In 2016, Surgeon General Vivek Murthy released a Report on Alcohol, Drugs, and Health entitled “Facing Addiction in America.” This first ever report of its kind reviews what the Office of the Surgeon General knows about substance misuse and gives suggestions for how to address this American epidemic as well as the related consequences. This shift in how to view substance abuse is a significant and hopefully a positive one. It may open doors to finding more effective treatment options for addicts, including recovery and therapy programs. What is certain: if Murthy’s vision of addiction becomes widespread, it could have unintended consequences on the criminal-justice system.

Surgeon General Has Declared Substance Abuse a Health Crisis

In the Surgeon General’s Report on Alcohol, Drugs, and Health findings showed that in 2015, “over 27 million people in the United States reported current use of illicit drugs or misuse of prescription drugs, and over 66 million people (nearly a quarter of the adult and adolescent population) reported binge drinking in the past month.” This drug and alcohol misuse is taking a toll on communities, families and society. In the United States, over 21 million people currently suffer from addiction or substance abuse disorder. These staggering statistics are just one reason Vivek Murthy decided to target substance abuse during his term as Surgeon General.

In the hopes of changing people’s minds on how addicts and addiction are viewed, Murthy and his office offer goals for this change. The report summarizes this “Vision of the Future” in relation to substance abuse:

• Problems caused by substance abuse and misuse are not limited to addiction. They also include possible health and safety concerns that result from substance abuse even if there isn’t a diagnosed disorder.
• Substance abuse is highly heritable. There are complex biological, genetic and social determinants of substance abuse disorders that directly affect the brain.
• Research-based prevention programs and policies are shown to reduce substance misuse and the related negative consequences significantly.
• Evidence and research based medical-assisted treatments (MAT) can assist recovery when applied to a chronic illness and have been shown to facilitate substance abuse disorders. These can reduce criminal behavior and the spread of infectious diseases.
• Chronic-illness-management may be needed to treat the most severe cases of substance abuse disorders.
• Access to recovery support is the key to long-term sobriety and wellness.

What furthers the Surgeon General’s support for viewing substance abuse as a mental disorder is the report’s findings on the neurobiology of substance abuse, misuse and addiction:

• Alcohol and drug addiction is a chronic brain disease that has the potential for recurrence and recovery.
• Addiction is a three-stage cycle: “binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. This cycle becomes more severe as a person continues substance use, and it produces dramatic changes in brain function that reduce a person’s ability to control their substance use.”
• “Well-supported scientific evidence shows that disruptions in three areas of the brain are particularly important in the onset, development, and maintenance of substance use disorders: the basal ganglia, the extended amygdala, and the prefrontal cortex. These disruptions:

○ enable substance-associated cues to trigger substance seeking (i.e., they increase incentive salience)

○ reduce sensitivity of brain systems involved in the experience of pleasure or reward, and heighten activation of brain stress systems

○ reduce functioning of brain executive control systems, which are involved in the ability to make decisions and regulate one’s actions, emotions, and impulses.”

• Scientific evidence shows that changes in the brain due to substance abuse persist long after non-use. It is not known if changes can be reversed.
• Adolescence is a critical at-risk period for substance abuse and addiction. Alcohol and drugs can have a significant effect on the adolescent brain. It is now yet known if these effects can be reversed.

When the Consequences of Addiction Become Criminal: Addiction in Prisons

The report hopes to find opportunities for recovery of users including the over 300,000 inmates currently in prison at state and federal institutions for drug-related convictions. However, one study even claims that over 65% of inmates meet the criteria for substance abuse disorder. Drug and alcohol rehabilitation for these individuals is costing taxpayers quite a bit of money. The criminal-justice system just isn’t set up to offer inexpensive rehab and detox options.

According to the Surgeon General’s report, substance abuse disorder has cost the country $442 billion annually in both criminal-justice and healthcare sectors.

The Federal Bureau of Prisons (BOP) must offer drug treatment plans to inmates in order to comply with the Violent Crime Control and Law Enforcement Act of 1994. Unfortunately, by the time the criminal-justice system catches up with an addict, it’s a critical situation. They lose the ability to seek private help in a reputable drug and alcohol rehabilitation center that will address their issues, including co-occurring disorders. Those without the resources to post bail are left to the prison system’s drug rehab programs – many of which leave the addict with few options for therapy or medical follow-up. This furthers the economic unbalance within the criminal-justice system.

For some, this push by the Surgeon General to encourage legislation that supports criminal-justice reform is a hopeful endeavour. This would push some of the drug offenders and addicts toward medical and evidence-based treatment options instead of working through a prison drug program. This has the possibility of unburdening the already overtaxed U.S. prison system as well as infusing the medical community with new patients.

What Do Mental Health Professionals Think of Addiction Viewed as a Disease?

This approach to substance abuse disorders and those who are imprisoned for crimes caused by their abuse is good news for mental health professionals. The Surgeon General’s report does a lot to remove the stigma from drug abusers. For proper rehabilitation, it’s important that the addict be viewed not as weak or as a criminal but as someone in need of medical intervention.

Looking at addiction through mental health instead of a criminal lens may have distinct effects on the U.S. prison system. For advocates and substance abusers, this is amazing news for getting the right help.