11/17/2016

Surgeon General releases first ever report on addiction in America

U.S. Surgeon General Dr. Vivek Murthy’s Office has released the report, “Facing Addiction in America,” which pulls together the latest information on the health impacts of drug and alcohol misuse, as well as on the issues surrounding treatment and prevention. It offers reasons for optimism despite a still-increasing overdose epidemic that has killed more than 500,000 Americans since 2000, and it presents evidence that addiction is a treatable brain disease, with new therapies under development.

“The report released today confirms what we have known for a long time: addiction is a disease of the brain that can and should be treated with evidence-based, compassionate care,” said Jeffrey Goldsmith, MD, OPPA member and president of the American Society of Addiction Medicine. “For too long, policy makers, the public, and even healthcare providers have misunderstood this disease as some sort of moral failing. We hope this report will put an end to that misperception once and for all.”

In 2015, the report notes, substance-abuse disorders affected 20.8 million people in the United States — as many as those with diabetes and 1½ times as many as those with cancer. Yet, Murthy said, only one in 10 people receives treatment.

“We would never tolerate a situation where only one in 10 people with cancer or diabetes gets treatment, and yet we do that with substance abuse disorders,” he said.

Below are some of the highlights of the report (source: Drug Free Action Alliance):

General Stats:

• Nearly 21 million people in America have a substance use disorder involving alcohol or drugs, an astonishing figure that is comparable to the number of people in our country with diabetes and higher than the total number of Americans suffering from all cancers combined. "
• In 2015, over 27 million people in the United States reported current use of illicit drugs or misuse of prescription drugs, and over 66 million people (nearly a quarter of the adult and adolescent population) reported binge drinking in the past month (NSDUH 2015)." 
• "It is estimated that the yearly economic impact of substance misuse is $249 billion for alcohol misuse and $193 billion for illicit drug use (Sacks J.J. et al 2015, NDIC 2011)."
• "Only about 10 percent of people with a substance use disorder receive any type of specialty treatment. Further, over 40 percent of people with a substance use disorder also have a mental health condition, yet fewer than half (48.0 percent) receive treatment for either disorder. (NSDUH 2015)"
• "...about 40 percent of individuals who know they have an alcohol or drug problem are not ready to stop using, and many others simply feel they do not have a problem or a need for treatment (NSDUH 2015)."

Neurobiology:

• "Well-supported scientific evidence shows that addiction to alcohol or drugs is a chronic brain disease that has potential for recurrence and recovery."
• "Well-supported evidence shows that the addiction process involves a three-stage cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. This cycle becomes more severe as a person continues substance use and it produces dramatic changes in brain function that reduce a person’s ability to control their substance use."

Prevention:

• "Well-supported scientific evidence exists for robust predictors (risk and protective factors) of substance use and misuse from birth through adulthood. These predictors show much consistency across gender, race and ethnicity, and income."
• "Well-supported scientific evidence shows that federal, state, and community-level policies designed to reduce alcohol availability and increase the costs of alcohol have immediate, positive benefits in reducing drinking and binge drinking, as well as the resulting harms from alcohol misuse, such as motor vehicle crashes and fatalities."
• "There is well-supported scientific evidence that laws targeting alcohol-impaired driving, such as administrative license revocation and lower per se legal blood alcohol limits for adults and persons under the legal drinking age, have helped cut alcohol-related traffic deaths per 100,000 in half since the early 1980s."

Early Intervention:

• "Only about 1 in 10 people with a substance use disorder receive any type of specialty treatment."
• "Well-supported scientific evidence shows that medications can be effective in treating serious substance use disorders, but they are under-used." 
• "Well-supported scientific evidence shows that treatment for substance use disorders—including inpatient, residential, and outpatient—are cost-effective compared with no treatment."
• "Well-supported scientific evidence shows that behavioral therapies can be effective in treating substance use disorders, but most evidence-based behavioral therapies are often implemented with limited fidelity and are under-used." 

Recovery:

• “Supported” scientific evidence indicates that approximately 50 percent of adults who once met diagnostic criteria for a substance use disorder—or about 25 million people—are currently in stable remission (1 year or longer). Even so, remission from a substance use disorder can take several years and multiple episodes of treatment, RSS, and/or mutual aid."
• "Well-supported scientific evidence demonstrates the effectiveness of 12-step mutual aid groups focused on alcohol and 12-step facilitation interventions."

Health Care Systems:

• "Well-supported scientific evidence shows that the traditional separation of substance use disorder treatment and mental health services from mainstream health care has created obstacles to successful care coordination. Efforts are needed to support integrating screening, assessments, interventions, use of medications, and care coordination between general health systems and specialty substance use disorder treatment programs or services."
• "Supported scientific evidence indicates that individuals with substance use disorders often access the health care system for reasons other than their substance use disorder. Many do not seek specialty treatment but they are over-represented in many general health care settings."
• "Supported evidence indicates that one fundamental way to address racial and ethnic disparities in health care is to increase the number of people who have health insurance coverage."
• "Well-supported evidence shows that the current substance use disorder workforce does not have the capacity to meet the existing need for integrated health care, and the current general health care workforce is undertrained to deal with substance use-related problems." 

Related

“Landmark report by Surgeon General calls drug crisis ‘a moral test for America’,” Washington Post, Nov. 17, 2016