By Pamela Erickson
In November 2016, the Surgeon General released a major report entitled, "Facing Addiction in America, the Surgeon General's Report on Alcohol, Drugs and Health." It is a major work on the issue of substance misuse that is comprehensive, well documented and uses the latest science.
But, it is very hard to read. It is 428 pages long and although the authors say it is "purposely written in accessible language without excessive scientific jargon"; even I had a hard time reading and digesting the material. There is an Executive Summary, but that is 13 pages long.
Therefore, I am summarizing a few of the main points as it pertains to alcohol and suggesting ways you can use the report without having to read it cover-to-cover. It should be noted that the report deals with the full array of "substance use disorders," so some of the discussion relates to all addictive substances not just alcohol. This can be a point of confusion at times.
1. "The United States has a serious substance misuse problem."
The first chapter begins with this statement and recounts the enormous cost to our country: 88,000 deaths annually due to alcohol, 47,055 drug overdose deaths in 2014, and $249 billion annual cost for excessive alcohol use. These are just a few of the statistics that illustrate the seriousness of this problem.
2. Advances in scientific knowledge now can show that addiction is a disease of the brain.
Chapter 2 of the report features a detailed description of how the brain becomes altered as addiction develops. It helps make the case that addiction is a brain disease and not merely a moral failing. If you want a thorough explanation of how the human body, especially the brain, reacts to substance use, it can be found in Chapter 2 of the report.
3. The "addiction cycle" has three stages, the first of which is binge use. This shines a light on the need to reduce binge drinking because it is much more common than drug use.
While drinking and other drug use among youth has shown very impressive reductions, binge drinking in the population at large is stuck at about 23%. (See chart below) In this report, the authors consider binge drinking as the first step in the path to addiction. While not all binge drinkers become addicts, reduction in binge drinking should also reduce addiction. There are currently 66 million binge drinkers in the U.S.
4. As with most serious and chronic illnesses, early intervention is vital.
Prevention and treatment for most serious diseases at the earliest stage possible is usually more effective and less costly. That is also true for addiction to alcohol and illicit drugs. It is particularly important to prevent and/or treat children and young adults as their brains are more susceptible to addiction. Therefore, we should redouble our efforts to reduce underage drinking, but also focus on young adults who typically drink at high levels. Of those 66 million who binge drink, 1.7 million are aged 12-17 and 214,000 are pregnant women. The report describes many prevention/intervention programs, policies and strategies that are effective and could be deployed to reduce this serious problem.
5. The authors recommend a "public health" approach to addiction that represents a cultural shift in thinking.
The shame that accompanies addiction can be a barrier to seeking effective treatment. Historically, it is the way we have dealt with addiction. I remember a great-uncle who was addicted to alcohol and completely shunned by the family as they were deeply ashamed of him. He led a sad and short life. If he were alive today, he might have found treatment and become a productive member of society. The Surgeon General should be credited with making the effort to change this culture which could improve the lives of many.
6. Recent legislative developments have expanded the access to prevention and treatment services.
Specifically, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act represent new resources. This should be helpful as many needing treatment did not get it. When asked why, 31% cited lack of health insurance. It should be noted that 41% did not receive treatment because they were "not ready" and 16% felt it would have a negative impact on their job. Reducing the shame and stigma of addiction may encourage more people to seek treatment.
7. We all have a role to play in reducing these serious problems.
The last chapter is the "Vision for the Future." It has specific suggestions for key stakeholders. But, each of us is a member of one or more of these groups, so we all have a role to play. This report can be used as a blue-print for all of us in dealing with this issue.
How to access and use this report:
- Download or order it from Addiction.SurgeonGeneral.gov. I found it difficult to use the on-line version because you want to skip back and forth. Therefore, downloading and printing it are recommended. You can also order a copy, but the website says they are sold out! (Hopefully, they will re-stock.)
- You can read the 13-page Executive Summary, but another idea is to read the Key findings for Chapters 2,3,4,5 and 6. They can be found in a boxed feature on the second page of chapters 2-6. This will give you an idea about what is in the heart of the report.
- I would suggest reading or, at least, skimming the last chapter as the authors outline the vision for the future and the role for key stakeholders.
- This report should be kept readily available and used as a reference. It not only has the latest science on brain function and addiction, but it can be used as a guide to effective policies and programs which should be implemented for reducing addiction in our communities.
- And, you can reference the report if faced with attempts to loosen alcohol regulations; reminding policy makers that alcohol misuse is still a significant public health and safety issue.
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.