While the debate rages whether the drug epidemic in the United States is best served by walls or treatment, millions of Americans suffer from alcoholism or addiction to legal and illegal drugs, but only a fraction are being treated, according to a report released on Thursday by the surgeon general.

One in seven people in the United States is expected to develop a substance use disorder at some point, the report said. But as of now, only one in 10 will receive treatment.

The report is the first from a surgeon general to address substance use disorders and the wider range of health problems related to alcohol and drugs.

It calls for, among other things, a cultural change in understanding that addiction is a brain disease, not a character flaw.

“It’s time to change how we view addiction,” Dr. Vivek H. Murthy, the surgeon general, said in releasing the report. “Not as a moral failing but as a chronic illness that must be treated with skill, urgency and compassion. The way we address this crisis is a test for America.”

The report is intended to try to prompt the public, policy makers and health care professionals to better address these issues.

“The deaths caused by prescription drug, heroin and fentanyl overdoses are growing exponentially every year, yet this report fails to provide any detailed road map for how best to curb opioid addiction,” Senator Edward J. Markey, Democrat of Massachusetts, said in a statement. New England has been noted as a major center of citizens addicted to pain killers.

According to the Surgeon General’s report, only about 10 percent of people with a substance use disorder receive any type of specialty treatment, the report said. And while more than 40 percent of people with such a disorder also have a mental health condition, fewer than half receive treatment for either.

From 40 percent to 70 percent of a person’s risk for developing a substance use disorder is genetic, the report said, but many environmental factors — like how old he or she is when first drinking or trying drugs — can influence the risk.

People who first drink alcohol before age 15 are four times more likely to become addicted at some time in their lives than are those who have their first drink at age 20 or older, the report said.

Nearly 70 percent of those who try an illicit drug before the age of 13 develop a substance use disorder within seven years, the report said, compared with 27 percent of those who first try an illicit drug after the age of 17.