On November 17, 2016, the Surgeon General issued a report finding alcohol and drug misuse and severe substance use disorders, commonly called addiction, to be one of America’s most pressing public health concerns. Nearly 21 million Americans – more than the number of people who have all cancers combined – suffer from substance use disorders.
“Alcohol and drug addiction take an enormous toll on individuals, families, and communities,” said U.S. Surgeon General Dr. Vivek Murthy. “Most Americans know someone who has been touched by an alcohol or a drug use disorder. Yet 90 percent of people with a substance use disorder are not getting treatment. That has to change.”
Today’s report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, marks the first time a U.S. Surgeon General has dedicated a report to substance misuse and related disorders. The report addresses alcohol, illicit drugs, and prescription drug misuse, with chapters dedicated to neurobiology, prevention, treatment, recovery, health systems integration, and recommendations for the future. It provides an in-depth look at the science of substance use disorders and addiction, calls for a cultural shift in the way Americans talk about the issue, and recommends actions we can take to prevent and treat these conditions, and promote recovery.
One in seven people in the U.S. is expected to develop a substance use disorder at some point in their lives. Yet only one in ten receives treatment. Among other things, the report shows that substance use disorders typically develop over time following repeated episodes of misuse that result in changes to the brain circuitry.
The Report makes clear that substance misuse – which includes use of a substance in any way that can cause harm to oneself or others – is an underappreciated but critical public health challenge that can lead to substance use disorders, such as addiction. In 2015, nearly 48 million Americans used an illicit drug or misused a prescription medication, approximately 67 million reported binge drinking in the past month, and nearly 28 million self-reported driving under the influence in the past year. This large, at-risk population of Americans can benefit from appropriate screening, prevention, and treatment services.
“Although substance misuse problems and use disorders may occur at any age, adolescence and young adulthood are particularly critical at-risk periods,” Dr. Murthy said. “Preventing or even simply delaying young people from trying substances is important to reducing the likelihood of a use disorder later in life.”
For example, people who use alcohol before the age of 15 are four times more likely to develop an alcohol use disorder later in life compared to those who have their first drink at age 20 or older.
One of the findings of this report is that substance use disorder treatment in the United States remains largely separate from the rest of health care and serves only a fraction of those in need of treatment.
The Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010 have increased access to these services, making it possible for more people to get the treatment and support services they need to get and stay well. Yet for a variety of reasons, including stigma, a treatment gap remains. This treatment gap can also be attributed to factors, including lack of screening for use disorders, fear of shame and discrimination associated with addressing substance use disorders, lack of access to and costs of care, and fragmentation of services in our health care system. Additionally, many people seek or are referred to substance use disorder treatment only after a crisis, such as an overdose, or through involvement with the criminal justice system.
“Families across this country are fighting addiction. They’re fighting an illness, as well as a stigma. They’re doing all they can, and we should do no less. At the U.S. Department of Health and Human Services, we have worked hard to make our nation healthier and save lives by increasing access to evidence-based treatment for those who need it,” said HHS Secretary Sylvia M. Burwell. “While there’s more to do, this historic report provides us guidance and outlines important steps we can take to move forward, build on our progress to address this public health crisis, and make a difference for more Americans.”
The report identifies substance use disorders as a public health problem that requires a public health solution. It recommends taking action by eradicating negative attitudes and changing the way people think about substance use disorders; recognizing substance misuse and intervening early; and expanding access to treatment.
“It’s time to change how we view addiction,” said Dr. Murthy. “Not as a moral failing but as a chronic illness that must be treated with skill, urgency and compassion. The way we address this crisis is a test for America.”
“The Surgeon General’s Report on Alcohol, Drugs, and Health provides a roadmap for working together to move our efforts forward,” said Kana Enomoto, principal deputy administrator for the Substance Abuse and Mental Health Services Administration. “I hope all who read it will be inspired to take action to stem the rising tide of this public health crisis and reduce the impact of substance misuse and addiction on individuals, communities, and our nation.”
Fortunately, both the Obama Administration and HHS have focused efforts at curbing addiction and there has been progress in this space. The Obama administration has invested in the research, development and evaluation of programs to prevent and treat substance misuse and substance use disorders, as well as support recovery. The President has also called for an investment of $1 billion to provide treatment to combat the opioid epidemic. In addition, HHS has developed a department-wide Opioid Initiative focused on improving opioid prescribing practices, expanding access to medication-assisted treatment for opioid use disorder, and increasing the use of naloxone to reverse opioid overdoses. The initiative concentrates on evidence-based strategies that can have the most significant impact on the crisis.
“We have the opportunity to transform lives and strengthen communities by addressing our country’s addiction crisis,” said Dr. Murthy. “There could not be a more important time for us to act.”
See the HHS Announcement
Also see the full report and executive summary
See also Medical Law Perspectives, January 2014 Report: Prescription Painkillers: Risks for Patients, Pharmacists, and Physicians
See the Medical Law Perspectives February 16, 2015, Blog: Pharmacy Owes Duty To Patient Not To Fill Excessive Prescriptions for Opioids
See the Medical Law Perspectives October 8, 2014, Blog: Opioid Pain Pill Abusers Switch to Heroin; Heroin Overdose Deaths Double