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Surgeon General’s Report Summary – Chapter 1

Surgeon General’s Report Summary – Chapter 1
Surgeon General’s Report Summary – Chapter 1

Introduction

This report begins with some staggering statistics.

  • In 2015, 66.7 million people in the U.S. reported binge drinking in the past month, and 27.1 million people were currently using illicit drugs or misusing prescription medication
  • 88,000 deaths a year in the U.S. come from misuse of alcohol, and 1 in 10 working adult’s deaths were because of alcohol misuse
  • In 2014, 47,055 deaths occurred from overdoses, and 28,647 people died from opioid overdoses
  • Substance misuse and substance use disorders cost more than $400 billion a year through lost production, crime, and well-being; of that $400 billion, alcohol misuse and alcohol use disorders cost the U.S. $249 billion
  • Pg. 1-1 and 1-2

According to a survey of 265 million people, by the National Survey on Drug Use and Health (NSDUH) for 2015, the prevalence of substance use, misuse, and disorders is as follows:

  • 175 million people, age 12 and older, stated that they used alcohol in the past year
  • 66 million people stated binge drinking in the previous month
  • 36 million people stated that they used marijuana in the past year
  • 5 million people stated that they misused prescription pain relievers
  • 300,000 people stated that they used heroin in the past year
  • Close to 8 percent of the population met diagnostic criteria for either a alcohol use disorder or substance use disorder for illicit drugs
  • Another 1 percent met criteria for both disorders
  • Out of the 20.8 million people who met the criteria for a substance use disorder in 2015, only 2.2 million received any type of treatment. Of those treated, 63.7 percent received specialty substance use disorder treatment
  • Pg. 1-7

Starting With Prevention

As stated in the Report, many people think the best place to begin to combat alcohol and drug misuse and dependence is with those already addicted. According to this Report, that is not the case. Although many people use, and misuse alcohol, and or drugs, many people do not fit the diagnostic criteria for dependence/ addiction.

In fact, greater impact is likely to be achieved by reducing substance misuse in the general population—that is, among people who are not addicted—than among those with severe substance use problems. Of course, efforts to reduce general population rates of substance use and misuse are also likely to reduce rates of substance use disorders, because substance use disorders typically develop over time following repeated episodes of misuse (often at escalating rates) that result in the progressive changes to brain circuitry that underlie addiction. –

Pg. 1-12

Vulnerability Factors

According to this Report, Substance misuse problems and substance use disorders are not inevitable.Pg. 1-15

There are factors that precede one’s vulnerability to a substance misuse problem, or substance use disorder. Those factors are as follows:

  • Community-Level: Easy access to inexpensive alcohol and other substances
  • Caregiver/ Family Level: Low parental monitoring; family history of substance use or mental disorders; high levels of family conflict or violence
  • Individual Level: Current mental disorders; low involvement in school; history of abuse and neglect; history of substance use during adolescence
  • Pg. 1-15

It should be noted that the above factors do not necessarily predetermine one’s vulnerability to a substance misuse problem or disorder:

Three important points about vulnerability should be highlighted. First, no single individual or community-level factor determines whether an individual will develop a substance misuse problem or disorder. Second, most risk and protective factors can be modified through preventive programs and policies to reduce vulnerability. Third, although substance misuse problems and disorders may occur at any age, adolescence and young adulthood are particularly critical at risk periods. – Pg. 1-15 – 1-16

If a person started using alcohol or other substances at an early age, they are at greater risk of developing a substance use disorder. The reason for this is, the last area of the brain that reaches maturity is the prefrontal cortex. This area of the brain is responsible for extended reasoning, delay of reward, and impulse control. This area of the brain is one of the most affected regions in a substance use disorder. – Pg. 1-16

How A Substance Use Disorder Is Diagnosed

The data used for this Report came mostly from the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), which classified substance disorders into two types of disorders: substance abuse and substance dependence. The current version of the DSM, part 5, which was published in May of 2013, integrated these two disorders into one: Substance Use Disorder (SUD) with three sub-classifications – mild, moderate, and severe.

An individual who is evaluated for a Substance Use Disorder is given a diagnosis based on the following diagnostic criteria:

  • Using in larger amounts or for longer than intended
  • Wanting to cut down or stop using, but not managing to
  • Spending a lot of time to get, use, or recover from use
  • Craving
  • Inability to manage commitments due to use
  • Continuing to use, even when it causes problems in relationships
  • Giving up important activities because of use
  • Continuing to use, even when it puts you in danger
  • Continuing to use, even when physical or psychological problems may be made worse by use
  • Increasing tolerance
  • Withdrawal symptoms
  • Pg. 1-17, Table 1.5

Two or fewer symptoms = no disorder

Two to three symptoms = mild disorder

Four to five symptoms = moderate disorder

Six or more = severe disorder

It is also worth noting that this Report uses the word addiction, which refers to the severe end of a Substance Use Disorder.

The new diagnostic criteria are thought to reduce an “all or nothing” approach to addiction.

Substance use disorders, including addiction, can occur with all substances listed in Table 1.1, not just those that are able to produce tolerance and withdrawal. It is also important to understand that substance use disorders do not occur immediately but over time, with repeated misuse and development of more symptoms. – Pg. 1-17 to 1-18

Separate Systems

Throughout this Report, prevention and screening for Substance Use Disorders is stressed greatly. Unfortunately, the health care system (i.e. – doctors, dentists, etc.) are separated from treatment centers. While the information regarding this separation is pertinent for those in the medical community, it can still apply for people in recovery. Because of this separation, a rare number of medical staff screen for potential Substance Use Disorders.

In a 2011 study conducted by the CDC (Center for Disease Control),

1 in 6 U.S. adults and 1 in 4 binge drinkers had ever been asked by a health professional about their drinking behavior. Pg. 1-19

What this means is, the possibility of a potential Substance Use Disorder is often overlooked, and can potentially allow a disorder to escalate. Along with the potential escalation of SUD’s, many other medical problems may follow.

A recent study showed that the presence of a substance use disorder often doubles the odds for the subsequent development of chronic and expensive medical illnesses, such as arthritis, chronic pain, heart disease, stroke, hypertension, diabetes, and asthma. – Pg. 1-20

Until screening for SUD’s becomes more prevalent, it is more important than ever for us in the recovery community to discuss our drinking and using history with our doctors, and other members of the medical community.

To view the PDF file of this chapter, please follow this link: https://addiction.surgeongeneral.gov/chapter-1-introduction.pdf

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