What’s Missing in the Surgeon General’s Report on Alcohol, Drugs, and Health?

From time to time the US Surgeon General issues reports that synthesize health research and public policy in a way intended to reach the public and generate support for needed improvements. Having been involved in the development of two such reports—including the paradigm-shifting Surgeon General’s Workshop on Drunk Driving several decades ago—and as a member of the NACoA board of directors, I paid close attention to the latest report, issued last fall, titled “Facing Addiction in America: the Surgeon General’s Report on Alcohol, Drugs, and Health.”

First of all, this is a splendid report, chock-full of statistics, illustrations, definitions, program profiles, research and practice recommendations, and a perspective that I believe significantly advances our understanding and forthrightly identifies our challenges, yet gives us reason for hope and optimism In its more than four hundred pages it covers research, prevention, intervention, recovery, and a “vision for the future” that I hope we can all subscribe to. I recommend it highly.

But something important is missing. In its comprehensive coverage of the issue, the report has neglected to include children of addiction. There is no mention of these innocent victims, either in the section on impact of alcohol and drug problems, in the prevention or intervention sections, in statistics, in the report’s compilation of proven and promising programs designed to address the problem or in recommendations for further research and practice. 

For example, in the section “Costs and Impact of Substance Use and Misuse,” the consequences on the individual user, on pregnancy, and on the risks of communicable disease are well documented, followed by specific subsections on DWI, overdosing, and intimate partner violence, sexual assault, and rape (US Department of Health and Human Services, 2016). Yet not a word on the one in four children exposed to alcohol addiction in the family, which can create health, social, legal, and economic problems over a lifetime, as well as the more acute problems of child abuse and neglect. 

More than twenty-eight million Americans are children of alcoholics; nearly eleven million are under the age of eighteen. 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.

Why is this important? Because unless we break the cycle of addiction—and the many problems associated with substance use disorders—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. As the body of research known as Adverse Childhood Experiences (ACE) documents, the risks to the array of problems of growing up in a household afflicted by parental substance dependence and addiction is substantial and is transmitted intergenerationally.

Understandably, the current focus on the opioid epidemic—with some seventy-eight people dying each day of overdose and the need to get more people into treatment, with only ten percent of those in need of treatment actually receiving it—absorbs our attention and our all-too-meager resources. However, children in the midst of parental dependence and addiction are in harm’s way, and we as a society have for far too long averted our eyes. 

While we support expansion of treatment as a means to recovery for individuals as well as reduced risks for children in their care, we must also support children of addiction to help them cope with their conditions and improve the means for recovery of the whole family.

Yet in the Surgeon General’s report, there are no research, practice or policy recommendations related to children of addiction. In the concluding chapter, “Vision for the Future: A Public Health Approach” there is a section entitled “Specific Suggestions for Key Stakeholders” including individuals and families, health care professionals, professional associations, and health care systems, but readers will find nary a word about children of addiction (US Department of Health and Human Services, 2016). 

Early during the report drafting stage, Sis Wenger, the president and CEO of NACoA, and I, along with other constituent groups met with the Surgeon General, Dr. Vivek H. Murthy, and were impressed with his attentiveness and sincerity as we all made our points about what the report should include. Some of our colleagues pushed hard for inclusion of sometimes controversial yet well-researched interventions such as increased alcohol taxes and regulation of alcohol outlet density, and those measures were thoughtfully included and well documented. That’s brave of Dr. Murthy. Yet looking out for the welfare of young victims of addiction did not make the cut. That’s regrettable.

But does it really matter that children of addiction are left out of this report? Absolutely, for several reasons. First, reports from the Surgeon General—the chief health official of the federal government—often set priorities for research, funding, and public policy. To be left out has great potential for harm, as such reports confer status on an issue and often help set an agenda for research and public policy. 

But there is another reason for concern; this report was developed with the direct involvement and support of NIAAA, NIDA, SAMHSA, professional societies, and addiction researchers and policy experts across the country. That this group of experts, steeped in research and policies, could miss or plainly avoid the consequences of parental alcohol and drug misuse and addiction on their children is quite troubling.

Compounding the problem is that the Affordable Care Act, including Medicaid expansion, which has provided increased support for treatment, is under threat from the new administration, so it is likely that there will be a higher priority placed on treatment availability and even less attention to other funding needs.

But we have some good news: we have proven interventions. For example, Celebrating Families! is an evidence-based, skills-building program designed for families who have been affected by addiction. This program uses an intergenerational approach, engaging parents with substance use disorders, their children through age seventeen, and the children’s caregivers. The program’s focus is to prevent children’s future addiction while also improving their mental and physical health. The Celebrating Families! curriculum is coordinated by NACoA and has been implemented in over one hundred jurisdictions.

Further, SAMHSA is reissuing its proven effective Children’s Program Kit, introduced in this column in the February issue of Counselor, and is making it available to education, prevention, and treatment programs as a tool for providing educational support groups for children of addiction. 

In his preface, Surgeon General Murthy observes that how we respond to this crisis is a moral test for America. He asks “Are we as a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings to care for one another?” (US Department of Health and Human Services, 2016). Tough questions, indeed. The answer must be yes, but the true test will be whether we will protect the youngest and most vulnerable among us. Who will march for the children that are devastated by their parents’ addiction and do not have the power to march on their own?

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