Many have been stating this as fact for years. It is true of course – science closed the book on the question of addiction’s etiology over the last 20 years. Substance Use Disorders are now commonly understood as a chronic, relapsing condition which originates in the brain. Triggered by a mix of genetic predisposition, environmental factors and reaction to the foreign chemical, the disorder can take total control of an individual’s mental status and physical functioning.

This mix of risk factors that increases likelihood of the disease is matched by an equally complex scheme of health issues that are triggered by drug misuse. Ischemic heart disease, liver disease, diseases of the central nervous system, co-occurring mental illness, cancer, permanent cognitive damage are but a few of the diseases that crowd our hospitals, emergency rooms and specialty care programs – highlighting substance misuse to be a factor in many of the leading causes of death.
And the costs of this health condition are staggering. Beyond the untold lives damaged by the disease, the economic costs rank in the billions – with a study from New Futures noting that New Hampshire alone loses over $1.8 billion per year due to substance misuse. And this cost is borne not only by the taxpaying resident, but business as well – via lost worker productivity, uncompensated care and other healthcare costs.

Given all of this, one would assume that the full weight of our health system has been brought to bear on this epidemic. But in fact the opposite has happened. Over the past 30 years, as the science around preventing and treating substance use disorders has evolved, the capacity to use that research to prevent the disease’s spread and reduce its harm on those affected has waned dramatically. Lack of sustained funding, and limited opportunities to develop skills in the healthcare workforce, have left our public health and primary care systems fundamentally unequipped to deploy the techniques and strategies well-documented by literature to reduce the risk of the disorder, and sustain long-term recovery of those with the diagnosis. Where there are glimmers of success, they are often overshadowed by the enormity of what one recovery advocate describes as “our modern-day plague” –23,000,000 Americans with a diagnosable substance use disorder, yet less than 10 percent able to access treatment needed to save their lives.

The nature of the issue is staggering – and under the weight of the challenge, it can make finding a place to start change difficult. However, in the smallest of statements, that change can begin – so let’s start by changing the narrative:

“Addiction is a children’s disease”

The images that are called to mind in the substance use epidemic are often adults, deep in the throes of their disorder. However, the science has been unequivocal that adults who develop a substance use disorder overwhelmingly begin their use as youth. A child who uses alcohol or other substances before the age of 15 is four to six times more likely to develop a diagnosable substance use disorder. New Hampshire ranks 4th highest in the nation for the percentage of youth who have the diagnosis – a staggering 8.94 percent (National Survey on Drug Use and Health, 2011-2012).

Knowing this, underscores the need to engage youth during their adolescence – to educate them about their risk, empower them to take control of their health through smart decision-making, and provide interventions at the earliest signs of potential risk to prevent the onset of disease.
As with any other illness, adolescence is a difficult developmental period to consider the late-term impacts of current decision-making and behavior. So, like with any other health threat, a robust array of prevention strategies must be deployed to ensure success. Eating broccoli alone has never prevented cancer – but healthy diet can reduce cancer risk, when coupled with other strategies. If we are going to prevent another generation being lost to the disease of addiction, we need to think in similar broad approaches.

This is where early screening comes in. As schools and communities ramp up other evidence-based public health approaches to prevent the onset of substance use disorders in youth, the healthcare community can adopt practices that ensure that pediatric patients are universally screened for substance misuse. Screening, Brief Intervention and Referral to Treatment (SBIRT) adoption across all domains of the healthcare system can ensure that prevention messaging is delivered within the context of the doctor/patient relationship – as is screening for everything from seatbelt safety to diet.
Of course, nothing is simple. Limits on visit time, confidentiality issues relative to minors, lack of reimbursement issues, limited clinical training in brief intervention techniques, and scarce access to treatment referral sources all conspire to make something that strikes as common sense seem anything but. However, we must balance these challenges with cost of inaction – poor health outcomes for millions, continued escalation of healthcare costs, emergency rooms and prisons over-crowded with the ravages of unchecked addiction. Truly integrating substance use disorders prevention and treatment into the healthcare system has fast become a moral and ethical as well as an economic imperative.

It is for this reason that the New Hampshire Charitable Foundation, with support from the Conrad N. Hilton Foundation, has launched a three-year initiative to support expansion of SBIRT protocols in health centers across New Hampshire, focusing on youth. Partnering with health centers, practice change experts and policy leaders, our focus is to take this complex issue and discover the best pathways to empower the healthcare field towards improved patient outcomes.

Dr. Harvey Cushing – well regarded as the father or modern neurosurgery – was also responsible for bringing a screening and brief intervention model into the healthcare field. In 1901, he brought a device from Europe to the United States, with the belief that if the healthcare field adopted its use, our nation might see a dramatic decline in death due to unchecked disease. That device was the blood pressure cuff, which has saved millions of lives by empowering the medical and scientific community to embrace strategies to reduce hypertension.

We have done it before – and we can do it again. For the health of generations of young people, both those alive today and those we will have in the future, we must.

By Tym Rourke, Director of Substance Use Disorder Grant-making and Strategic Initiative, NH Charitable Foundation