Although crowed out by the election, Surgeon General Vivek H. Murthy’s report on substance abuse, Facing Addiction in America, offers a detailed roadmap to expanding this nation’s strategy on addressing the ever-present problem of substance use.  The Surgeon General said, “the reason I’m issuing this report is I want to call our country to action around what has become a pressing public health issue. I want our country to understand the magnitude of this crisis I’m not sure everyone does.”

This is especially true for the child welfare field which has constantly felt the impact of substance abuse.  Various reports and research indicates that anywhere from 30 to more than 60 percent of child welfare cases are impacted by substance abuse and or mental health disorders.

Much of the focus over recent years has been on reducing numbers in care, in-home services and other broad strategies around intervention services but substance abuse continues to be a major challenge in reducing child abuse and reducing foster care placements. Recently the focus has changed to opioid abuse, including heroin, methamphetamines a few years before that and crack and cocaine before that while there has been a continual and sometimes ignored impact of alcohol.

Within child welfare the impact of the opioid-heroin epidemic has been clear with a significant increase in the number of children entering foster care.  Foster care placements have increased to 427,000 as of 2015 approximately an 8% increase from four years earlier.

The Surgeon General’s report indicates that drug addiction, mainly the opioid epidemic, has killed more than 500,000 people since the year 2000. It also points out that substance abuse disorders affect 20.8 million people in the United States.  The report points out that that figure equals the number of people with diabetes and is 1 1/2 times as many as those with cancer.  Despite this only one in 10 people receive treatment.  General Murthy went on to say that “we would never tolerate a situation where only one in 10 people with cancer or diabetes gets treatment and yet we do that with substance abuse disorders.”

Here are a few of the many points by the Surgeon General that may be relevant to the child welfare field:

  • Until recently, substance misuse problems…were viewed as social problems, best managed at the individual and family levels, and sometimes through the existing social infrastructure…and when necessary through civil and criminal justice intervention…the existing health care system was neither trained to care for nor especially eager to accept patients with substance use disorders…
  • Some groups of people are more vulnerable to substance misuse disorder…men tend to drink more than women…women who use cocaine, opioids or alcohol progress from initial use disorder at a faster rate than men…
  • The yearly economic impact of alcohol misuse …is estimated at $249 billion…and the impact of illicit drug use disorders is estimated at $193 billion
  • Well-supported scientific evidence shows that substance use disorders can be effectively treated, with recurrence no higher than those for other chronic diseases
  • It can take a year of abstinence before a person enters remission for people trying to recover from an alcohol abuse disorder, it can take four or five years before the chance of relapse drops to 15%.
  • Only about 1 in 10 people …receive any type of specialty treatment
  • Reasons for not getting treatment include…30.6 percent who do not have health care coverage/could not afford it
  • 12.6 percent did not know where to get the treatment or no program has the type of treatment needed
  • Reviews of evaluations of drug courts showed a drop in recidivism from 50 to 38 percent
  • Children of parents with substance use problems were more likely to require child protective services at younger ages, to experience repeat neglect and abuse from parents…an estimated 19 percent of adolescents served by child welfare system have experienced some form of substance use disorder

To get a more comprehensive review see Facing Addiction in America