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 2017, 151,800 Americans died from drug-
or alcohol-induced causes or suicide. That equates to
416 deaths per day, 17 per hour and one person dying
every 3.5 minutes. With additional lives hanging in
the balance, we must act. There are evidence-based
solutions that can help slow the crises.


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 &


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


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

See These Strategies at Work.

Case Study

Sobriety Treatment and Recovery Teams (Start)

Sobriety Treatment and Recovery
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

Case Study

The Life Skills Training (LST) Program

The Life Skills Training (LST)
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

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

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


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
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


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
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
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]
or Albert Lang, [email protected]

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