In 2016, the office of Surgeon General Vivek Murthy released its first ever report on substance use and the public health challenges it creates, called “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health.” The report discusses the prevalence of substance use, the neurobiology of addiction, prevention programs and policies, early intervention and treatment, recovery support services, integration of substance use services into health care, and the vision for the future. Despite the seriousness and prevalence of substance misuse and the challenges this creates, “Facing Addiction” cites multiple reasons for optimism.
Substance Use Prevalence
In 2015, more than 27 million Americans admitted to using illicit drugs or abusing prescription drugs. Over 66 million Americans (that’s almost a quarter of adolescents and adults) said they had engaged in binge drinking within the past month. These figures are telling given that substance abuse and misuse leads to more substance use-related violence and crime, child abuse and increased healthcare costs, with an estimated expense of $249 billion for alcohol misuse and $193 billion for illicit drugs.1
Though there are a large number of people with substance use disorders, only around 10% of them are being treated. More than 40% of this same population also have a mental health disorder, but unfortunately, less than half are getting treatment for either condition. This treatment gap occurs for numerous reasons including not being able to afford or access treatment, fear and/or shame, the lack of screenings done in general healthcare settings, not realizing the need for treatment, and the number of people (roughly 40%) who say they don’t want to quit.2
The Neurobiology of Addiction
Understanding the biological roots of addiction can help communities and individuals be more sensitive to and supportive of those who struggle with substance use disorders. The report notes that addiction is a biological condition, not a personality flaw, and it creates actual physical changes in the brains of certain individuals when they use alcohol and/or drugs repeatedly. Addictive substances cause a rush of dopamine in the brain, creating a pleasurable feeling that the brain learns to tolerate after repeated exposure, in turn creating the need to use more of the substance to get the same feeling. Additionally, in people with substance use disorders, the circuits in the prefrontal cortex, which aids in impulse control, judgment and decision making, are impaired, causing the user to have less self-control.3
Prevention Programs and Treatment
Prevention programs and policies, as well as early intervention, treatment and management are also discussed. The bottom line: prevention programs work and treatment is effective in managing symptoms and warding off relapse. In fact, people with substance use disorders have about the same rate of relapse after treatment as those with other chronic health conditions, such as asthma or diabetes, and more than 25 million Americans are currently in remission from their substance use disorders.4
Recovery Support Services
Recovery support services are an equally important part of treating substance use disorders, the report says, simply because recovery takes at least a year and up to five years before the risk of relapse grows smaller. When individuals have completed treatment, having recovery services to help give them a supportive environment in which to continue to make changes in their lives to get to a place of remission is key. Recovery support services can come from group therapy, 12-Step programs such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), sober housing, coaches, community centers and even high schools. Recovery support services can also help the loved ones of individuals affected with substance use disorders.5
Integration of Substance Use Services into Mainstream Healthcare
The Surgeon General advocates for integrating the prevention, treatment and recovery of substance use disorders with general healthcare instead of keeping it separate as it has been. As with any chronic illness, it’s better to start treatment before a crisis, like an overdose or a drunk driving incident, occurs. Because of this, the use of substance use disorder screenings in general healthcare settings can help identify people who are misusing substances or in the early stages of addiction and get users into treatment before crises occur. Treatment can also reduce the number of substance use-related crimes and violence and loss of productivity associated with substance use disorder.6
Vision and Recommendations
Everyone, not just healthcare providers, has a part to play in focusing on substance misuse as a public health challenge. The report gives five conclusions:
- Effective strategies need to be put into place to address the public health issue of substance misuse and substance use disorders.
- The prevention policies and programs that now exist should be put into action everywhere.
- Integrating substance use disorder prevention, treatment and recovery into general healthcare “could significantly improve the quality, effectiveness and safety of all healthcare.”7
- Recent health reform and parity laws, such as the Affordable Care Act, help make treatment more accessible and affordable for people with substance use disorders.
- Though there is a large amount of research on substance use disorders, more is needed to guide our future approach to substance misuse and substance use disorders as a significant public health challenge.8
Hope for the Future
There are good reasons to be positive about the future. Research has shown us that addiction is treatable and effective prevention programs and treatments are available. Recovery support services are also becoming more widely available, which helps individuals working toward remission to get there more effectively. Healthcare is becoming increasingly more accessible and affordable, creating more opportunities for those with substance use disorders to seek help, as well as access to prevention programs. Finally, prison inmates are receiving better treatment in and out of prison, and non-violent offenders are more often going to treatment instead of prison. “Together, these changes are leading to a new landscape of care for alcohol and drug misuse problems in America, and to new hope for millions of people who suffer from them.”9
You can read more and access the Surgeon General’s full report here: https://addiction.surgeongeneral.gov/.
4. https://addiction.surgeongeneral.gov/executive-summary/report/neurobiology-substance-use-misuse-and-addiction and https://addiction.surgeongeneral.gov/executive-summary/report/early-intervention-treatment-and-management-substance-use-disorders
6. https://addiction.surgeongeneral.gov/executive-summary/report/early-intervention-treatment-and-management-substance-use-disorders and https://addiction.surgeongeneral.gov/executive-summary/report/health-care-systems-and-substance-use-disorders
Written by Sarah E. Ludwig