Surgeon general’s report: One in seven Americans face substance addiction
19 November 2016
One in seven Americans will become addicted to drugs or alcohol in their lifetimes, but only 10 percent of those affected will ever receive any help in treating their addictions. These are some of the grim statistics provided in a new report released Thursday by the US surgeon general and the Department of Health and Human Services.
“Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health” reports that over 27 million people in the United States reported current use of illicit drugs or misuse of prescription drugs in 2015, and over 66 million people reported binge drinking in the past month.
The victims of this health and societal crisis are the tens of thousands of lives lost and ruined each year due to substance misuse. Substance addiction cuts across all segments of society, but has hit rural communities, the deindustrialized Rust Belt and impoverished areas of Appalachia particularly hard.
Alcohol misuse contributes to 88,000 deaths in the US every year; 1 in 10 deaths among working adults is due to alcohol misuse. In 2014, there were 47,055 drug overdose deaths, including 28,647 people who died from a drug overdose involving some type of opioid, more than in any previous year on record.
The report uses the term “misuse” as opposed to “abuse” in an effort to remove some of the stigma of addiction to encourage and facilitate treatment.
While the US spends more than any other country on health care, it ranks 27th in life expectancy, at a time when life expectancy continues to increase in other developed countries. The report notes that this disparity in life expectancy “is largely due to substance misuse and associated physical and mental health problems.”
The report points to recent research showing 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 witnessed in other racial and ethnic populations.
The surgeon general estimates that substance misuse disorders cost “more than $400 billion annually in crime, health and lost productivity.” The human costs are devastating, including deaths and injuries from motor vehicle crashes, intimate partner and sexual violence, suicide attempts and fatalities, overdoses, and numerous health problems.
In 2014, 9,967 people were killed in motor vehicle accidents in the US while driving under the influence of alcohol, accounting for nearly one third of all traffic-related fatalities. While there are approximately 1.3 million arrests for driving under the influence each year, this number represents only about 1 percent of the actual alcohol-impaired driving incidents reported in national surveys.
The Centers for Disease Control and Prevention (CDC) reports more than 2,200 alcohol overdose (alcohol poisoning) deaths in the US each year, an average of six a day. More than three quarters of alcohol overdose deaths occur among adults between the ages of 35 and 64, and 76 percent who die are men.
In 2014, 47,055 drug overdose deaths occurred in the US, with 61 percent of these the result of opioid use, including prescription opioids and heroin. The number of people dying from opioid overdoses increased nearly fourfold between 1999 and 2014.
The report notes that the over-prescription of opioid pain relievers beginning in the 1990s has led to a rapid escalation of their use and misuse among a wide demographic of men and women across the US. The use of opioids is so widespread that more people use prescription opioids (38 percent) than all tobacco products combined (31 percent).
Nearly 30,000 people died due to a heroin or prescription opioid overdose in 2014, and an estimated 20,000 died as a result of an unintentional overdose of alcohol, cocaine, or non-opioid prescription drugs.
The illegal manufacturing and distribution of synthetic opioids such as fentanyl, which are often combined with heroin or distributed as heroin, are contributing to the rapid increase in opioid overdose deaths.
Alcohol and drug misuse have numerous longer-term effects on physical and mental health. Heavy drinking can lead to hypertension, liver disease and certain cancers; regular marijuana use is associated with chronic bronchitis; and use of stimulants such as cocaine can lead to heart disease.
Alcohol and substance misuse during pregnancy can result in long lasting health effects for the baby. Alcohol misuse can cause fetal alcohol spectrum disorders (FASDs), resulting in physical, mental and behavioral problems in children. It is estimated that FASDs affect as many as 2 to 5 percent of the population. The opioid crisis has resulted in a fivefold increase in the number of babies dependent on opioids at birth.
The National Survey on Drug Use and Health (NSDUH) found that among the more than 265 million Americans aged 12 and over in 2015, almost 8 percent of this population met diagnostic criteria for a substance use disorder for alcohol or illicit drugs. Another 1 percent met the criteria for both an alcohol and illicit drug use disorder.
Although 20.8 million people met the diagnostic criteria for a substance use disorder in 2015, only 2.2 million of them received any type of treatment. The surgeon general’s report is short on answers as to why this is the case.
The report includes a chapter on “The Neurobiology of Substance Use, Misuse, and Addiction,” which describes the three main circuits in the brain involved in addiction, and explains how substance use can “hijack” the normal functioning of these circuits.
“Understanding this transformation in the brain is critical to understanding why addiction is a health condition, not a moral failing or character flaw,” the authors note. They also point to medications that have proven useful in treating both drug and alcohol addiction, but which have been often overlooked and under-prescribed.
The surgeon general’s report recommends health professionals act on this research in their treatment of those suffering from addiction. However, the fact that 90 percent of those in need of treatment never receive it—and addiction and overdose deaths continue to skyrocket—points to deeper economic and social factors. This includes the lack of funding for alcohol and drug misuse treatment at federal, state and local level, leading to those in need often ending up in the prison system instead of in treatment.
Recognizing the role of poverty, unemployment and other life stresses as contributing factors to addiction, the surgeon general’s report recommends initiatives to provide affordable housing, job training and recovery support to “address the risk and protective factors that are most actionable at the local level.”
Arguing that “the health care system alone cannot address all of the major determinants of health related to substance misuse,” the authors recommend rallying “community-based organizations, religious institutions, law enforcement, local businesses, researchers and other public, private, and voluntary entities” to tackle the crisis.
Under conditions where austerity and budget cuts can only be expected to deepen under the future Trump administration, such band-aid prescriptions offer little hope to the tens of millions suffering from addiction, many of whom face a future of increased health problems, overdose and death.