One addiction at a time? Not necessarily

Addiction and Recovery

By Bob Gaydos

      Once upon a time, not that long ago, you used to be able to find an AA meeting by looking for a church with a cluster of people standing outside and smoking. That’s still possible, but the clusters have grown smaller. More significantly, as people in recovery joined much of the rest of society in quitting smoking, the air in the meeting rooms cleared up and ash trays disappeared from the tables.

      But it wasn’t easy. Many people in recovery say snuffing the cigarettes was much harder than putting down the drink or the drug. Until recently, that belief, supported by research, meant recovery programs focused solely on the alcohol addiction and left the nicotine addiction to be addressed at a later time, if the person so desired. It was too hard to do both at the same time, the thinking went, and the primary goal was to address the substance abuse.

      This, even though statistics showed that: 1. more than 80 percent of clients in rehab were smokers; 2. people with addictions to alcohol (or other drugs) were significantly more likely to be smokers than those without an alcohol abuse disorder (17 percent of adults); and 3. people who have been treated for alcohol problems were more likely to die of health issues related to tobacco than to alcohol, since they have a higher risk of heart disease and cancer than non-smokers. Also, non-smokers in recovery live longer than smokers in recovery.

      Time and research have changed the treat-one-addiction-at-a-time philosophy, at least to the extent that more rehabs are now offering stop-smoking programs as well as traditional alcohol/drugs programs. This may have something to do with the fact that surveys have shown that a sizable majority of smokers in treatment for alcohol or drug addiction say they also want to quit smoking and that they think it is better to do so within six months of stopping drinking or using drugs rather than waiting until later.

      A primary motivator for quitting smoking early in recovery from alcohol abuse is the strong connection between smoking and drinking. For many alcoholics, the two activities went hand-in-hand. In direct contradiction to previous thinking which said quitting smoking would make it harder for people new to recovery to stay sober, some treatment specialists today say that continuing to smoke while not drinking can be a strong trigger for relapse. Nicotine stimulates the brain’s pleasure receptors, feeding the “need” for more.

      No one says it’s easy to quit smoking and drinking at the same time, but it’s often suggested to use the motivation and strategies used to stop drinking to also stop smoking. That means, for certain, not trying to do it on one’s own, but rather, being open to a variety of help from behavioral therapists to nicotine replacement therapies, to encouragement from friends and family, to online and in-person support from groups such as Nicotine Anonymous (https://www.nicotine-anonymous.org) and the American Lung Association (https://www.lung.org/stop-smoking).

       Ideally, recovery from alcohol or other drugs means adopting a healthier lifestyle including exercise, proper nutrition and emotionally or spiritually rewarding behaviors. Smoking doesn’t qualify.

Bob Gaydos is a freelance writer. rjgaydos@gmail.com

  

Smoking can lead to premature death

Addiction and Recovery

By Bob Gaydos

“The cigarette is a very efficient and highly engineered drug-delivery system.”

      The sentence appears on the web site of the National Institute on Drug Abuse. With its sheer bluntness, it says all you need to know about why more than 50 million Americans smoked a cigarette last month despite massive campaigns detailing the health risks of smoking, despite the fact that many of those risks are printed right on the cigarette pack, despite restrictions on smoking in public areas, and even despite the increasingly high cost of smoking because of taxes placed on tobacco products.

     Nicotine delivers endorphins, euphoria, dopamine to the brain with each puff on the cigarette. A pack a day is about 200 “hits” of good feeling. Stop puffing, it goes away. The brain doesn’t like the change in mood. Withdrawal can be unpleasant.

     “Cigarette smoking harms nearly every organ in the body, and smoking is the leading preventable cause of premature death in the United States.”

    That sentence also appears on the NIDA web site (www.drugabuse.gov) and the two statements taken together are why it’s important not to ignore the addiction health threats staring us in the face — or assaulting the senses of non-smokers — amidst the daily serving of headlines on drunk drivers and drug overdoses. 

    Nearly half a million deaths annually are still attributed to smoking and, despite significant progress in reducing the number of smokers, according to NIDA, “if current smoking rates continue, 5.6 million Americans who are currently younger than 18 will die prematurely from smoking-related disease.”

    Nicotine is addictive. Smoking kills people before their time. 

And yes, a lot of people have gotten the message. Surveys show smoking rates for people 18 and older continue to go down and the rate of smoking among those under 18 is at historically low levels. That latter is key because tobacco is often the first substance adolescents use to emulate adults and often leads to other substance use disorders. Research also suggests that nicotine has a strong impact on still-developing adolescent brains, making it more difficult for those who want to quit when they are older. And nearly everyone who smokes has tried to quit. Some succeed. Some have a hard time.

   The jury is still out on e-cigarettes as a replacement for cigarettes. They remove the chemicals that, when burned, are responsible for the various health risks attribute to cigarettes, leaving vapers to go for the nicotine rush. But some research suggests other possible risks, especially for young users, so it’s buyer beware.

    Significantly, for the focus of this column, research shows a strong connection between smoking and persons with alcohol or other substance dependence and a prevalence of smoking (65 to 85 percent) among persons in treatment for all substance use disorders. Addictions often go together, but quitting one doesn’t always mean quitting others is easier. The next column will report on what some people with alcohol or other substance use disorders have experienced as they tried to quit smoking.

Bob Gaydos is a freelance writer. rjgaydos@gmail.com

Test your knowledge on addiction

Addiction and recovery

By Bob Gaydos

The more things change, the more some other things seem to stay the same. This is particularly true in the field of addiction and substance abuse. With (a) an opioid epidemic sweeping the nation, (b) a growing nationwide movement to legalize the use of marijuana for medicinal and even recreational use, and (c) a growing consensus that the “war on drugs” has failed, a new administration in Washington seems determined to stick to the old, law-and-order approach to addiction.

This suggests that, while we may be in the midst of an unprecedented technological revolution, some of us may still be operating with outdated information. That’s why, from time to time, I devote a column to facts about alcohol and drug addiction. After all, if we’re going to treat it as a war, or as a crusade against a major health issue, we should know what we’re up against.

And, since Americans love quizzes, I’ve put one together to test your addiction IQ. It’s updated from one I offered a few years ago. Quizzes may be fun, but obviously this is a serious issue. The questions and answers are based on reports and other published materials of the National Center on Addiction and Substance Abuse.

What’s your addiction IQ?

1. a) 10 million; b) 20 million); c) 40 million; d) 60 million Americans 12 or older have substance abuse problems.
2. a) 15%; b) 25%; c) 50%; d) 75% of all high school students have used addictive substances, including cigarettes, alcohol, marijuana or cocaine.
3. More than a) 50%; b) 60%; c) 75%; d) 90% of people with a substance problem began smoking, drinking or using other drugs before age 18.
4. a) 26%; b) 36%; c) 46%; d) 56% of children under age 18 live in a household where someone age 18 or older is smoking, drinking excessively, misusing prescription drugs or using illegal drugs.
5. Seven in 10 people with the chronic diseases of high blood pressure, major depression and diabetes receive treatment. How many people who need treatment for substance problems receive any form of care? a) 1 in 10; b) 2 in 10; c) 3 in 10; d) 5 in 10.
6. The National Institute on Alcohol Abuse and Alcoholism defines risky drinking for women as: a) 3; b) 7; c) 10; d) 12 drinks in a week.
7. The NIAAA defines risky drinking for men as more than: a) 12; b) 14; c) 16; d) 20 drinks in a week.
8. Among people with a prescription drug use problem, nearly: a) 25%; b) 30%; c) 50%; d) 75% have another substance problem.

    9. Of every dollar state and federal governments spend on substance problems: a) 2 cents; b) 5 cents; c) 10 cents; d) 25 cents goes to prevention and treatment.

True or false

   10. Having a high tolerance (feeling less effect from the substance with continued use) is a sign that the person is not addictive.

   11. Because they use substances at lower levels than men, women typically progress from substance use to addiction more slowly than men and experience the health consequences of substance use, such as death, cancer, heart disease and memory problems, less intensely than men.

   12. Addiction, substance use and abuse are the largest preventable and most costly health problems facing the U.S. today, responsible for more than 20 percent of deaths in the U.S.

   13. Addiction, substance use and abuse cause or contribute to more than 70 other conditions requiring medical care, including cancer, respiratory disease, cardiovascular disease, HIV/AIDS, pregnancy complications, cirrhosis, ulcers and trauma, and account for one-third of all hospital in-patient costs.

   14. Total costs to federal, state and local governments of addiction, substance use and abuse are at least $468 billion per year – almost $1,500 for every person in America.

    15. Addiction can’t be a disease because it is caused by the individual’s choice to use drugs or alcohol.

Answers: 1(c); 2(d); 3(d); 4(c); 5(a); 6(b); 7(b); 8(d); 9(a).

10: False. High tolerance is a warning sign of a possible substance problem.

11: False. Women generally progress more quickly than men in addiction and suffer more intensely.

12, 13 and 14: True. Just putting out some perspective on the scope of the problem.

15: False, according to National Center on Addiction and Substance Abuse: “While the first use (or early stage use) may be by choice, once the brain has been changed by addiction, most experts believe that the person loses control of his or her behavior. Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices, such as diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.”

Keep score yourself. The only way to fail is to ignore the issue altogether.

* * *

More info:

www.centeronaddiction.org.

www.niaaa.nih.gov.

bobgaydos.blogspot.com

E-cigs: Way to quit smoking or new way to get hooked?

Addiction and Recovery

By Bob Gaydos

Is it a Catch-22 or a smoke screen? Are e-cigarettes the most promising product to come along to help smokers quit their nicotine addiction, or are they a clever, new way to get non-smokers hooked? Or, are they both?

At this point, no one can say for sure, but there appears to be an informal and growing consensus that electronic cigarettes represent a real health benefit for longtime smokers. That’s because e-cigs do not contain tobacco and the many harmful substances that are released and inhaled when cigarettes are smoked. At the same time, there is concern that too little is known about possible negative health effects on e-cig users and bystanders of chemicals that are released when their vapor is inhaled.

That is an important health issue, but the purpose of this column is to discuss addiction. In that regard, again because of the newness of the product, there is too little information to know if e-cigs, as widely touted, can actually help smokers break their nicotine addiction. Even more significantly, as the Food and Drug Administration says on its web site, “It is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.”

As public health campaigns against tobacco products have

sharply reduced sales of tobacco products in the United States, e-cigarettes have quickly blossomed into a $2-plus billion industry that shows no signs of slowing down.

Cities and states have scrambled to pass laws regulating where e-cigs can be used. New York City bans using them wherever smoking is banned. (You must be 18 to buy them.) In an effort to provide uniformity to the law, the FDA is poised to extend some or all of its regulations for tobacco products to electronic cigarettes. That has a lot of smokers upset, saying the government shouldn’t make it harder for people trying to quit smoking by vaping -- the term for using e-cigarettes.

E-cigs use a battery to heat and vaporize nicotine that is mixed with water, flavoring and a base (two types) to carry the mixture. Unlike traditional cigarettes, cigars and pipes, there is no combustion -- the source for the health problems. For e-cig users, it’s more like inhaling fog, with a shot of nicotine (in varying doses), while enjoying the same hand-to-mouth, tactile experience of lighting up. Smoking without the smoke.

Again, that sounds like a sensible way to help longtime smokers avoid the serious health risks associated with using combustible cigarettes, while still getting their nicotine fix. It says nothing about that fix -- the addiction to nicotine. Some studies have raised concerns about the addictive power of the nicotine used in e-cigs, even at lower doses.

Meanwhile, many anti-smoking groups and health experts pose this question: If e-cigarettes are being sold as a way to reduce the harm of smoking tobacco for longtime smokers, why are they also being marketed in such a way as to attract thousands of young users who have never smoked traditional cigarettes? (It is worth noting that big tobacco companies are also big sellers of e-cigarettes.)

The fear, cited by the FDA as well as public health advocates, is that electronic cigarettes may act as a gateway product, luring young users into trying tobacco products.

A recent report in the Journal of the American Medical Association lends weight to that fear. The report noted that, in a recent study, 16 percent of 10th-graders reported using e-cigarettes. The study said that the group of teenagers included those who had smoked before (43 percent) and those who had not and that, in follow-up studies, the teens who had never smoked before were more likely to try smoking traditional cigarettes after trying e-cigs. Curiosity? Suggestibility? Peer pressure? Being a teenager?

Among those who suffer from it and those who treat it, there’s a saying: Addiction is a disease of more. In other words, if I can feel this good with just a little nicotine, how good can I feel with even more? Or, if this is such a cool experience -- making believe I’m smoking even though I’m not inhaling any nicotine -- how cool can it be with the real thing?

Sukhwinder Singh and his wife, Satnam Kaur, own Smokers Heaven, an e-cigarette shop in the Town of Wallkill in upstate New York. He says 75 percent of his customers are trying to quit smoking. “They’re trying to go from smoking thousands of chemicals, to one, nicotine.” He says many have been advised by their doctors to switch to e-cigs.

Singh says he only sells flavorings made in the United States (not China) because there are more controls on the ingredients, another concern for the FDA. “I don’t push nicotine on anyone,” he adds, saying that he tries to steer younger non-smokers who are curious about the product to non-nicotine mixtures. He and his wife sample the choices of hundreds of appetizing-sounding flavors -- without nicotine -- so they can tell their customers what they are like.

The fact that e-cigs are also cheaper than combustible cigarettes -- many more puffs per buck -- adds to the argument that they are a sensible, harm-reduction, health product.  But the FDA says there is as yet no proof of that. If they came under FDA control, e-cig makers would have to pass scientific muster to gain approval for sale. That could be expensive and time-consuming.

But even if producers eventually do offer scientific evidence of harm reduction, e-cigs are still delivery devices for a highly addictive substance -- nicotine. For this reason, the FDA is being urged, at the very least, to make e-cigarettes subject to the same regulations that prohibit companies from advertising and marketing tobacco products in ways designed to appeal to young consumers.

Are e-cigs safer for some? Maybe so. Time will tell. But even time won’t erase one question: If there’s no addiction to quit (no harm to reduce), why risk creating one?

rjgaydos@gmail.com

E-cigarettes and the FDA

Electronic cigarettes, also known as e-cigarettes, are battery-operated products designed to deliver nicotine, flavor and other chemicals. They turn chemicals, including highly addictive nicotine, into an aerosol that is inhaled by the user. Most e-cigarettes are manufactured to look like conventional cigarettes, cigars, or pipes. Some resemble everyday items such as pens and USB memory sticks.

Only e-cigarettes that are marketed for therapeutic purposes are currently regulated by the FDA Center for Drug Evaluation and Research. Currently, the FDA Center for Tobacco Products regulates cigarettes, cigarette tobacco, roll-your-own tobacco and smokeless tobacco.

FDA has issued a proposed rule that would extend the agency’s tobacco authority to cover additional products that meet the legal definition of a tobacco product, such as e-cigarettes.

http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm172906.htm