In an unprecedented action to “end the public health crisis of addiction” the Office of the Surgeon General released its first ever report on the challenges of addiction in America, titled Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. This well constructed, evidenced based report highlighted the horrors and challenges we face in helping those with substance use disorders. The report cited 5 key areas that must be addressed. They are:
- The Neurobiology of Substance Use, Misuse, and Addiction
- Prevention Programs and Policies
- Early Intervention, Treatment, and Management of Substance Use Disorders
- Recovery: The Many Paths to Wellness
- Health Care Systems and Substance Use Disorders
Moreover, the report unflinchingly addressed the collateral damage done to families and entire communities when this devastating disease is untreated. Accordingly, the report’s overarching message is that addictive disease is among the most pressing public health problems in the United States
At present, 21 million Americans age 12 and older have been diagnosed with substance use disorder. Another 2 million remain undiagnosed, bringing the total to 23 million addicts in the U.S. today. To put these numbers in perspective, there are slightly more than people with substance use disorder than with diabetes, and addiction is 1.5 times more prevalent in the U.S. than cancer—any type of cancer. Yet unlike diabetes or cancer, only 1 in 10 of those with substance use disorder receive any type of treatment. The results are disastrous, not only for the individual, but also to his or her family, the community and to our nation. And it’s getting worse. Today 8,000 Americans, most of whom are teens and children, will use an intoxicating, addictive substance for the very first time.
“A moral test for America”
In his accompanying letter to the report, The Surgeon General, Dr. Vivek H Murthy writes:
“We can never forget that the faces of substance use disorders are real people,”…Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?”
While it’s not breaking news, the Surgeon General’s endorsement for expanding prevention and treatment services in the community, increasing access to treatment, and training more clinicians to recognize and treat substance use disorders is important. The Surgeon General believes that treatment should be integrated into the traditional medical care system, citing the Mental Health Parity and Addiction Equity Act of 2008, mandating payers to reimburse for legitimate treatment modalities, as they would for any other medical condition. Moreover, substance use disorder is a chronic debilitating condition with relapse rates comparable to diabetes, asthma, and hypertension—but here’s the big difference. When an asthmatic or diabetic patient relapses, they do not commit crimes or hurt others to self-medicate their symptoms. All the more reason to support prevention, and when that fails, provide addiction medicine and psychiatry treatment with the necessary resources.
Why Does This Matter?
First and foremost, the best available evidence reveals that addiction, officially known as Substance Use Disorder is a multifaceted disease with numerous risk factors from trauma and in utero exposure to genetic hardwiring. Substance use may compromise development and learning and cause measurable changes in the brain’s reward, motivation, and mood systems.
Dr. Murphy suggests that more research is needed to “understand the biopsy-chosocial aspects of addiction.” In addition, more dedicated classroom and clinical training of physicians and health professionals is desperately needed to diagnose, refer, or treat this disease. And finally, community wide calls to action of all the stakeholders (clinicians, researchers, families, educators, courts and the health care system providers and payers) to work collaboratively toward providing the resources necessary to educate, prevent, and treat this deadly disease.