Surgeon General Vivek Murthy On The Addiction Crisis In America

By John Lavitt 12/04/16

"Many people are suspicious of methadone and buprenorphine...They believe in abstinence and abstinence only, but science tells us very clearly that there are multiple paths to recovery."

Surgeon General Vivek Murthy On The Addiction Crisis In America
Dr. Vivek Murphy keeps his focus on the future. via Facebook

Appointed by President Barack Obama, Dr. Vivek Murthy was confirmed on December 15, 2014, as the 19th United States Surgeon General. Being a first generation immigrant from India and the United Kingdom, Dr. Murthy is proud to have assumed the role of "America’s Doctor," responsible for communicating and applying the latest scientific information to help improve personal and public health.

On November 17, 2016, Dr. Murthy released Facing Addiction In America: The Surgeon General’s Report On Alcohol, Drugs, And Health. As the first-ever report of its kind, the goal is to deal with the current national drug crisis, including the opioid epidemic and prescription drug misuse, in the same manner that the famous 1964 Surgeon General’s report confronted the dangers of tobacco use in the country. A few days after the report, Dr. Murthy spoke to The Fix about his findings and what he hopes to accomplish moving forward.

The decision to issue a report on alcohol, drugs, and health was the first major decision I made after becoming Surgeon General.

As a first-generation immigrant from the United Kingdom whose family moved there from India, you became an American citizen and embraced the American dream. What does it mean for you to have reached the heights of distinction by becoming the Surgeon General? What would you hope other immigrants take from your success?

That’s a great question, and let me say this right away: It is just a great honor to have the opportunity to serve as Surgeon General. For my family, coming from humble roots as they did, this is not an opportunity to serve that they ever expected that I would have, but my parents did come here because they hoped that America would be a place where my sister and I would have opportunities. They believed this country would provide us with opportunities to learn, opportunities to support a family, and opportunities to contribute. I am grateful to say that we have found that and so much more.

What my own immigrant experience reminds me of is that our nation is an incredibly diverse place that has historically been a land of immigrants. We should never forget that everybody has something that they can contribute to our country, whether they came here a year ago or a generation ago or ten generations ago. I try to remind myself of that reality every day, and it’s why I try to make it a point to ensure that I work to create opportunities for as many people as possible to come and serve in government. We need more smart, talented, effective people in government at the local, state, and federal levels. It’s a responsibility of all of us who have had the privilege of serving in government to create opportunities for others.

On November 17, 2016, you released Facing Addiction In America: The Surgeon General’s Report On Alcohol, Drugs, And Health. The first-ever report of its kind, why did you decide to release it and what do you hope to accomplish?

The decision to issue a report on alcohol, drugs, and health was the first major decision I made after becoming Surgeon General. I made that decision because for far too long people with substance use disorders have suffered in the shadows. For too long as a country, we have treated addiction primarily as a criminal justice issue, instead of as the public health issue that it really is. When I issued the report on November 17th, it was time for us to start treating addiction as a chronic illness and not as a moral failing.

It also was time for us to recognize the scope of our addiction crisis in America. Having traveled across the country, I found that addiction touches all of our communities. At the same time, so many people remain unaware of how widespread this problem is. They often feel that they and their families are one of a small number of folks who are suffering, and, as a result, they end up suffering in silence. In contrast to this mistaken perception, this is a widespread problem. There are 20.8 million people in America who are living with a substance use disorder. Let’s put that number in perspective: that’s more than the number of people who have all cancers combined and it’s similar to the number of people who have diabetes. This is a major public health problem, and it’s time for us to recognize that fact.

Finally, I issued the report because it is time for us to highlight how there are now proven prevention and treatment programs that can help Americans who are living with substance use disorders. The good news is that we now have evidence-based strategies to prevent substance use disorders and to treat them once they develop. The problem, however, is that we are not using them nearly as much as we should. Only 1 in 10 people with a substance use disorder is getting treatment right now; that’s a massive gap that needs to be closed. We also know that prevention and treatment are cost-effective. For every dollar that we spend on treatment, we save four dollars in healthcare costs and seven dollars in criminal justice system costs. On the prevention side, there are programs that return up to $64 for every single dollar invested. When people ask me whether or not we can afford to invest in prevention and treatment programs, I tell them that we can’t afford not to invest in these programs. Substance use disorders are right now costing our country $442 billion dollars a year. Unless we focus on investing in prevention and treatment programs in our communities, we are only going to see that number increase.

You have said, "The most important thing is, we have to change attitudes towards addiction and get people into treatment. Addiction is a disease of the brain, not a character flaw."

How do you believe that the deeply ingrained stigma of addiction—believed to be not a disease but a character flaw—can be overcome?

Eradicating the stigma around addiction is going to require each of us to step up and play a part. What we are talking about here is culture change, and you can’t legislate a change in people’s attitudes or a shift in culture. Culture is formed by the attitudes and beliefs of people all across our country, and that means we actually do have the power to overcome some of these negative attitudes and biases that have developed around addiction.

Shifting how we think about addiction is very important because there are so many people who need treatment, but don’t feel comfortable stepping forward and asking for help because they fear that they will be judged. As I traveled across the country as part of our opioids tour, I met people who were scared to come and talk to me if there was a camera nearby. They were worried that if it became known that they were struggling with a substance use disorder, they would lose their job, be ostracized by their friends and they might even be looked at differently by their doctor. We know the unfortunate stigma around addiction is a problem that is impacting our ability to get people to come forward and ask for help. It’s even difficult to get communities to accept treatment centers in their neighborhoods.

This is why it’s so important for us to make this culture shift about how we think about addiction. The good news is that each of us has the power to make that happen. Each time we take that step and change how we think about and talk about addiction, we give other people the permission to make that shift as well. We give them the opportunity to come forward and share their story, and that is the beginning of healing.

In the report, you urge a holistic approach to battling the addiction epidemic that should involve policy makers, regulators, scientists, families, schools and local communities. Behind such a holistic effort, there needs to be a lot of capital. Despite passing the Comprehensive Addiction and Recovery Act and President Obama signing CARA into law, Congress has not funded the initiatives within. Without money from the federal government as well as state and local support, are these efforts bound to fail?

In the report, we lay out a number of steps that we have to take in order to address the addiction crisis in America. Certainly, many of these require a greater investment by us as a country. We know that in order to ensure that treatment and prevention programs are being utilized in communities all across America it is going to require capital investment. As I mentioned earlier, we know that treatment programs not only are proven to work, but they save lives and money as well. In the report, we have an entire chapter where we describe a number of prevention programs that have already been implemented in communities across the country. These programs all return a range of amounts for the investment, but some of them are up to $64 for every dollar spent. That’s an incredible return on investment. To ensure that these programs are available everywhere, however, we do have to invest as a country.

At the same time, I also want to be clear that there are steps that we call for in the report that actually don’t require further investment from the federal side. For example, we know we need to change the way we see addiction. People can begin to make this change on their own and help to affect their families and their communities. Another step that can be taken involves our recommendations for clinicians in regards to how further training can help them learn how to screen for and diagnose and treat substance use disorders. Such training can be accelerated by medical schools and residency programs right now. We also know that integrating the treatment of substance use disorders with traditional medical treatment is an approach that healthcare providers can begin to take as well. In fact, many healthcare systems have already started doing that in response to shifting payment models that focus on paying more for value as opposed to volume of care. Others have made this shift because they recognize that it’s long past due. They integrate this type of care because it makes it easier for patients to access treatment for substance use disorders.

While federal investment is very important, many steps can be taken within our communities with existing resources. When it comes to this problem, we need to focus on working on all fronts because there is no single solution to addressing addiction in America. It’s going to take all of us working in our traditional roles as well. It’s going to require parents talking to our kids about addiction. It’s going to require teachers and principals leading prevention programs in schools. It’s going to require law enforcement officials to not only equip themselves with naloxone to address the rash of opioid overdoses, but also work with public health officials to get people in need connected to treatment. It’s going to require our healthcare system to provide the best training to our clinicians while offering the integrative care that our patients need and deserve. All of this is in addition to the investment that needs to be made by government so the prevention and treatment services are both provided and adequately funded.

You hope that actions taken in response to the report will mirror actions taken in response to the 1964 Surgeon General's report on tobacco. At that time, 42 percent of the population smoked but few recognized the danger. That report led to decades of effective legislation and efforts to promote tobacco control. Today, the smoking rate has been cut by more than half. Do you see the present report leading to such positive results? What are the biggest barriers?

I’m glad that you brought up the 1964 report because it helps to show how reports by Surgeon Generals have had a long and important history in America, spurring our nation to action on critical public health issues. The 1964 report on tobacco was one great example of that positive action: It helped to spearhead a half-century of work on tobacco control. Right now, this is a time when I believe that our nation has to be called to action to address the addiction crisis and that’s why I issued the report on alcohol, drugs, and health. My hope is that it will move people to not only implement policies and programs that we know work, but also to examine how they think about and talk about substance use disorders in their own lives.

For example, we know that the words we use are powerful tools that shape the environment in which we live. If we talk about addiction as a character flaw or a moral failing, then we intentionally or unintentionally tell people that they will be judged if they come forward and admit that they have a problem. This is exactly why it’s up to us to think about how we’re talking about addiction and to ensure that our words and our actions are being informed by compassion and by science, and not by old misconceptions about addiction. In the report, one of things we lay out is how addiction has a biological basis. It’s a chronic disease of the brain. We know that somewhere between 40 and 70 percent of a person’s individual likelihood of developing a substance use disorder is based in genetics. After the genetic influence, the remainder is governed by other factors, including the environment in which you grew up. Given such factors, you start to realize that any of us could be susceptible to a substance use disorder. It’s a mistake to see it as a path that people always actively choose. Given the conflict of factors, some related to your genetics and some related to your environment, many people can be led beyond choice down the path of addiction. Such a realization helps us to understand that our approach truly needs to be informed by science and by compassion.

In the report, we call for people to accept this approach for thinking about addiction in order to allow science and compassion to properly guide us. My hope is we’ll be able to look back on this report and see how it shined a light on a critical public health challenge. We’ll be able to see how it called our nation to action around both a cultural shift as well as policy and programmatic shifts, and how it ultimately helped to bring people out of the shadows and get them the help that they’ve needed for a long, long time.

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Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.