Facing Addiction in America
On November 17, 2016 The Surgeon General of The United States (Dr. Vivik Murthy) issued THE FIRST Surgeon General Report on our addictions problems. Since addictions in America may well be the single most threatening condition facing the nation’s health and economy, as well as casting strong doubt about a good future, one would hope such concerns are alive and well at the CDC and elsewhere in the government. The report noted that addiction is a chronic brain-based disease; let’s hope that they intend to fix it with MORE than just more pills! It is clear that the neurobiology of substance use disorders includes parts of the brain most involved in specific actions and behaviors: basal ganglia, reward centers, amygdala, and prefrontal cortex are all impacted by addictions. Such changes correlate well with experiences like binge-intoxication, withdrawal and negative affects, and preoccupation with anticipation of relief. Brain change
implications also include addictive outcomes like cue-sensitization, self-medicating stress reactions, rewards, use/abuse incentives, and weakened prefrontal executive functions in decision making, etc. A key issue in addictions is SELF-MEDICATION of negative affects and various punishing mental health symptoms. In my mind, and based on approximately 40 years of experience in the co-occurring disorders treatment field, I see addictions as bio-psycho-social-spiritual in nature. Our treatment and recovery efforts need to include all four components of this reality, not purely biological interventions. Treatment and self-help do work; we now have approximately 25,000,000 formerly addicted people in sustained, stable recovery. Generally, formal treatment is short-term and more intensive while recovery process (self-help, AA, 12 Steps, peer supports, etc.) are longer-term processes. Often formal treatment initiates the first small change in people; once a little more stable, many people then move into self-help for a much longer-term recovery process. Some people wait until they bottom-out; in this situation, one enters treatment or self-help as a necessity to prevent total emotional/physical collapse or suicide.
Most of the data used in the report comes from 2015 and refers to adults (sometimes including adolescents). The data below certainly hint that Americans have inability to manage negative emotions/stress and, perhaps, the emptiness in our hearts/souls. So much materialism has NOT positively impacted our habitual use of substances. With the recent economic downturn, we face more stress. More stress often results in more self-medication. So9 here we are! As a quick review I will simply state some details from the report.
How Bad is Bad? It is VERY bad!
- One in 7 people in The United States will experience a substance use disorder sometime in their lifetime.
- Only about 10% of addicted people enter formal treatment. This is a fact despite reasonably good outcomes from evidence-based treatments (especially behavioral) and self-help.
- 27,000,000 people suffer from a current alcohol or other drug (AOD) or prescribed medications abuse problem.
- 48,000,000 have used an illicit substances or abused medications in the past.
- 28,000,000 have been under the influence while driving sometime in the past year.
- Although not in the report, cell-phone addiction may also be serious cause of automobile accidents and deaths on our highways and roadways.
- About 40% of people suffering from an addiction also have another mental disorder, and less than half of this group enters formal treatment.
- It appears that alcohol is still the number one substance used regarding lives lost and overall costs.
- It is estimated that for every dollar spent on AOD problems, we save four dollars in health care costs and seven dollars in corrections costs.
- The total cost to American society of our addictions problem is $442,000,000,000 each year. How long can our economy last with this kind of annual loss.
- The primary reasons for so few people in treatment are many, but mainly poor healthcare screening, fear and shame, discrimination, cost, and strong stigma.
We better wake up!
More people need to be in treatment and self-help. Treatment and self-help MUST learn to work together; the future health and welfare of our country may well depend upon this new alliance. Our federal and state governments MUST put additional resources into formal treatment and recovery services. The future of The United States depends upon swift and decisive actions by the government and the American people.
For more information see Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. (November 16, 2016). Washington, DC: United States Government Publication. `
By Anthony R. Quintiliani, PhD., LADC
Author of Mindful Happiness
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