Shifting Our National Approach to Addiction
The nationwide shift in the way we view and respond to problematic use of drugs and alcohol got a big boost last week with the release of Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. The report affirms and highlights what many advocates, researchers and providers in the field have been promoting for years: addiction is a health issue, not the result of any individual’s moral shortcomings, and must be addressed through a public health approach. This means shifting the focus away from punitive policies toward a comprehensive strategy that combines health and social services. This report provides new impetus for us to act collaboratively to address substance use disorders.
In the 1960s, the Surgeon General’s report on smoking contributed to a cultural shift by connecting smoking and cancer. Through facts and science, the report helped Americans understand this causal relationship. This shift eventually led to policy changes and regulations that reduced smoking and related diseases. Facing Addiction, the first Surgeon General’s report on the topic, has the potential to create a similar cultural shift by legitimizing addiction as a public health issue and proposing action priorities. Now it’s up to advocates, their allies and policymakers to lead the way forward.
Crucial to this work is the understanding that there is no one set path to wellness for individuals who experience problematic use of alcohol and drugs. Providers must work with individuals to determine what combination of factors within and beyond the health system will enable successful management of an addiction. The report calls for prevention, treatment and long-term support approaches similar to the way the health system handles management of other chronic illnesses. It synthesizes the evidence that these methods work for substance use disorders. It also reaffirms the critical importance of protecting comprehensive health insurance coverage, and the improvements made through the Affordable Care Act.
The report lays out some strategies for change that align with our vision here at Community Catalyst including:
- Prevention: The report promotes SBIRT (Screening, Brief Intervention, and Referral to Treatment) and other prevention strategies starting in adolescence when most addiction begins. Our SBIRT project helps support an upstream approach to substance use disorders that is crucially needed, yet often underused and underfunded.
- Treatment: The report emphasizes that treatment should be person-centered and include strengths-based approaches. The key component is working with the individual to determine a treatment plan, incorporating a variety of services that includes medication-assisted treatment, behavioral therapies and recovery support services. The most effective treatment, according to the report, “attends to multiple needs of the individual, not just his or her drug abuse.”
- Integration: The report highlights evidence showing effective management of substance use disorders integrates medical treatment for addiction with a broad range of health and social services including housing and employment support, and child welfare. This efficient approach is beneficial for both the individual and society. The report showcases how Medicaid has been particularly groundbreaking in its approach to substance use disorders, encouraging states to conduct demonstrations to test policy innovations through 1115 waivers, and provide care coordination through Health Homes. At Community Catalyst, we advocate for this whole-person approach, recognizing that integration of social and community supports with health services is essential to promoting overall health.
- Harm reduction & alternatives to incarceration: The report underscores the need for programs that “work with populations who may not be ready to stop substance use – offering individuals strategies to reduce risks while still using substances.” This approach to substance use is crucial to Community Catalyst’s work on pre-arrest diversion, which seeks to divert people away from the criminal justice system (including arrest and jail) and into health and social services.
- Recovery support services: Because recovery-oriented services are designed to draw on the person’s goals, strengths, family supports and community resources, they have the potential to be more responsive to the cultural diversity of the communities they serve – a big priority of ours with regard to health equity and reducing health disparities. The report affirms the need to enhance recovery services. We are proud to be participating in SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS).
This report is an important tool for all those working to advance policies and practices that improve the health of people with substance use disorders. It arms us with evidence and effective strategies. It also lays out the need for community leaders across health, government, social services, education, law enforcement, business, faith, academic and advocacy sectors to work together.
We strongly urge the next administration to use this report as a blueprint as they develop their plans to address addiction. Although it is tragically unfortunate to be in the midst of a national addiction crisis, we have the attention of the nation and the highest levels of government. It’s our responsibility to act and to advocate for others to join together to forge effective public health-focused solutions.