…a report he released yesterday reveals that Surgeon General Vivek Murthy is utterly conventional in his attitude toward drinking and other kinds of recreational drug use, which he views as a problem to be minimized by the government.
Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health claims “addiction is a chronic brain disease” caused by exposure to psychoactive substances, even while acknowledging that the vast majority of people who consume those substances do not become addicted to them.
The report describes even low-risk, harmless, and beneficial drug use as “misuse,” giving the government broad license to meddle with personal choices through policies aimed at making drugs more expensive and less accessible.
Murthy argues that driving down total consumption, rather than focusing on problematic use, is the most effective way to reduce the harm caused by alcohol and other drugs.
As he sees it, every drinker and drug user, no matter how careful, controlled, or responsible, is a legitimate target of government intervention.
Murthy’s report eschews the term substance abuse, explaining that the phrase “is increasingly avoided by professionals because it can be shaming.” Instead the report talks about “substance misuse,” which “is now the preferred term.” But substance misuse is just as judgmental, vague, and arbitrary as substance abuse.
Murthy says, “it generally suggests use in a manner that could cause harm to the user or those around them.” Could cause harm? That definition is wide enough to cover all drug use.
Murthy does seem to think drug use is problematic even when it causes no problems.
If a man at a dinner party drinks a cocktail before the meal, a few glasses of wine during it, and a little bourbon afterward, he is drinking too much, according to Murthy, even if he takes a cab home. By that standard, at least 44 percent of past-month drinkers are misusing alcohol.
Murthy also counts all consumption of federally proscribed drugs as misuse, no matter the context or consequences.
As far as he is concerned, all 36 million Americans who consumed cannabis last year misused it, even if they lived in states where the drug is legal for medical or recreational purposes (which is now most states).
According to the CDC, there were 18,893 deaths involving opioid analgesics in 2014, the most recent year for which data are available. That year, according to the National Survey on Drug Use and Health, 10.3 million Americans used prescription painkillers for nonmedical purposes.
On average, they ran a 0.2 percent chance of dying as a result. For those who avoided mixing narcotic painkillers with other depressants (a typical factor in opioid-related deaths), the risk was even smaller—on the order of 0.02 percent.
Murthy also seems confused when he talks about addiction. “We now know from solid data that substance abuse disorders don’t discriminate,” he recently told NPR. “They affect the rich and the poor, all socioeconomic groups and ethnic groups. They affect people in urban areas and rural ones.”
But according to Murthy’s report, “Prevalence of substance misuse and substance use disorders differs by race and ethnicity and gender.” Furthermore, “genetic, social, and environmental risk factors” increase a person’s vulnerability to addiction, while “protective factors” reduce it.
Risk factors include
- “low parental monitoring,”
- “high levels of family conflict or violence,”
- “current mental disorders,”
- “low involvement in school,” and
- “a history of abuse and neglect.”
Protective factors include
- “involvement in school,
- engagement in healthy recreational and social activities, and
- good coping skills.”
…it sounds like substance abuse disorders do discriminate, since they are more common among troubled people in difficult circumstances.
The fact that everyone is not equally prone to addiction tells us that Murthy’s account, in which a “substance abuse disorder” is “a medical illness caused by repeated misuse of a substance or substances,” cannot be accurate.
According to the report,
“prolonged, repeated misuse of any of these substances can produce changes to the brain that can lead to a substance use disorder, an independent illness that significantly impairs health and function and may require specialty treatment”
Those cans are carrying a lot of weight. In fact, as Murthy concedes, drug use typically does not “lead to a substance use disorder”; controlled use is much more common.
“For a wide range of reasons that remain only partially understood,” says the executive summary, “some individuals are able to use alcohol or drugs in moderation and not develop addiction or even milder substance use disorders, whereas others—between 4 and 23 percent depending on the substance—proceed readily from trying a substance to developing a substance use disorder.”
By saying “some” and “others” instead of “most” and “a minority,” the report obfuscates the point that the vast majority of drinkers and drug users are not addicts.
Murthy’s equation of addiction with cancer and diabetes is also misleading. “Now we understand that these disorders actually change the circuitry in your brain.
All experiences change the brain; that does not make them diseases.
Although the medical terminology is supposed to reduce the stigma associated with drug addiction and encourage people to seek help, it is not clear that describing the problem as an illness rather than a habit makes it any easier to change.
Author: Jacob Sullum is a senior editor at Reason magazine and a nationally syndicated columnist.