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Surgeon General Urges Stepped-Up Attention to Addiction Issues
New report echoes ACP's calls for expanded access to treatment and integration of behavior health into primary care
Dec. 2, 2016 (ACP) -- More people in the United States take prescription opiates than smoke tobacco. One in four adolescents and adults reports binge drinking at least once in the past month. Fewer than half of those who suffer from substance abuse and another mental illness get treatment for either.
These statistics are among the findings from the new Surgeon General's Report on Alcohol, Drugs and Health: Facing Addiction in America.
"Our health care system has not given the same level of attention to substance use disorders as it has to other health concerns that affect similar numbers of people," the report notes. "Substance use disorder treatment in the United States remains largely segregated from the rest of health care and serves only a fraction of those in need of treatment."
But the report, issued in November by the office of Dr. Vivek Murthy, isn't all gloom-and-doom. Like the American College of Physicians has done on this issue, the surgeon general is calling for change and hoping for reform.
"All across our country, we have examples of communities that are starting to step up and implement prevention programs and treatment programs, and people's lives are changing as a result of that," Murthy told National Public Radio. "We've been dealing with substance disorders for centuries. What's different now is that we have solutions that work."
But, as he said in an interview with The Washington Post, many people seem to be missing the full extent of the problem: "I want our country to understand the magnitude of this crisis. I'm not sure everyone does."
Major messages of the report include:
Addiction is not voluntary. Science reveals the biological processes in the brain that contribute to addiction, and "understanding this transformation in the brain is critical to understanding why addiction is a health condition, not a moral failing or character flaw," according to the report. "Addiction is a disease."
Murthy put it this way when speaking with NPR: "Now we understand that these disorders actually change the circuitry in your brain. They affect your ability to make decisions, and change your reward system and your stress response. That tells us that addiction is a chronic disease of the brain, and we need to treat it with the same urgency and compassion that we do with any other illness."
Addiction can be prevented. The report says there's strong evidence that certain factors predict the likelihood of substance abuse. In addition, "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," the report says. It adds that there's strong evidence suggesting that drunken driving laws work.
However, the report notes, "as yet, insufficient evidence exists of the effects of state policies to reduce inappropriate prescribing of opioid pain medications."
ACP supports efforts to limit the use of opioid painkillers through prescribing guidelines but has advocated against restrictions that could prevent physicians from prescribing appropriate therapy for their patients.
There are many routes to recovery."People can and do recover," the report says. "The recovery movement offers a valuable opportunity for people with substance use disorders and their loved ones to get the support they need to gradually return to a healthy and productive life away from the destructive impact of substance use."
Noting that treatment can be "effective," the report says that "more than 25 million individuals with a previous substance use disorder are in remission and living healthy, productive lives."
Like the surgeon general, ACP is concerned about the lack of access to addiction services.
"There's a huge gap between need for treatment and the number who are getting treatment," said Ryan Crowley, senior associate for health policy with ACP.
Knowledge is outpacing reform. Despite advances in understanding of how to effectively prevent and reverse addiction, "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," according to the report.
It calls for the implementation of effective strategies and policies, more access to care, more research and "full integration of the continuum of services for substance use disorders with the rest of health care."
Last year, ACP issued a position paper calling for better integration of behavioral health into primary care. The College also has supported a variety of related reforms, including the elimination of payment problems and barriers, better training and a battle against stigma.
To further the College's goals in the overall fight against addiction, and in line with the surgeon general's report, "ACP members can play a role in helping their patients get treatment," Crowley said. "They can screen their patients, diagnose them and provide treatment for substance use disorders. Or they can refer their patients to behavioral health professionals if they aren't comfortable themselves providing treatment."
The surgeon general's report, Facing Addiction in America, is available online.