In January 2016, Dr. Vivek Murthy, then the 19th Surgeon General of the United States, released a report entitled “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.” The publication is a sobering reminder of the country’s drug problems and the need for education and rehab centers. It is also a call for health care providers, policymakers and citizens to understand and respond to the crisis.
According to an article in the New York Times, people in America are dying of heroin overdoses but not as many are dying from opioid painkillers prescribed by medical doctors. Only a few of those abusing either substance get treatment, however. One in seven Americans will develop a substance use disorder at some time during their lives, but only one in 10 will get help.
Substance use disorder can be successfully treated. First, however, people must be able to recognize the signs of addiction and know where to go for help. The disorder is a brain disease, not a personal failing. If society is better educated about the problem, it will be more likely that individuals will get treatment.
Substance Use Disorder Is an Illness
The surgeon general’s report addresses addiction issues and health problems related to drugs and alcohol, and it stresses the need for a change in the way we see the problem. Addiction, Dr. Murthy says, is a complex brain disease, not a character flaw. She also calls the situation a crisis and adds that people who need help must be treated with “skill, urgency and compassion.” That’s why it is so important to have caring, trained rehab specialists.
The National Institute on Drug Abuse (NIDA) defines addiction as “a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain.” Substance use disorder is a brain condition and a mental illness. It begins with a range of substance-related behaviors that lead to the final stage of addiction. However, the repeated use of alcohol or drugs also leads to physical illnesses.
Cultural Beliefs Affect Addictive Behavior
The story of tobacco and the medical profession is an example of how culture can influence health. Before the information age, medical doctors were the ultimate authorities on fitness and well-being. In the 1930s, the question of whether it was safe to smoke came to the public’s attention. Cigarette companies turned to research and doctors to reassure their patients.
Until the 1950s, doctors played a role in cigarette advertising. One ad said, “20,679 physicians say Luckies are less irritating.” The ad agency sent doctors free cigarettes and asked them if they were gentler to “sensitive and tender” throats. The company then claimed its “research” led to healthier smoking.
The ads ran in magazines like Ladies’ Home Journal and Time. Some even showed doctors using microscopes in a lab. One even proclaimed that, “More doctors smoke Camels than any other cigarette!” Before the 1950s, cigarette ads were commonplace in medical journals.
Although people questioned the dangers of smoking, Congress did not put warnings on packages of cigarettes until 1965. As this example shows, cultural norms play a big role in people’s behavior. Experts say it is time to change the way Americans think about drugs and alcohol.
Lack of Treatment Costs Everybody
NIDA estimates that alcohol, drugs, and nicotine cost the U.S. over $74 billion every year. This includes related crime, reduced productivity and health care costs. Over 63,000 Americans died from alcohol-related illnesses while another 480,000 deaths were linked to tobacco use. The following statistics estimate the cost based on results from 2007 to 2013:
- In 2007, illicit drugs cost $11 billion in health care and $193 billion overall.
- In 2010, tobacco cost $168 billion in health care and $300 billion overall.
- In 2010, alcohol cost $27 billion in health care and $249 billion overall.
- In 2010, prescription opioids cost $26 billion in health care and $78.5 billion overall.
Addiction Treatment Pays for Itself
The National Institutes of Health (NIH) says addiction treatment saves the U.S. much more than it costs. It also costs less than other options, such as putting people in jail. As an example, the NIH quotes the following figures: The cost for one year of methadone maintenance treatment is around $4,700 per patient. In contrast, the cost of one year in prison is around $24,000.
Other statistics show that every dollar spent on addiction treatment programs has a return of $4 to $7 in costs that result from drug-related theft, crime, and court costs. In just the field of health care, the savings can go as high as $12 saved for every $1 spent.
Financial numbers fail to account for the other ways that society benefits. Relationships between family, friends, and coworkers improve. Also, more work gets done and accidents, overdoses, and deaths go down.
Too Few People Get Help
Health care reform in 2012 meant that millions of Americans who had no access to addiction treatment would be eligible for care, but far too few seek treatment. Results from a National Survey on Drug Use and Health showed that 23.5 million, or one in 10, people in the U.S. were addicted to drugs or alcohol in 2010. Of those, only 11 percent got treatment. That means that over 20 million Americans over the age of 12 were not getting the help they needed. The study revealed other sobering statistics:
- Most Americans who go without treatment say they don’t have insurance or the money to pay for it.
- Almost half of those who got treatment said they paid for it with their own money.
- Unlike other chronic illnesses, most of the money for treating substance use disorders comes from the government.
- Over 75 percent of treatment costs are paid by federal, state and local governments.
- Private insurance and out-of-pocket expenses must pay for the rest.
- Screening and treatment are not a part of the health care system.
- Fewer than 7 percent were referred by their doctors or health care providers.
- Over 65 percent were self-referred or came through the criminal justice system.
Millions of Young People Needed Treatment in 2015
The Substance Abuse and Mental Health Administration estimated that 21.7 million people over the age of 12 needed substance abuse treatment in the year preceding the 2015 survey. The biggest number belonged to young people between the ages of 18 and 25. The smallest group was made up of teens between the ages of 12 and 17. Approximately one in 20 teens, one in six young adults, and one in 14 adults over 26 were categorized as needing rehab in 2015.
Of the 21.7 million people who were identified as needing treatment in 2015, 19.3 million, or 89 percent, did not receive help in a specialized facility. The other 2.3 million, 11 percent, entered a specialized facility for rehab. Around 95 percent of those in rehab thought it was unneeded. The other 5 percent realized their need for help, emphasizing again the importance of education on causes and signs.
Relapse Is Not Failure
The goal of rehab is to send people back with the ability to play a healthy role in the home, at wor, and in the community. Studies show that most people who get into recovery programs for extended periods and stay in maintenance afterward can stop using drugs. Also, their physical and emotional well-being improves, and they are less likely to be involved in criminal activities. Individual results, however, rely on the effectiveness of the rehab, the nature of their relationship with caregivers and counselors, and the severity of the addiction itself.
Individuals in recovery are no less likely to relapse than those with other chronic health conditions such as high blood pressure or asthma are, but the process lasts a lifetime. Like chronic physical illnesses, addiction requires physical and behavioral changes. Relapse is likely, but it does not mean failure. It does mean that it is time to renew or adjust the regimen.
Staying in Rehab Lowers Relapse Rate
Keeping people in rehab long enough to give them a chance to recover is the goal of rehab. That is why successful programs have to encourage compliance. Individual factors that influence therapy include the following:
- Individuals must want to change their behavior.
- They need support from friends and family.
- Many respond to pressure from families, employers, and court systems.
- They need a positive relationship with the clinicians.
- The plan should be well understood and closely monitored.
- Social services, counseling and medical care should be provided.
Physical Dependence and Addiction Are Not the Same
Physical dependence means that people adjust to the substance and need greater amounts to get the same effects. They also experience mental and physical symptoms if they stop taking it. Addiction, on the other hand, means they are not able to stop. They have trouble with social obligations, family and work, and they go through withdrawal if they can’t use.
Physical dependence can occur with the long-term use of medications, even if they are prescribed and taken as directed. It can happen on it its own, or it can be tied to addiction. Distinguishing between the two can be tricky, especially when the medication is needed for a chronic physical condition. Sometimes, the need for more medication results from the physical illness itself and not from dependence.
People Continue to Use Drugs for Many Reasons
Most people who have a substance use disorder think they can stop on their own. Although some succeed, others need rehab for long-term abstinence. One of the reasons abstaining is so difficult is that extended drug use creates changes in the brain that stick around for a long time after a person stops using the drug.
Changes in the brain caused by extended drug use can lead a person to make impulsive decisions that cause them to continue using. Other factors also play a role in perpetuating addiction:
- Mental illness, work stress, and family problems may lead to ongoing use.
- Meeting acquaintances involved with drug use in the past may trigger a relapse.
- Reminders of the past, such as streets, smells or buildings, can lead to cravings.
Help Is Available
Addiction specialists acknowledge the difficulty of staying sober, but they also say that actively taking part in rehab can help even the hardest-to-treat individuals. They also know that treatment is not a one-size-fits-all therapy. To be successful, it must consist of a variety of components geared to individual needs.
Specialists usually recommend a combination of counseling, medication, behavioral therapy and education. Most programs also include support groups and classes to improve communication and teach people how to cope with stress. Learning how to deal with relapse is also important. If you or a loved one has a problem with substance use disorder, it’s important to remember that help is available.