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A new analysis shows fewer Americans are dying from alcohol, drugs and suicide, but some Midwestern states saw deaths rise.
Pain in the Nation 2026: The Epidemics of Alcohol, Drug and Suicide Deaths shows that 16% fewer deaths occurred in 2024 compared to 2023, which is the first significant decease since 1999.
The report, from Trust for America’s Health, says that nationwide, there were 26% fewer drug overdoses and alcohol-related deaths, and suicides decreased by 4% and 3% respectively. Alcohol-induced mortality and drug overdoses were down across all demographic and geographic groups, according to the report. Synthetic opioids, such as fentanyl, remained the deadliest drug, but cocaine deaths are down.
These types of deaths are colloquially known as “deaths of despair,” a term coined by economists Anne Case and Angus Deaton in their 2020 book.
Iowa, South Dakota, North Dakota and Wyoming saw increases and Nebraska’s rate remained unchanged across the two years. The most drastic improvements occurred in Appalachia and the East Coast.
“Having a mental health challenge or facing drug use, it is not a moral failing,” Dr. J. Nadine Gracia, President and CEO of TFAH said, “We know that there are so many factors that contribute to these types of challenges.”
Alison Lynch, director of the Division of Addiction Medicine at The University of Iowa, said the report highlights the need for effective public health tracking so policy makers can respond to what’s happening on the ground.
In recent years, Iowa has been one of the top states for binge drinking and methamphetamine use, Lynch said.
“Iowa is taking a hard hit right now, because of that constellation of different factors that are increasing our risk for death,” she said.
The report also reflects on the state of suicide prevention. Dr. Brian Ahmedani, the director of The Center for Healthcare Improvement and the Director of Research for Behavioral Health Services for Henry Ford Health, said in the report that about 1 in 20 Americans have had suicidal thoughts in the past year.
“That’s a lot of people, and there’s a good chance that an individual has struggled themselves or knows somebody in their life who has struggled with suicidal thoughts,” Ahmedani said in the report. “We have an obligation to learn from these experiences and take action.”
To conduct the analysis, the researchers analyzed data from the National Center for Health Statistics. These “deaths of despair” peaked in 2021, and preliminary 2025 data suggests the current national trend downward will continue. Still, researchers and advocates worry about the loss of resources.
In sweeping cuts made during the first months of the second Trump administration, the Substance Abuse and Mental Health Services Administration lost roughly $1 billion in grant funds, meaning fewer resources for medication-assisted treatment, data collection and suicide prevention.
“Sustaining and building on recent progress requires the federal government to invest even
more in programs that reduce and prevent harm—not cut them—while also investing in the
skilled workforce and modern data systems necessary to deliver and evaluate those programs effectively,” Gracia said in a release.
Mental health caregivers and activists in Iowa say a number of factors may explain why Iowa was one of the few states to show increases in suicides, alcohol-related deaths and some overdoses.
Lynch said the culture of binge drinking, social isolation in rural areas, as well as economic conditions, might explain part of why more deaths are happening in parts of the Midwest.
“Alcohol is a big part of our culture,” Lynch said. “I live in a college town, every fall we have football games, and what do people do? They tailgate.”
The Division of Addiction Medicine works to encourage people to begin their recovery journey, with specific cultural and social aspects in mind. Rather than trying to make someone embrace complete sobriety on day one, the organization encourages people to start small steps to begin their recovery.
“Once people do well with reaching one of their health goals, it's really empowering,” Lynch said. They often feel better, and they're often now interested in taking the next step.”
Ryan Crane, executive director of NAMI Iowa, echoed Lynch’s response to the report.
“The best thing for a reader who is not in the behavioral health sector to do, upon reading this, is to reach out to a friend who may be experiencing isolation. When we connect, and show we care, we can make a real difference,” Crane wrote in an email.
He also encouraged people to be aware of the toll social isolation plays in the suicide risk for older, rural Iowans — who often have access to firearms.
The Midwest Newsroom is an investigative and enterprise journalism collaboration that includes Iowa Public Radio, KCUR, Nebraska Public Media, St. Louis Public Radio and NPR. There are many ways you can contact us with story ideas and leads, and you can find that information here.
The Midwest Newsroom is a partner of The Trust Project. We invite you to review our ethics and practices here.
METHODOLOY
Reporter Daniel Wheaton received an embargoed version of Pain in the Nation: The Epidemics of Alcohol, Drug and Suicide, and analyzed the data for Iowa, Kansas, Missouri and Nebraska. He spoke with mental health researchers and advocates in Iowa, as it was an outlier in the report.
TYPE OF ARTICLE
News – Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources.
