Appalachians Struggle With Suicide, Overdoses, And Other Diseases Of Despair

In May of 2023, the Biden administration ended the Covid-19 national and public health emergencies. After years of coping with Covid-19, many people are eager to “return to normal.” However, the pandemic left long-term scars on Appalachian communities. A new report from the Appalachian Regional Commission indicates that for the countless rural people who lost loved ones to diseases of despair, there can never be a “return to normal.”

Living deep in the Appalachian mountains can be lonely. Some residents have to travel for miles to find their nearest neighbor; they might need to venture even further from home to find a doctor or psychiatrist. In rural Appalachia, there is a shortage of counselors and mental health professionals. Socioeconomic and healthcare inequities can lead many Appalachians to diseases of despair: suicidal ideation or attempts, drug overdoses, kidney or liver damage from alcohol dependency, etc.

In March of 2023, the Appalachian Regional Commission released a report about the rising rates of diseases of despair in rural Appalachia. During 2019-2020, there was a spike in regional deaths caused by diseases of despair, explain researchers from East Tennessee State University’s Center for Rural Health Research and NORC at the University of Chicago.

This increase concerns rural health advocates since diseases of despair were on the decline in the years before the pandemic. “Between 2017 and 2018, both the Appalachian Region and the non-Appalachian U.S. saw the first decline in the all-cause mortality rate since 2011 to 2012,” says the Appalachian Regional Commission’s report. Rural Appalachian healthcare centers reported a promising decrease in fatal drug overdoses in 2017-2018.

During the pandemic, communities across the country struggled with substance abuse and suicide. Social isolation, stress, and decreased access to mental health treatment may have pushed some people to self-medicate with drugs or alcohol. However, Appalachians have been disproportionately harmed by these diseases of despair.

East Tennessee State University paints a stark image of this health crisis: “Between 2019 and 2020, the diseases of despair mortality rate increased by 24% in the Appalachian region and 20% in the non-Appalachian United States. In 2020, the rate was 37% higher in the Appalachian region than the rest of the U.S.” In rural Central Appalachian communities, this mortality rate increase was as high as 41% between 2019-2020.

When compared to the rest of the country, Appalachians are significantly more likely to struggle with higher rates of opioid overdoses, suicide, and liver disease.

With the end of the national pandemic emergency, Appalachians may also feel additional pressures in the wake of these diseases of despair. Many Appalachians struggle to find affordable, reliable healthcare. According to the US Department of Labor, you might have to spend more money to cover the costs of your own PPE, Covid-19 vaccines, or Covid-19 tests. These extra costs may leave already-struggling Appalachians feeling adrift.

Despite the dark reality of Appalachia’s diseases of despair, local advocates create beacons of hope. Lawson Koeppel helps run a nonprofit called the Virginia Harm Reduction Coalition in Roanoke, Virginia. Koeppel and his team have provided thousands of doses of naloxone (a life-saving treatment that can reverse symptoms of a drug overdose) to people in need. “I know what it’s like to wake up in the morning, not want to get high and still end up getting high. I know what it’s like to be stigmatized for drug use. I know what it’s like to be ostracized,” Koeppel states in an article written by Noah Smith for Direct Relief. Koeppel continues, “If you offer somebody a way to improve their health… It turns out, they take it, especially if it’s a low barrier.”

The Appalachian Regional Commissioner’s recent report indicates that years into the pandemic, Appalachians need more support to cope with substance abuse, grief, and mental health. If you are struggling, you might consider contacting these resources: 988 Suicide & Crisis Lifeline, Appalachian Substance Abuse Coalition, the Appalachian Mind Health Initiative, or a local health department or crisis center.