Surgeon Generals Report Presented to Conrad N. Hilton

Surgeon Generals Report Presented to Conrad N. Hilton

Surgeon Generals Report Presented to Conrad N. Hilton Foundation Youth Substance Use Prevention and Early Intervention Strategic Initiative Grantees January 19, 2017 Meg Gwaltney History of Report Started in Spring 2015 1st Draft: December 2015

Multiple rounds of review: January 2016-October 2016 Launched on November 17, 2016 Authors Tom McLellan George Koob Nora Volkow Rico Catalano Westley Clark Keith Humphreys Connie Weisner

2 Chapter 1 Rationale for the Report Drug and alcohol misuse and disorders are public health challenges that affect millions and place enormous burdens on society The U.S. has a serious substance misuse problem and is facing an unprecedented opioid epidemic The health care system has historically treated substance misuse and disorders as moral failings rather than chronic diseases There was a need for a comprehensive review of the science around substance misuse and substance use disorders 3

Contents of the Report Chapter 1: Introduction and Overview of the Report Chapter 2: The Neurobiology of Substance Use, Misuse, and Addiction Chapter 3: Prevention Programs and Policies Chapter 4: Early Intervention, Treatment, and Management of Substance Use Disorders Chapter 5: Recovery: The Many Paths to Wellness Chapter 6: Health Care Systems and Substance Use Disorders Chapter 7: Vision for the Future: A Public Health Approach 4 Chapter 1 Scope of the Issue

Among U.S. population aged 12 or older: Over 66 million reported binge drinking* Over 47 million used an illicit or non-prescribed drug Almost 21 million met criteria for a substance use disorder * Binge drinking = drinking 5 or more drinks on one occasion for men and 4 or more drinks for women 5 Chapter 1 Cost of Substance Misuse and Substance Use Disorders 6

Chapter 2: Neurobiology Defining Addiction Substance use research has made considerable advances and we can now see the living brain This research shows that addiction is a chronic brain disease with potential for recurrence and recovery 7 Chapter 2: Neurobiology Conclusion With addiction, dramatic changes in brain function occur that reduce a persons ability to control his or her substance use Brain changes persist long after substance use stops

It is not known how much these changes may be reversed or how long it takes Adolescence is a critical at-risk period for substance use and addiction All addictive drugs have especially harmful effects on the adolescent brain, which is still undergoing significant development 8 Chapter 3: Prevention What We Know About Risk and Protective Factors Risk and protective factors that predict substance use problems are reliable targets for prevention Risk and protective factors are consistent across diverse population groups

Different communities/neighborhoods have different levels of risk and protection 9 Chapter 3: Prevention Examples of Effective Prevention Programs Aged 0-10 Aged 10-18 College Students Adults Nurse-Family

Partnership Life Skills Training Brief Alcohol Screening Team Awareness and and Intervention for Team Resilience (adult College Students workplace) The Good Behavior Game and ClassroomCentered Intervention Project Toward No Drug Abuse

Parent Handbook Raising Healthy Children Strengthening Families Program: For Parents and Youth 1014 The Fast Track Program Strong African American Families Project Share (older

adults) Computerized AlcoholRelated Problems Survey (older adults) 10 Chapter 3: Prevention Examples of Effective Prevention Policies Reduce Availability Reduce Drinking of Alcohol and Driving Reduce Underage Drinking Price and tax

policies 0.08% BAC laws Alcohol outlet density Commercial host (dram shop) liability Reduce days and hours of alcohol sales Sobriety checkpoints DUI courts

Minimum Legal Drinking Age (MLDA) MLDA compliance checks Zero tolerance Ignition interlock for convicted offenders Preventing Prescription Drug Misuse Prescription drug

monitoring programs Criminal/civil social host liability 11 Chapter 3: Prevention Conclusion Over 60 prevention programs and policies have been shown to prevent substance use problems in rigorous research Communities are an effective organizing force for bringing evidence-based policies and programs to scale to improve public health As yet, there is insufficient evidence of the effects of state

policies for reducing inappropriate prescribing of opioid pain medications 12 Chapter 4: Treatment Qualities of Effective Substance Use Disorder Treatment Individualized treatment plans Goals that are person-centered and strength-based Targeted efforts to keep the individual engaged in care Care that considers both physical and mental health Culturally competent care that considers age, gender identity, race and ethnicity, language, health literacy, religion, sexual orientation, culture, physical health problems, and cooccurring conditions

13 Chapter 4: Treatment The Promise of Technology for Addiction Treatment Technology can: Increase access to care in previously underserved areas and settings Enable service providers to care for more clients Provide alternative care options for individuals who are hesitant to seek in-person treatment Increase the chances that interventions are delivered as they were designed and intended Decrease treatment costs

14 Chapter 4: Treatment Conclusion Substance use disorders can be effectively treated, with recurrence rates no higher than those for other chronic illnesses such as diabetes, asthma, and hypertension Medications can be effective in treating serious substance use disorders, but they are under-used Substance misuse and substance use disorders can be reliably and easily identified through screening Treatment is cost-effective compared with no treatment 15 Chapter 5: Recovery

Recovery: The Many Paths to Wellness An estimated 25 million Americans are currently in remission There is an emerging social movement of recovery advocacy and services Recovery-oriented services and systems are being developed and increasingly researched There are many pathways that make recovery possible, including treatment, recovery support services, and mutual aid 16 Chapter 5: Recovery Recovery Support Services Mutual Aid Groups (Peer) Recovery Coaching

Recovery Housing Recovery Management Recovery Community Centers Recovery-based Education 17 Chapter 5: Recovery Conclusion Celebrate and support recovery, but let it stand on its own Make health care systems amenable to recovery concepts, people, and organizations Invest in research on the effectiveness of recovery supports Conduct research on how health care systems can work best with recovery support services Expand research on the innovative and emerging recovery supports that are happening in diverse communities and

cultures 18 Chapter 6 : Health Care Systems Importance of Integration Integration Is key to addressing the full spectrum of substance use problems and consequences Represents the most promising way to improve access to and quality of treatment Has the potential to reduce health disparities Can lead to improved health outcomes through better care coordination Integrating substance misuse services with medical care is

especially critical considering substance use disorders are often associated with other medical conditions 19 Chapter 6 : Health Care Systems Promising Innovations in Health Care Settings Medicaid innovations Alternative Benefit Plans, managed care plans, home and communitybased services and supports, health homes, demonstrations to test policy innovations Electronic Health Records and Health Information Technology Meaningful use to coordinate care, EHR incentive programs, clinical decision support tools, and prescription drug monitoring programs Disease registries

Databases related to substance use disorders can alert providers of those at higher risk of substance misuse or disorders. 20 Chapter 6 : Health Care Systems Conclusion Integrating care for substance use disorders into mainstream health care can increase quality, effectiveness, and efficiency of health care Health IT is expanding to support greater communication and collaboration among providers, fostering better integrated care A larger, more diverse workforce is needed, with skills to prevent, identify, and treat substance use disorders: Todays substance use disorder workforce does not have capacity to meet existing need for integrated care

General health care workforce is undertrained to deal with substance use-related problems 21 Chapter 7: Vision for the Future A Public Health Approach Provides concrete, evidence-based recommendations on how to reduce substance misuse and related harms in communities across the U.S. Implications for policy and practice are discussed for each finding Outlines the role of specific stakeholder groups in changing the culture, policies, and practices specific to addressing substance misuse

22 Chapter 7: Vision for the Future Five Overarching Messages 1. Both substance misuse and substance use disorders harm the health and well-being of individuals and communities. Addressing them requires implementation of effective strategies 2. Highly effective community-based prevention programs and policies exist and should be widely implemented 3. Full integration of the continuum of services for substance use disorders with the rest of health care could significantly improve the quality, effectiveness, and safety of all health care 23

Chapter 7: Vision for the Future Five Overarching Messages, Cont. 4. Coordination and implementation of recent health reform and parity laws will help ensure increased access to services for people with substance use disorders 5. A large body of research has clarified the biological, psychological, and social underpinnings of substance misuse and related disorders and described effective prevention, treatment, and recovery support services. Future research is needed to guide the new public health approach to substance misuse and substance use disorders 24 Chapter 7: Vision for the Future Stakeholders Can Help Change the Culture

Move toward public health-based approach, which involves addressing individual, environmental, and societal factors that influence substance misuse and its consequences Create a society where: Communities are willing to invest in prevention services People feel comfortable seeking treatment There is no wrong door for accessing health services Health care professionals treat substance use disorders with same level of compassion and care as other chronic diseases People are celebrated and supported for efforts to get well and for steps in recovery

25 Chapter 7: Vision for the Future Recommendations for Stakeholders Stakeholders can help change the culture, attitudes, and practices around substance misuse:

Individuals and families Educators and academic institutions Health care professionals and professional associations Health care systems Communities Private sector: Industry and commerce Federal, state, local, and tribal governments Researchers 26 Chapter 7: Vision for the Future In Summary Everyone has a role to play in addressing substance misuse and substance use disorders, and in changing the conversation around substance use, to improve the health, safety, and wellbeing of individuals and communities across our nation.

Improved Public Health 27 Next Steps: What Hilton Grantees Can Do Expand Evidence-based Interventions Work with community leaders and community coalitions to implement prevention, treatment, and recovery programs and policies Incorporate the Science into Health Care Expand training of health care professionals, improve availability, access, and quality of services in all health settings Translate the Science into Public Understanding Use traditional and social media to inform the public, particularly parents and community leaders

28 Next Steps: What Hilton Grantees Can Do, Cont. Mobilize Different Sectors of the Community Engage with stakeholders such as policymakers, law enforcement, health care, education, businesses, and the faith community to encourage change Encourage Parents to Talk to Their Children Provide guidance and tools for parents to talk to their children about alcohol and drugs and the risks they face Monitor and Evaluate Progress Continually assess accomplishments and community needs and adjust strategies as appropriate; share progress with stakeholders 29

SGR Website SGR website and collateral materials are available to support grantee activities www.Addiction.SurgeonGeneral.gov www.Addiction.SurgeonGeneral.Gov 30 Materials & Collateral Products Teaser Video and Flyer Partner Toolkit

Web banners, images for social media Blogs, short messages articles PowerPoint slides Report highlights 31 Materials & Collateral Products (contd) Fact sheets on Reports key findings and recommendations

Overall Highlights Individuals and Families Communities Health Professionals and Health Care Systems State, Local, and Tribal Governments 32 Questions? Meg Gwaltney: [email protected] Alicia Sparks: [email protected] 33

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