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Surgeon General: "Never Too Early, Never Too Late to Prevent Substance Misuse"

Alcohol and drugs--the topic of the Surgeon General's reportYouth Especially Can Learn to Benefit From Alcohol-Free Life, According to DHHS Report on Addiction

In November 2016, the U.S. Department of Health and Human Services set the tone for the next generation of policies towards alcohol and addictive drugs with Facing Addiction In America: The Surgeon General’s Report on Alcohol, Drugs and Health. The report aims to confront the harm caused by illicit drug use, prescription drug misuse, and disordered drinking. In doing so, Surgeon General Vivek H. Murthy advocates an approach that emphasizes prevention, treatment, and integration of addiction services into standard healthcare. Just as importantly, Dr. Murthy pushes back against the dead-end of individual blame, bringing hope for pragmatic solutions to the estimated 20.8 million Americans in need of treatment for substance misuse—including the 15.7 million experiencing harm from alcohol use.

"It may surprise many people to recognize that alcohol leads to the other substances," said Dr. Murthy in an interview with PBS Newshour.

Central to the treatment strategy is the neurobiological model of addiction. In this model, addictive behaviors can be explained by a combination of dysfunctional reward systems in the brain and insufficient opportunities to build healthier ones. This quasi-disease model treats recovery as a retraining process, and likewise clears the way to prevention efforts.

If an individual experiencing that disease can retrain their reward circuits, quality prevention education and training can reinforce addiction resistance before the disease gets hold. At the same time, the report acknowledges that addiction emerges from a combination of drug exposure, quality of life, and genetic susceptibility; a sensible effort to combat addiction must identify and/or address all three.

In particular, Dr. Murthy singles out the age that someone first uses alcohol or other drugs as a risk factor for later misuse, emphasizing that “preventing or even just delaying young people from trying substances is important for reducing the likelihood of more serious problems later on.” The report encourages common-sense alcohol access regulations such as alcohol prices, restrictions on points of sale, and minimum purchasing ages, and urges they be extended to other legal recreational substances such as marijuana.

Vivek Murthy 72Yet the report insists, “It is never too early and never too late to prevent substance misuse.” Aside from engaging youth, the report pushes all medical professionals to screen for alcohol and substance misuse. That includes primary care doctors, as well as psychiatrists and emergency personnel. These screens create opportunities to engage in non-emergency behavioral treatments, improving patients’ abilities to control problem use before it creates lasting harm. “With any other health condition like heart disease,” Dr. Murthy writes, “detecting problems and offering treatment only after a crisis is not considered good medicine.”

Yet even when acute interventions are needed, “only 1 in 10 people with substance abuse disorders are getting treatment," Dr Murthy said to reporters. "That is unacceptable, and we have to close the gap."

For those who experience serious problems, the report recommends fully integrating substance abuse services with the existing medical and health insurance framework. Moreover, recovery can be a long process, and individuals need access not to just to acute detox but long-term “recovery support systems.” The systems include AA and other supportive groups, but also case management, sober living environments, and similar supportive spaces for people looking to reinforce an alcohol- and drug-free lifestyle.

"We're encouraged to see alcohol addiction given equal weight to other drugs of abuse," said Alcohol Justice Executive Director/CEO Bruce Lee Livingston, "and to see it implicated in worsening other addictions. We also strongly agree with the idea that prevention is the best solution—now government agencies at all levels must make good on the Surgeon General's words."

Although many of Dr. Murthy's recommendations seem common-sense to those familiar with evidence-based prevention and recovery, Dr. Murthy cautions that “this change will require a major cultural shift in the way we think about, talk about, look at, and act toward people with substance use disorders.” Yet the report is optimistic, citing the lifting of stigmas attached to HIV. AIDS, after all, was once regarded as a mysterious and terrifying plague. Now, it is just a disease to be treated.