Middle-aged white Americans without college degrees started dying at higher rates in the early 1990s, years before the opioid epidemic took hold. The culprit wasn’t a pharmaceutical product or economic shock, but something harder to quantify: they stopped going to church.
A new study from economists at Ohio State University, Wellesley College, and the University of Notre Dame reveals that states with the steepest declines in religious participation between 1985 and 2000 experienced the sharpest subsequent increases in deaths from suicide, drug overdoses, and alcoholic liver disease. The pattern held across gender and geography, appearing in both rural counties and urban centers.
The findings, published in the Journal of the European Economic Association, challenge the conventional narrative that deaths of despair began with the introduction of OxyContin in the late 1990s. Instead, the data suggests the crisis was already building as religious participation collapsed, particularly among less educated white Americans.
When Sunday Shopping Replaced Sunday Service
The researchers identified a natural experiment in 1985, when Minnesota, South Carolina, and Texas repealed their blue laws, which had restricted Sunday commerce. These laws had effectively protected church attendance from competition with shopping and entertainment.
After repeal, weekly religious participation dropped 5 to 10 percentage points in those states. Mortality from despair-related causes began climbing at higher rates than in states that maintained their blue laws. The pattern was consistent enough to suggest causation, not just correlation.
“What we see in this study is the beginning of the story, before opioids became a major issue, and it shows rises in deaths of despair were already beginning to happen when the opioid crisis hit,” Tamar Oostrom, assistant professor of economics at Ohio State, explains.
The research team analyzed religiosity data from the General Social Survey alongside CDC mortality records. They found that mortality rates among middle-aged white Americans had been declining from the late 1970s into the early 1990s before leveling off and then spiking after 1996, when OxyContin entered the market. According to the authors, the drug accelerated a crisis already underway.
What Churches Provided That Nothing Else Could
The study ruled out a simple explanation: that churches merely served as social gathering spaces. Other forms of community participation remained stable during the same period. Americans didn’t stop socializing entirely, they just stopped attending religious services.
What made religion distinct? The data suggests it offered a shared framework for meaning and identity that helped people navigate life’s difficulties. Belief in God remained relatively constant throughout the study period. What disappeared was the practice, the weekly ritual of showing up and participating in organized religious life.
The findings raise an uncomfortable question about whether anything can fill that void. Evidence so far is discouraging. Community participation broadly shows no signs of rebounding, and the benefits of religious involvement for life satisfaction appear hard to replicate through secular alternatives. The rise of social media, rather than creating new forms of meaningful connection, may be making effective substitutes even less likely to emerge.
As American life shed one of its most durable sources of shared meaning and routine connection, the consequences for mortality may have been both profound and enduring. Whether that trend can be reversed remains an open question.
Journal of the European Economic Association: 10.1093/jeea/jvaf048
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