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

Maybe there‘s a little addiction, disorder in all of us

Addiction and Recovery

By Bob Gaydos

   
Opioids and alcohol get most of the attention, although marijuana, currently undergoing a reputation rehabilitation, has been grabbing plenty of headlines lately. But if you spend any amount of time studying the issue, it doesn’t take long to wonder if there isn’t an addiction, compulsion, behavioral disorder — call it what you will — for every human on the planet.

    Some conditions are more serious than others, but all

either involve the brain’s reward system or relieve anxiety, stimulate compulsive use and bring with them an opportunity for negative consequences. Consider the following an inventory of sorts, a look at some of the substances people use or behaviors they engage in, perhaps to excess. Maybe someone you know shows some of the signs of trouble.

Medically recognized substance use disorders

    Alcohol Use Disorder: Alcohol is a depressant. Alcohol use disorder is more common among adult men than among women, but the gap is narrowing. It typically develops at a young age. Severe use is commonly referred to as alcoholism.

Caffeine Intoxication: Heavy intake of caffeine resulting in symptoms including restlessness, nervousness, insomnia, gastrointestinal disturbance, rambling thoughts and speech, cardiac rhythm disturbances.

Cannabis Use Disorder: Highest among 18- to29-year-olds. Often the first drug used and often used with other drugs. Prevalence decreases with age.

Hallucinogen Use Disorder: These substances alter perception. Phencyclidine — “angel dust” or PCP — produces feelings of separation of mind from body.

Inhalant Use Disorder: Sniffing glue. Inhalant substances are volatile hydrocarbons, toxic gases that are released from glues, fuels and paints, that can have psychoactive effects. Occurs primarily among ages 12 to 17.

Opioid Use Disorder: Opioid drugs include heroin and prescription pain-relievers such as oxycodone, codeine, morphine, and fentanyl. According to the American Society of Addiction Medicine, opioid-related overdoses are now the leading cause of death in Americans under 50 years of age and prescribed opioids are the “overwhelming initial source” of addiction.
    Sedative, Hypnotic, or Anxiolytic Use Disorder: Addiction to sleeping pills and anti-anxiety medications (Valium, Xanax, Librium). These are brain depressants. Rates are highest among 18- to 29-year-olds.
    Stimulant Use Disorder: This group include amphetamines, Ritalin and cocaine. These drugs are commonly prescribed for the treatment of attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. Cocaine use in the U.S. is highest among those aged 18 to 25.

Tobacco Use Disorder: Nicotine in tobacco acts as a stimulant for the central nervous system. Studies show that 68 percent of adult smokers want to quit and 50 percent of smokers have tried.

Behavioral disorders

Binge-eating disorder (overeating disorder): Uncontrolled eating, often accompanied by purging (bulimia).

Gambling disorder: Because of the quick feedback, it can provide reward symptoms to the brain much like alcohol or cocaine.

        Gaming disorder: It has been recognized officially by the World Health Organization, but is still under study in the United States for classification as an addictive behavior. Other behaviors under study include smartphone use, Internet gambling, pornography, eating and shopping.

Compulsive behaviors

        These can include such things as hoarding, shopping, sex, eating, gambling, exercise, even talking compulsively. While the behaviors may not provide the pleasure reward of an addiction, they serve to relieve anxiety and stress and, if unchecked, can have serious negative consequences in a person’s life.

What else to know

        Simply put, an addiction is a repetitive use of a substance or engagement in a behavior because of the rewards message the substance or behavior transmits to the brain, despite numerous negative consequences the activity produces in the person’s life. Tolerance increases with time. The person may not even be aware of the damage being done by the behavior, or may continue in spite of it. At some point, the substance or behavior may dominate the addicted person’s daily life. It is highly likely that these conditions are accompanied by other mental health conditions, such as anxiety or depression.

    Science has been unable to come up with one cause of addiction, nor can it predict who will become addicted. However, there are numerous risk factors that can be recognized, some of which may be avoidable, some not. Genetics/family history play a significant role in determining vulnerability as do environmental factors, including growing up in a dysfunctional family and early exposure to substances or abuse. The presence of other mental health issues can also contribute to susceptibility to addictive behavior. Even physiology may play a role since men seem to be more susceptible to addiction than women.

That said, there are a number of conditions that can predict the presence of an addiction. The following list is adapted from one used by the Mayo Clinic. Substitute the specific substance or behavior for the word “drug.”
    — Feeling that you have to use the drug regularly — daily or even several times a day.

— Having intense urges for the drug that block out any other thoughts.

— Over time, needing more of the drug to get the same effect.

— Taking larger amounts of the drug over a longer period of time than you intended.

— Making certain that you maintain a supply of the drug.
    — Spending money on the drug, even though you can't afford it.
    — Not meeting obligations and school, family or work responsibilities, or cutting back on social or recreational activities because of drug use.
    — Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm.
    — Doing things to get the drug that you normally wouldn't do, such as stealing.
    — Driving or engaging in other risky activities when you're under the influence of the drug.
    — Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug.
    — Failing in your attempts to stop using the drug.
    — Experiencing withdrawal symptoms when you attempt to stop taking the drug.

Generally, two or three symptoms suggest a mild disorder, four or five a moderate one and anything more, a severe disorder.

The good news is that there is a variety of treatment available for all these conditions. If a problem is suspected, don’t try to deal with it alone. Consult with a health professional (doctor, psychologist, social worker, addiction specialist) and begin the road to recovery.

Fentanyl: From blessing to curse

Addiction and Recovery

By Bob Gaydos

Fentanyl.

The word strikes fear into everyone involved in fighting America’s epidemic of opioid overdoses. It was approved for medical use 50 years ago as a potent pain killer. Today, it is increasingly thought of simply as a killer.

In January, in a five-day period, there were five overdose deaths in Orange County, N.Y.. Fentanyl was involved in each one. In the past couple of years, drug dealers have taken to adding fentanyl or analogues of it to the heroin they sell, making it many times more powerful and dangerous, since their customers don’t know it’s in the mix. Fentanyl is used orally, smoked, snorted, or injected. It can be hundreds of times more powerful than street drugs. The synthetic opioid was cited as the cause of 20,100 deaths in the United States in 2016, more than any other pain killer or heroin.

David Hoovler, Orange County district attorney, says 88 people died in Orange County from confirmed or suspected opioid overdoses last year. Performers Prince and Tom Petty are both said to have died from accidental overdoses of pain medications that included fentanyl.

While the White House has declared an opioid emergency in the country, it has devoted little time, money and energy to fighting it thus far. That makes it incumbent on citizens frightened at the rising death toll, especially among young people, to do their part in turning the tide. That effort always starts with information and truth is, despite its frequent appearance in headlines, social media and in TV reports, a lot of people don’t know much, if anything, about fentanyl. Consider this a basic introduction to the killer pain killer.

In its prescription form, fentanyl is known by such names as Actiq, Duragesic, and Sublimaze. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

Signs and Symptoms

According to the National Institute on Drug Abuse, common signs that someone is abusing fentanyl include:

• Confusion
• Depression
• Difficulty walking
• Altered heart rate
• Labored breathing
• Slurred speech
• Weakness
• Dizziness, lightheadedness, and fainting
• Shaking

• Sleepiness
• Visual hallucinations
• Nausea and vomiting
• Pinpoint pupils

    Long-term fentanyl use can produce several adverse effects beyond the symptoms listed. They include:

• Severe gastrointestinal problems
• Seizures
• Weakened immune system

• Paranoia
• Social withdrawal
• Lack of motivation
• Delusions and personality changes

And of course, when combined with other street drugs like heroin, fentanyl can cause respiratory distress, coma or death.

The latter is something with which America has become all-too-familiar. Even here, though, there is help. According to the Substance Abuse and Mental Health Services Administration, “The evidence is strong for the use of naloxone to reverse the effects of an opioid overdose. Distributing naloxone and teaching people to use it is an effective means of preventing deaths among people who misuse heroin, fentanyl, prescription opioids, and other opioids. With brief training, most adults can learn to administer life-saving naloxone.”

If you are interested in starting a naloxone program, need to find out how to obtain naloxone to prevent overdoses, or simply want more information, SAMSHA’s Opioid Overdose Prevention Toolkit – 2016 includes sections for physicians, first responders and family members on administering naloxone. Many local organizations have already taken this step.

Finally, if you have a prescription for fentanyl or any opioid and are concerned about a young person in your household gaining access to it -- the most common way teenagers can get it -- keep it in a locked location and keep a record of how much of the prescription you have used. And by all means do not be reluctant to have that talk about drug abuse and the special risks of abusing prescription drugs.

Treatment for addiction to fentanyl should include detox supervised by a medical professional as withdrawal symptoms can be severe. The usual follow-ups -- in-patient or outpatient rehab and 12-step recovery programs -- are strongly suggested.

Earlier this month, Governor Andrew M. Cuomo announced a 30-day budget amendment to add 11 fentanyl analogs to the state controlled substances schedule to help support law enforcement efforts to stop the spread of the drug. DA Hoovler says any help for law enforcement on illegal drugs is welcome, but much more investment is also needed in prevention and treatment for all opioid abuse, including ongoing anti-drug programs in schools and treatment on demand for addicts. Those who want help should be able to get it. If enough people demand it, perhaps the White House will hear.

*  *  *

More information

NIDA: www.drugabuse.gov

SAMSHA: www.samhsa.gov

Narcotics Anonymous Mid-Hudson: 845-431-9011; www.newyorkna.org

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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.

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Addiction and Recovery

It’s a disease, not a moral failing

By Bob Gaydos

Dr. Benjamin  Rush

There’s a week for everything in this country, some serious, some not so: National Handwashing Awareness Week; Celebrate Your Name Week; Fix a Leak Week; Mental Health Awareness Week; Freelance Writers Appreciation Week; Nurses Week; National Kraut Sandwich Week; National Indoor Plant Week.

One of the more serious ones -- National Drug and Alcohol Facts Week -- recently passed with little notice. However, there was a useful, informative blog about the week on the recordonline.com news site. It was written by Dr. Judith Branche, of Cornerstone Family Healthcare’s Center for Recovery in Newburgh. Dr. Branche is Board Certified in Addiction Medicine.

One paragraph in the blog especially struck home with me: “(A) significant problem is the lack of understanding of the problem for what it truly is. Therefore, I would like to take this opportunity to explain what a substance use disorder really is. Addiction is a chronic disorder of the brain which affects brain chemistry in a significant way. This may be a new concept for many who believe that drug addiction is no more than a moral failing or a character defect that a person should be able to overcome if he or she puts their mind to it. Nothing could be further from the truth.”

Amen, amen, amen. I’ve been writing on this topic for about a decade. In my opinion, this remains the biggest problem with regard to alcoholism and addiction -- that many, probably a majority, of people do not buy the disease concept. This includes  many government officials who are in a position to help lessen the harmful impact of the disease. They look upon it as a law and order issue, rather than a health issue.

So we declare a war on drugs and throw the addicts in prison along with the pushers. Diabetics don’t get locked up for being victims of sugar. More to the point, executives of food companies who load their products up with sugar under dozens of other names don’t get arrested for fraud or posing a public health risk. They get bonuses. Their customers who wind up addicted to sugar get insulin and a new diet plan. Follow it, or get sicker.

Addicts, alcoholics who want to fight their disease have to first fight insurance companies to get coverage for treatment, probably have to “fail” at outpatient treatment if they want in-patient rehab and then hope they are lucky enough to find an in-patient slot. Winding up in prison is a whole lot easier.

The tricky thing about the disease of addiction is that many of those who have it do commit crimes while under the influence or in search of money to get more drugs. Alcoholics do drive drunk and kill or injure others. This is where moral judgments take over, understandably. But while their disease may explain their actions; it does not excuse addicts from the consequences. Still, in paying the price, addicts should at a minimum also be offered a chance at treatment. It’s possible to get clean and sober behind bars.

Of course, much of the damage addicts do is not of the criminal variety. It is of the personal variety, often directed at those who care most about them. Living with an active alcoholic can be like living in a volcano -- unpredictably eruptive. Indiscriminately destructive. Loving the addict and hating the disease, as Al-Anon suggests, is excellent advice, but no one says it’s easy. It takes a lot of practice and patience and it does not mean accepting or enabling unacceptable behavior. But if more people tried it, I believe the disease concept would become more real and the stigma attached to the disease would lessen. That would help those seeking recovery and the people closest to the addict would be better able to deal with life, regardless of whether the alcoholic/addict was active or not.

Of course, the addict has to accept the disease concept as well if he or she hopes to having meaningful recovery. Simply abstaining from using through will power often makes for a more miserable person who is just not drinking. Rather than saying, "I'm an alcoholic and I can't drink for the rest of my life," the alcoholic can say, "I have a disease that makes it mentally and physically impossible for me to drink safely." Obviously, the alcoholic can drink anytime he or she wants, but the treatment for the disease is abstaining and finding some other source of solace, serenity, strength to deal with the rigors of life.

That's not an easy decision either. But the more society talks about addiction as a disease, not a moral failing, the sooner, I believe, we will see more positive results in fighting it.

(Author’s note: While the opinions expressed are solely mine, they are based on discussions with hundreds of alcoholics, addicts and professionals in the substance abuse field.)

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Who says so?

• American physician Benjamin Rush (1745–1813), who signed the Declaration of Independencence, is often cited as the first who understood drunkenness to be what is now called a "loss of control" and possibly the first to use the term "addiction" in connection with this meaning. He wrote: “My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.’” He said, "Habitual drunkenness should be regarded not as a bad habit but as a disease," describing it as "a palsy of the will."
• Between 1980 and 1991, medical organizations, including the AMA, established policies on the disease theory. These policies were developed in 1987 in part because third-party reimbursement for treatment was difficult or impossible unless alcoholism were categorized as a disease. The policies of the AMA, state, in part: "The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice." In 1991, the AMA endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.

Source: WIKIPEDIA