Tox Tuesday: The Surgeon General’s Report on Alcohol, Drugs, and Health

In an effort to take genuinely effective steps to prevent and treat substance-related issues, the first-ever Surgeon General’s Report on Alcohol, Drugs, and Health has been released. In all, the report details what we know about substance misuse, how the neurobiological processes can turn casual substance use into a compulsive disorder, like addiction, and how the public, policymakers, and health care systems can use that knowledge to address substance misuse and related consequences.

First, the report defines both “substance” and “substance misuse.” A substance is a psychoactive compound with the potential to cause health and social problems, including substance use disorders such as addiction. For the purpose of the report, these substances can be divided into three major categories: alcohol, illicit drugs (including prescription drugs used non-medically), and over-the-counter drugs. Substance misuse is defined as the use of alcohol or drugs in a manner, situation, amount, or frequency that could cause harm to the user or to those around them.

Although different in many respects, the substances discussed in the report share three main features that make them important to public health and safety. First, many people use and misuse these substances. In fact, 66.7 million individuals in the U.S. aged 12 or older admitted to binge drinking in the past month and 27.1 million people aged 12 or older used an illicit drug, or misused prescription drugs in the past month.

Second, individuals can use these substances in a manner that causes harm to the user or those around them, known as substance misuse, and often results in health or social problems of varying degrees. And third, prolonged, repeated misuse of any of these substances can produce changes to the brain that can lead to a substance use disorder (addiction) that significantly impairs health and function and requires specialty treatment.

Keeping those points and definitions in mind, the report supplies a vast amount of statistics and indicates that in 2014 alone there were 47,055 drug overdose deaths including 28,647 people who died from a drug overdose involving some type of opioid, including prescription pain relievers and heroin—more than in any previous year on record.

This comes at the same time that opioid analgesic pain relievers became the most prescribed class of medications in the U.S., with more than 289 million prescriptions written each year. The increase in prescriptions of opioid pain relievers has been accompanied by dramatic increases in misuse and by a more than 200% increase in the number of emergency department visits from 2005 to 2011. The report also states that 61% of the drug overdose deaths that occurred in the U.S. in 2014, were the result of opioid use, including prescription opioids and heroin.

Additionally, the report states that drug overdose deaths have continued to rise as a result of the illicit manufacturing and distribution of synthetic opioids, such as fentanyl, and the illegal diversion of prescription opioids. Illicit fentanyl, for example, is often combined with heroin or counterfeit prescription drugs or sold as heroin, and can be deadly in very small doses.

The report goes on to explain that when taking alcohol, illicit drugs, and over-the-counter drugs into account, almost 8% (20.8 million people) of the population met diagnostic criteria for a substance use disorder for alcohol or illicit drugs, and another 1% met diagnostic criteria for both. However, only 2.2 million individuals out of the 20.8 million people who met diagnostic criteria for a substance use disorder, received any type of treatment.

To change these statistics and offer more effective and widespread treatment, the report explains that America first needs to look at drug misuse or addiction treatment and the individuals who need it, in a different way.

For example, the report states it is sometimes thought that concern over substance use and misuse should be secondary to the real issue of substance use disorders like addiction. However, this is an important misconception as individuals with substance use disorders have elevated rates of substance misuse–related health and social problems and costs, and many people who misuse substances do not meet the diagnostic criteria for a substance use disorder. In 2015, for example, 12.5 million individuals misused a pain reliever in the past year—setting the stage for a potential overdose—but only 2.9 million met diagnostic criteria for a prescription medication disorder.

“The clear implications of these data are that a comprehensive approach to reducing the misuse of alcohol and drugs—one that includes the implementation of effective prevention programs and policy strategies as well as high-quality treatment services—is needed to reduce the problems and costs of substance misuse in the U.S.,” the report states.

“In fact, greater impact is likely to be achieved by reducing substance misuse in the general population—that is, among people who are not addicted—than among those with severe substance use problems. Of course, efforts to reduce general population rates of substance use and misuse are also likely to reduce rates of substance use disorders, because substance use disorders typically develop over time following repeated episodes of misuse that result in the progressive changes to brain circuitry that underlie addiction.”

The report goes on to explain that making 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. Negative attitudes and ways of talking about substance misuse and substance use disorders can be entrenched to help change social attitudes.

“By coming together as a society, it is similarly possible to change attitudes toward substance misuse and substance use disorders,” the report states. “This [will help] people become comfortable talking about their concerns with their doctors and widening access to prevention and treatment. Now is the time to make this change, for the health and well-being of all Americans.”

The report also explains that many of the drug and alcohol misuse and abuse statistics are especially shocking as the U.S. spends more than any other country on health care. However, the U.S. also ranks 27th in life expectancy, which has plateaued or decreased for some segments of the population at a time when life expectancy continues to increase in other developed countries. A difference largely due to substance misuse and associated physical and mental health problems.

For example, recent research has shown an unprecedented increase in mortality among middle-aged white Americans between 1999 and 2014 that was largely driven by alcohol and drug misuse and suicides, although this trend was not seen within other racial and ethnic populations. An analysis from the Centers for Disease Control and Prevention (CDC) demonstrated that alcohol and drug misuse accounted for a roughly four month decline in life expectancy among white Americans; no other cause of death had a larger negative impact in this population.

In addition to the direct impact substance misuse is having on the American population, substance misuse and substance use disorders also have serious economic consequences, costing more than $400 billion annually in crime, health, and lost productivity. Despite decades of expense and effort focused on a criminal justice–based model for addressing substance use-related problems, substance misuse remains a national public health crisis.

By taking into account these facts and other statistics, the reports explains that we can create more effective ways to deal with substance misuse and also find additional ways to help educate Americans about the dangers and consequences of substance misuse.

“By adopting an evidence-based public health approach, America has the opportunity to take genuinely effective steps to prevent and treat substance-related issues,” the report states. “Such an approach can prevent substance initiation or escalation from use to a disorder, and thus reduce the number of people suffering with addiction; it can shorten the duration of illness for sufferers; and it can reduce the number of substance-related deaths.

“A public health approach will also reduce collateral damage created by substance misuse, such as infectious disease transmission and motor vehicle crashes. Thus, promoting much wider adoption of appropriate evidence-based prevention, treatment, and recovery strategies needs to be a top public health priority.”

The read the report in its entirety, click here.

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