Surgeon General’s Report: Stopping Addiction Before it Starts
The new Surgeon General’s report, which presents a comprehensive public health approach to addressing the scourge of addiction in our society, is just the impetus our nation needs to finally implement a research-based rather than a punitive and moralistic approach to addiction care.
Among the many insightful points, strategies and recommendations highlighted in the report that reflect Center on Addiction’s concerns and priorities is one that we feel merits special attention. That is the essential role of prevention in facing this disease head on.
In recent years, in light of the opioid epidemic, our addiction control strategy has leaned more heavily toward treatment than prevention. This is understandable given the acute nature of the crisis and the need to stem the tide of overdoses and fatalities. But to avoid locking ourselves into a pattern of responding to the latest crisis rather than avoiding it before it occurs, we must invest more resources in preventing the disease of addiction and the tobacco, alcohol and other drug use and misuse that leads to it.
Years of research – our own and that of others – has shown that substance use and addiction can indeed be prevented. But for prevention to work, it must be grounded in science and adapted regularly to address evolving risk factors, vulnerable populations and new and emerging addictive substances.
It has long been our position that a child who reaches age 21 without smoking, misusing alcohol or using illegal drugs is virtually certain never to do so. Neuroscience research has shown that the teen brain is especially sensitive to addiction and, therefore, prevention must begin early and be sustained throughout adolescence and early adulthood.
We know that substance use prevention starts in the home. Although many families feel they lack influence over their children who are bombarded by unhealthy messages from their peers, social environment and the media, nothing could be further from the truth. While parents can’t control their children’s behavior, research clearly shows that they have tremendous influence in protecting them from nicotine, alcohol and other drug use and addiction. But families do not and should not have to act alone. Prevention continues in the doctor’s office through patient education and screening, and in the classroom through age-appropriate and well-integrated programming throughout a child’s academic career.
Unfortunately, federal funding for prevention research and programs has been cut significantly and many currently operating programs have not adapted to the new scientific findings related to substance use and addiction risk. As a result, many schools and communities, which have either cut back on their prevention programming or have continued to operate outdated programs and initiatives that may not be based in research, are finding that their efforts are not producing meaningful reductions in youth substance use and addiction.
This is not because prevention doesn’t work. It’s because we are not implementing best practices or providing adequate resources and support to the programs that we do implement. We know that by strengthening prevention awareness and strategies among families and communities, expanding health-promoting, rather than punitive programming and services in our schools, and training health professionals to engage and intervene early with at-risk youth, we can make great strides in helping young people steer clear of nicotine, alcohol and other drug use and becoming addicted to them.
But to do this well, we need to clearly define what research shows is effective in prevention and juxtapose that with the current landscape of family, school, community and health care prevention efforts. Four years ago, we undertook this goal in relation to the addiction treatment system in the United States. That effort led to the publication of a report that laid bare the tremendous gap between addiction treatment science and actual practice and offered workable recommendations for closing that gap.
Now it’s time to do the same for addiction prevention. In addition to putting out fires caused by our latest addiction crisis, let’s preemptively reduce the chances that such a crisis will arise in the first place. The health and well-being of our nation’s youth depend on it.
Linda Richter, PhD
Dr. Richter is Director of Policy Research and Analysis at Center on Addiction