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fewer Millennials are taking part in traditional family building, and the ones doing it are waiting longer than their parents did. Now the structure of social life isn’t that different for many people in their mid-30s than it was in their early 20s, which provides plenty of time for drinking on dates and with friends for them to start to get a little tired of it.

“Folks in the Millennial generation have maybe a better sense of balance. Some do yoga or meditation or are physically active, so they don’t need to find stimulation and stress reduction in substances.” That mirrors the generation’s general interest in maintaining its health,

Millennials who haven’t developed their generation’s signature coping skills often use alcohol heavily. Starke sees an alarming number of people under 35 with advanced liver disease or alcohol hepatitis. As attitudes may be moderating for many young adults, plenty of others are struggling: Nearly 90,000 people still die from alcohol-related causes in America every year, and that number hasn’t started to meaningfully improve.

“It still seems like this is a generation of self-medicating, but they’re using things differently,” says Starke, and the normalization and ever more common legalization of cannabis have a big part in that.

A 2017 study found that in counties with legalized medicinal cannabis, alcohol sales dropped more than 12 percent when compared with similar counties without weed. Recreational legalization has the potential to bolster that effect by making cannabis products even more broadly accessible

She sees many patients looking for help with opioids, as well as benzodiazepines such as Xanax.

uicide rates are up among young adults, and prescription-drug abuse is a problem the country is only beginning to address

Gen Z is drinking at lower rates than adolescents have in generations, and so much about a person’s lifetime relationship with substance abuse and consumption is set by use in early life.

“For many people, when they’re honest with their friends [about wanting to skip out on drinks], their friends are like, ‘Oh my God, I was thinking about that too,’” says UNC’s Starke. “I don’t know too many people who have gotten a negative response.”

Drunkorexia addresses the need to be the life of the party while staying extremely thin, pointing to a flawed mind-set about body image and alcoholism among college students, mostly women.

why would a promising college freshman choose this unhealthy pattern? It’s probably not a choice, but mental health and addiction issues mixed together. Studies show that having a preexisting eating disorder or alcoholism are predictors of drunkorexia

surveys from colleges range widely: One report concluded that 34 percent of all students surveyed had engaged in this behavior; another said 81 percent of students who drink heavily had

In 2001, it found, only 12 percent of English 16- and 17-year-olds considered themselves non-drinkers; in 2016, that was up to 35 percent.

“Alcohol doesn’t play as important a role in socializing as it did in the past,” Mr. Nicholls said. “Young people can now have an active social life without leaving their house.”

Alcohol has become more expensive in Britain over the last decade, driven in part by higher taxes, which may help dissuade young drinkers. Some young people guessed a reason for the decline is that their peers have become more likely to resort to drugs like marijuana and ecstasy, which are often more accessible to minors than alcohol.

“I suppose it was a combination of it being more cool and more enjoyable,” said James Samouel, a 19-year-old history student who grew up in south London, referring to marijuana use by peers. “A health thing as well — alcohol is so much worse for you.

But in fact, surveys show that drug use, while still common, has also become less prevalent among young people.

“It doesn’t seem that people are switching from drinking to drugs,” said Dr. Melissa Oldham, the lead author of the Sheffield University report. “It’s a move away from alcohol and drugs to other hobbies.”

People who drank 45 grams of alcohol or more a day—about as much as in three glasses of wine—increased their risk of dying sooner by up to a third. Among women, anything more than 25 grams of alcohol increased their risk of dying sooner. 

The findings suggest that the average man can drink up to about three drinks a day and expect to live as long as nondrinkers. Women might want to stop at about two drinks, the research suggested.

Health officials in Canada this year recommended that people have two drinks or fewer a week to lower health risks. That replaced guidance that 10 drinks a week was a low health risk. 

A recent series of articles on fraternities by Bloomberg News’s David Glovin and John Hechinger notes that since 2005, more than 60 people—the majority of them students—have died in incidents linked to fraternities, a sobering number in itself, but one that is dwarfed by the numbers of serious injuries, assaults, and sexual crimes that regularly take place in these houses.

I have spent most of the past year looking deeply into the questions posed by these lawsuits, and more generally into the particular nature of fraternity life on the modern American campus

to answer the vexing question “why don’t colleges just get rid of their bad fraternities?”—the system, and its individual frats, have only grown in power and influence. Indeed, in many substantive ways, fraternities are now mightier than the colleges and universities that host them.

The entire multibillion-dollar, 2,000-campus American college system

the Kappa Alpha Society. Word of the group spread, and a new kind of college institution was founded, and with it a brand-new notion: that going to college could include some pleasure. It was the American age of societies, and this new type fit right in.

every moment of the experience is sweetened by the general understanding that with each kegger and rager, each lazy afternoon spent snoozing on the quad (a forgotten highlighter slowly drying out on the open pages of Introduction to Economics, a Coke Zero sweating beside it), they are actively engaged in the most significant act of self-improvement available to an American young person: college!

There are many thousands of American undergraduates whose economic futures (and those of their parents) would be far brighter if they knocked off some of their general-education requirements online, or at the local community college—for pennies on the dollar—before entering the Weimar Republic of traditional-college pricing. But college education, like weddings and funerals, tends to prompt irrational financial decision making,

depends overwhelmingly for its very existence on one resource: an ever-renewing supply of fee-paying undergraduates. It could never attract hundreds of thousands of them each year—many of them woefully unprepared for the experience, a staggering number (some 40 percent) destined never to get a degree, more than 60 percent of them saddled with student loans that they very well may carry with them to their deathbeds—if the experience were not accurately marketed as a blast.

When colleges tried to shut them down, fraternities asserted that any threat to men’s membership in the clubs constituted an infringement of their right to freedom of association. It was, at best, a legally delicate argument, but it was a symbolically potent one, and it has withstood through the years. The powerful and well-funded political-action committee that represents fraternities in Washington has fought successfully to ensure that freedom-of-association language is included in all higher-education reauthorization legislation, thus “disallowing public Universities the ability to ban fraternities.”

While the fraternities continued to exert their independence from the colleges with which they were affiliated, these same colleges started to develop an increasingly bedeviling kind of interdependence with the accursed societies

the fraternities involved themselves very deeply in the business of student housing, which provided tremendous financial savings to their host institutions, and allowed them to expand the number of students they could admit. Today, one in eight American students at four-year colleges lives in a Greek house

fraternities tie alumni to their colleges in a powerful and lucrative way. At least one study has affirmed what had long been assumed: that fraternity men tend to be generous to their alma maters. Furthermore, fraternities provide colleges with unlimited social programming of a kind that is highly attractive to legions of potential students

It is true that fraternity lawsuits tend to involve at least one, and often more, of the four horsemen of the student-life apocalypse, a set of factors that exist far beyond frat row

the binge-drinking epidemic, which anyone outside the problem has a hard time grasping as serious (everyone drinks in college!) and which anyone with knowledge of the current situation understands as a lurid and complicated disaster

The second is the issue of sexual assault of female undergraduates by their male peers, a subject of urgent importance but one that remains stubbornly difficult even to quantify

The third is the growing pervasiveness of violent hazing on campus

But it’s impossible to examine particular types of campus calamity and not find that a large number of them cluster at fraternity houses

the fourth is the fact that Boomers, who in their own days destroyed the doctrine of in loco parentis so that they could party in blissful, unsupervised freedom, have grown up into the helicopter parents of today

during the period of time under consideration, serious falls from fraternity houses on the two Palouse campuses far outnumbered those from other types of student residences, including privately owned apartments occupied by students. I began to view Amanda Andaverde’s situation in a new light.

Why are so many colleges allowing students to live and party in such unsafe locations? And why do the lawsuits against fraternities for this kind of serious injury and death—so predictable and so preventable—have such a hard time getting traction? The answers lie in the recent history of fraternities and the colleges and universities that host them.

This question is perhaps most elegantly expressed in the subtitle of Robert D. Bickel and Peter F. Lake’s authoritative 1999 book on the subject, The Rights and Responsibilities of the Modern University: Who Assumes the Risks of College Life?

The answer to this question has been steadily evolving ever since the 1960s, when dramatic changes took place on American campuses, changes that affected both a university’s ability to control student behavior and the status of fraternities in the undergraduate firmament. During this period of student unrest, the fraternities—long the unquestioned leaders in the area of sabotaging or ignoring the patriarchal control of school administrators—became the exact opposite: representatives of the very status quo the new activists sought to overthrow. Suddenly their beer bashes and sorority mixers, their panty raids and obsession with the big game, seemed impossibly reactionary when compared with the mind-altering drugs being sampled in off-campus apartments where sexual liberation was being born and the Little Red Book proved, if nothing else, a fantastic coaster for a leaky bong.

American colleges began to regard their students not as dependents whose private lives they must shape and monitor, but as adult consumers whose contract was solely for an education, not an upbringing. The doctrine of in loco parentis was abolished at school after school.

Through it all, fraternities—for so long the repositories of the most outrageous behavior—moldered, all but forgotten.

Animal House, released in 1978, at once predicted and to no small extent occasioned the roaring return of fraternity life that began in the early ’80s and that gave birth to today’s vital Greek scene

In this newly forming culture, the drugs and personal liberation of the ’60s would be paired with the self-serving materialism of the ’80s, all of which made partying for its own sake—and not as a philosophical adjunct to solving some complicated problem in Southeast Asia—a righteous activity for the pampered young collegian. Fraternity life was reborn with a vengeance.

These new members and their countless guests brought with them hard drugs, new and ever-developing sexual attitudes, and a stunningly high tolerance for squalor

Adult supervision was nowhere to be found. Colleges had little authority to intervene in what took place in the personal lives of its students visiting private property. Fraternities, eager to provide their members with the independence that is at the heart of the system—and responsive to members’ wish for the same level of freedom that non-Greek students enjoyed—had largely gotten rid of the live-in resident advisers who had once provided some sort of check on the brothers

, in 1984 Congress passed the National Minimum Drinking Age Act, with the ultimate result of raising the legal drinking age to 21 in all 50 states. This change moved college partying away from bars and college-sponsored events and toward private houses—an ideal situation for fraternities

lawsuits began to pour in.

Liability insurance became both ruinously expensive and increasingly difficult to obtain. The insurance industry ranked American fraternities as the sixth-worst insurance risk in the country—just ahead of toxic-waste-removal companies.

For fraternities to survive, they needed to do four separate but related things: take the task of acquiring insurance out of the hands of the local chapters and place it in the hands of the vast national organizations; develop procedures and policies that would transfer as much of their liability as possible to outside parties; find new and creative means of protecting their massive assets from juries; and—perhaps most important of all—find a way of indemnifying the national and local organizations from the dangerous and illegal behavior of some of their undergraduate members.

comprising a set of realities you should absolutely understand in detail if your son ever decides to join a fraternity.

you may think you belong to Tau Kappa Epsilon or Sigma Nu or Delta Tau Delta—but if you find yourself a part of life-changing litigation involving one of those outfits, what you really belong to is FIPG, because its risk-management policy (and your adherence to or violation of it) will determine your fate far more than the vows you made during your initiation ritual

the need to manage or transfer risk presented by alcohol is perhaps the most important factor in protecting the system’s longevity. Any plaintiff’s attorney worth his salt knows how to use relevant social-host and dramshop laws against a fraternity; to avoid this kind of liability, the fraternity needs to establish that the young men being charged were not acting within the scope of their status as fraternity members. Once they violated their frat’s alcohol policy, they parted company with the frat.

there are actually only two FIPG-approved means of serving drinks at a frat party. The first is to hire a third-party vendor who will sell drinks and to whom some liability—most significant, that of checking whether drinkers are of legal age—will be transferred. The second and far more common is to have a BYO event, in which the liability for each bottle of alcohol resides solely in the person who brought it.

these policies make it possible for fraternities to be the one industry in the country in which every aspect of serving alcohol can be monitored and managed by people who are legally too young to drink it.

But when the inevitable catastrophes do happen, that policy can come to seem more like a cynical hoax than a real-world solution to a serious problem.

Thanks in part to the guest/witness list, Larry can be cut loose, both from the expensive insurance he was required to help pay for (by dint of his dues) as a precondition of membership, and from any legal defense paid for by the organization. What will happen to Larry now?

“I’ve recovered millions and millions of dollars from homeowners’ policies,” a top fraternal plaintiff’s attorney told me. For that is how many of the claims against boys who violate the strict policies are paid: from their parents’ homeowners’ insurance

, the Fraternal Information and Programming Group’s chillingly comprehensive crisis-management plan was included in its manual for many years

the plan serves a dual purpose, at once benevolent and mercenary. The benevolent part is accomplished by the clear directive that injured parties are to receive immediate medical attention, and that all fraternity brothers who come into contact with the relevant emergency workers are to be completely forthright

“Until proven otherwise,” Fierberg told me in April of fraternities, “they all are very risky organizations for young people to be involved in.” He maintains that fraternities “are part of an industry that has tremendous risk and a tremendous history of rape, serious injury, and death, and the vast majority share common risk-management policies that are fundamentally flawed. Most of them are awash in alcohol. And most if not all of them are bereft of any meaningful adult supervision.”

the interests of the national organization and the individual members cleave sharply as this crisis-management plan is followed. Those questionnaires and honest accounts—submitted gratefully to the grown-ups who have arrived, the brothers believe, to help them—may return to haunt many of the brothers, providing possible cause for separating them from the fraternity, dropping them from the fraternity’s insurance, laying the blame on them as individuals and not on the fraternity as the sponsoring organization.

So here is the essential question: In the matter of these disasters, are fraternities acting in an ethical manner, requiring good behavior from their members and punishing them soundly for bad or even horrific decisions? Or are they keeping a cool distance from the mayhem, knowing full well that misbehavior occurs with regularity (“most events take place at night”) and doing nothing about it until the inevitable tragedy occurs, at which point they cajole members into incriminating themselves via a crisis-management plan presented as being in their favor?

I have had long and wide-ranging conversations with both men, in which each put forth his perspective on the situation.

the young men who typically rush so gratefully into the open arms of the representatives from their beloved national—an outfit to which they have pledged eternal allegiance—would be far better served by not talking to them at all, by walking away from the chapter house as quickly as possible and calling a lawyer.

The fraternity system, he argues, is “the largest industry in this country directly involved in the provision of alcohol to underage people.” The crisis-management plans reveal that in “the foreseeable future” there may be “the death or serious injury” of a healthy young person at a fraternity function.

His belief is that what’s tarnishing the reputation of the fraternities is the bad behavior of a very few members, who ignore all the risk-management training that is requisite for membership, who flout policies that could not be any more clear, and who are shocked when the response from the home office is not to help them cover their asses but to ensure that—perhaps for the first time in their lives—they are held 100 percent accountable for their actions.

The fraternity system, he argues, is “the largest industry in this country directly involved in the provision of alcohol to underage people.” The crisis-management plans reveal that in “the foreseeable future” there may be “the death or serious injury” of a healthy young person at a fraternity function.

His belief is that what’s tarnishing the reputation of the fraternities is the bad behavior of a very few members, who ignore all the risk-management training that is requisite for membership, who flout policies that could not be any more clear, and who are shocked when the response from the home office is not to help them cover their asses but to ensure that—perhaps for the first time in their lives—they are held 100 percent accountable for their actions.

Unspoken but inherent in this larger philosophy is the idea that it is in a young man’s nature to court danger and to behave in a foolhardy manner; the fraternity experience is intended to help tame the baser passions, to channel protean energies into productive endeavors such as service, sport, and career preparation.

In a sense, Fierberg, Smithhisler, and the powerful forces they each represent operate as a check and balance on the system. Personal-injury lawsuits bring the hated media attention and potential financial losses that motivate fraternities to improve. It would be a neat, almost a perfect, system, if the people wandering into it were not young, healthy college students with everything to lose.

In a sense, Fierberg, Smithhisler, and the powerful forces they each represent operate as a check and balance on the system. Personal-injury lawsuits bring the hated media attention and potential financial losses that motivate fraternities to improve. It would be a neat, almost a perfect, system, if the people wandering into it were not young, healthy college students with everything to lose.

Wesleyan is one of those places that has by now become so hard to get into that the mere fact of attendance is testament, in most cases, to a level of high-school preparation—combined with sheer academic ability—that exists among students at only a handful of top colleges in this country and that is almost without historical precedent.

Wesleyan is one of those places that has by now become so hard to get into that the mere fact of attendance is testament, in most cases, to a level of high-school preparation—combined with sheer academic ability—that exists among students at only a handful of top colleges in this country and that is almost without historical precedent.

This January, after publishing a withering series of reports on fraternity malfeasance, the editors of Bloomberg.com published an editorial with a surprising headline: “Abolish Fraternities.” It compared colleges and universities to companies, and fraternities to units that “don’t fit into their business model, fail to yield an adequate return or cause reputational harm.”

A college or university can choose, as Wesleyan did, to end its formal relationship with a troublesome fraternity, but—if that fiasco proves anything—keeping a fraternity at arm’s length can be more devastating to a university and its students than keeping it in the fold.

A college or university can choose, as Wesleyan did, to end its formal relationship with a troublesome fraternity, but—if that fiasco proves anything—keeping a fraternity at arm’s length can be more devastating to a university and its students than keeping it in the fold.

there is a Grand Canyon–size chasm between the official risk-management policies of the fraternities and the way life is actually lived in countless dangerous chapters.

When there is a common denominator among hundreds of such injuries and deaths, one that exists across all kinds of campuses, from private to public, prestigious to obscure, then it is more than newsworthy: it begins to approach a national scandal.

When there is a common denominator among hundreds of such injuries and deaths, one that exists across all kinds of campuses, from private to public, prestigious to obscure, then it is more than newsworthy: it begins to approach a national scandal.

He had expected his eating habits to change once he began taking the medication — he became less interested in fatty, sugary foods and found himself eating smaller meals — but he didn’t anticipate the aversion to alcohol.“That’s what surprised me,” he said. “It makes you want to do all the things doctors have told you your whole life.”

“Bro culture is a dynamic that’s been creating men-only environments in their most toxic form by encouraging bad behaviors, from excessive drinking to heavy sexualized talk, that excludes women and any person who doesn’t support those behaviors,” Ms. Cooper says.

She adds that it isn’t just women whom bro culture excludes. It’s anyone who doesn’t want to participate in these kinds of behaviors. “Very few people enjoy those things, but they don’t want to stand up to the popular crowd making the rules,” she says. “I like beer pong as much as the next person, but I don’t want to do it at work. “

Perhaps the biggest efforts involve separating work from alcohol. Stories abound in Silicon Valley about networking events that happen late into the night at alcohol- and drug-fueled parties

“We make sure the activities we do within the company and with the founders are gender-neutral,” Ms. Hebb says. “We aren’t doing whiskey drinking and shooting. We’ll do a scavenger hunt, or a hike, which is actually a better way to get to know people than over drinks. Is a scavenger hunt less bro-ey than drinks? It’s different, and we think that relates to a broader group of people who have felt excluded from a singular way of networking

In 2017, Pipeline Angels announced an alcohol-free policy. It came about when Pipeline Angels’ founder, Natalia Oberti Noguera, attended a tech conference where the host announced an impromptu “drunk talk” on stage. It’s a fairly common tactic in Silicon Valley, with the idea being that a volunteer from the audience will drink a lot and then give a talk in the hopes that alcohol will make that person more vulnerable and more forthcoming.

“Do you know who volunteered to give the drunk talk? A white guy,” Ms. Oberti Noguera says. She didn’t see that as surprising given the potential reputational risks of getting drunk for someone other than a white man.

“We’re already vulnerable,” she says. “It’s not safe in terms of our reputation for a woman, a man of color or a nonbinary person to get drunk and give a drunk talk at a professional event. And so I thought I can take someone else’s mistake and make it a best practice. Now all our events, including meals and evening receptions, are alcohol-free.”

“Something like 90% of VC investors are men,” Ms. Nelson says. “Only 2% of VC dollars go to women. That’s the definition of bro culture—men supporting men, opening doors for one another and making those connections.”

“We’re opening doors for people that weren’t open before,” she says. “You can really have whatever kind of culture you want. It’s up to us to determine what that is.”

A regular burglary would probably not be newsworthy. But this one involved alcohol - and lots of it. Again there are confusing reports but Reuters put the number well above 1,000 bottles of Johnnie Walker Black Label - said to be worth about $80 each on the black market

Pakistan is a country where the majority-Muslim population is by law not allowed to drink alcohol. Some still drink, but alcohol is notoriously hard to come by. That has created a lucrative black market across the country.

This could mean two things: North Korean diplomats have been able to import a lot more than they are meant to and, unless they spend most of their days utterly drunk, they might have been selling the excess booze on the black market. North Korea's embassy has not commented on the allegations.

Some of our greatest music was written under the influence: would David stop that? Jazz might not exist without it. All of our recent presidents were stoners at some point - and the current president in his teens was an enthusiast even by Hawaii standards in the 1970s. Does David think that the man who wrote Dreams From My Father suffered from impaired memory? Does he believe that Michael Phelps who smoked pot and became the most decorated Olympian of all time didn't do one of those two things? Can we not discuss drugs rationally, rather than with this vast super-structure of boomer-era culture-war synapses attached to it?

Here's the "drug abuse" site's description of how dreadful canabis dependency can be: Long-term marijuana abusers trying to quit report withdrawal symptoms including: irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to remain abstinent. These symptoms begin within about 1 day following abstinence, peak at 2-3 days, and subside within 1 or 2 weeks following drug cessation. How many alcoholics would kill for a two-week readjustment period after using a drug for a lifetime?

In saying his core point is to protect the vulnerable and poor, he also fails inexplicably to note how enforcement of petty marijuana possession laws in urban centers needlessly ruins countless lives, and does so with a racial disparity that is simply staggering. The first thing you'd do to improve the prospects of the young black men David rightly cares about is to stop incarcerating the black pot-smokers at rates white kids and their parents would not tolerate for a milli-second.

Why is the president being accused of hypocrisy? Mr Sirisena has encouraged women in the country to play a more active part in politics, boasting last year that his government had acted to ensure more women were returned at future elections.

Just how much do women drink in Sri Lanka anyway?According to World Heath Organization data from 2014, 80.5% of women never drink, compared to 56.9% of men.Less than 0.1% of women above the age of 15 are prone to heavy drinking, compared with 0.8% of men in the same age bracket.

their explanation begins by dismantling several others.

Was the source of the problem America’s all-too-ready supply of prescription opioids?

About a million Americans now use heroin daily or near-daily. Many others use illicitly obtained synthetic opioids like fentanyl.

As Case and Deaton note, most people who abuse or become addicted to opioids continue to lead functional lives and many eventually escape their dependence

The oversupply of opioids did not create the conditions for despair. Instead, it appears, the oversupply fed upon a white working class already adrift.

although opioid deaths plateaued, at least temporarily, in 2018, suicides and alcohol-related deaths continue upward.

Could deaths of despair be related to the rising incidence of obesity?

Case and Deaton report that we’re seeing the same troubling health trends “among the underweight, normal weight, overweight, and obese.”

Is the problem poverty?

Overdose deaths are most common in high-poverty Appalachia and along the low-poverty Eastern Seaboard, in places such as Massachusetts, New Hampshire, Delaware, and Connecticut. Meanwhile, some high-poverty states, such as Arkansas and Mississippi, have been less affected. Black and Hispanic populations are poorer but less affected, too.

How about income inequality? Case and Deaton have found that patterns of inequality, like patterns of poverty, simply don’t match the patterns of mortality by race or region.

A consistently strong economic correlate, by contrast, is the percentage of a local population that is employed

In the late nineteen-sixties, Case and Deaton note, all but five per cent of men of prime working age, from twenty-five to fifty-four, had jobs; by 2010, twenty per cent did not.

What Case and Deaton have found is that the places with a smaller fraction of the working-age population in jobs are places with higher rates of deaths of despair—and that this holds true even when you look at rates of suicide, drug overdoses, and alcohol-related liver disease separately. They all go up where joblessness does.

Conservatives tend to offer cultural explanations

People are taking the lazy way out of responsibilities, the argument goes, and so they choose alcohol, drugs, and welfare and disability checks over a commitment to hard work, family, and community. And now they are paying the price for their hedonism and decadence—with addiction, emptiness, and suicide.

Yet, if the main problem were that a large group of people were withdrawing from the workforce by choice, wages should have risen in parallel.

Case and Deaton argue that the problem arises from the cumulative effect of a long economic stagnation and the way we as a nation have dealt with it

For the first few decades after the Second World War, per-capita U.S. economic growth averaged between two and three per cent a year. In the nineties, however, it dipped below two per cent. In the early two-thousands, it was less than one per cent. This past decade, it remained below 1.5 per cent.

Different populations have experienced this slowdown very differently

Anti-discrimination measures improved earnings and job prospects for black and Hispanic Americans. Though their earnings still lag behind those of the white working class, life for this generation of people of color is better than it was for the last.

Not so for whites without a college education. Among the men, median wages have not only flattened; they have declined since 1979. The work that the less educated can find isn’t as stable: hours are more uncertain, and job duration is shorter

Among advanced economies, this deterioration in pay and job stability is unique to the United States.

The United States has provided unusually casual access to means of death.

The problem isn’t that people are not the way they used to be. It’s that the economy and the structure of work are not the way they used to be

Today, about seventy-five per cent of college graduates are married by age forty-five, but only sixty per cent of non-college graduates are

Nonmarital childbearing has reached forty per cent among less educated white women.

Religious institutions previously played a vital role in connecting people to a community. But the number of Americans who attend religious services has declined markedly over the past half century, falling to just one-third of the general population today.

Case and Deaton see a picture of steady economic and social breakdown, amid over-all prosperity.

climate—the amount of social and economic instability not only in your life but also in your family and community—matters, too. Émile Durkheim pointed out more than a century ago that despair and then suicide result when people’s material and social circumstances fall below their expectations.

why has the steep rise in deaths of despair been so uniquely American

In the past four decades, Americans without bachelor’s degrees—the majority of the working-age population—have seen themselves become ever less valued in our economy. Their effort and experience provide smaller rewards than before, and they encounter longer periods between employment.

The availability of opioids has indeed played a role, and the same goes for firearms

The U.S. has also embraced automation and globalization with greater alacrity and fewer restrictions than other countries have. Displaced workers here get relatively little in the way of protection and support.

And we’ve enabled capital to take a larger share of the economic gains. “Economists long thought that the ratio of wages to profits was an immutable constant, about two to one,” Case and Deaton point out. But since 1970, they find, it has declined significantly.

A more unexpected culprit identified by Case and Deaton is our complicated and costly health-care system.

The focus of Case and Deaton’s indictment is on the fact that America’s health-care system is peculiarly reliant on employer-provided insurance.

As they show, the premiums that employers pay amount to a perverse tax on hiring lower-skilled workers.

According to the Kaiser Family Foundation, in 2019 the average family policy cost twenty-one thousand dollars, of which employers typically paid seventy per cent.

“For a well-paid employee earning a salary of $150,000, the average family policy adds less than 10 percent to the cost of employing the worker,” Case and Deaton write. “For a low-wage worker on half the median wage, it is 60 percent.”

between 1970 and 2016, the earnings that laborers received fell twenty-one per cent. But their total compensation, taken to include the cost of their benefits (in particular, health care), rose sixty-eight per cent. Increases in health-care costs have devoured take-home pay for those below the median income.

this makes American health care itself a prime cause of our rising death rates.

we must change the way we pay for health care. Instead of preserving a system that discourages employers from hiring, retaining, and developing workers without bachelor’s degrees, we need to make health-care payments proportional to wages—as with tax-based systems like Medicare.

So far, the American approach to the rise in white working-class mortality has been to pour resources into addiction-treatment centers and suicide-prevention programs. Yet the rates of suicide and addiction remain sky-high. It’s as if we’re using pressure dressings on a bullet wound to the chest instead of getting at the source of the bleeding.

Case and Deaton want us to recognize that the more widespread response is a sense of hopelessness and helplessness. And here culture does play a role.

When it comes to people whose lives aren’t going well, American culture is a harsh judge: if you can’t find enough work, if your wages are too low, if you can’t be counted on to support a family, if you don’t have a promising future, then there must be something wrong with you

We Americans are reluctant to acknowledge that our economy serves the educated classes and penalizes the rest. But that’s exactly the situation, and “Deaths of Despair” shows how the immiseration of the less educated has resulted in the loss of hundreds of thousands of lives, even as the economy has thrived and the stock market has soared.

capitalism, having failed America’s less educated workers for decades, must change, as it has in the past. “There have been previous periods when capitalism failed most people, as the Industrial Revolution got under way at the beginning of the nineteenth century, and again after the Great Depression,” they write. “But the beast was tamed, not slain.”

Today, the battles are over an employer-based system for financing health care, corporate governance that puts shareholders’ interests ahead of workers’, tax plans that benefit capital holders over wage earners.

We are better at addressing fast-moving crises than slow-building ones. It wouldn’t be surprising, then, if we simply absorbed current conditions as the new normal.

American adults say they're drinking 14% more often during the coronavirus pandemic, according to a report in the journal JAMA Network Open. The increase in frequency of drinking for women was more pronounced, up 17% compared to last year.

Stores sold 54% more alcohol in late March compared the year prior, according to Nielsen.

"Alcohol compromises the body's immune system and increases the risk of adverse health outcomes," the WHO stated. "Therefore, people should minimize their alcohol consumption at any time, and particularly during the COVID-19 pandemic."

Two weeks after the killing of George Floyd, crowds inspired by Black Lives Matter protests in America marched to the statue of a slave trader named Edward Colston in the center of the English port city of Bristol. They wrapped ropes around the neck of the bronze effigy, pulled it to the pavement, rolled and dragged it through the streets, and then pushed it into the harbor.

Colston was Bristol's biggest philanthropist. His name adorned the city's concert hall, an office tower, as well as schools and streets. The plaque beneath the statue, which was erected in 1895, called him "one of the most virtuous and wise sons" of Bristol. What it failed to mention – and what angered the protesters – is that Colston made much of his fortune with the Royal African Company, which shipped tens of thousands of enslaved people across the Atlantic to work on plantations during Colston's tenure. An estimated one in five people died during the crossing.

A reader poll in the Bristol Post found about 60% of respondents backed protesters pulling down the statue, while around 40% thought it shouldn't have been toppled.

Bristol Mayor Marvin Rees, who has lived in Washington and Philadelphia, has had his own unnerving experiences with American police. He said he was flabbergasted when a cop in the U.S. once threatened to arrest him for jaywalking

After that, Rees says, he changed the way he dealt with police in the U.S. When asking for directions in New York City one day, he made sure to speak as he took care to approach an officer from the front.

Some white residents were doubly angry. They were still mad that the Colston statue had been pulled down illegally and that another statue had gone up without government authorization or public input.

"I think it's beautiful," Aidid said. "It stands for so much that Bristol has needed. When I walked past here today, I finally felt like it's not a direct insult to my humanity, to my life."

The next morning, government workers unbolted the statue and took it down, leaving the pedestal empty, once again.

In July, a London sculptor had his own statue hoisted up on the pedestal. It depicted a Black female protester holding her fist up in a Black power salute.

Washington and Colorado have set out to invent a whole industry from scratch and, in theory, to avoid the shortcomings of other markets in legal vices — tobacco, alcohol, gambling — that lurched into being without much forethought, and have supplied, along with much pleasure, much misery.

the complexities of turning an illicit herb into a regulated, safe, consumer-friendly business. Among the things on the to-do list: certifying labs to test for potency and contamination. (Pot can contain, among other nasty things, pesticides, molds and salmonella.) Devising rules on labeling, so users know what they’re getting. Hiring inspectors, to make sure the sellers comply. Establishing limits on advertising, because you don’t want allowing to become promoting.

One practical challenge facing the legalization pioneers is how to keep the marijuana market from being swallowed by a few big profiteers — the pot equivalent of Big Tobacco, or even the actual tobacco industry — a powerful oligopoly with every incentive to turn us into a nation of stoners.

the likely best model is something resembling the wine industry — a fragmented market, many producers, none dominant. This could be done by limiting the size of licensed purveyors. It would help, too, to let individuals grow a few plants at home

there is evidence that pot dealers, like purveyors of alcohol, get the bulk of their profit from those who use the product to excess. “When you get a for-profit producer or distributor industry going, their incentives are to increase sales,

states can take a cut of what will be, according to estimates, a $35 billion to $45 billion industry and earmark some of these new tax revenues for good causes. It’s the same tactic used to win public approval of lotteries — and with the same danger: that some worthy government function comes to depend on creating more addicts. And how do you divvy up the revenues? How much goes to offset health consequences? How much goes to enforcement? How do you calibrate taxes so the price of pot is high enough to discourage excessive use, but not so high that a cheap black market arises?

no one has come up with a pot version of the breathalyzer to determine quickly whether a driver is impaired.

California demonstrates a different kind of unintended consequences. The state’s medical marijuana law is such a free-for-all that in Los Angeles there are now said to be more pot dispensaries than Starbucks outlets.

In the past, drug abuse deaths were more common in middle-aged blacks than in middle-aged whites. Now they are more common in whites. The same pattern holds for deaths from alcoholic cirrhosis of the liver. The suicide rate for whites was four times that of blacks.

Could people be taking drugs and killing themselves as a response to the economic slowdown? Maybe. But, if so, Dr. Deaton and Dr. Case said, then why aren’t people in other countries responding the same way?

Recent reports of illness and disability might provide some clues. More middle-aged whites report that their general health is not good; and, more report chronic pain

older people are actually doing better — less addiction, disability rates falling.

how much of what they are seeing might be attributed to the explosive increase in prescription narcotics.

the people who report pain in middle age are the people who report difficulty in socializing, shopping, sitting for three hours, walking for two blocks.

Dr. Deaton envisions poorly educated middle-aged white Americans who feel socially isolated are out of work, suffering from chronic pain and turning to narcotics or alcohol for relief, or taking their own lives. Starting in the 1990s, he said, there was a huge emphasis on controlling pain, with pain charts going up in every doctor’s office and a concomitant increase in prescription narcotics.

Dr. Deaton noted that blacks and Hispanics may have been protected to an extent. Some pharmacies in neighborhoods where blacks and Hispanics live do not even stock those drugs, and doctors have been less likely to prescribe them for these groups.

So we're all the same after all.Under the right conditions - no control over your life, low pay, no job, little in the way of job prospects, no healthcare, little education, families break down when the man can't be the breadwinner, and then along comes poor health, substance abuse, depression, despair - all those ills that were blamed on black people's supposed lack of morals.Now that white kids are dying of heroin we need to change the laws, end the war on drugs, legalize pot, and change how we talk about what were formerly known as 'junkies'.White men are in despair as a result of economic problems, white kids are doing hard drugs in numbers that everyone's starting to notice, and AIDS is plaguing white communities, and now we need to care. So we're all human?

Because white people are depressed over their diminution in society by the policies of the Federal Government, the education system, racial animosity and biased media outlets that are rampant through the society. These doctors are clueless liberals that will try to find any reason to blame, other than the truth. It's not the drugs, it's what is causing them to want the drugs. White males have been denigrated for the past 50 years. The effects have to be building up and weighing on them.

John is a trusted commenter Boston 6 hours ago No, their diminution in society came from globalized capitalism. A lot of these working class white people were Reagan voters. I'm the same age as them, I saw it happen. They thought they were getting "Morning in America" but instead they got morning for Walmart and sunset for the working class. That's enough to make anybody turn to pills and booze.

DougH Lithonia, GA 7 hours ago To some extent, it's of their own making. High school educated whites tend to vote Republican. Over the last 30 years, Republicans have sold them a bill of goods. They abandoned unions, opposed increases in the minimum wage, and opposed regulation, including safety, wage fairness, etc.So now they are paid less. They have no way of changing that (short of high education) and the big beneficiaries of lower taxes have been the businesses and owners that for which they work. Did those owners bless the workers with the fruits of their benefits? Of course not. They kept the reduced expenses as profit, increased CEO wages, and kept cutting benefits before finally shipping their jobs overseas.Perhaps, if they stopped voting against their own interests, they would fair better.

dw659 Chicago 8 hours ago Why? Simple. Because to males, a 'loss of control' is an unacceptable change. 200 years of being 'in control' just because you are born white and male is ending. Many men can't face a world where they are of 'lower status' than women, blacks, Hispanics, Asians, etc. They don't want to live in that world.....

dale south africa 5 hours ago Its true ! I am a conservative man and i live i johannesburg. I cant imagine what it must be like respecting all things under the suns . From females, gays blacks etc Children of slaves dictating societies . oprah picking presidents. the bully is not allowed to be at his natural best and strongest with this new liberal socialist agenda , everyone equal attitude. im not white but if I was who would want that

Linda is a trusted commenter Oklahoma 54 minutes ago I know so many white men in this small town I live in who never had anything to do with their children. They didn't care about anybody through their productive years and now they're surprised that nobody cares about them.

AC USA 5 hours ago Could it be because these guys have no close family ties? They are the ages that their parents are probably in nursing homes or already passed away. These blue collar, high school educated guys fathered unwanted children with women to whom they may or may hot have been married and divorced. But now at middle age comes time for them to feel wanted and valued by their progeny (dad, dispense some life wisdom to us, help us with college, getting married, a down payment on a house, take your grand-kids fishing, etc.), but they dumped their kids by not wanting to pay child support, or having a bad attitude and not helping their kids at all past age 18. So they kids moved on without dad's love and "support" (monetary or emotionally). The "all for myself mentality" they have espoused has finally come home to roost. There is no going back in time, they are all alone, have no purpose as jobs are hard to come by at that age - even more-so blue collar ones - so they drink/take pills to dull the pain, then overdo it.

suzinne bronx 5 hours ago Think white families more often DO NOT stick together. At middle age and white, have ZERO contact with any family members. By the time I was 16 most had died, moved away or become estranged. Know this amps up my chances for suicide, and that's probably going to pan out too. Flag

Paul '52 is a trusted commenter NYC 2 hours ago The is the first cohort to experience the phenomenon that if you do the same job as your parents you won't do as well or better. These are the auto workers, the airport baggage handlers, the truck drivers. They are, in fact, more productive than their fathers, but they're not paid as well and they don't have pensions. And the disappointment is taking its toll.

Deaton and the economist Anne Case, who is also his wife, coined the term “deaths of despair” to describe the surge of mortality from alcohol, drugs and suicide.

“The meaningfulness of the working-class life seems to have evaporated,” Angus Deaton, the Nobel Prize-winning economist, told us. “The economy just seems to have stopped delivering for these people.”

Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of “deaths of despair.”

“I’m a capitalist, and even I think capitalism is broken,” says Ray Dalio, the founder of Bridgewater, the world’s largest hedge fund.

The suffering was invisible to affluent Americans, but the consequences are now evident to all: The survivors mostly voted for Trump, some in hopes that he would rescue them

The stock market is near record highs, but working-class Americans (often defined as those without college degrees) continue to struggle. If you’re only a high school graduate, or worse, a dropout, work no longer pays.

If the federal minimum wage in 1968 had kept up with inflation and productivity, it would now be $22 an hour. Instead, it’s $7.25.

we would return to the Kristof family farm in Yamhill and see a humanitarian crisis unfolding in a community we loved — and a similar unraveling was happening in towns across the country. This was not one town’s problem, but a crisis in the American system.

Even in this presidential campaign, the unraveling of working-class communities receives little attention. There is talk about the middle class, but very little about the working class

One consequence is that the bottom end of America’s labor force is not very productive, in ways that reduce our country’s competitiveness

we discuss college access but not the one in seven children who don’t graduate from high school.

“We have to stop being obsessed over impeachment and start actually digging in and solving the problems that got Donald Trump elected in the first place,”

We have to treat America’s cancer.

the situation is worsening, because families have imploded under the pressure of drug and alcohol abuse, and children are growing up in desperate circumstances

In the 1970s and ’80s it was common to hear derogatory suggestions that the forces ripping apart African-American communities were rooted in “black culture.” The idea was that “deadbeat dads,” self-destructive drug abuse and family breakdown were the fundamental causes, and that all people needed to do was show “personal responsibility.

A Harvard sociologist, William Julius Wilson, countered that the true underlying problem was lost jobs, and he turned out to be right. When good jobs left white towns like Yamhill a couple of decades later because of globalization and automation, the same pathologies unfolded there.

Men in particular felt the loss not only of income but also of dignity that accompanied a good job. Lonely and troubled, they self-medicated with alcohol or drugs, and they accumulated criminal records that left them less employable and less marriageable.

Family structure collapsed.

The problems are also rooted in disastrous policy choices over 50 years

The United States wrested power from labor and gave it to business, and it suppressed wages and cut taxes rather than invest in human capital, as our peer countries did.

The kids on the No. 6 bus rode into a cataclysm as working-class communities disintegrated across America because of lost jobs, broken families, gloom — and failed policies.

Americans also bought into a misconceived “personal responsibility” narrative that blamed people for being poor.

It’s true, of course, that personal responsibility matters: People we spoke to often acknowledged engaging in self-destructive behaviors.

But when you can predict wretched outcomes based on the ZIP code where a child is born, the problem is not bad choices the infant is making.

If we’re going to obsess about personal responsibility, let’s also have a conversation about social responsibility.

Why did deaths of despair claim Farlan, Zealan, Nathan, Rogena and so many others?

First, well-paying jobs disappeared

Second, there was an explosion of drugs

Third, the war on drugs sent fathers and mothers to jail, shattering families.

Both political parties embraced mass incarceration and the war on drugs, which was particularly devastating for black Americans, and ignored an education system that often consigned the poor — especially children of color — to failing schools

Since 1988, American schools have become increasingly segregated by race, and kids in poor districts perform on average four grade levels behind those in rich districts.

Yet it’s not hopeless. America is polarized with ferocious arguments about social issues, but we should be able to agree on what doesn’t work: neglect and underinvestment in children. Here’s what does work.

ob training and retraining give people dignity as well as an economic lifeline. Such jobs programs are common in other countries.

For instance, autoworkers were laid off during the 2008-9 economic crisis both in Detroit and across the Canadian border in nearby Windsor, Ontario. As the scholar Victor Tan Chen has showed, the two countries responded differently

The United States focused on money, providing extended unemployment benefits. Canada emphasized job retraining, rapidly steering workers into new jobs in fields like health care, and Canadian workers also did not have to worry about losing health insurance.

The focus on job placement meant that Canadian workers were ushered more quickly back into workaday society and thus today seem less entangled in drugs and family breakdown.

Another successful strategy is investing not just in prisons but also in human capital to keep people out of prisons.

We attended a thrilling graduation in Tulsa, Okla., for 17 women completing an impressive local drug treatment program called Women in Recovery.

The graduates had an average of 15 years of addiction each, and all were on probation after committing crimes. Yet they had quit drugs and started jobs

Women in Recovery has a recidivism rate after three years of only 4 percent, and consequently has saved Oklahoma $70 million in prison spending,

Bravo for philanthropy, but the United States would never build interstate highways through volunteers and donations, and we can’t build a national preschool program or a national drug recovery program with private money.

For individuals trying to break an addiction, a first step is to face up to the problem — and that’s what America should do as well

The survey also looked at behavior among adults 19 to 30 years old. For this group, use of marijuana in 2022 was significantly greater, at 44 percent, up from 28 percent in 2012.

But their self-reported binge drinking had fallen to 30.5 percent, down from 35.2 percent a decade earlier.

“Drug use trends evolve over decades and across development, from adolescent to adulthood,”

, a recent study found that alcohol-related deaths continued to increase among people 65 and older, with deaths among women in this age group rising at a faster rate than among men

more significant, we are not very good at predicting who is likely to be dangerous in the future.

“Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

“Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the s

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group

But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

Let’s push for home visitation programs that encourage parents to speak to children and read to them; many low-income homes don’t have a single kid’s book. We also need initiatives to reduce exposure to lead and other toxins. Finally, how about screenings for problems like hearing and visual impairment — all followed by a good prekindergarten.

all young children should have a primary care physician who screens them for eight barriers to learning: vision problems, hearing deficits, undertreated asthma, anemia, dental pain, hunger, lead exposure and behavioral problems.

Let’s broaden the conversation about opportunity, to build not just safety nets for those who stumble but also to help all American kids achieve lift-off.