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The disease of addiction lingers around the edges of my life with a sometimes subtle and, at other times, nearly all-consuming presence.

My friend’s sister has reeled through cycles of opioid treatment and relapse for more than a decade, costing her parents endless nights of worry that have replaced their golden years of retirement with a constant stream of costs: financial, emotional, existential.

A neighbor with addiction ransacked our house one evening while our family was out, rifling through cabinets and overturning mattresses and couch cushions, as if cash would be found there.

A friend in my graduating class was killed by a drunk driver. I remember her beautiful smile and exuberant spirit. She didn’t survive past early adulthood.

At family reunions, I worry about who among my relatives may be struggling.

With more than 30 million Americans abusing drugs, and 82 million adults who are binge and heavy drinkers, addiction is no longer harming someone else’s child or spouse, colleague or neighbor. It’s on the home front and demands our closest attention.

In the field of public health, discovering root causes is considered the holy grail of ending a mortal crisis. As new regulations and health system improvements are vigorously curtailing the flow of prescription painkillers, one super highway that led thousands into opioid addiction is being shut down. But cocaine, heroin, meth, fentanyl and new illicit drugs are readily available.

Last fall, researchers from the University of Pittsburgh made headlines with their release of a 38-year analysis of all drug-related deaths in the United States. The sobering results were captured in a simple graph that features a continuously upward death line, spanning from 1979 through 2016. In documenting the colossal scale of the epidemic, Dr. Hawre Jawal and his colleagues offered a concise conclusion: until we understand the root causes that are driving the aggressive escalation of drug overdose deaths in America, one drug may continue to top the next in stealing the lives of our loved ones. Many fear this crisis could get worse.

The findings demand a hard look at other 40-year trends that have paralleled the nation’s exponential growth of drug overdoses.

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Here’s one: Over the past four decades, new technologies have created a hyper-connected world. Information about every vice and cure-all is now at our finger tips. It’s been a boon for drug traffickers. But how do we better leverage modern communications to improve public health?

Here’s another alarming trend. The CDC reports a 25 percent increase in suicides since 1999, making it the tenth leading cause of death in America. While the causes are multifaceted, risk factors include weak social supports, substance abuse, mental illness, financial instability and access to a firearm.

Perhaps at the heart of the addiction mess, the Pew Research Center documents how real wages and the purchasing power of workers, relative to inflation, have remained stagnant since the 1970s. In today’s economy, middle- and low-wage workers have fallen far behind top wage earners. With addiction often recognized as a disease of despair, how regular citizens are paid, respected and engaged throughout their working lives matters a great deal.

In an era of sluggish wages, the increasing vigor of our social safety net offers a lifeline to meet basic needs like shelter and food. It has prevented poverty from deepening. Thank goodness. But emergency services are an imperfect fix to deeper issues. And over time, reliance on charity can erode personal dignity and self-determination. Comprehensive economic solutions that move low-income individuals into careers that pay a decent living wage will ensure the kind of inclusive, equitable society that benefits everyone.

The embedded relationship between substance abuse, mental illness and imprisonment is a particularly expensive and vicious cycle. As a result of growing public awareness, mass incarceration rates are declining for the first time in 20 years but we still have a long way to go. As law enforcement officers can affirm, we will never “arrest our way out of” addiction-driven crimes. Mobilizing people-first employment solutions and ready access to behavioral health services will help keep our families and communities from unraveling in the first place.

There have also been some brighter trends, like rising high school and college graduation rates and life-saving technological breakthroughs. Plus, the science on ways to prevent addiction is robust. For example, youth who are surrounded by caring, supportive adults and engaged in positive activities throughout childhood are less likely to experience addiction when they are older. Two-generation strategies that simultaneously help parents and children thrive economically and socially are a linchpin to building and sustaining vibrant communities.

Recently, I sat on a metal gym bleacher next to a church pastor, anticipating our daughters’ basketball tip-off. Unusual for his morning off, he was dressed in a black clergy shirt and white collar and had just returned from the funeral of a friend’s 27-year-old son. Yet another overdose.

On that crisp winter morning, it was a stark reminder that the devastation caused by addiction will be dogging us through 2019, as it has for many years now, until we get to the root it.

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Becca Raley is the Executive Director of the Partnership for Better Health and co-chair of the Cumberland-Perry Task Force on Opioid Prescribing.

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