Tackling The Surgeon General’s Report: Part 3, 10 Things I Like and Don’t Like

This is the last of a three part series on the Surgeon General’s Report on Alcohol, Drugs and Health by COBE Administrative Director Tom Bannard. Part 1 was dedicated to the historical context of the report. Part 2 was a user’s guide, focusing on practical uses for the report to different target audiences.

1. The Public Health Approach – The report’s call for treating substance use from a public health standpoint, by a non-partisan, well respected government office is important. And its about time. The document is written in a general way and meets the needs of many different constituencies. It is readable and full of references. Considering the billions of dollars we have put into research on substance use, we deserve a document of this quality.

2. Drug Interdiction Efforts – The word “interdiction” (law enforcement-centered supply reduction) appears 0 times in the document. In one sense, this is a repudiation of the primary tactic of addressing substance use in America. On the other hand, there is no reference to studies that consider the effectiveness of interdiction efforts. Do these exist? If we are spending more than $50 billion a year in the criminal justice system (compared to $4 billion in treatment), we should know how well it is working.[1]

3. Differing Consequences for African Americans and Latinos – While each section of the report spends some time on “Special Populations”, the report never dives into the enormous disparity in consequences (especially criminal justice related) despite similar rates of use. This is a glaring omission.

4. Call for Integration of Substance Use into the Rest of Healthcare – This is a long overdue call-out of the failure to integrate substance use throughout the health care system despite the far reaching health consequences of substance use. Calls for early intervention, more education and better prescribing practices are obvious areas for growth for a health care system that has failed to meet the needs of those with substance use disorders.

5. A Whole Chapter on Recovery – This is exciting! A whole chapter on recovery recognizes that a variety of recovery support services deserve a seat at the table in the larger conversation about substance use. While it is clear that we need far more research in this area, with comparatively few scholarly references, this inclusion is a nudge to the hard work of recovery advocates over the past 30 years.

6. A Solid Free Textbook – Most research on substance use disorders is publicly funded. We deserve this information. I have one text book from my counselor studies in substance use that I still reference from time to time; I use this once a week. This is a tremendous resource, it is easily searchable, and I will certainly use it in future classes I teach. No textbook is perfect, but this is a great place to start.

7. Show Me the Treatment Outcomes – While the report calls for “the establishment of recovery outcomes and measures” and for research that “measures the value of the recovery oriented system of care”, which are both incredibly important, it fails to call out treatment providers on their inability to implement long term tracking measures and consistent outcomes. This is a multibillion dollar health care industry. Can you imagine if providers did not track cancer treatment success rates? Where is the accountability? The report also entirely fails to mention the “blueprint studies” about physicians help programs or pilot’s programs which have far and away the best treatment outcomes of any intervention and who track patients for 5 years. Perhaps there are some take-aways in those programs that we should examine.

8. Shout Out to Recovery High Schools and Collegiate Recovery – (Bias alert! I run the Collegiate Recovery Program at VCU) The report mentions these two interventions as promising practices, and the support of this respected voice has helped make inroads as we advocate for the value of these programs.

9. Stop Talking Dirty – The call for changing language around substance use is really welcome, and professionals need to be the leaders in this effort. We need to use person centered language, we need to switch from substance abuse to misuse, and we need to end our obsession with the dichotomous “alcoholic/addict” and understand that substance use challenges happen on a continuum.

10. Why Aren’t We Talking about This? – Maybe I’m a little biased because I took the 6 hours to read it, but you cannot read through this document without learning a whole heck of a lot and opening your mind to some different approaches to substance use. Is it perfect? No, but it’s a really good starting point.

[1] “The Economic Impact of Illicit Drug User on American Society.” U.S. Department of Justice. 2011. https://www.justice.gov/archive/ndic/pubs44/44731/44731p.pdf