I was laying on my porch on a summer afternoon with my feet up on the couch when I realized that the health of all Americans was about to change for the better. It is a wonderful day in the life of a physician when the word gets out that there is hope on the horizon and an answer in the air. I say all Americans, because in 1964 when Dr. Terry, the Surgeon General at that time, released a report detailing the dangers of cigarette smoking as a cause of cancer, even those that had second hand smoke exposure were also well on their way to more health. I was relieved that officials with responsibility for the nation’s health had made an important statement.
The moment was repeated in a way when the Surgeon General’s Report on Alcohol, Drugs and Health was recently released. The difference this time was that the news went out to every person with a cell phone simultaneously in a matter of minutes. Even if it was embedded in some newsfeed somewhere or some friends of a friend’s Facebook post, it was there.
Why is this so important?
Because the number of people that are affected by someone else’s substance use and abuse is exponentially higher than the numbers of those with the substance problem themselves. There are 80,000 deaths related to alcohol misuse and 47,000 deaths due to drug overdoses each year. This does not include the millions of people who are not classified as addicted but are engaged in substance misuse and are at greater risk to themselves and others and the subsequent development of a substance use disorder. Multiply that by the number of friends, loved ones, extended family members, co-workers, neighbors, and even encounters with strangers just one person has and you can begin to see just how large that number can be.
The neurobiological basis for substance use disorders has been established by a growing body of research. It concludes that addiction is a chronic disease of the brain involving hijacking of the brain’s reward system. This hijacking is responsible for the behaviors of the addicted individual that drive them further into their addiction. In other words, they won’t stop using because they can’t stop. Dopamine “hits” or “floods” come with use of the addictive substance.
This is why the substance is addictive. The addict wants and must have more.
While recommendations about expanding treatment and training more clinicians to recognize and refer to treatment were contained in the report, the power of the report is most of all going to be in getting all of us with phones and without them to talk to another person about the realities of uncontrollable craving. If we do this, we bring the darkness of addiction into the light. The Surgeon General has “shone” us the way.
So here is a summary of the report. Please read it. You will be amazed. And you might even amaze yourself at what you can do with the knowledge in it.
For a viewpoint of the report see: Journal of the American Medical Association’s On Line First.