US surgeon general: Addiction is a medical crisis, ‘not a character flaw’

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Surgeon general's addiction report

In what may be his last significant act as President Barack Obama’s surgeon general, Dr. Vivek Murthy released a report Thursday calling for a major cultural shift in the way Americans view drug and alcohol addiction.

The report, “Facing Addiction in America,” details the toll addiction takes on the nation — 78 people die each day from an opioid overdose; 20 million have a substance use disorder — and explains how brain science offers hope for recovery. While its findings have been reported elsewhere, including by other federal agencies, the report seeks to inspire action and sway public opinion in the style of the 1964 surgeon general’s landmark report on smoking.

According to the report, the estimated yearly economic impact of drug and alcohol abuse in the U.S. is $442 billion.

Surgeon general's addiction report

The surgeon general states the biggest contributor in the crisis is the ‘treatment gap.’ Only ten percent of people suffering from addiction ever receive any type of specialized treatment.

Murthy states major reasons for this treatment gap are inability to access or afford care, and the fear of discrimination if one’s addiction status is revealed.

He further points out that, historically, the war on drugs has been fought through the criminal justice system – whereas solutions and resources in the medical community have been increasingly neglected.

In an interview Wednesday, Murthy said he hasn’t spoken to Trump but looks forward to working with his administration to save lives with expanded access to treatment.

“We have made progress,” Murthy said. “How do we keep that progress going? A key part is making sure people have insurance coverage.”

Here are a few takeaways from the surgeon general’s report:

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NOT A MORAL FAILING

Addiction is a chronic illness, not a character flaw or a moral failing, the report says. Stigma and shame have kept people from seeking help and weakened public investment.

Murthy issues a call to action in the preface: “How we respond to this crisis is a moral test for America. Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss?”

Surgeon general addiction report
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MEDICATION MYTHS

The surgeon general’s report refutes abstinence-only philosophies as unscientific and supports medications such as buprenorphine and methadone that are used to treat opioid addition. That may annoy supporters of traditional 12-step programs who see medications as substituting one addiction for another.

Medication-assisted treatment (MAT) for opioid addiction can take time. “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.

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TV-STYLE INTERVENTIONS

Staged interventions, like those depicted on TV, may backfire. Planned surprise confrontations “have not been demonstrated to be an effective way to engage people in treatment,” the report says. The trouble with the approach? According to the surgeon general’s report, it can heighten resistance and attack the self-worth of the addict.

intervention

Public exposure and shaming of addicts – such as depicted on the long-running TV show “Intervention” – more often has negative effects on an addict.

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ALCOHOLICS ANONYMOUS

Alcoholics Anonymous was founded in 1935 because mainstream medicine wasn’t treating alcohol disorders. That started a legacy of separating addiction treatment from the rest of medicine.

The report makes room for AA and other recovery support services, noting they don’t require health insurance and are free, but it also says they “are not the same as treatment and have only recently been included as part of the health care system.”

AA gets praise for adaptability. American Indians, for instance, have incorporated Native spirituality and allowed families to attend meetings. Research shows AA to be “an effective recovery resource,” the report concludes.

A meeting of Alcoholics Anonymous

A meeting of Alcoholics Anonymous in the 1950s was based on much the same 12-step program used today.

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WHAT ABOUT MARIJUANA?

The report suggests learning from alcohol and tobacco policies to find out what works to minimize harm as marijuana becomes legal.

Voters in eight states have approved adult use of recreational marijuana and more than two dozen states have medical marijuana laws. The report cites “a growing body of research” suggesting marijuana’s chemicals can help with “pain, nausea, epilepsy, obesity, wasting disease, addiction, autoimmune disorders, and other conditions.”

Murthy supports easing existing barriers to marijuana studies, but said Wednesday that he’s worried the legalization movement is moving faster than research. “Marijuana is in fact addictive,” he said.

An electronic billboard displays a marijuana hashtag at Times Square in New York

An electronic billboard displays a marijuana hashtag at Times Square in New York, U.S., November 7, 2016. REUTERS/Shannon Stapleton

Story includes content from The Associated Press.