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January 19, 2017
Over 50 years have passed since the Surgeon General of the U.S.’ seminal work on the dangers of tobacco to public health. At that time Marlboro man was a regular advertising feature at major sporting events, James Bond was rarely seen without a cigarette between his lips and smoking was still allowed on planes.
It has taken a concerted effort combining scientific research, public health policy, education and access to treatment to reach the point where only 17% of the U.S population smoke compared to 37% in the 1970s.
The U.S Surgeon General has now released a report, ‘Facing Addiction in America’, the first of its kind focusing on the serious public health problem posed by addiction to alcohol and drugs.
The report has won praise worldwide for its clear assertion that addiction is a chronic neurological disorder, and that those who suffer from it have the same right to treatment as patients with other diseases. It rightly points out that to achieve this there must be a ‘major cultural shift in the way we think about, talk about, look at and act towards people with a substance use disorder’.
If we draw comparison to another chronic illness, diabetes, the shocking disparity in treatment becomes apparent. 70% of patients with diabetes in the U.S receive some form of treatment, compared to only 10% of patients with an addiction disorder.
Despite having a nationalized health system, the UK fares even worse: while an estimated 15% of the population suffer from alcohol dependence, only 1% of patients receive treatment. This would be enough of a scandal if only those suffering from the disorder were affected, however we know that the cost to society of alcohol-related harm is around £21 billion per year in the U.K and what’s more, research has shown that for every £1 invested in the treatment of alcohol addiction £5 is saved on health, welfare and crime costs.
As the U.S Surgeon General points out, we have evidence-based treatments at our disposal including the 12-step program and cognitive behavioural therapy. Use of the 12-step programme in treatment has been proven to increase rates of abstinence in alcohol-dependent patients.
In truth a concerted effort must be made to tackle the societal problem of addiction in the same way that we approached tobacco smoking including public health measures and education. But as it is now scientific consensus that addiction is a chronic disease, we must consider that there is a strong moral case to allow patients with disease access to the effective treatments that are available.
Resident Medical Officer