Substance Abuse Disorders Isolated from the Health Care system.
On November 17th, 2016, the Surgeon General of the United States, Vivak H Murthy, published a landmark report entitled, “Facing Addiction in America” a comprehensive review of substance use, misuse, and disorders. Previous reports of the Surgeon General have highlighted the public health crisis challenges of Tobacco, AIDS, and Mental Health issues, and the hope is that this latest report will increase understanding and create a sense of urgency to address substance use disorders in the United States.
21 million people in America have a substance use disorder. This is comparable to the number of people with diabetes and is higher than the total number of Americans suffering from all cancers combined. This constitutes a major public health crisis that affects individuals, families, and communities. It is estimated that the yearly economic impact for alcohol abuse is 249 billion and 193 billion for illicit drug use. Despite this, our health care system has not given as much attention to addiction as it has other health care problems that affect the same number of people and substance use issues have remained mostly isolated form the rest of health care.
As highlighted in the Surgeon General’s report, only one in 10 people with a substance use disorder receives treatment. The report identifies many contributing factors including guilt, shame and misunderstanding about substance use disorders, the inability to access or afford treatment, and the need of screening in traditional medical settings. Furthermore, it is reported that 40% of individuals who know they have a problem are not ready to stop using
Despite the enormity of the problem the Surgeon General believes there is reason to be optimistic. There is well supported scientific evidence which shows that substance use disorders can be effectively treated with recurrence rates no higher than for the other chronic illnesses such as diabetes, asthma, and hypertension. There is also well supported scientific evidence that treatment for substance use disorders including inpatient, residential, and outpatient are cost-effective compared to the cost of no treatment. The good news according to the Substance Abuse and Mental Health Services Association (SAMHSA) is that prevention works, treatment is effective, and recovery is possible.