Trump outperformed the previous Republican candidate Mitt Romney the most in counties with the highest drug, alcohol and suicide mortality rates.
Monnat's recent policy brief, which provides a great deal more detail on this issue, is available here. She further explained in the NPR segment:
[I]n many of the counties where he did the best, economic distress has really been building, and social and family networks have been breaking down for several decades. And so I think these findings reflect larger economic and social problems that sort of go beyond drug and alcohol abuse and suicide. It's really about downward mobility and the dismantling of the American dream at a larger community level. And Trump really has sort of capitalized on and exploited the feelings of the people in these communities. In a lot of these places, good-paying jobs and the dignity that goes along with those good-paying jobs has been replaced by suffering and hopelessness and the belief that people in power don't really care about them or their communities.I especially appreciated some of Monnat's policy prescriptions, not least because they call attention to rural difference and are focused on the community as much as on the individual:
The policies really need to reflect the economic and health challenges of rural and small city America in the same ways that they've tried to target large urban cities. And that includes good-paying stable jobs, especially for those without a college degree. That needs to be the staple of any economic policy. What people really want is to be able to support themselves and their families.I have written about rural substance abuse here and here.