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Surgeon general’s report calls for response to addiction crisis

November 24, 2016 at 6:25 PM EDT
U.S. Surgeon General Vivek Murthy is warning Americans of the prevalence of substance abuse and the risks of not addressing it. His new report describes the lethal impact and widespread scope of addiction. William Brangham speaks with Murthy for more on why so few people find effective treatment, the stigma around addiction and the corresponding medical and legal costs of the problem.

WILLIAM BRANGHAM:  According to the surgeon general’s report more than 27 million Americans have problems with prescription drugs, illegal drugs or alcohol.  But just a fraction of those people, only 10 percent, get meaningful help.  The report cites missed opportunities for prevention and treatment and it says our substance abuse costs the country a staggering 440 billion a year.  I’m joined by the US surgeon general Dr. Vivek Murthy. Doctor, thank you very much for being here.
VIVEK MURTHY, U.S. Surgeon General: Really glad to be with you.
WILLIAM BRANGHAM: This is a pretty sobering report.  Millions of people suffering, very, very few people are getting help.  When you compiled all this data, were you surprised by what you had found?
VIVEK MURTHY: Well, I had seen the problem up close as a doctor practicing medicine.  When I came into medicine, I expected as an internal medicine doctor to primarily see people with diabetes, heart disease and cancer, and I was shocked by the number of patients who came under my care who actually had substance abuse.
WILLIAM BRANGHAM: You were seeing this in private practice before being tapped to be in the federal government?
VIVEK MURTHY: Yes, I have always seen this — we even — starting in medical school itself and then on throughout my medical career, the experience was not unique to me but many of my clinician colleagues were seeing the same thing and they were really surprised.
When I became surgeon general and had the privilege of travelling around the country and hearing people’s stories firsthand, I found that every community was touched in some way by substance abuse disorders.  I went to a small fishing village in Alaska called Napaskiak which is accessible only by boat and no roads to go there and even in this small village of less than 500 people, the small little building where they kept medications had been broken into multiple times by people seeking out prescription painkillers.
WILLIAM BRANGHAM: You say in this report that we as a nation need to think differently about addiction and to look at substance abuse and addiction differently.  How do we look at it now and what would you like to see change?
VIVEK MURTHY: Unfortunately, for too many people, addiction is a disease of choice, they see as a character flaw as evidence of moral failing, but what we know they are clearly from the science, is that addiction is actually none of those things it’s a chronic disease of the brain.
We have good scientific studies that tell us that addiction impacts the circuits in your brain and in specific parts of the brain that affect impulse control, decision making and your stress and reward response.  When we understand that, we start to have a better sense of why it is so easy for people to relapse with substance abuse disorders and why people experience withdrawal symptoms and cravings.
WILLIAM BRANGHAM: Can you explain — that number really jumps, 440 billion dollars in costs from substance abuse.  How do the costs add up?
VIVEK MURTHY: These costs come from several streams.  One is from direct healthcare costs.  Also losses in workplace productivity as well as criminal justice system costs.  The good news is we have evidence-based treatment and prevention strategies at work.  The problem is they’re just not getting it to enough people.
WILLIAM BRANGHAM: Why is that? You report details quite a bit of these things that you argue absolutely are proven to work but aren’t being used, why is that?
VIVEK MURTHY: It’s really striking and it’s especially striking when you recognize it.  Not only do we have a humanitarian reason to get treatments to people but we know that for every dollar that we invest in treatment we save four dollars in healthcare costs, seven dollars in criminal justice system costs.  We have prevention programs that are proven, that can save up to 64 dollars for every one dollar invested.
A part of the reason that people haven’t gotten these treatments is that, as a country, number one, we haven’t invested enough in expansion of treatment programs.  Number two, we haven’t trained our clinicians widely enough in how to recognize, diagnose and treat substance abuse disorders and, third, there is this ongoing, unfortunate stigma around substance abuse disorders that prevents people from seeking help in the first place.
WILLIAM BRANGHAM: On the prevention side, what is it that works? What is it that we know can be done to help people to stop these substance abuse problems from developing?
VIVEK MURTHY: Well, the good news is that, there are prevention programs that don’t just target one particular kind of substance but they can be effective reducing rates of use of alcohol, tobacco as well as elicit substances particularly by our youth and these programs are varied but some of them are school-based programs, one called the behavior game which trains young children in how to deal with stress in a healthy way and how to understand some of these substances of misuse and understand how to deal with them responsibly.
There are also community-based programs that focus on education and on dealing with stress in a healthy way.  And this is a key point which is, as I’ve traveled around the country, I have found many times when people are using substances or when they begin, they begin trying to medicate some type of pain they’re experiencing.  It may not be physical pain.  It may be emotional pain or stress they’re experiencing.  If we can help equip young people in particular with healthy ways of dealing with stress we can go a long way toward preventing substance abuse disorders.
WILLIAM BRANGHAM: There are many people in the treatment and the substance abuse world who are so cheered by this report and it’s called to action.  There are others say it is too little, too late.  I know Massachusetts senator Ed Markey wrote that overdoses from the opioid epidemic are still rising and he says, yet this report fails to provide any detailed road map for how best to curb opioid addiction.  What’s your response to that?
VIVEK MURTHY: A couple of things.  Number one, in this report we took a broad view of all substances.  We didn’t just look at opioids but we also looked at alcohol, and it may surprise many people to recognize that alcohol leads to the other substances in terms of cost and lives lost.
So we dealt with a range of substances.  If you read the report carefully where you understand there is in fact a road map for how we should approach prevention and how we should approach treatment, there is also attention to given to recovery because what we have realized over time is that treatment is not a two-week process where you go in, get cured and are good to go.  Instead, we have to focus on long-term treatment because this is a chronic illness.  We give a fair amount of attention to recovery services which are the social supports and ongoing counseling that people need in order to reduce the amount of relapses.
My feeling is we have a number of concrete steps in the report that communities can take and we, in fact, dedicate the entire last chapter of the report to action, to not just defining the action doctors and nurses can take but what policymakers and families and law enforcement and teachers and educators need to take.
This report has something for everyone.  And that’s appropriate.  Substance abuse disorders touch everyone.  That’s something I’ve seen firsthand and we all need to play a part in addressing addiction in America.
WILLIAM BRANGHAM: Alright. Dr.  Vivek Murthy, surgeon general of the United States. Thank you very much.
VIVEK MURTHY: Glad to be with you.