Donald Trump takes the stage last night at Hy-Vee Hall in Des Moines for the third stop of his "thank you tour." (Photo by Jabin Botsford/The Washington Post)

THE BIG IDEA:  A  new study  from Penn State University suggests a relationship between the opioid epidemic and support for Donald Trump.

The president-elect performed better than Mitt Romney in many places, but he fared best compared to the Republican nominee four years ago in the counties with the highest drug, alcohol and suicide mortality rates.

Shannon M. Monnat, an assistant professor of rural sociology and demography, created a data set with numbers from 3,106 counties. She found this trend to be true nationally but especially so in two regions: In the industrial Midwest, which is how academics refer to the Rust Belt, Trump ran ahead of Romney by an average of 16.7 percent in the quarter of counties with the highest mortality, compared to 8.1 percent in the lowest quartile. In New England,  Trump did worse than Romney by an average of 3.1 percent in the lowest mortality counties but better than the former Massachusetts governor by an average of 10 percent in the highest mortality counties .

Drug syringe and cooked heroin (Studio shot)

-- Overdoses, alcoholism and suicide are known by experts collectively as “the diseases of despair.”  People often (but not always) turn to pills, syringes, the bottle and other self-destructive behaviors when they lose hope, when they don’t have the means to live comfortably or when they don’t get the dignity that comes from work.

It is intuitive that the least economically distressed counties also tend to have the lowest mortality rates, and vice versa. In this way,  alcoholism, overdoses and suicide are symptoms of the deeper social decay that was caused by deindustrialization.  This decay led to the fears and anxieties which Trump so effectively capitalized on.

Correlation is not causation, of course. But while the places with the biggest mortality problems are usually the places that have been hit hardest economically, Monnat points out in a footnote:  “Even when using statistical models that include 14 demographic, economic, social, and health care factors, the drug, alcohol and suicide mortality rate remains a significant and positive predictor of Trump overperformance nationally.”

Trump speaks last night. (Jabin Botsford/The Washington Post)

--   I saw this firsthand on the campaign trail all year, in countless interviews with folks who were down in the dumps and struggling to get ahead (or, quite frankly, just get by).  Many supported Barack Obama eight years ago because they were desperate for hope and change. They’re still desperate, and now they’re hopeful Trump can bring the change they’re looking for.

-- This really ought to be one of the biggest storylines that everyone takes away from 2016.  One big reason that elites along the Acela Corridor were so caught off guard by Trump’s victory is that they’re so insulated from the stomach-churning scourge of addiction and cycle of brokenness. Washington has never been richer or further removed from the pain of everyday Americans, as Hillary Clinton called them in the video announcing her candidacy. Trump’s solutions may not actually help the “the forgotten man” that he talked so much about on the stump. In fact, his administration may very well push policies that ultimately only add to their pain. The tax cuts he wants will disproportionately benefit the most affluent people in the bluest states, for example. But the system has failed them. Trump promised to blow it up; Clinton represented more of the same.

OxyContin pills at a pharmacy. (Toby Talbot/AP)

-- Three glaring illustrations from the Penn State report:

Scioto County, Ohio : This is the setting for Sam Quinones’s book “Dreamland,” a blue-collar place with a once-thriving manufacturing base that became the pill-mill capital of America after the nation’s first large “pain clinic” opened.  The   drug, alcohol and suicide mortality rate more than doubled from 32.9 (per 100,000 people) in 1999 to 74.8 in 2014, Monnat notes, and Trump received 33 percent more of the county’s vote than Romney .

Mingo County, West Virginia :  The drug, alcohol and suicide mortality rate spiked from 53.6 in 1999 to 161.1 in 2014, making it the seventh highest in the U.S. Trump’s share of the vote was 19 percent higher than Romney’s.  “Mining and related industries employed nearly 40 percent of the county’s workers in the 1980s and accounted for two-thirds of the county’s earnings. Since then, mining has dropped to 20 percent of employment and a third of wages, and household income has declined by 10 percent. Mingo County now has an adult poverty rate of 23 percent and a disability rate of 32 percent,” per Monnat.

Coos County, New Hampshire ,  which   has the highest drug, alcohol and suicide mortality rate in New England, swung from Obama to Trump:  “The share of jobs in manufacturing there declined from 38 percent to 7 percent, and payroll wages from manufacturing dropped from 49 percent to 9 percent since the mid-1980s,” Monnat explains.

-- Let this sink in: A federal government report released yesterday shows that life expectancy is now  declining  in America.  Besides war, plague and famine, there have been few moments in all of human history when that has happened. This is more troubling because it is  not  happening in other western countries. The National Center for Health Statistics found that death rates rose for eight of the top 10 leading causes of death in 2015. Death rates rose for white men, white women and black men. This happened despite a drop in the death rate from cancer, thanks to fewer people smoking and better chemo. “The overall death rate rose 1.2 percent in 2015, its first uptick since 1999,”  Lenny Bernstein reports . “The number of unintentional injuries — which include overdoses from drugs, alcohol and other chemicals, as well as motor vehicle crashes and other accidents — climbed to more than 146,000 in 2015 from slightly more than 136,000 in 2014. … Deaths from suicide, the 10th-leading cause of death in the United States, rose to 44,193 from 42,773 in 2014.”

-- The statistics are staggering. All told, over the past decade, around 400,000 Americans died from drug overdoses, another 400,000 committed suicide and about 250,000 died from alcohol-induced diseases.

Amanda Wendler, 31, is a recovering heroin addict whi lives at home with her mother and stepfather. She recently began taking a monthly shot of Naltrexone -- a drug that blocks the effect of opioids. She first became addicted to prescription drugs after a snowboarding accident when she was a teenager. (Bonnie Jo Mount/The Washington Post)

-- While these numbers are painful to see on paper, they are even more heart wrenching when you consider the individual stories behind them.  My Washington Post colleagues have produced some truly extraordinary reportage as part of a year-long series called “ Unnatural Causes : Sick and dying in small-town America,” which set out to explore  why  death rates are rising so much for  whites in midlife, especially women . Each of these pieces merits a second read in the wake of Trump’s victory:

• Eli Saslow told  the story of Anna Marrie Jones  in Tecumsah, Oklahoma, who died at 54 from cirrhosis of the liver brought on by heavy drinking.
• Anne Hull  wrote about Jessica Kilpatrick , a recovering addict in Walker County, Alabama, and her struggles to stay clean as she works a fast-food job.
• Eli returned in July with  the tale of Amanda Wendler  in Farmington Hills, Michigan, and her unending days of waiting for a key injection that could help curb her heroin cravings.
• A Kentucky undertaker and funeral-home owner  ruminated on lost members of their community  to Terrence McCoy.
• Kimberly Kindy and Dan Keating  shared the story of Karen Franklin , a 60-year-old in Bakersfield, California, who takes more than a dozen different prescription drugs.
• Amy Ellis Nutt examined the epidemic of suicide in La Plata County, Colorado, by studying the cases of  seven women who took their lives  near what’s known as the river of lost souls.
• Lenny Bernstein and Scott Higham  investigated the DEA , which caved to industry pressure and slowed enforcement while the opioid epidemic grew out of control. Five former agency supervisors went on the record to blow the whistle on how top agency officials delayed and blocked enforcement actions.
• Lenny and Scott, along with David Fallis, also looked at the role played by  13 companies that knew or should have known  that hundreds of millions of their pills were ending up on the black market.

DJT in DSM. (Jabin Botsford/The Washington Post)

-- Widening the aperture: For millions of others who are not trying to self-medicate away their blues, the American Dream continues to fade.  Working hard and playing by the rules in this country no longer ensures that you’ll get ahead. That social compact is broken. Downward mobility is too often the norm.

Consider this disquieting data point:  In another study published yesterday, economists and sociologists from Stanford, Harvard and the University of California identified the income of 30-year-olds starting in 1970, using tax records and census data, and compared it with the earnings of their parents when they were about the same age.  In 1970, 92 percent of American 30-year-olds earned more than their parents did at a similar age. In 2014, that number was just 51 percent.  “My parents thought that one thing about America is that their kids could do better than they were able to do,” Stanford economist Raj Chetty, who emigrated from India at age 9,  told the Wall Street Journal . “That was important in my parents’ decision to come here. … Wages have stagnated in the middle class. When you’re in that situation, it becomes very hard for children to do better than their parents.” ( Check out the Equality of Opportunity web site  for some charts visualizing this.)

-- It’s been tough to be a blue-collar worker for a long time now.  Our Fact Checker calls out the White House this morning for repeatedly exaggerating the number of manufacturing jobs that have been created during the past eight years.  Press Secretary Josh Earnest claims that, during Obama’s presidency, the number of manufacturing jobs increased by more than 800,000. But actually, the number of jobs has fallen by 300,000.  Glenn Kessler explains the cherry picking  that's going on: “Earnest is counting from when the low point in U.S. manufacturing was reached in February 2010. … That was about 1.1 million fewer than when Obama took office — and nearly 2.3 million fewer than when the Great Recession officially began in December 2007. So 807,000 jobs represents the number of jobs created since the low point in Obama’s term, not ‘while he was in office.’”