This is part 2 of a 3 part series on the Surgeon General’s Report on Alcohol, Drugs and Health. Part 1 was dedicated to the historical context of the report. Part 2 is meant to be a user’s guide, focusing on practical uses for the report to different target audiences.
While working closely with family members of substance users over the past 5 years, the dearth of easily accessible, accurate information about drugs, alcohol, and their treatment has been hugely frustrating. There are good resources that address pieces of the discussion, such as “Get Your Loved One Sober” by Robert Myers and the Recovery Research Institute by John Kelly and his team at Harvard. But I have found nothing as comprehensive (and free!) as the Surgeon General’s Report.
While its 413 pages are certainly intimidating (I must admit, I have not run into anyone else on campus who has read it cover to cover), the report does a really nice job breaking the information into somewhat manageable chunks and highlighting key findings. I think the report could be an ideal text-book for an introductory class on substance use and an invaluable resource for family members hungry for education about substance use disorders.
This section of our series is meant to help you navigate the report and make use of the work presented by some of our most brilliant researchers.
A Note on Terminology
Importantly, the report formalizes a new language for substance use. It highlights the preferred terms which are outlined in new medical standards in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The new standards replace the terms substance abuse and substance dependence with three levels of substance use disorder: mild, moderate and severe.
In the report, addiction is often used to describe severe cases of the disorders. Importantly, this shifts the focus away from the dichotomous terms “addict”/ “alcoholic” which often leaves families wondering, “Is he one?” and not responding until the problem was extreme. The report is very clear that interventions can be effective at every level of problem severity and emphasizes the importance of early interventions and different levels of care.
Additionally, though people often reclaim the stigmatized language in order to empower their own recoveries, external labeling of these conditions can be stigmatizing and unhelpful. People can more readily admit there is an issue if they are not backed into a corner with, “Are you an addict?”
Our friends in the field will be pleased to know that throughout the report, the authors identify whether a finding is well-supported, supported, or promising depending on how rigorous and numerous the research studies are that examine the intervention. (Note: Intervention here means a professionally delivered program, service, or policy designed to prevent substance misuse or treat an individual’s substance use disorder. It does not mean intervention like you see on TV.) While the report is not an exhaustive exploration of all of the science available, it emphasizes findings that have the potential for the greatest public health impact and the greatest potential for action.
Broad Audiences & Applications
Like our COBE Town Hall coming up in April, the report attempts to reach a broad audience that includes people with substance use disorders, families, community members, educators, professionals, advocates, policymakers, and researchers.
This is quite a difficult task as these groups have a broad range of experience, education, and each come with their own bias. But it is incredibly important that we create cohesion and common ground because none of these groups can progress far on their own.
Here are some of the ways the report might be useful to these groups:
People with Substance Use Disorders – Without explicitly calling out incarceration as an ineffective solution, the report is clear that substance use and misuse and substance use disorders are public health challenges that must be met with compassion and evidence based services. The report dedicates an entire chapter to recovery, which has been under studied, and explicitly validates several recovery supports including 12 step, recovery housing, recovery support services, and peer recovery coaching. Additionally, the report outlines the effectiveness and value of treatment in general, and affirms several different treatment modalities including Medication Assisted Treatment, Cognitive Behavioral Therapy, Twelve Step Facilitated Treatment, Community Reinforcement Approach, The Matrix Model, and Contingency Management. Of note, the report does not dive into contemplative science based approaches, though there is promising evidence of the effectiveness of these interventions as well. Finally, the report emphasizes the importance of prevention (especially school, family and community based prevention) and the importance of early intervention by all health care providers, not just those practicing in specialty substance use facilities.
Families – While the report may feel overwhelming, families are very fortunate to have a comprehensive and free resource to start to understand substance use. For those raising children, Chapters 2 (The Neurobiology of Substance Use, Misuse, and Addiction) and Chapter 3 (Prevention Programs and Policies) would be very helpful in understanding risk and getting a primer on what effective prevention looks like. For those who have a loved one who has developed a substance use disorder, Chapters 2, Chapter 4 (Early Intervention, Treatment and Management of Substance Use Disorders), and Chapter 5 (Recovery) will be most useful.
Community Members – There are very few people who do not know someone who is affected by a substance use disorders, and the consequences of substance misuse impact everyone. The report is very clear on effective interventions, policy implementations that work, and also identifies the chasms in implementing evidence based interventions. For example, the Prevention section reports that less than 10% of principles use evidence based prevention in their schools. The report offers a great reference point for community members looking for solutions that really work. As Linda Hancock, one of our prevention gurus at The Wellness Resource Center at VCU says, “When doing Prevention, we have to ask ourselves: ‘Am I busy or am I effective’. We need to be both.
Educators – While many of the uses that community members may find are echoed here, there are numerous ways educators can use this report, from making prevention programming decisions guided by the existing evidence, to use the report as text book for substance use classes (Your students will love the price!). Additionally, the report repeatedly emphasizes the importance of better integrating primary care and other medical providers with substance use treatment (More on this in part 3!). The report points out workforce, resource and training shortages that have hampered efforts at better care.
Professionals – For professionals, it is helpful to have a 1 stop refresher on broader areas of substance use. Because we tend to work in very specialized parts of the field, it is too easy to avoid stepping back and looking at the big picture. Taking some time to get an update on the state of science in the field is quite a worthy exercise.
Advocates and Policymakers – The report offers a tremendous reference and has the weight of the Surgeon General behind it. Advocates may be writing lots of letters and emails that say, “As pointed out in the Surgeon General’s report…” The report can be a great playbook for progress in different states and nationally.
Researchers – Apart from validating and giving voice to the incredible work of many of our brightest minds, the report offers very clear recommendations on the future of research. Given the collaborations between SAMHSA, NIAAA, NIDA, and other governmental agencies on this report, researchers would do well to listen. A simple search for “Recommendations for Researchers” might be a great starting point. Additionally, researchers interested in dipping their toe in another area of the field have a great literature review starting point in the 1400 + references. Having some of our best minds looking at other aspects of substance use with fresh eyes could result in some tremendous breakthroughs.
Organization of the Report (This is taken directly from the Report itself)
This Report is divided into Chapters, highlighting the key issues and most important research findings in those topics. The final chapter concludes with recommendations for key stakeholders, including implications for practice and policy.
Chapter 1 – Introduction and Overview describes the overall rationale for the Report, defines key terms used throughout the Report, introduces the major issues covered in the topical chapters, and describes the organization, format, and the scientific standards that dictated content and emphasis within the Report.
Chapter 2 – The Neurobiology of Substance Use, Misuse, and Addiction reviews brain research on the neurobiological processes that turn casual substance use into a compulsive disorder.
Chapter 3 – Prevention Program and Policies reviews the scientific evidence on preventing substance misuse, substance use-related problems, and substance use disorders.
Chapter 4 – Early Intervention, Treatment, and Management of Substance Use Disorders describes the goals, settings, and stages of treatment, and reviews the effectiveness of the major components of early intervention and treatment approaches, including behavioral therapies, medications, and social services.
Chapter 5 – Recovery: The Many Paths to Wellness discusses perspectives on remission and recovery from substance use disorders and reviews the types and effectiveness of RSS.
Chapter 6 – Health Care Systems and Substance Use Disorders reviews ongoing changes in organization, delivery, and financing of care for substance use disorders in both specialty treatment programs and in mainstream health care settings.
Chapter 7 – Vision for the Future: A Public Health Approach presents a realistic vision for a comprehensive, effective, and humane public health approach to addressing substance misuse and substance use disorders in our country, including actionable recommendations for parents, families, communities, health care organizations, educators, researchers, and policymakers.