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NatCon17: Surgeon general advocates prevention efforts

April 6, 2017
by Tom Valentino, Senior Editor
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Medication-assisted treatment and recovery services work, but in order for the U.S. population to reach its full health potential, behavioral health and addiction treatment providers need to go on the offensive, U.S. Surgeon General Vivek Murthy, MD, MBA, told attendees at the National Council for Behavioral Health Conference on Tuesday in Seattle.

“If we solely look at problems through lens of treatment, we won’t get where we need to go,” Murthy said.

Early in his term as surgeon general, Murthy engaged in a listening tour in communities across the country, and he said the stories he heard gave him a better understanding of the toll mental illness and addiction have taken on families. During a Q & A session at NatCon, Murthy advocated prevention programs, saying they are both cost-effective and under-utilized currently. One example he cited was the Good Behavior Game, a classroom behavior management program designed to prevent substance use disorder in a high-risk group by rewarding children for staying on task during instructional times. Murthy said there is a $64 return on every dollar invested in the program.

Murthy also spoke at length on the role communities can play in supporting emotional health in individuals. Murthy noted that in the 1980s, 20% of U.S. adults reported feeling lonely, a statistic that has soared to 40% today. Chronic stress and isolation put individuals at a higher risk for premature mortality, as well as heart disease and dementia. Digging deeper into substance use disorder, Murthy cited chronic stress as an emotional factor that can heighten risk.

To that end, Murthy strongly encouraged NatCon attendees to pursue initiatives that strengthen communities and drive conversations about mental health and substance use disorders, using science and research to educate the general public and change outdated narratives in the public discourse.





As one of the scientists involved, we very much appreciate the shout-out from the Surgeon General. More than 10,000 teachers are using the PAX Good Behavior Game (see research summary on NREPP at Ohio, New Mexico, Washington State, and Oregon lead with implementation. Multiple health-care companies are now using PAXGBG as both prevention, intervention and a treatment protocol. At Hopkins, my colleagues continue to follow the students from multiple randomized control comparative effectiveness studies. Some of the children are now in their mid-30's. There are now multiple replications of these core results in the US, Canada and Europe as well as among Indigenous peoples. The official website is, Using the data (e.g., effect sizes) the Surgeon General cite from the Washington State Institute for Public Policy, it is possible to compute predicted effects for single teacher or a whole population—assuming the strategy is well implemented. Here is such a projection for 1,000 students receiving PAX GBG for two years (first & second grade).

86 Fewer young people will need any form of special education services
56 More boys will likely graduate from high school.
67 More boys will likely enter university
89 More girls will likely graduate from high school (less teen pregnancy)
69 More girls will likely enter university
10 Fewer young people will commit and be convicted of serious violent crimes
96 Fewer young people will likely develop serious drug addictions
66 Fewer young people will likely become regular smokers
35 Fewer young people will likely develop serious alcohol addictions
49 Fewer young peope will likely contemplate suicide
66 Fewer young people will likely attempt suicide

This hyperlinked video has interviews with teachers, current students and "graduating" students who have been through PAX Good Behavior Game. The video explains what it really is and how it works.