Addiction is taking a stunning toll on America and must not be thought of as a "character flaw," the U.S. surgeon general said in a landmark report published Thursday.
Seventy-eight people die each day from opioid overdose, and another 20.8 million have a substance use disorder, but just 10 percent of those 20.8 million receive treatment, Dr. Vivek Murthy wrote in the report, "Facing Addiction in America."
"Substance use disorders represent one of the most pressing public health crises of our time," the report says. "For far too long, too many in our country have viewed addiction as a moral failing. This unfortunate stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help."
It's the first publication from a surgeon general that has addressed drug and alcohol addiction, though other federal agencies have reported the same findings. The goal of the 400-plus-page report, Murthy said, is to change public attitude toward addiction the way the 1964 surgeon general's landmark report on the dangers of smoking did more than 50 years ago.
"That really helped to focus us as a culture and as a medical profession," Dr. Eric Strain, director of the Center for Substance Abuse Treatment and Research at the Johns Hopkins University School of Medicine, told NBC News. "This is a report that likewise hopefully will galvanize us to say, 'Hey, these are conditions that are medical problems, we have a database and approaches that can help. It's not hopeless and we can make a difference in the lives of people.'"
The report was personal for Murthy: Before he became surgeon general two years ago, nurses he worked with as a doctor in Boston begged him to address the drug crisis in America. The problem has been exacerbated by the stigma that surrounds it, he said.
"I've seen the pain that it causes not only [addicts], but also their families," he told NBC News. "Millions of our brothers and sisters have been forced to live in the shadows because they don't feel comfortable coming forward."
"I have people who come up to me all the time ... telling me that they are worried they'll be fired from their job, that they'll be ostracized," he added.
The report comes as America wrestles with a growing heroin epidemic, which has been captured in heartbreaking photos of adults slumped over from overdoses in the presence of young children.
Among the key findings of the report:
Overdoses kill more people than car accidents do.
Approximately 50,000 people died from an alcohol, opioid or other drug overdose in 2014, compared with 32,744 who died from car accidents that year. And the number of people currently struggling with a substance use disorder is more than the number of people suffering from any kind of cancer.
The approach to treating addiction can't be different than treating any other chronic illness, Murthy writes in a preface to his report.
"We must help everyone see that addiction is not a character flaw — it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer."
Prevention is just as important as treatment.
It's up to entire communities — teachers and principals, parents, doctors — to keep children from falling through the cracks, Murthy told NBC News. According to his report, individuals who start drinking before age 15 are four times more likely to become addicted later on than those who start at age 20 or later.
"I'm calling the country to action," he said. "We are going to need everybody to address addiction in America."
Surprise interventions, like those on TV, don't work.
Springing a staged confrontation on an addict "may backfire by heightening resistance and diminishing self-esteem on the part of the targeted individual," the report says. Professional clinical programs or services can lead to remission or even full recovery, particularly when supplemented by social services and monitoring after the addict leaves treatment.
"There's reason to be hopeful. We have evidenced-based treatment plans that work," Murthy told NBC News.
More than 25 million people who once had a problem with alcohol or drugs no longer do, according to a national survey cited in the report. The report also commends group recovery programs such as Alcoholics Anonymous, which can help individuals stay on track after a treatment program.
Obamacare has helped.
The Affordable Care Act — known as Obamacare, which President-elect Donald Trump has pledged to repeal — has given 20 million people access to health insurance who wouldn't otherwise have it. Paired with the Mental Health Parity and Addiction Equity Act of 2008, which makes addiction treatment an essential health benefit, treatment is now possible for millions.
Murthy urged Americans and insurance providers to treat addicts "with the same compassion and care that we give other illnesses."
"I want you to imagine only one in ten people with diabetes or cancer getting treatment," he told NBC News. "We wouldn't tolerate it. It's absolutely imperative that we invest in treatment to get people the help they need."
While the surgeon general's report was lauded by experts, some felt it didn't go far enough.
William Maixner, a professor of anesthesiology at Duke University School of Medicine and director of Duke’s Center for Translational Pain Medicine and Innovative Pain Therapies, told NBC News he had hoped the report would propose alternatives to opioids for pain management.
"There's very little language regarding the need for discovery of new treatments, discovery of new therapies for chronic pain — which is another epidemic," he said. "One of the reasons we have this hidden epidemic in chronic pain is the fact that we don't have good therapies, and many physicians rely on the use of opioids."
"We find, unfortunately, that a large number of these individuals are treated by opioids by well-intended individuals who have very little option but opioids to go to," he added.