The term “deaths of despair” was coined in 2015 by Princeton economists Anne Case and Angus Deaton. The researchers were seeking to find what was causing the decline in U.S. life expectancies in the later part of the 20th century. They discovered the dramatic increase in death rates for middle-aged, white non-Hispanic men and women was coming from three causes: drug overdoses, suicide, and alcoholic liver disease. Deaths from these causes have increased between 56 percent and 387 percent and average 70,000 per year.

The researchers said, “The pillars that once helped give life meaning—a good job, a stable home life, a voice in the community—have all eroded.” Those pillars are certainly important, but another factor may have an even more detrimental effect.

Research suggests a potential cause of deaths of despair could be the decline in religious participation that began in the late 1980s. The researchers found “there is a strong negative relationship between religiosity and mortality due to deaths of despair.”

In 2010, country singer Jason Aldean released a song called “Church Pew or Bar Stool” in which he complains about how he’s stuck in a “church pew or bar stool kind of town.” He sings, “There’s only two means of salvation around here that seem to work / Whiskey or the Bible, a shot glass or revival.” That’s a crude dichotomy, but it appears to increasingly be the choice many Americans face. They’ll either find hope from a community of faith or the lonely despair that leads them to self-medicate with alcohol and drugs.