prescription painkillers, chronic pain, and mental stress can become a killer combination. The familiar path of addiction lies before many men who find themselves in this situation. Opioid painkillers are known to be a gateway drug for heroin, which tends to be cheaper on the street than black market prescription pills.

Even if this demographic group does not travel on the path of opioid addiction, they may try to drown their mental stress and anxiety with alcohol. Hence, the increase in alcohol liver disease.

The reason why the same factors that are killing middle-aged white Americans are not affecting African Americans and Hispanic Americans is uncertain. It is possible that a racial element exists in the way doctors prescribe pain medication.


Clearly the Princeton researchers have stumbled upon a serious health problem. While certainly rehab services will save a considerable number of middle-aged white Americans who have become addicted, the underlying social and economic problems will remain and, in some way will have to be addressed.

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