People who were alive in the 1950s (or watched Mad Men) know smoking used to be allowed everywhere—in grocery stores, sitting at your desk at work, even in the maternity ward of hospitals. Lung cancer be damned, second-hand smoke—what’s that? The dangers of tobacco just weren’t understood and widely accepted. Then, in 1964, the US Surgeon General published a report on the dangers of smoking and all of that started to change.
Now, President Barack Obama’s badass Surgeon General Dr. Vivek Murthy has used the time he has left in the post to release a groundbreaking report called Facing Addiction in America. In spite of some opposition from people who thought he was too young (he’ll be 40 in July) and the NRA, who didn’t like that he called gun violence a threat to public health (duh), he’s been rocking the job. This final move is no exception.
Facing Addiction
By now, we have all heard the scary statistics about the heroin epidemic sweeping the US. But what this report makes clear is that addiction isn’t just about illegal drugs and everyone is at risk—regardless of gender, race and ethnicity and income. It clearly states that nearly 21 million Americans struggle with substance use. That’s more than the number of people who have all forms of cancer combined. The number of drug overdoses is higher than ever, with a staggering 47,055 deaths reported in 2014. Still, the government funds devoted to substance abuse lag far behind the money allocated to combating other medical conditions, like heart disease and diabetes.
Not Bad, Just Sick
The report gets right to heart of the matter when it comes to addiction by explaining that it is not a moral failing. Anybody who has struggled with substance abuse understands acutely that reaching for the bottle or crack pipe has nothing to do with morals. People who are trying to stay sober and failing often have the best of intentions; the problem is once a drug hits an addict’s system, the chemistry of the brain changes. Decision-making processes are altered and basically, shit gets crazy. Murthy gets this and his report calls for, among other things, a widespread cultural change in understanding that addiction is a brain disease, not a character flaw.
Finally, somebody who is in a respected position of authority has turned the stigma of addiction on its head! “It’s time to change how we view addiction,” Murthy said when releasing the report. “Not as a moral failing but as a chronic illness that must be treated with skill, urgency and compassion. The way we address this crisis is a test for America.”
Murthy flips the script on the whole moral failing thing—pointing out that ignoring this crisis any longer and continuing to blame the addicts would be America’s real moral failing. He issues a call to action in the report’s preface, asking, “Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss?” Can I get an amen?
Redefining Recovery
Murthy’s report works hard to highlight common misconceptions about addiction and recovery and also point out what’s working, so we can do more if it. One interesting takeaway is the ever-evolving definition of recovery. The report says that although specific elements of the definition may differ, everybody agrees that recovery “goes beyond the remission of symptoms to include a positive change in the whole person.”
The report reinforces the idea that total abstinence from all drugs is not always sufficient to define recovery. On that note, the Surgeon General is a big supporter of Medication-Assisted Treatment (MAT) with medications such as Suboxone and methadone used to treat opioid addition. The report’s findings claim that expanding access to these types of treatment can really help combat the opioid epidemic in our country, but it’s no quick fix and must be combined with other forms of therapy. “One study suggested that individuals who receive MAT for fewer than 3 years are more likely to relapse than those who are in treatment for 3 or more years,” the report states. So, providing a framework for long-term MAT and social supports is necessary if we want to help these folks. This means more access to MAT, more therapy with MAT and providing a safe place where those on long-term medication protocols can begin to recover.
This may not be a popular sentiment among 12-step traditionalists, but it is probably realistic. Perhaps the disapproving subset of the recovery community should apply some of their own beloved spiritual principle of open-mindedness to this problem. If we are going to combat addiction, don’t people who are already in recovery need to break down their own stigmas and stereotypes about what recovery is?
The Surgeon General’s report does recognize the value of the 12-step approach. In fact, it explicitly states that there is ample “well-supported scientific evidence” of the efficacy of 12 step. While this report alone may not serve to put to rest the age-old debate whether 12-step is in fact “evidence-based,” it certainly seems to have a handle on the different ways 12-step involvement can enhance recovery. The research also suggests that professional treatment programs or sober coaches that encourage involvement in AA and NA lower health care costs by reducing relapses and need for further treatment.
What about Booze and Pot?
According to the report, alcohol is by far the most prevalent substance abused, followed by marijuana, with misuse of prescription pain relievers coming in third place. If you’re thinking it seems like a waste of time to push for new recovery legislation when alcohol is legal in all 50 states and pot is well on its way, then this report has some thoughts for you. Good old alcohol tax policies get a shout-out in the section on evidence-based prevention: “Higher alcohol taxes have also been shown to reduce alcohol consumption.” Other policies proven by research include limiting the density of stores selling alcohol, banning Sunday sales and stricter penalties for bars found to be serving minors. This suggests staying vigilant about the legislation surrounding legal drugs is an important part of the big picture.
The report also suggests we should apply what has worked with alcohol and tobacco policies to minimize harm as marijuana becomes legal all over the US. Legalizing marijuana is no longer just a song lyric. Voters in 28 states have now approved recreational or medical marijuana laws. There is a lot we still don’t know when it comes to pot and addiction. It is often overlooked as a serious threat to addicts (like, can you really OD on pot?). In the report, Murthy supports easing existing barriers to marijuana studies, but also stated publicly that marijuana is addictive and he’s worried the legalization movement is moving faster than research. On one hand, he recognizes that pot may have therapeutic benefits, but also can’t deny its role in the addiction epidemic. He calls for marijuana screening and early intervention procedures for use in general and primary care and general mental health care settings.
Access to Treatment
Everybody is wondering what a Trump White House might mean for recovery legislation. Red states that helped get him elected, such as West Virginia, Ohio and Kentucky, have the highest overdose rates. Enforcing laws that require insurers to cover addiction treatment will be a true test of Trump’s promise to put average Americans ahead of corporate interests. One thing is for sure, addiction is bad business. Not only does it break families apart but it also costs the nation major bucks—with, according to this report, alcohol abuse wreaking an estimated yearly economic impact of $249 billion and illicit drug use totaling $193 billion.
Since the report was published, Murthy has publicly stated he hasn’t spoken to Trump but looks forward to working with his administration. “We have made progress,” Murthy said. “How do we keep that progress going? A key part is making sure people have insurance coverage.” Let’s just hope that if Trump makes good on his promise to dismantle Obamacare, there are safeguards put in place to protect those who are currently depending on its coverage for rehab. And that whatever comes next serves to expand access to affordable treatment instead of moving backward.
There are a lot of moving pieces presented in the Surgeon General’s report. It is groundbreaking in that it refutes the idea that addicts are immoral or flawed and acknowledges the disease concept of addiction as medically-proven truth. For those of us in long-term recovery who have struggled against the stigmas and misconceptions about being addicts, this definitely feels like a triumph. What remains to be seen is whether the extensive recommendations contained within the report will inspire practical application by informing public policy and popular opinion. I guess, as the 12-step euphemism goes, more will be revealed.
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