Unaddressed Issues in This Year’s Most Important Document

Looking back over this year’s headlines on so many happenings in the world of addiction and behavioral health, it may be excusable to have given short shrift to one of this decade’s most important documents: Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (HHS, 2017).

By most accounts, the report is excellent in that it advances our understanding of addiction in over four hundred pages covering research, prevention, intervention, recovery, and a humanitarian vision for the future.

The report goes a long way toward fulfilling its intention to articulate an approach to addiction that is science-based and compassionate at the same time. It represents the first attempt by any US Health and Human Services Administration (HHS) to approach substance use and addiction not as an ethical issue or a matter of criminality, but as a human experience to be understood and a human dilemma calling for a humane response.

“Once viewed largely as a moral failing or character flaw,” the report says, addictions are “now understood to be chronic illnesses characterized by clinically significant impairments in health, social function, and voluntary control over substance use” (HHS, 2017). It sees addiction as a chronic illness, to be treated as other medical conditions.

Where the report falls short is its omission of the plight facing children who grew up in an addicted household (i.e., children of alcoholism and other addictions). 

As pointed out by the National Association for Children of Alcoholics (NACoA)—now the National Association for Children of Addiction—there is not a word in the report of the one in four children exposed to alcohol addiction in the family (Denniston, 2017). More than twenty-eight million Americans are children of alcoholics; nearly eleven million under age eighteen.

According to NACoA, “Drinking is the primary factor in family conflict and disruption, and the home environment of children of alcoholics is typically characterized by a lack of parenting; poor home management; lack of family communication skills; emotional or physical violence; and increased family stress including work problems, illness, marital strain, and financial problems” (Denniston, 2017). 

In the June 2017 issue of Counselor, Robert Denniston of NACoA’s board of directors, points out that unless we break the cycle of addiction, these children will be at high risk of drug and alcohol disorders themselves, as well as many other health issues, from depression to heart disease to cancer.

Where the Surgeon General’s report really misses the boat is in its almost complete omission of the role of trauma as the most prevalent and universal basis for addiction. We have come to understand from teachers, most notably Canadian physician Dr. Gabor Maté, that childhood trauma—as in physical, sexual or emotional abuse, multigenerational family violence, parental addiction or mental illness, divorce or other loss—is the template for adult addiction. 

Dr. Maté points out that sometimes the trauma is less overt and takes more subtle forms that cause a sensitive child to experience pain, but it is always pain that underlies addiction and it is always pain, conscious or not, that the addiction is meant to help a person escape. “Not why the addiction, but why the pain?” is Dr. Maté’s mantra. Facing Addiction in America barely addresses pain—human pain, emotional pain, spiritual emptiness, and the loss of self.

While the most progressive addiction treatment providers are becoming more trauma-informed to fully address the spectrum of addictive behaviors, so much more education and training is needed. The Surgeon General’s report could have been so much more powerful and effective if it had called for a trauma-based view of addiction and treatment, and for trauma education of health care professionals.

If we continue to focus mostly on symptoms and behaviors, the underlying causes of addiction will remain mostly untouched. 

Progress, not perfection.

References

Denniston, R. (2017). What’s missing in the Surgeon General’s report on alcohol, drugs, and health. Counselor, 18(3), 10–1.  

US Department of Health and Human Services. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Retrieved from https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf