not affected as much by diseases of despair. instead, this affects people who have little reason to believe that the future will be better. as a result, this problem is distributed unevenly, for example by affecting working-class people in the united states more than working-class people in europe, even when the european economy was weaker. it also affects white people more than racially disadvantaged groups, possibly because working-class white people are more likely to believe that they are not doing better than their parents did, while non-white people in similar economic situations are more likely to believe that they are better off than their parents. effects starting in 1998, a rise in deaths of despair has resulted in an unexpected increase in the number of middle-aged white americans dying (the age-specific mortality rate). by 2014, the increasing number of deaths of despair had resulted in a drop in overall life expectancy. anne case and angus deaton propose that the increase in mid-life mortality is the result of cumulative disadvantages that have occurred over decades, and that solving it will require patience and perseverance for many years, rather than a quick fix that produces immediate results. the number of deaths of despair in the united states has been estimated at 150,000 per year in 2017. even though the main cause of diseases of despair may not be purely economical, the consequences of this phenomenon are, in terms of money, expensive. according to a report from 2016, alcohol misuse, misuse of illegal drugs and non-prescribed medications, treatment of associated disorders and lost productivity cost the u.s. more than $400 billion every year. about 40 percent of those costs were paid by government, which implies a huge cost of alcohol and drug misuse to taxpayers. another study claims even higher costs of around $1.5 trillion in economic loss, loss of productivity and societal harm. terminology the phrase diseases of despair has been criticized for medicalizing problems that are primarily social and economic, and for underplaying the role of specific drugs, such as oxycontin, in increasing deaths. while the disease model of addiction has a strong body of empirical support, there is weak evidence for biological markers of suicidal thoughts and behaviors and no evidence that suicide fits a disease model. the use of the phrase diseases of despair to describe suicide in medical literature is more reflective of the medical model than suicidal thoughts and behaviors.