Last year Surgeon General, Dr. Vivek Murthy, told us he would help us face addiction and this year that’s exactly what he’s doing. In the first report ever to address addiction and treatment coming from the surgeon general, Dr. Murthy released some intense statistics, a collective view on stigma, and hope for the future of the current addiction epidemic we have going on here in the U.S. The hope is that this report will shape the government’s approach to treating substance use disorders and help the public become more educated about this disease. Though critics say little in this report is new, it’s jarring to see the numbers. There is no question that addiction is a major public health challenge that is taking an enormous toll on communities and families throughout our country. Let’s take a look at what the report says and how we can move forward with this information.

What are the alcohol and drug misuse problems we’re currently facing?

According to the report, 20.8 million people in America have a substance use disorder, but only one in ten is getting treatment. This number is comparable to the number of Americans with diabetes and 1.5 times the number of all cancers combined. Yet we don’t use the same amount of resources in addressing substance use disorder that we do in addressing diabetes or cancer. This must change. More people use prescription opioids than use tobacco. Almost everyone in the U.S. is affected by addiction, whether they have a substance use disorder, know someone who does, or have lost someone they love to this disease. Almost 8 percent of the population met diagnostic criteria for a substance use disorder for alcohol or illicit drugs. Additionally, another 1 percent met the diagnostic criteria for both an alcohol use disorder or a drug use disorder. This tells us that addiction is a spectrum and substance use disorders can range from mild to severe. We often associate addiction with hard drugs like heroin, cocaine, and other opioids, but alcohol misuse accounts for around 88,000 deaths in the U.S. annually, this includes 1 in 10 total deaths among working-age adults. A person who starts drinking at age 15 or younger has a 4 times greater risk of developing a substance use disorder with alcohol, compared to a person who starts drinking at age 21.

Another notable result of the surgeon general’s report was the undeniable impact addiction has on the U.S. economy and communities as a whole. The estimated yearly costs of substance misuse are $249 billion for alcohol misuse and $193 billion for illicit drug use. Communities are experiencing costs as a result of substance misuse such as alcohol- and drug-related crime and violence, abuse, and neglect of children, and the associated increased costs of health care. In 2014, driving under the influence represented close to one-third of all traffic-related fatalities in the U.S. DUI’s cost the U.S. more than $44 billion each year in prosecution, higher insurance rates, higher taxes, medical claims, and property damage.

The conclusion?

Substance use is dangerous for our health, our economy, and our lives. How can we prevent it?

How can substance use disorders be treated and prevented?

Now that we’re motivated to make changes and face addiction we need to explore the opportunities we have to treat and prevent substance use disorders. The surgeon general’s report spoke about effective prevention programs and policies that exist and if implemented, they can support encourage protective factors and reduce substance misuse. Programs such as Communities that Care and Communities Mobilizing for Change on Alcohol were mentioned as being successful in reduced drug and alcohol use among adolescents.  Other policy interventions like minimum legal drinking age laws, raising alcohol prices, and limiting to whom and where alcohol can be bought and sold have also been successful in reducing alcohol-related outcomes.

As I mentioned earlier, only one in ten people who need addiction treatment are getting it. Few other medical conditions are engulfed by as much shame and misunderstanding as substance use disorders. Our society has always use of alcohol and drugs and the presence of addiction has a moral failing or weakness and these issues have historically been treated mainly through the criminal justice system. The U.S. health care system has not given the same amount of attention to substance use disorders as it has other medical conditions. Treatment for addiction remains greatly separated from the rest of health care. According to the report, reasons for not seeking treatment included 30.6 percent of people did not have health care coverage or could not afford it, 16.4 percent believed it would have a negative effect on their job, and 8.3 percent believed it would cause neighbors/community to have a negative opinion of them. This proves that the treatment gap is due in large part to inaccessible treatment, fear of shame and discrimination, and lack of screening for substance use and misuse in general health care environments.

Research shows that treatment works and is cost-effective. In fact, every dollar spent on substance use disorder treatment saves $4 in health care costs and $7 in criminal justice costs.

What can we be hopeful about going forward?

Despite the numbers and the overwhelming feelings of darkness about the current addiction epidemic, we have much to be hopeful for. Society is now beginning to understand that substance use disorders change brain circuitry and affect abilities to make decisions, change your reward system, and respond to stress. Addiction is a chronic brain disease and treating it as such will help save lives and allow more people to get help. Support services are available and have become more popular such as mutual aid groups, recovery housing, and recovery coaches, to collaborate with and continue helping after addiction treatment. Health care reform is increasing access to prevention and treatment services to improve public health. The criminal justice system is engaged in efforts to place non-violent drug offenders in treatment instead of prison and improve the deliverance of evidence-based treatment for prisoners. Effective treatments are available and continue to change lives and promote recovery every day.

The groundwork has been laid out and the surgeon general has delivered a great deal of information for us to digest. The time is now for us to get to work in recognizing recovery and working towards it for others and for our society.

 

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Dr. Vivek Murthy. Facing Addiction in America The Surgeon General’s Report on Alcohol, Drugs, and Health. https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf. “Surgeon General Murthy Wants America To Face Up To Addiction.” NPR17 November 2016. http://www.npr.org/sections/health-shots/2016/11/17/502402409/surgeon-general-murthy-wants-america-to-face-up-to-addiction. “Fraction of Americans With Drug Addiction Receive Treatment, Surgeon General Says.” The New York Times. 17 November 2016. http://www.nytimes.com/2016/11/18/us/substance-abuse-surgeon-general-report.html.
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Facing addiction in America: the Surgeon General’s warning report
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