By adopting an evidence-based public health approach, America has the opportunity to take genuinely effective steps to prevent and treat substance-related issues. Such an approach can prevent substance initiation or escalation from use to a disorder, and thus reduce the number of people suffering with addiction; it can shorten the duration of illness for sufferers; and it can reduce the number of substance-related deaths. A public health approach will also reduce collateral damage created by substance misuse, such as infectious disease transmission and motor vehicle crashes. Thus, promoting much wider adoption of appropriate evidence-based prevention, treatment, and recovery strategies needs to be a top public health priority.

Making this change will require a major cultural shift in the way we think about, talk about, look at, and act toward people with substance use disorders. Negative attitudes and ways of talking about substance misuse and substance use disorders can be entrenched, but it is possible to change social attitudes. This has been done many times in the past: Cancer and HIV used to be surrounded by fear and judgment, now they are regarded by many as simply medical conditions. This has helped people become comfortable talking about their concerns with their doctors, widening access to prevention and treatment. By coming together as a society with the resolve to do so, it is similarly possible to change attitudes toward substance misuse and substance use disorders. There is a strong scientific as well as moral case for addressing substance use disorders with a public health model that focuses on reducing both health and social justice disparities, and it aligns strongly with an economic case. Now is the time to make this change, for the health and well-being of all Americans.