Millions of Americans suffer from alcoholism or addiction to legal and illegal drugs, but only 10 percent are being treated, according to a report released Thursday by the surgeon general.
One in seven people in the United States is expected to develop a substance use disorder at some point in their lives, said the report, the first from a surgeon general to address substance use disorders and the wider range of health problems related to alcohol and drugs.
It calls for, among other recommendations, a cultural change in understanding that addiction is a brain disease, not a character flaw.
“It’s time to change how we view addiction,” Dr. Vivek H. Murthy, the surgeon general, said in releasing the report. “Not as a moral failing but as a chronic illness that must be treated with skill, urgency, and compassion. The way we address this crisis is a test for America.”
The report is intended to try to prompt the public, policy makers, and health care professionals to better address these issues.
Those who work in the fields of addiction and recovery liken it to the landmark surgeon general reports of the 1950s and 1960s that said smoking caused lung cancer and led Congress in 1965 to require health warnings on cigarette packs.
But it is not clear that this report will be nearly as influential.
At least one senator called it a “missed opportunity.”
“The deaths caused by prescription drug, heroin, and fentanyl overdoses are growing exponentially every year, yet this report fails to provide any detailed road map for how best to curb opioid addiction,” Senator Edward J. Markey, Democrat of Massachusetts, said in a statement.
The magnitude of the opioid epidemic, he said, “demanded a far more detailed discussion.”
In addition, the report comes at the tail end of the Obama administration, which pleaded unsuccessfully with Congress this year for $1 billion to fight the opioid epidemic. Congress instead set aside $181 million, a move that a disappointed President Obama said was better than nothing.
And it comes as the incoming president, Donald Trump, prepares to appoint his own surgeon general and has his own ideas about how to combat the epidemic.
Trump has said that he will “try everything we can” to get Americans “unaddicted” to drugs, but his chief proposal is to build a wall on the border with Mexico. The wall, he said in New Hampshire last month, would keep out drug dealers and keep out “the heroin poisoning our youth.”
Even if a wall kept some heroin out of the United States, it would not necessarily solve the problem. While many Americans are dying of overdoses of heroin, many others are dying from opioid painkillers legally prescribed within the United States. And in some states, deaths from synthetic opioids such as fentanyl, which are coming from China, are overtaking deaths from heroin.
On a conference call, Murthy was asked how Trump’s plans to roll back the Affordable Health Care Act might affect his call to action on substance abuse.
“The issue of addiction affects everyone regardless of political party,” race, ethnicity, or socioeconomic status, he said, adding that the effort to combat the drug epidemic has been bipartisan.
“The urgency to address addiction is only growing,” Murthy said. He vowed to continue his work to “change how we’re talking about addiction and get people to step forward and ask for help.”
The new report said that 78 people die every day in the United States from opioid overdoses, a number that has nearly quadrupled since 1999.
It estimated that the annual economic toll related to alcohol is $249 billion and that the toll related to drugs is $193 billion.
The majority of people who misuse substances do not develop a use disorder, the report said. But roughly one in seven Americans — 14.6 percent of the population — are expected to develop such a disorder at some point.
Only about one in ten of those with a substance use disorder receive any type of specialty treatment, the report said. And while more than 40 percent of people with such a disorder also have a mental health condition, fewer than half receive treatment for either.
Heredity accounts for 40 to 70 percent of a person’s risk of developing a substance abuse disorder, the report said, but many environmental factors — including how old he or she is when first drinking or trying drugs — can influence the risk.
People who first drink alcohol before age 15 are four times more likely to become addicted at some time in their lives than are those who have their first drink at age 20 or older, the report said.
Nearly 70 percent of those who try an illicit drug before the age of 13 develop a substance use disorder within seven years, the report said, compared with 27 percent of those who first try an illicit drug after the age of 17.