ASTHO President Rallies Health Officials to Prevent Substance Misuse and Addictions

November 15, 2016|1:16 p.m.| Leslie Erdelack

Substance misuse remains a serious and multifaceted public health problem in the United States, one that ASTHO President Jay Butler will confront as part of the 2017 President’s Challenge. We talked with Dr. Butler to find out what led him to focus on preventing substance misuse and addictions and why he believes health officials are up to the challenge.

ASTHO President Jay Butler

Jay Butler, MD, CPE, was appointed chief medical officer for the Alaska Department of Health and Social Services and director of the Division of Public Health in December 2014. He maintains clinical board certification in infectious diseases, internal medicine, and general pediatrics and has spent much of his career as a medical epidemiologist investigating and responding to public health emergencies, including H1N1, SARS, avian influenza, and hantavirus outbreaks.

Leading up to the launch of the 2017 President’s Challenge, Butler considered many attention-worthy public health issues before deciding to focus on substance misuse and addictions. He thought carefully about the issues in his own jurisdiction and recalled what a previous job helped him see firsthand: Shortly before he returned to the health department as a state health official, Butler worked for the Alaska Native Tribal Health Consortium in Anchorage, where he helped create Healthy Alaskans 2020, a framework of 25 health priorities and targets for the state. During this time, he attended listening sessions in communities across the state to understand which health issues were most important to Alaskans and every region cited alcohol or drug misuse as a key concern.

Drawing on his background, Butler uses epidemiological principles to trace a parallel between the progression of infectious diseases and the progression of addiction. “In infectious disease,” Butler explains, “everything comes down to a host, a parasite, and a lack of immunity. In addictions, we have a healthy person, an addictive substance, and susceptibility to addiction. Susceptibility may be heightened by genetic factors, underlying health conditions, such as traumatic brain injuries or mental illnesses, and stress. Stress may be recognized during difficult current life circumstances, but it is often unrecognized and produced by remote events, such as adverse childhood experiences or, in certain communities, historical trauma.” These factors, according to Butler, are a formula for substance dependency that can lead to addiction and death, if not recognized and managed appropriately.

In addition to being a considerable public health threat, overdose deaths from prescription opioids and heroin have brought to light the underlying causes of all forms of substance misuse and addictions. However, Butler is quick to remind us that opioids, while currently the most publicized epidemic, are not the only form of deadly addiction. For instance, although alcohol is legal and widely commercialized, it continues to be a leading cause of death in Alaska and a prominent factor in unintentional injuries, suicide, and liver disease.

With his vision for the President’s Challenge beginning to come into focus, Butler began looking at the types of legal, illicit, and therapeutic substances that are often misused, as well as the overlay of factors and conditions that influence health and stress.

Unlike the traditional model of disease causation, Butler describes the interrelatedness of these factors as a web of cause and effect. “In none of these issues will we make progress unless we address the central challenge of substance misuse and addictions,” Butler says. Consequently, the 2017 President’s Challenge urges the public health community to look at the issue of substance misuse more broadly, beyond any one drug category, to better understand the social and cultural factors surrounding addictions, like poverty, homelessness, incarceration, interpersonal violence, and access to healthcare, particularly behavioral health services.

Now, state health officials are standing together with a variety of cross-sector partners, including behavioral health and substance abuse agencies, child welfare, attorneys general, and many others to work on these important issues. “The challenge we face is something that strikes very close to home for all of us,” Butler told state and federal partners during a recent call. It’s time for addictions to be viewed as chronic, complex neurobiological conditions that require ongoing management, support, and compassion, instead of simply the end result of a series of bad decisions.

“They may have had choices earlier in their lives,” Butler explained, recalling patients he encountered over the years in his medical practice, “but those choices were lost when the effects of addiction changed the way the brain functions.”

As ASTHO’s 2017 President’s Challenge rolls out over the next year, check back to learn more about what state and territorial health departments are doing and how they are making a difference.

For more information, download the factsheet and visit ASTHO’s President’s Challenge web page.

Leslie Erdelack is senior editor of communications at ASTHO.