US Surgeon General weighs in on addiction treatment and recovery

Hoping to create a landmark change in direction of treatment for alcohol and drug addictions comparable to the 1964 report on cigarette smoking, the US Surgeon General has issued a report, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. While not breaking new ground in therapies or treatment recommendations, the 428-page report brings together a wide range of studies, and leans in the direction of taking a population-health perspective on these addictions: It’s hard to identify a sector of healthcare or public health services that is not called on to step up their activities. Opioid addiction, either from DEA Schedule 1 substances (heroin and derivatives) or abuse of Schedule 2 prescription drugs (opioids and the growing number of synthetic opioid-like substances) call for the most urgent action.

The societal and healthcare costs of addictions are well known: just under 29,000 deaths from opioid abuse (heroin and prescription drugs) were recorded in 2014, double the number of such deaths since 2010. (Alcohol-related abuse, while obviously a major concern in addiction treatment, has been fairly stable by most measures counted by the Substance Abuse and Mental Health Services Administration of HHS.)

Specific to prescription drug abuse, the most critical area of concern is abuse of opioid drugs. Policy in this addiction area subdivides into prevention (essentially, attempting to minimize the exposure of individuals to abused drugs); treatment; and recovery/maintenance. “Medication-Assisted Treatment” (MAT) is one of the main processes for the treatment stage; for opioids, the drugs methadone, buprenorphine and naltrexone are the primary existing treatments (however, the report skips over a variety of drugs and vaccines in clinical research).

Differing schools of thought on drug abuse and therapy are dealt with directly in the report. One is that drug addiction is definitively tied to physical condition: “We now know that there is a neurobiological basis for substance use disorders with potential for both recovery and recurrence,” is how Vivek Murthy, Surgeon General, puts it. Acknowledging this should put addiction recovery more in the mainstream of healthcare services, and more integrated with both health and hospital systems and with medical professions.