Appalachian Diseases of Despair, 2025 update

In 2008, NORC and ETSU conducted a study—“An Analysis of Mental Health Services and Substance Abuse Disparities and Access to Treatment Services in the Appalachian Region”—on behalf of ARC, which found that treatment admission rates for primary abuse of opiates and synthetics were higher in Appalachia than the rest of the nation, and were growing at a faster pace.6 In 2017, ARC commissioned NORC to investigate “diseases of despair” in Appalachia. At the time, health economists Anne Case and Angus Deaton had begun to research increasing morbidity and mortality from three main causes: alcohol, prescription- and illegal-drug overdose; suicide; and alcoholic liver disease/cirrhosis of the liver. These have been referred to as “deaths of despair,” or “diseases of despair.”7 The original 2017 Appalachian Diseases of Despair study was based on 2015 mortality data. At that time, the United States was seeing a dramatic rise in overdose deaths from synthetic opioids, particularly those involving illicitly manufactured fentanyl.8 In 2020, NORC and ETSU updated the Diseases of Despair report to include data through 2018.9 In 2022, ARC commissioned NORC and ETSU to determine changes between 2018 and 2020, which highlighted the initial impact of the COVID19 pandemic. In 2023, 2024, and 2025, we have conducted an annual update, with this report including data through 2023, which continues to show the impact of COVID-19 on diseases of despair mortality in Appalachia.