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National Approaches to Addressing Substance Use Disorders

In 2018, the Office of the Surgeon General released Facing Addiction in America: The Surgeon General's Spotlight on Opioids. In describing a vision for the future of America, the Surgeon General calls for a change in the way society addresses substance use disorders (SUDs). The report emphasizes the importance of focusing on prevention and treatment and considering the biological, psychological, and social factors that influence SUD.

The Historical Treatment of Substance Use Disorders

Historically, substance misuse has been treated as a crime rather than a chronic disease. The Congressional Research Service's (CRS) Drug Enforcement in the United States: History, Policy, and Trends describes the history of drug enforcement in the U.S. While laws passed in the 1950s established prison sentences and increased penalties for drug offenses, the “War on Drugs” is most closely associated with the criminalization of substance misuse. The War on Drugs was a period of drug control that began in the 1970s, when Congress passed the Controlled Substances Act to create a framework for federal regulation of controlled substances. The Drug Enforcement Administration was established to coordinate all federal drug enforcement efforts. After the passage of the Controlled Substances Act, drug misuse was primarily addressed through the criminal justice system and federal convictions for drug offenses increased. Laws in the 1980s established criminal penalties for possession of a controlled substance, including penalties for specific federal drug trafficking offenses and drug violations committed by minors.

A Public Health-Based Approach to Addressing Substance Use Disorders

In the 21st century, the federal government gradually shifted to a drug control policy focused on prevention, treatment, and enforcement. Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health calls for a public health-based approach to addressing SUDs and discusses the importance of building awareness of substance misuse as a public health problem. Public health is the science of preventing disease and injury and promoting and protecting the health of populations and communities. The public health system in the U.S. consists of federal, state, local, tribal and territorial public health agencies, including rural public health agencies, as well as non-governmental organizations and other partners, and is guided by the ten essential services. Public health approaches recognize the multi-faceted nature of substance misuse and focus on addressing the myriad of individual, environmental, and social factors that contribute to SUDs.

Specifically, the report calls for a public health systems approach to substance misuse that:

  • “Defines the problem through the systematic collection of data on the scope, characteristics, and consequences of substance misuse;
  • Identifies the risk and protective factors that increase or decrease the risk for substance misuse and its consequences, and the factors that could be modified through interventions;
  • Works across the public and private sector to develop and test interventions that address social, environmental, or economic determinants of substance misuse and related health consequences;
  • Supports broad implementation of effective prevention and treatment interventions and recovery supports in a wide range of settings; and
  • Monitors the impact of these interventions on substance misuse and related problems as well as on risk and protective factors.”

Resources to Learn More

Defining and Implementing a Public Health Response to Drug Use and Misuse
Outlines a policy statement from the American Public Health Association regarding the public health challenges of drug use and misuse contributing to overdose deaths, HIV, and hepatitis C infections. Proposes recommendations to redirect the current U.S. drug policy and prioritize prevention, treatment and recovery.
Organization(s): American Public Health Association
Date: 11/2013

Drug Enforcement in the United States: History, Policy, and Trends
Describes the historical development of drug enforcement to address methamphetamine, marijuana, heroin, and prescription drug abuse in the U.S. from the 1990s to the present.
Organization: Congressional Research Service
Date: 10/2014

Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health
Explains the neurobiological basis for SUDs. Discusses the biological, psychological, and social structures for improving diagnosis, prevention, and treatment of alcohol and drug misuse. Includes evidence-based prevention strategies, effective treatments, recovery support services, and public policies and financing to promote access to SUD services.
Organization(s): U.S. Department of Health and Human Services, Office of the Surgeon General
Date: 11/2016