The huge toll that substance use and misuse is having on individuals, families, and communities in the USA has culminated in a major public health crisis that shows few signs of abating. Last week, the US Surgeon General released Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health—the Surgeon General's first-ever statement on this topic. This 426-page report addresses the problem of substance use and the wide range of adverse health effects from alcohol and both legal and illegal drugs. It brings together evidence on prevention; treatment; and recovery interventions, policies, and programmes.

There are some alarming statistics. 20·8 million people in the USA have a substance use disorder, equivalent to the number of Americans with diabetes. In 2014, there were 47 055 drug overdose deaths, 28 647 of which involved prescription opioid drugs and heroin. Of the one in seven Americans (14·6% of the population) expected to develop a substance use disorder during their lives, only one in ten will receive treatment. More than 66·7 million people reported binge drinking in the past month. Alcohol misuse contributes to 88 000 deaths in the USA each year. These numbers do not include the millions of people misusing substances who will later develop a substance disorder.

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Thumbnail: CC Flickr Mike Mozart