U.S. Surgeon General Vivek Murthy called addiction to drugs and alcohol “a moral test for America,” given the more than 20 million people in the country with substance abuse problems in a new report released Thursday.

The report is the first from his office to address substance abuse and Murthy hopes that it will influence how the public treats the issue much like the Surgeon General’s report on tobacco began a move away from the product 50 years ago.

“We can never forget that the faces of substance use disorders are real people,” Murthy wrote in a letter accompanying the report. “Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?”

The report attempts to erode some of the stigma surrounding substance abuse by highlighting the growing evidence that substance abuse has roots in neurobiology. Repeated use of drugs changes the brain so that it demands more to function.

Only 10% of people with a substance abuse receive treatment, according to an editorial by Murthy, and the report looks at ways to help the millions who go untreated. Recommended initiatives include expansion of community-based programs, increased investment in training for health workers and policy reforms.

The report assesses addiction and substance abuse across a wide range of drugs, but opioids have received the most attention given the scale of the opioid crisis in the U.S. Nearly 30,000 people die from heroin or prescription opioid misuse every year, according to the report.

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Write to Justin Worland at justin.worland@time.com.