This past November, the highly anticipated and long overdue, first-ever Surgeon General’s report on alcohol, drugs and health was released. The report entitled Facing Addiction in America: The Surgeon General’s Report on Drugs, Alcohol, and Health was created to highlight ”the important health and social problems associated with alcohol and drug misuse in America” and the need for a comprehensive approach to address substance use disorders (SUDs) in the United States. The report is a welcome call to action for the addiction and public health communities.
In his capacity as ”America’s Doctor,” Surgeon General Vivek H. Murphy is finally putting addiction front and center when it comes to discussions about how to improve America’s health. Perhaps most noteworthy is the report’s call for a public health model for addressing substance misuse and related consequences. This embraces approaches that many advocates, researchers, and practitioners have called for since the height of the “war on drugs.”
The report provides the level of visibility and rallying cry needed to ensure that adequate resources are finally committed to transforming the landscape of addiction prevention, treatment, and recovery policy and practice in this country. In particular, it highlights that effective prevention programs and policies exist but are underutilized—a challenge that the Conrad N. Hilton Foundation has strived to address since its initial investment in alcohol and drug prevention in the early 1980s.
The comprehensive approach outlined in the report is encouraging. It highlights the key components needed to help inform the public’s understanding of substance misuse and addiction as health issues and outlines evidence-based and promising approaches to prevent substance misuse and addiction, intervene before crisis, provide access to high-quality treatment, and help people recover.
A Need To Educate The Public
The report begins by calling for ”enhanced public education to improve awareness about substance use problems.” This is important because although some progress has been made on this front, the public still struggles to fully comprehend substance use as a health issue. This is why the Hilton Foundation has partnered with Frameworks Institute to develop more effective communication approaches on substance use. Despite progress over the past three decades in the science of substance misuse and addiction, the public’s understanding about these issues has not caught up, according to Frameworks research.
When it comes to the impact of substance use on youth, the public is particularly naïve and continues to embrace the belief that substance use is a “rite of passage” for young people—a belief that decreases the public’s sense of urgency for implementing innovative prevention and early intervention approaches.
Fortunately, the report emphasizes that adolescence is a critical “at-risk period” for substance use and addiction. According to the nonprofit National Center on Addiction and Substance Abuse, research indicates that 90 percent of people who develop a substance use disorder started their use before age eighteen. However, this information is largely missing from the public’s dialogue, as is an understanding about the risk and protective factors that contribute to whether a young person develops a substance use disorder. The report provides an opportunity to shed light on these findings as well as on the broader thirty-year body of research showing that evidence-based prevention can make a difference.
In addition to calling for ”widespread implementation of evidence-based prevention policies and programs,” the report highlights the need to ”improve access to evidence-based treatment services, integrated with mainstream health care, for those at risk for or affected by substance use disorders.” These components lie at the core of the strategic initiative that the Hilton Foundation launched in 2013. The initiative is designed to prevent substance use disorders from developing during adolescence by training health care practitioners and other youth services practitioners to have conversations with young people about substance use as a health risk behavior so they better understand the connection among their health, alcohol and drug use, and mental health.
Screening, Brief Intervention, And Referral To Treatment (SBIRT)
In line with recent guidance from the American Academy of Pediatrics, the Hilton Foundation initiative is supporting activities to develop research and learning to better understand how the public health approach referred to as Screening, Brief Intervention, and Referral to Treatment (SBIRT) can provide a framework to help practitioners across a range of settings prevent or delay the onset of substance use in lower-risk youth, discourage ongoing use and reduce harm in youth with moderate risk, and refer young people who have developed SUDs to potentially life-saving treatment. This approach stands in stark contrast to the ”Just Say No” approach of the past and instead centers on supporting young people in their decision making rather than lecturing them or using scare tactics. We know that those approaches are ineffective, yet, unfortunately, they are the default in still too many places.
Finally, the report calls for a strong investment in ”recovery support services (RSS) that can support people in sustaining their recovery and preventing relapse; and [in] research-informed public policies and financing strategies to ensure that substance misuse and use disorder services are accessible, compassionate, efficient, and sustainable.”
At the Hilton Foundation, our plea is that these efforts place young people at the forefront. For most people, addiction begins with use during adolescence. Yet youth services are rarely the priority and instead tend to be an afterthought. Incredible work is happening to organize young people in recovery to be peer advocates for others and to explore how they can also be assets in strengthening the entire continuum from prevention to recovery supports. In partnership with organizations like the Center for Social Innovation and Young People in Recovery, we are investing in strategies to explore how young people who have overcome addiction can use that experience to inform and improve approaches to working with youth, particularly those at risk of developing a problem with alcohol or drugs.
More than fifty years ago, the first Surgeon General’s report on smoking and health was released. Since then we have made significant strides in reducing smoking rates, and millions of lives have been saved.
Reason For Optimism
Despite the narrative often portrayed, there is reason for optimism that we can do the same for substance use and addiction. This year’s Monitoring the Future survey of substance use among youth once again showed reductions in use of illicit drugs—other than marijuana—to the lowest level in the history of the survey, as well as continued declines in alcohol use and binge drinking. The Hilton Foundation proudly stands with the Surgeon General, our partners, other philanthropic entities, and all those affected by addiction in calling for a significant investment in public health responses to addiction.
We have ”the way” to prevent addiction—unfortunately, we haven’t had the will. The Surgeon General’s report not only provides a compelling case for why we need to change course but also shows the road map for how. We urge you to join the collective effort to face addiction in America.
“The Opioid Abuse Crisis Is A Rare Area Of Bipartisan Consensus,” by Robert Blendon, Caitlin McMurtry, John Benson, and Justin Sayde, September 12, 2016, Health Affairs Blog.
“To Address Substance Use Among Adolescents, Look To Pediatric Primary Care,” by Sharon Levy, August 9, 2016, Health Affairs Blog.
“To Prevent Addiction In Adults, Help Teens Learn How To Cope,” by Elaine Korry, November 12, 2015, NPR Shots. This story was produced by Youth Today.
“Foundation Grants To Prevent Substance Use Disorders,” by Lee-Lee Prina, June 2015 issue, Health Affairs (GrantWatch section).