Inside the Surgeon General’s Report On Alcohol, Drugs and Health

By Kelly Burch 11/21/16

"Substance use disorders represent one of the most pressing public health crises of our time."

The Surgeon General reading the report.
Surgeon General Vivek Murthy reading the Report on Alcohol, Drugs and Health via Twitter

The U.S. Surgeon General released the first ever report on alcohol, drugs and health last week, reaffirming what many in the recovery community know: addiction is a disease, treatment works, and recovery is possible.

“For far too long, too many in our country have viewed addiction as a moral failing. This unfortunate stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help,” Surgeon General Vivek Murthy said in an executive summary of the report. “We must help everyone see that addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”

The 400-page report, Facing Addiction In America: The Surgeon General’s Report on Alcohol, Drugs and Health, aims to reduce stigma around addiction by exploring the neurobiological basis of the disease. It also shows how widespread addiction is. In 2015, substance use disorders affected 20.8 million Americans, or about 8 percent of the adolescent and teen population. That is similar to the number of people suffering from diabetes, and 1.5 times the number of Americans with cancer.

“The substance misuse problem in America won’t wait,” said Kana Enomoto, principal deputy administrator of the Substance Abuse and Mental Health Services Administration. “The addiction problem touches us all. We all need to play a part in solving it.”

Murthy and other policy makers hope that the report will mark a critical moment in the fight against addiction, much like the 1964 Surgeon General’s report on smoking and tobacco use changed the nation’s attitudes toward the deadly habit.

For Murthy, the release of the report fulfilled a promise he made to nurses at the Brigham and Women’s Hospital in Boston, where he used to work. When he left to become Surgeon General in 2014, they urged him to address the nation’s addiction problem. In his two years on the job, Murthy has become even more invested in that goal.

“I have come to appreciate even more deeply something I recognized through my own experience in patient care: that substance use disorders represent one of the most pressing public health crises of our time,” he said.

The Extent of the Problem

The Surgeon General’s report begins by examining how common substance abuse is in the United States. Last year, 27 million people in the country reported using illegal drugs or misusing prescription drugs, and about a quarter of the adult and adolescent population reported binge drinking within the past month.

The report outlined the many consequences of widespread substance misuse. An immediate consequence, overdose, has become so frequent that more people now die of drug overdoses than in car accidents. Indirect effects of impaired judgement can lead to risky sexual behaviors and needle sharing (contributing to recent outbreaks of HIV and other diseases) and impaired driving. In fact, the report found that more than 10 percent of all drivers reported driving impaired last year.

There are also long-term effects, for individuals and society. Physical ailments ranging from hypertension to chronic bronchitis have been connected to substance misuse. Social consequences like reduced productivity and higher healthcare costs are also mentioned. One of the most alarming trends the report outlined is the effect of substance abuse on the next generation. The report found that fetal alcohol spectrum disorder affects up to 5 percent of the population, and that there has been a five-fold increase in the number of babies born addicted to opioids as a result of the “ongoing opioid crisis.”

These trends have a shocking economic impact, the report found. It estimated that alcohol abuse and misuse costs the United States $249 billion annually, and drug abuse costs an additional $193 billion.

Another major issue—as people in recovery know—is access to treatment. Each year 23.4 million people need help for drug or alcohol problems, but only 10 percent will receive any type of treatment. Although 40 percent of people with substance use disorder have a co-occurring mental illness, 52 percent will not receive treatment for either disorder. 

Understanding Addiction and Treatment

Despite the grim statistics, the report specifically calls for optimism and hope. In addition to scientific advances in the understanding of brain processes, there are many treatment and prevention programs that have been shown to work, as well promising treatments awaiting approval.

The report “describes the considerable evidence showing that prevention, treatment, and recovery policies and programs really do work,” says Sylvia Mathews Burwell, Secretary for the Department of Health and Human Services. “Throughout, the Report provides examples of how individuals, organizations, and communities can partner to lessen and eliminate substance misuse. These efforts have to start now.”

The second chapter of the report explains the neuroscience of addiction, how the disease hijacks normal brain circuits, and leads people to need more and more of a drug just to feel normal.

“Understanding this transformation in the brain is critical to understanding why addiction is a health condition, not a moral failing or character flaw,” the report says.

The report then turns to prevention practices. It calls for more research into why some people become addicted after trying a substance. The likelihood of becoming addicted ranges from 4 percent to 23 percent depending on the substance, and is also tied to the individual: Between 40 and 70 percent of a person’s risk for developing a substance use disorder is genetic, the report says.

Preventative measures must address both risk factors and protection factors. A major risk factor for addiction is the age of first use, with younger users much more likely to develop addiction. Because of this, prevention efforts aimed at delaying first use are very important.

The next three chapters are dedicated to treatment and recovery. The report calls for an holistic, integrated approach to care, and a recovery strategy that fits an individual’s personal and cultural preferences. Importantly, the report rejects of the idea that medication-assisted treatment is merely “substituting one addiction for another.”

“This belief has reinforced scientifically unsound ‘abstinence-only’ philosophies … in many treatment centers and has severely limited the use of these medications,” the report says. “Abundant scientific data show that long-term use of maintenance medications successfully reduces substance use, risk of relapse and overdose, associated criminal behavior, and transmission of infectious disease, as well as helps patients return to a healthy, functional life.”

The Science Of Relapse

Understanding the biological basis of addiction helps to explain the prevalence of relapse. Relapses, the report emphasizes, do not mean that treatment isn’t working. Instead, they are an expected part of treating the substance use disorder. In fact, relapse rates are similar to those for physical illnesses including diabetes, asthma and hypertension.

“Because the brain can take a long time to return to health following a long period of heavy substance use, risk of relapse is high at first,” the report says. However, some risk of relapse continues for many years. For people recovering from alcohol use disorder, it takes 4 to 5 years for the risk of relapse to drop below 15 percent.

Peer support programs like Alcoholics Anonymous and recovery coaches are both effective in supporting sobriety, the report says. Communities like recovery centers and recovery high schools must be studied more to understand their effectiveness.

Looking Forward

The Surgeon General’s report ends by calling for changes in the way that the country approaches addiction and recovery. The country must move past shame and stigma, into a holistic medical approach to the disease.

“One of the recurring themes in this Surgeon General’s Report is that sound scientific knowledge about how to address substance use disorders effectively has outpaced society’s ability and, in some cases, willingness to implement that knowledge,” the report says.

While research has clarified the science around addiction, additional research is needed to inform the public-health approach to addiction going forward.

“Community leaders should work together to mobilize the capacities of health care organizations, local governmental public health, social service organizations, educational systems, community-based organizations, religious institutions, law enforcement, local businesses, researchers, and other public, private, and voluntary entities that are part of the broader public health system,” the report says.

For Surgeon General Vivek Murthy, taking that next step will define the character of the country.

“How we respond to this crisis is a moral test for America,” he says. “Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.