Recovery Vs. Stigma: Can the Surgeon General’s Report on Addiction Create Lasting Change?

A Call to Action: More on how education and public health measures can help eradicate addiction…with some thoughts about past successes with tobacco/nicotine addiction.

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Drug of Choice?

Addiction is a medical condition. However, it is currently stigmatized so much that we are punishing our nations’ sick, instead of treating them. Here, we offer a CALL TO ACTION!

More on how education and public health campaigns can help sway public opinion…and how we can look to past campaigns for anti-smoking to be our guide. Ideas that brighten our future! Then, we invite your active feedback and participation in the comments section. In fact, we try to respond to ALL reader comments with a personal reply.

The medical establishment’s call for change

In 1964, the Surgeon General of the US released revolutionary work that acknowledged the health consequences of tobacco. At that time, smoking was culturally accepted, encouraged even. People smoked indoors and every hero and every housewife were rendered sexier by the Marlborough between their lips.

Likewise, the medical establishment is now recognizing the importance of viewing drug and alcohol problems as medical conditions. Why is the definition of addiction as a medical issue important?

An important move toward non-punitive interventions for addicts

The U.S Surgeon General has now released a report, ‘Facing Addiction in America’. This is the first of its kind. The report focuses on the health issues posed by addiction to alcohol and drugs; it acknowledges that rather than addiction being a moral failing of some sort on the part of the addict. Now we understand that addiction is, in fact, a chronic neurological disorder. This classification is powerful because it entitles sufferers of addiction to treatment rather than nothing or a punitive intervention, as would be the case with any other disease.

A Call for Compassion

The Surgeon General suggests that 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’. The existence of this document could signal a great shift in understanding which will lead to more comparable treatment for addicts and those suffering with other diseases. This a concept is complicated by the notion that addicts have the element of choice in their behavior, where as those suffering from diabetes do not have that luxury.

Historically, we have thought of addicts as being weak willed or as having character failings that have left them morally weak citizens and so susceptible to addiction. This has been true of society at large, law enforcement, and in the treatment industry. However, t is becoming more evident that the nature of this neurological disorder is that it is characterized by an inability to choose to stop using. Furthermore, research is showing us that long-term changes to the brain and its chemistry shut down decision-making centers of the brain. The inherent nature of the disease of addiction is biological therefore making it morally unacceptable to punish addicts rather than offer medical help.

Current Lack of Funding

Addiction treatment is underfunded to the point that treatment just isn’t available for a majority of addicts. Take these sobering statistics into account:

  • 70% of patients with diabetes in the U.S receive some form of treatment
  • Only 10% of patients with an addiction disorder receive some form of treatment.

The situation is not much better overseas. Despite having a nationalized health system at present – which the public are fighting hard to keep against those who would privatize and dismantle this jewel of our nation- he UK fares worse still.

While an estimated 15% of the population suffer from alcohol dependence, only 1% of patients receive treatment.

The consequences of the lack of appropriate interventions for addicts are far reaching. We know that the impact is not just suffered by the individual. Instead, the effects of addiction ripple out to family, and community. In our country, the financial cost to society of alcohol-related harm is around £21 billion per year.

Disregarding these facts seems counterintuitive and lacking in foresight. 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. The treatment industry and all those in the mental health field are in an ever-evolving world. So, by deepening tour understanding of mental illness/wellness and adapting treatment practices accordingly, we may better serve needs. How might we continue to grow our understanding?

Broadening our Understanding

As our understanding of addiction has broadened, so has our definition of what it is that constitutes an addiction. The concepts that have helped to define substance addiction, particularly in relation to alcoholism, have been applied to other compulsive behaviors. Today, people may be said to have any of a variety of ‘process addictions’, such as sex, shopping, or gambling.

Is there truly a similarity between these behaviors and drugs?


The neurological reward system in instances of process addiction is triggered, hijacked in fact, in much the same way. As an aside, food addictions are normally classified as process addictions, even though substances are involved, this is due to the perception that food is not directly mood altering/psychotropic.

This broader definition of addiction has opened our minds even further to the concept of addiction as being more a neurological disease than a moral failing. The discussion around addiction has widened to include debates on the pathological predisposition of the client towards obsessive, compulsive, impulsive behavior as well as the, social, political, economic and cultural influences that may play a part in forming ‘an addict.’

In fact, much empirical evidence to connects both substance and process addictions to pre-existing risk factors and contextual issues. Though these studies show that sometimes these external factors and the presence of addiction correlate that does not prove causality. However, it is useful to address related issues even if a cause and effect relationship with the presenting issues is not proven.

Grass Roots Recovery

It is not just the clinical world that has made the link between substance and behavioral addictions. People who identify as process addicts (gambling, food, sex, etc.) have adopted the self-help mechanisms and understanding of addictions pioneered by those suffering with substance addictions. There is now an Anonymous Fellowship for pretty much any addictive behavior you could think of.

Good News

All this is great progress, especially in reducing the stigma attached to addiction. As a result, treatment can become more available. Depending on the political climate and how funding is being distributed by the government of the time, we’ll see cases of addiction increase or decrease . The bottom line? The Surgeon General’s statement is good news for addicts.


This report is indicative of a societal shift in understanding, one that acknowledges the stereotypes and prejudices regarding addicts and addiction. Analyzing and interpreting addictions though both scientific/medical and a social science lens helps us to define addiction and identity in a more refined and accurate fashion, and respond accordingly.

Moving forward

The comparison between the way in which we approached the problem of tobacco addiction and the way in which we deal with substance addiction is useful. We must adopt a multifaceted approach that includes public health education and public health measures. This will make treatment available to those who needs it. The positive consequences of such a move will ripple out from the individual, to their families, to society at large and to the purse of the government… if they have the foresight to adapt their approach to addicts.

About the author
Jason Shiers, Dip Psych, MBACP is a Transactional Analysis Psychodynamic Psychotherapist, and Head of Digital for and Jason has been helping people with all types of addictions for 23 years. He practices holistically calling on various modalities including, psychotherapy, 12 steps, mindfulness, energy and meditation to help people empower themselves to make positive change in their lives.
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