Excerpt

This Surgeon General's Report has been created because of the important health and social problems associated with alcohol and drug misuse in America. As described in this Report, a comprehensive approach is needed to address substance use problems in the United States that includes several key components:

• Enhanced public education to improve awareness about substance use problems and demand for more effective policies and practices to address them;
• Widespread implementation of evidence-based prevention policies and programs to prevent substance misuse and related harms;
• Improved access to evidence-based treatment services, integrated with mainstream health care, for those at risk for or affected by substance use disorders;
• Recovery support services (RSS) to assist individuals in maintaining remission and preventing relapse; and
• Research-informed public policies and financing strategies to ensure that substance misuse and use disorder services are accessible, compassionate, efficient, and sustainable.

Recognizing these needs, the Report explains the neurobiological basis for substance use disorders and provides the biological, psychological, and social frameworks for improving diagnosis, prevention, and treatment of alcohol and drug misuse. It also describes evidence-based prevention strategies, such as public policies that can reduce substance misuse problems (e.g., driving under the influence [DUI]); effective treatment strategies, including medications and behavioral therapies for treating substance use disorders; and RSS for people who have completed treatment. Additionally, the Report describes recent changes in health care financing, including changes in health insurance regulations, which support the integration of clinical prevention and treatment services for substance use disorders into mainstream health care practice, and defines a research agenda for addressing alcohol and drug misuse as medical conditions.

Thus, this first Surgeon General's Report on Alcohol, Drugs, and Health is not issued simply because of the prevalence of substance misuse or even the related devastating harms and costs, but also to help inform policymakers, health care professionals, and the general public about effective, practical, and sustainable strategies to address these problems. These strategies have the potential to substantially reduce substance misuse and related problems; promote early intervention for substance misuse and substance use disorders; and improve the availability of high-quality treatment and RSS for persons with substance use disorders.

Contents

• MESSAGE FROM THE SECRETARY, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
• FOREWORD FROM THE PRINCIPAL DEPUTY ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
• PREFACE FROM THE SURGEON GENERAL, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
• ACKNOWLEDGMENTS
• CHAPTER 1. INTRODUCTION AND OVERVIEW OF THE REPORT
  • Chapter 1 Preview
  • Substances Discussed in this Report
  • Prevalence of Substance Use, Misuse Problems, and Disorders
  • Costs and Impact of Substance Use and Misuse
  • Vulnerability to Substance Misuse Problems and Disorders
  • Diagnosing a Substance Use Disorder
  • The Separation of Substance Use Treatment and General Health Care
  • Recent Changes in Health Care Policy and Law
  • Marijuana: A Changing Legal and Research Environment
  • Purpose, Focus, and Format of the Report
  • References
• CHAPTER 2. THE NEUROBIOLOGY OF SUBSTANCE USE, MISUSE, AND ADDICTION
  • Chapter 2 Preview
  • Conducting Research on the Neurobiology of Substance Use, Misuse, and Addiction
  • The Primary Brain Regions Involved in Substance Use Disorders
  • The Addiction Cycle
  • Binge/Intoxication Stage: Basal Ganglia
  • Withdrawal/Negative Affect Stage: Extended Amygdala
  • Preoccupation/Anticipation Stage: Prefrontal Cortex
  • Different Classes of Substances Affect the Brain and Behavior in Different Ways
  • Factors that Increase Risk for Substance Use, Misuse, and Addiction
  • Use of Multiple Substances and Co-occurring Mental Health Conditions
  • Biological Factors Contributing to Population-based Differences in Substance Misuse and Substance Use Disorders
  • Recommendations for Research
  • References
• CHAPTER 3. PREVENTION PROGRAMS AND POLICIES
  • Chapter 3 Preview
  • Why We Should Care About Prevention
  • Risk and Protective Factors
  • Types of Prevention Interventions
  • Evidence-based Prevention Programs
  • Evidence-based Community Coalition-based Prevention Models
  • Evidence-based Prevention Policies
  • Prevention Interventions for Specific Populations
  • Maximizing Prevention Program and Policy Effectiveness
  • Improving the Dissemination and Implementation of Evidence-based Programs
  • Recommendations for Research
  • References
• CHAPTER 4. EARLY INTERVENTION, TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS
  • Chapter 4 Preview
  • Continuum of Treatment Services
  • Early Intervention: Identifying and Engaging Individuals At Risk for Substance Misuse and Substance Use Disorders
  • Treatment Engagement: Reaching and Reducing Harm Among Those Who Need Treatment
  • Principles of Effective Treatment and Treatment Planning
  • Evidence-based Treatment: Components of Care
  • Emerging Treatment Technologies
  • Considerations for Specific Populations
  • Recommendations for Research
  • References
• CHAPTER 5. RECOVERY: THE MANY PATHS TO WELLNESS
  • Chapter 5 Preview
  • Recovery Definitions, Values, and Controversies
  • Perspectives of Those in Recovery
  • Estimating the Number of People “In Recovery”
  • Recovery-oriented Systems of Care
  • Recovery Supports
  • Social and Recreational Recovery Infrastructures and Social Media
  • Specific Populations and Recovery
  • Recommendations for Research
  • References
• CHAPTER 6. HEALTH CARE SYSTEMS AND SUBSTANCE USE DISORDERS
  • Chapter 6 Preview
  • Key Components of Health Care Systems
  • Substance Use Disorder Services Have Traditionally Been Separate From Mental Health and General Health Care
  • A Growing Impetus for Integration
  • Financing Systems for Substance Use Disorder Services
  • Challenges Facing the Integration of Substance Use Services and Health Care
  • Promising Innovations That Improve Access to Substance Use Disorder Treatment
  • Recommendations for Research
  • References
• CHAPTER 7. VISION FOR THE FUTURE: A PUBLIC HEALTH APPROACH
  • Time for a Change
  • Specific Suggestions for Key Stakeholders
  • Conclusion
  • References
• GLOSSARY OF TERMS
• LIST OF ABBREVIATIONS
• APPENDIX A. REVIEW PROCESS FOR PREVENTION PROGRAMS
• APPENDIX B. EVIDENCE-BASED PREVENTION PROGRAMS AND POLICIES
• APPENDIX C. RESOURCE GUIDE
• APPENDIX D. IMPORTANT FACTS ABOUT ALCOHOL AND DRUGS

Suggested citation:

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.