Surgeon General’s Report on Addiction: A Call to Action for the Challenge of Our Time

Calling to Action

The sense that substance abuse and addiction issues have reached a bell-weather moment in our culture is neither new nor imagined. For the better part of this year, we have been chronicling a steady, unprecedented recent rise in addiction and overdose rates and calling for more informed, aggressive policies and robust funding to tackle an issue that has now eclipsed most recent public health scares in its acute impact and sweeping scope.

In terms of our shared human experience, it has been a startling and scary ride as we have watched both celebrities and ordinary citizens publicly struggle and fall to newly potent varieties of opiates, while first responders and officials struggled to keep up and, if possible, save lives.

Politically, addiction has finally become more than an astute sound bite, evolving into an issue that helped define how candidates might approach health policy and community education.

And presidential and legislative action came to at last reflect the urgency of an issue that now kills more Americans than auto accidents each year. Now, importantly, our country’s chief medical officer has issued the first report from that office directly targeting substance abuse, recognizing it as a national health crisis but also a “time for a great opportunity.”

Surgeon General Report

Released this week, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health seeks to bolster awareness and spur action to end what Dr. Vivek Murthy said is a public health crisis both underappreciated and undertreated. From a medical standpoint, it serves as a distillation of what scientists currently know about addiction, from its causes to potential interventions.

The report, for example, emphasizes the changing scientific focus on addiction as a chronic malady akin to diabetes. Research has repeatedly shown that the brains of people with addiction disorders become rewired, hampering a person’s ability to make healthy decisions in light of potential or real consequences, deal with stress, and avoid temptation.

It’s all about ACTION

But the report also serves as a kind of rallying point for continued, committed action on the part of lawmakers, providers, health experts, and community leaders to enact real measures to combat stigma and arrest the growth of an illness that, as of 2015, surpassed cancer in terms of the number of Americans affected.

Even though media and government officials have paid more attention to opioid abuse in recent years, Murthy suggests, addiction disorders are still not widely recognized and treated like diabetes and other diseases. That needs to change, the report urges.

“We have to help people understand that [addiction] is not a disease of choice or a character flaw,” Murthy said in a recent phone conference. “This is a chronic disease of the brain.”

Record Numbers

U.S. deaths from drug overdoses hit a record high in 2014, increasing 6.5 percent to 47,055, propelled by prescription painkiller and heroin abuse, according to the Centers for Disease Control and Prevention. And just this past month, it was revealed that opioid addiction alone had risen almost 200 percent among children and teens.

The report comes in the midst of a broader government effort to address addiction, in particular opioid painkiller abuse. President Barack Obama has requested an additional $1.1 billion to help address the problem. Opioids include oxycodone, hydrocodone, fentanyl, and morphine and are sold under such brand names as OxyContin, Percocet, Vicodin, and Actiq.

Treatment is an Investment

In 2015 more than 27 million people in the United States reported using illegal drugs or misusing prescription drugs. More than 66 million people, or nearly a quarter of all adolescents and adults, reported binge drinking within the previous month.

But, despite the fact that 20.8 million Americans have a recognizable substance use disorder, only around 10 percent receive treatment. That is also a problem that will have a long-term impact on societal infrastructure and productivity, the report suggests. The estimated annual economic impact of drug abuse is $193 billion, while the estimated economic impact of alcohol abuse is $249 billion.

Research shows that every dollar invested in treatment saves $4 in healthcare costs and lost productivity and $7 in criminal justice costs. “We can’t afford not to invest in treatment because we are going to pay a lot more later,” the Surgeon General emphasized.

The report urges a multi-faceted approach to battling the addiction epidemic that should involve policymakers, regulators, scientists, families, schools, and local communities. The goal is to increase access to existing treatment programs, which have been shown to reduce the risk of relapse, while at the same time expanding new and more effective programs.

Early intervention is also critical. If a person has their first drink before the age of 15, their likelihood of developing an alcohol problem is four times greater than if the first drink is taken after the age of 21.

Change, Change, Change

Murthy’s report, in both its call for broad-based change –and his hope that it will have a ripple effect spurring societal shifts and changing norms – has been compared to the landmark 1964 Surgeon General’s report on tobacco. At that time, 42 percent of the population smoked but few recognized the danger until the ninth Surgeon General, Luther Terry, connected tobacco use with a host of illnesses, including lung disease and cancer.

What followed was a robust legacy of public service campaigns, increased dialogue about risks, changes in perception, and changes in the legalities surrounding advertising for tobacco products that together cut smoking rates significantly and reduced related ailments. Murthy is not shy about embracing the comparison.

“That Surgeon General’s report catalyzed a half century of work on tobacco control and now the smoking rate is less than 17 percent,” he said.

Movement at large

While the lasting impact of this latest report remains to be seen, it has hit a sweet spot when it comes to the level of concern around an issue. We do need powerful changes in the way we treat addiction as a country. And, as this report seems to recognize, the path forward must be informed by research, reality, a spirit of empathy, and conviction.

Like the tobacco campaigns that helped to create a groundswell of new beliefs and behaviors, this latest call to action also needs continued momentum and a sense that where there are challenges, there are also opportunities. Because while we have all come to see with new clarity the way substance abuse can derail promising lives, destroy potential, and drain communities of resources and sometimes hope, there is much we can do to turn the tide if we recognize, and accept, our roles in contributing to a solution.

Kudos to the Surgeon General for trying to use his stature and smarts to galvanize that kind of movement. It’s the right approach, and it’s right on time.