Most people blame the opioid epidemic for the sharp rise in overdoses, suicides, and alcohol-related disease across the United States.
New research suggests the story began earlier.
A large analysis from Ohio State University shows that mortality linked to addiction, self-harm, and liver disease started rising years before prescription opioids became widespread, tracking closely with a major decline in religious participation during the late 20th century.
The data suggest opioids accelerated an existing problem rather than creating it.
The Trend Began Years Before Prescription Opioids
Public debate often frames the late 1990s as the starting point of America’s modern mortality crisis.
State-level data tell a different story.
Between 1985 and 2000, deaths from overdoses, suicide, and alcohol-related liver disease increased steadily in states that experienced the sharpest drops in church attendance. This shift occurred well before OxyContin entered the market.
The timing matters. It shows that social changes preceded pharmaceutical ones.
One Group Faced the Steepest Risk
The rise in mortality did not spread evenly across the population.
The strongest pattern appeared among:
Middle-aged adults
White Americans
People without a four-year college degree
This same group experienced the most pronounced decline in regular church attendance during the same period.
The pattern held across men and women and appeared in both rural and urban regions.
Why Religious Participation May Have Supported Health
The findings do not suggest that belief alone protects health.
They point instead to participation and belonging.
Regular involvement in religious communities historically offered:
Stable social networks
Shared identity and purpose
Emotional support during hardship
Structure and routine
As attendance declined, many people lost access to one of the few institutions that consistently provided meaning and connection outside work or family.
Importantly, belief levels declined far less than participation. The loss centered on community engagement, not faith itself.
Policy Changes Reinforced the Pattern
Researchers strengthened their analysis by examining what happened after states repealed Sunday business restrictions.
When states removed these laws:
Church attendance dropped sharply
Mortality from overdose, suicide, and alcohol-related disease rose in later years
States that kept the restrictions did not show the same shifts at the same scale.
This sequence supports a causal relationship rather than coincidence.
Other Social Activities Did Not Replace the Loss
Researchers examined whether people replaced religious participation with other forms of social involvement.
They did not.
Civic groups, clubs, and other organizations failed to expand enough to offset the decline. Digital interaction later increased, but it did not provide the same protective structure.
Religious institutions offered a unique combination of identity, accountability, and in-person connection that proved difficult to replace.
Opioids Accelerated an Already Vulnerable Environment
When powerful prescription opioids entered communities in the mid-1990s, mortality rates climbed sharply.
Communities already fractured by social disconnection absorbed the damage more quickly and more deeply.
Drugs worsened the crisis. They did not start it.
What This Research Ultimately Shows
This study reframes one of the most painful public-health trends in modern America.
Social erosion matters. Community loss matters. Meaning and belonging shape health outcomes long before medicine intervenes.
When institutions that anchor people disappear, health often follows.
Medical Disclaimer
This article provides information for educational purposes only. It does not offer medical, psychological, or public-health advice. Individuals facing substance-use challenges, mental-health distress, or suicidal thoughts should seek immediate professional help.
