The U.S. Department of Health and Human Services released its first report on addiction in the country Friday, and Surgeon General Vivek Murthy said it was “a new call to action to end the public health crisis of addiction.” According to estimates in the report, titled “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” abuse of alcohol and illicit drugs cost the country about $442 billion a year.

Data from the report, which is for U.S. citizens 12 years old or older, showed that more than one of every seven Americans had misused alcohol or some drug in the past year. About 88,000 people die in the U.S. every year due to alcohol misuse and over 47,000 deaths in 2014 were caused by drug overdose, including 28,647 who consumed too much of some form of an opioid. These numbers were higher than any other previous year on record.

More men reported abusing both alcohol (68.6 percent) and other substances (20.5 percent) than women (62.9 percent and 15.3 percent, respectively) over the past year. White Americans (70.3 percent) abused alcohol more than any other demographic while American Indians or Alaskan Natives (22.9 percent) were the largest abusers of illicit drugs as a proportion of their population.

The U.S. spends more than any other country in the world on health care but ranks only 27th in life expectancy. Analysis by the Centers for Disease Control and Prevention showed that alcohol and drug abuse was the biggest factor for a decline in life expectancy among white Americans.

The report, which talks about prevention programs, treatment and recovery as well, also points out that the addiction epidemic in the country is not a moral failing but rather “a chronic brain disease that has the potential for both recurrence (relapse) and recovery.” At the same time, Murthy says: “How we respond to this crisis is a moral test for America. Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?”

Since marijuana is now legal (medically or recreationally, or both) in many states but still outlawed by federal laws, the report includes marijuana in its list of illicit drugs and the data should be interpreted accordingly.