BM - Smoking, alcohol and substance abuse Flashcards
What is drug addiction?
Chronic condition characterised by compulsive drug seeking and use, despite harmful consequences.
This applies to all drugs, not just smoking and alcohol.
7000 people die every year directly because of alcohol.
Nearly 1 million people die each year directly because of smoking.
What is ‘addiction’ in terms of DSM-5?
Addiction” is not a specific diagnosis in the (DSM-5)–(APA)
DSM-5 replaced substance abuse and substance dependence with: substance use disorder. Associated symptoms of substance use disorder: impaired control, social impairment, risky use, and pharmacological criteria (tolerance and withdrawal).
DSM-5 is a list of conditions which contribute to mental disorders.
This definition introduces tolerance and withdrawal which are heavily biological.
What does DSM say about addiction?
DSM describes pattern of use of an intoxicating substance leading to clinically significant distress, manifested by at least two of the following, occurring within a 12-month period:
- Substance often taken in larger amounts or over a longer period than interested
- Persistent desire or unsuccessful effort to cut down or control use of the substance
- A great deal of time spent in activities to obtain the substance, use the substance, or recover from it’s effects
- Craving/strong desire to use substance
- Recurrent use resulting in failure to fulfil work, school or home obligations
- Continued substance use despite persistent/recurrent social or interpersonal problems caused or exacerbated by use
- Important social, occupational, or recreational activities are given up/reduced due to substance use
- Recurrent substance use in situations where it is physically hazardous
Continued substance use despite having a persistent or recurrent physical or psychological problem that is likely to have been caused/exacerbated by substance use
How many people want to stop smoking?
70% o people who regularly smoke don’t want to.
What is tolerance?
Tolerance, defined by either of the following:
- Need for increased amounts of the substance to achieve intoxication or desired effect
A markedly diminished effect with continued use of the same amount of the substance
We know that tolerance is environmentally conditioned. Biologically when you’re in a specific pub you recognise the environment but then if you went somewhere else, had a different alcohol in a different place you would have a lower tolerance.
What is withdrawal?
Withdrawal, either of the following:
The characteristic withdrawal syndrome for that substance (see DSM-5)
The substance (or related substance) taken to relieve/avoid withdrawal symptoms
What is the history of smoking?
• 1492 Columbus discovers tobacco in the New World
• 16th Century – Pipe Smoking in England began
• 1610 Sir Francis Bacon writes that tobacco use is increasing and is a custom hard to quit
• 1693 Smoking is banned in the House of Commons chamber
• 1761 London Physician John Hill does a clinical study of tobacco effects
• 1791 Cases of snuff caused nasal cancers reported by John Hill
• 1889 – Research by Langley & Dickenson on the effect of nicotine upon nerve cells
• 1912 1st strong connection between is made between smoking and lung cancer
• 1930 – 1st statistical correlation made between cancer and smoking
• 1939 –” Tobacco Misuse and Lung Carcinoma” by Franz Hermann Muller of the University of Cologne is published.
• 1951 – 1st epidemiological study showing association between smoking and lung cancer
• 1962 Royal College of Physicians 1st report on “Smoking & Health”
• 1978 – BMJ article: passive smoking is harmful to health
• 1988 – BMJ editorial & article on the link between smoking and leukemia
• 1998 – Government White Paper published on tobacco control
• 1998 EU directive to ban tobacco advertising and sponsorship
• 2004 – Ireland – first country in the world to ban smoking in workplaces & public places
• 2007 – Smoking Ban brought in UK
• 2008 – Smoking ban applies to mental health settings
2015 – Smoking banned in cars with anyone under 18 present
Some smoking facts…
Although cancer was found to be associated with smoking at early as 1791, it couldn’t be proved as the only way to do this is through an experiment (forcing some to smoke and other not - unethical). Therefore could only be viewed as a correlation rather than causation.
2007 ban most effective intervention to date.
> 85% of people with a mental health problem smoke (as opposed to around 20% of the general population). Much of this is a form of self-medication.
WHO tobacco facts…
- Tobacco is one of the biggest public health threats.
- Over one billion smokers in the world
- Globally, use of tobacco products is increasing, although it is decreasing in high-income countries
- Nearly half the world’s children breathe air polluted by tobacco
- The epidemic is shifting to the developing world
- Over 80% of the world’s smokers live in low and middle income countries.
- Tobacco use kills 5.4 million people a year
- Tobacco kills up to half of all users
- It is a risk factor for six of the eight leading causes of death in the world
- 100 million deaths were caused by tobacco in the 20th century.
- Unchecked, tobacco- related deaths will increase to more than eight million by the year 2030, and 80% of those deaths will occur in the developing world
50% of regular smokers will die of direct causes from the smoking.
1 in 2 individuals will develop cancer at some point in their lives. Adding on negative health choices elevate the risk.
As treatments get better, it actually increases the numbers of people who undertake the bad health behaviour, because it is less worrying to them.
Heroine is normally most addictive drug in the world, very very closely followed by nicotine (almost the same).
A packet of cigarettes costs between 1-2p to make!! Make a huuuggeeee profit!
What is the global prevalence of smoking?
WHO statistics
• Almost 1 billion men in the world smoke cigarettes, about 35% of men in developed (but decreasing rapidly!) and 50% in developing countries.
• Around 250 million women in the world smoke cigarettes, about 22% in developed (also decreasing rapidly) and 9% in developing countries.
• Global smoking prevalence has hit a peak, and is declining in the more wealthy countries but in poorer, developing countries smoking is increasing.
Tobacco will kill over 175 million people worldwide between now and the year 2030
The less money you have, the more you smoke generally
social norms are hugely strong in encouraging people to take up negative behaviours
Tobacco facts europe
• Tobacco is the single largest cause of avoidable death in the EU
• Tobacco accounts for over a million deaths in Europe as whole.
• Estimated that 25% of all deaths in the Union could be attributed to smoking
The EU is actively developing a tobacco control policy.
What is the current UK prevalence of smoking?
• There are currently estimated to be 10 million smokers in Great Britain.
• This equates to 20% of men and 17% of women
Smoking prevalence is highest in the 20-24 age group for both men and women (32% and 30% respectively) but thereafter in older age groups the proportion of smokers declines.
Smoking in adults over 16 in England 2006
- results from the General Household Survey show, overall smoking prevalence has decreased. In 2006, 22 per cent of adults reported smoking, compared to 24 per cent in 2005 and 39 per cent in 1980
- as with previous years, smoking was higher among men than women (23 per cent and 21 per cent respectively) although this gap is narrowing
- those in the routine and manual groups reported the highest prevalence of smoking (29 per cent)
- there has been a marked increase in the proportion of smokers who smoke mainly hand-rolled tobacco. In 1990, 18 per cent of men and two per cent of women who smoked said they smoked mainly hand-rolled cigarettes, but by 2006 this had risen to 34 per cent and 17 per cent respectively
- current smokers smoked an average of 13.5 cigarettes a day
Very resistant to change behaviour - even if doubled the price of a packet only would drop by 10% tomorrow.
Smoking among adults in GB in 2007
Among adults
• two-thirds (67 per cent) of adults report that they do not allow smoking at all in their home, an increase from 61 per cent in 2006
• four in five people agree with the smoking ban in public places
And almost 8 in 10 current smokers reported trying to give up smoking at some point in the past
Smoking effects in England in adults 35 and over in 2006-07
In England in 2006/o7 among adults aged 35 and over:
445,100 hospital admissions are estimated to be attributable to smoking. This accounts for 5% of all hospital admissions among this age group. Around a quarter 26 per cent (107,600) of all admissions with a primary diagnosis of respiratory diseases, 16 per cent (139,600) of all admissions with a primary diagnosis of circulatory diseases and 13 per cent (163,200) of all admissions with a primary diagnosis of cancer are attributable to smoking
In England in 2007 among adults aged 35 and over:
82,900 deaths (18 per cent of all deaths of adults aged 35 and over) were estimated to be caused by smoking with a larger proportion of men (23 per cent) estimated to die from smoking-related diseases than women (14 per cent)
Smoking in england in children 11-15
Two-thirds of pupils reported they had never smoked. The proportion who had never smoked rose from 47% in 1982 to 67% in 2007
Six per cent of children reported that they were regular smokers (smoked at least once a week)
Regular smokers smoked on average 6 cigarettes a day
Girls were more likely to have ever smoked than boys (36% compared to 31%) and to smoke regularly (8% compared with 5%)
Since 1990 there has been an increase in the number of pupils being refused cigarettes at point of sale, from 37% in 1990 to 53% in 2006
Why do people smoke?
Despite the impact on health, people continue to smoke – why?
Smoking is a highly addictive substance
“Cigarettes are highly efficient nicotine delivery devices and are as addictive as drugs such as heroin or cocaine.” Royal College of Physicians, 2000.
View that adults smoke to cope with life- personal reasons
Children/adolescents smoking is motivated by attempts to achieve the status of cool and hard, and to gain group membership –social reasons.
Young people – way of rebelling or getting at those in authority
Myths – re loss of weight, relaxing etc
What does smoking do to your body?
nose cancer mouth cancer coughing and sneezing shortness of breath lung cancer leukaemia bronchitis and emphysema kidney cancer bladder cancer fertility affected gangrene stroke defective vision larynx cancer throat cancer oesophagus cancer aortic aneurysm CHD stomach cancer peptic ulver pancreas cancer peripheral vascular disease
Smoking’s impact on health
- Smoking harms nearly every organ of the body, causes many diseases, reduces quality of life and life expectancy
- The most recent estimates show that around 114,000 people in the UK are killed by smoking every year, accounting for one fifth of all UK deaths (Peto et al). Half of all smokers will be killed by their habit.
- The three main diseases associated with cigarette smoking and death are: lung cancer, chronic obstructive lung disease (bronchitis and emphysema) and coronary heart disease.
- It is estimated that between 1950 and 2000 six million Britons, 60 million people worldwide, died from tobacco-related diseases
- Half of all teenagers who are currently smoking will die from diseases caused by tobacco if they continue to smoke. One quarter will die after 70 years of age and one quarter before, with those dying before 70 losing on average 21 years of life.
- Risk of dying from lung cancer is 22X higher among men who smoke
Second hand smoke
- People that breath secondhand smoke are at risk of the same diseases as smokers, including cancer and heart disease, because secondhand smoke contains 4,000 toxic chemicals. It is estimated that secondhand smoke causes thousands of deaths each year.
- Children are particularly affected by secondhand smoke because their bodies are still developing, and around half of all British children are growing up in homes where at least one parent is a smoker.
- Smoke in the air contains about 4,000 chemicals
- Over 50 of these chemicals are carcinogens: they cause cancer. and also contribute directly to other diseases, such as asthma, heart disease and emphysema.
Mortality in relation to smoking
Dell et al 2004 (BMJ, 328)
- Longitudinal study of UK male doctors who smoke - studied for 50yrs
- Recorded all deaths for 50 years (1951-2000)
- Smokers on average lose 10 years of life
- Stopping smoking works, stopping smoking at age 35-44 gains about 9 years of life
scenarios for future deaths from tobacco…
increasing at an increasing rate towards 2050
smoking prevalence and mental health
• Psychiatric patients are twice as likely to smoke as general population (El-Guebaly & Hodgins, 1992).
• 45% of all cigarettes smoked by individuals with a psychiatric disorder (Lasser et al. 2000)
• While general smoking rates are falling – not so among psychiatric populations (McCloughen, 2003).
• Mental health: smoking, treatment and going smoke free
Eden Evins, Director, Addiction Research Program, Massachusetts General Hospital & Assistant Professor of Psychiatry, Harvard Medical School, Boston, USA
smoking prevalence and mental health issues in order….
(in increasing order)
generalised anxiety
depression
psychosis
