Facing Addiction in America: A Call to Action from the United States Surgeon General
Fifty years ago, the Surgeon General’s landmark report on the adverse health consequences of smoking and tobacco triggered nationwide efforts to prevent tobacco use.
Similarly, on November 17, 2016, the United States Department of Health and Human Services released, under Vivek H. Murphy’s leadership, the first ever Surgeon General’s Report on Alcohol, Drugs and Health titled “Facing Addiction in America” (the Report). This groundbreaking report issues a call to action to end the public health crisis of addiction and provides a comprehensive account of the current knowledge base surrounding the neurobiology of addiction, prevention, treatment and recovery and how to integrate substance use services into health systems. The Report outlines the 30 year body of research supporting the effectiveness of prevention, includes recommendations for expanding the utilization of current evidence-based prevention approaches and highlights the need for additional research to further expand the knowledge base regarding prevention and early intervention, a key focus of the Conrad N. Hilton Foundation’s Youth Substance Use Prevention Strategic Initiative.
The Report highlights well-supported scientific evidence that demonstrates the effectiveness of prevention programs and policies. The Report emphasizes the importance of understanding “risk factors” that contribute to the likelihood that a young person first tries alcohol or drugs and develops a substance use disorder and the “protective factors” that may offer some degree of protection from risks factors. Another key prevention finding highlighted is that the earlier a person tries alcohol or drugs, the more likely he or she is to develop a substance use disorder; as we know 90 percent of individuals who experience a substance use disorder in adulthood began use before the age of eighteen. Therefore, preventing or delaying young people from trying substances is important for reducing the likelihood of Substance Use Disorder development and can be achieved by prevention and early intervention approaches designed to reduce risk and enhance protective factors. A key theme of the Report is helping healthcare providers understand and identify risk and protective factors so they have the knowledge and ability to respond to youth substance use before it becomes severe and leads to crisis.
Currently, many young people do not receive substance use services until after entering into crisis, such as overdose or involvement through the criminal justice system. The Report states that detecting problems and offering support only after people are already in crisis is not only bad medical practice, but also would be considered unacceptable for any other health conditions, like heart disease. Screening adolescents using evidence-based tools across all healthcare settings is the Report’s recommendation for identifying youth with, or at risk for developing, a substance use disorder. Another essential aspect of screening adolescents noted in the Report is identifying current risk factors and existing protective factors so that youth can receive a tailored and more efficient prevention and early intervention response.
There is a growing need for health care professionals such as physicians, nurses, nurse practitioners and other staff to be trained in evidence-based screenings for adolescents as well as appropriate methods of intervention. Several of the Foundation’s partners are engaged in efforts to educate healthcare practitioners about addiction and the role of screening and early intervention in promoting health and wellbeing of youth. The Report repeatedly calls for public and private systems of care to continue expanding their support for providing quality screening and early intervention education and training to healthcare providers.
The Report specifically highlights the Foundation’s efforts to expand the evidence base in support of screening and early intervention to address substance misuse problems in pediatrics and other settings that serve youth: one of the three main goals of the initiative. Current evidence shows the effectiveness of screening and brief intervention for alcohol use in adults across health care settings, but there is still a great need to expand the evidence base of behavioral interventions for adolescents. The Report supports implementing a continuum of care that includes effective prevention, early interventions, treatment options and recovery supports all of which should be tailored to meet the needs of each individual.
On November 17, Foundation staff attended the launch event for the report in Los Angeles, hosted by Facing Addiction, a partner of the Substance Use Prevention Strategic Initiative, in conjunction with the Surgeon General’s office. Entitled Facing Addiction in America – A National Summit, the event featured the United States Surgeon General Dr. Vivek Murthy and the media, stakeholders in the addiction field, policy makers and public figures. This event provided an opportunity to highlight the report in a national conversation about addiction and featured a video address from Foundation president and CEO, Peter Laugharn. Laugharn expressed the Foundation’s support of the Surgeon General’s Report for calling attention to these efforts and how the Substance Use Prevention Strategic Initiative works to advance the progress being made to prevent and reduce the use of alcohol and other drugs among young people in communities across the country.
It is loud and clear that prevention works, but it must be evidence-based. The Report proclaimed that there is a need for an ongoing investment in resources and infrastructure to ensure that prevention policies and programs can be implemented consistently, sustainably and at sufficient scale to reap the rewards of reduced substance misuse and its consequences in communities, which resonates with the current goals and objectives of the Substance Use Prevention Strategic Initiative. The initiative is continuing to explore new, innovative approaches to support a public health approach to addressing substance use among adolescents. Key learnings from our investments thus far inform new approaches that capitalize on new technologies and comprehensive approaches to implementation of evidence-based prevention and early intervention practices in the communities our young people call home.
“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.” -Alexa Eggleston
While there is a long way to go in preventing and reducing youth substance use and many challenges to overcome in route, there are evidence-based solutions in prevention, treatment and recovery that work.
“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.” -Alexa Eggleston