SMOKING - Blog

Patricia used to approach the holidays with an overwhelming sense of dread, because she never knew what her alcoholic brother might do to ruin them. As Thanksgiving floral arrangements gave way to sparkling Christmas ornaments and the drone of holiday music, her stomach would clench more each day and her mood would grow darker.

“Some years were just awful,” she recalls. “So often my brother would show up drunk and make a scene at family gatherings. He’d scare his kids, embarrass his wife, and break my mother’s heart over and over again. One year he got arrested a week before Christmas for driving under the influence and for disorderly conduct. I remember that we called the judge to ask if they could keep him in jail until after the holidays. We all breathed a collective sigh of relief when they did just that. We could finally relax and enjoy ourselves, knowing he was safe but unable to spoil things for everyone.”

Thankfully, those painful memories are distant ones now, because Patricia’s brother—after 25 years as a practicing alcoholic—stopped drinking 20 years ago. “But it took me several years after he went into treatment to trust him and his recovery,” she says. “For a long time, I still prepared myself for the worst, half expecting another midnight phone call saying he had been an accident.”

The holiday scene Patricia describes today, however, is right out of a Norman Rockwell painting. “My brother is a grandfather now, and he is like an excited little boy, eagerly watching his grandkids open the gifts he laboriously and lovingly picked out for each of them. I’m so grateful that my parents got to experience his sobriety and witness the profound changes he made in his life before they died.”

Patricia says her own involvement in the Twelve Step program of Al-Anon has helped her understand that addiction is truly a disease that affects the entire family. She says recovery has allowed her to unearth the meaning of the holiday season and reclaim them as the joyous and contemplative occasions they were meant to be.

In autumn, the early settlers of our country gathered and evaluated their harvest, preparing themselves for the challenging winter months ahead as they gave thanks for the bounty their hard work brought them. “This is how I view Twelve Step recovery and Thanksgiving now,” Patricia says. “I welcome it as a time to take stock of past experiences and meditate on the lessons I’ve learned—seeing those lessons as my ‘harvest,’ my protection for any future difficulties. Then I find ways to express my gratitude for all I’ve been given.”

Two years after her brother began recovery, for example, Patricia gave him a little music box for Thanksgiving that played “We’ve Only Just Begun,” thanking him for rekindling the flame of family that was almost extinguished in the winds of his alcoholism.

Patricia describes herself as a spiritual person who sees Christmas as another opportunity for deep reflection. “To me, Christmas is about love, acceptance and expectancy—a symbol of birth and hope,” she says. “I try to carry through with the ‘attitude of gratitude’ that I learned about in Twelve Step recovery, and use Christmas as a time to help others.”

Some years she and her husband and daughter play “secret Santa” and buy gifts for a family in need. Sometimes they serve meals at a homeless shelter or take an elderly friend out for a holiday lunch. She also likes to write letters of appreciation at Christmas to the special people in her life, letting them know what gifts they are to her.

“Recovery has been transformative for me, for my brother, and for my whole family,” she says. “Twenty years ago, I hated the holidays and feared what my brother would do. But then he sobered up and I got my big brother back. Along the way, I discovered the Twelve Steps. I guess miracles really do happen. Isn’t that what the holidays are all about?”

Alive & Free is a health column that offers information to help prevent and address addiction and substance abuse problems. It is provided by Hazelden web site at www.hazelden.org.

OA offers a spiritual solution to compulsive overeating

“I did not enter my first meeting with hope,” recalls one member of Overeaters Anonymous. “I entered with despair. But I left with hope, because it was the first time in my life that I realized or heard that I was not morally imperfect, that I was not weak-willed, that I was not some defect. I had a disease—the disease of compulsive overeating.”

These words capture some core principles of Overeaters Anonymous (OA). One is that its members have an abnormal relationship with food. Another is that no plan for healing this relationship can succeed when it’s based on personal willpower alone.

As an alternative, OA suggests reliance on a “power greater than ourselves,” also referred to as God or a Higher Power. This frankly spiritual approach sets OA apart from other responses to overeating.

Atheists and agnostics may well express skepticism: What can a relationship to God or a Higher Power possibly have to do with overeating? What can possibly work other than dieting, exercise, and self-control?

OA offers three answers to these questions:

First, you are free to define God or Higher Power in any way that you choose. These words refer to any source of help outside ourselves—for example, fellow members of OA. No belief in a supernatural being is required. As a result, OA’s doors are open to atheists, agnostics, and members of any religion.

Second, any solution to overeating must address mental obsession with eating. “Overeaters Anonymous,” the group’s core text, includes stories of people who lost dozens of pounds through dieting, exercising, and purging—only to regain the weight later. Even when these people shed pounds, their thoughts focused on food.

One OA member describes this mental state: “My whole life was about getting the food, buying the food, preparing the food, sneaking the food, and hiding the food from morning until night.”

Another person said, “I used food for everything. It was my excitement. It was my entertainment. It was my antidepressant. It was my social life.”

Driven by such compulsion, OA members recall doing things that no sane person would do: Eating stale, spoiled, or rotten food. Stealing from other people’s plates. Picking up food off the ground.

Third, abandon all attempts to remove the obsession by yourself. After all, your attempts to do this in the past have consistently failed. Instead, turn to your Higher Power for help.

“Overeaters Anonymous” the book puts it this way: “This mental obsession was something we couldn’t be rid of by our unaided human will. Another power, stronger than ourselves, had to be found to relieve us of it, if we were to stop eating compulsively and stay stopped.”

This solution might sound vague or impractical. But OA offers practical suggestions for getting daily guidance from a self-transcending source. For example:

• Rather than eating in response to a craving, attend an OA meeting or call someone in the program.
• Meet regularly with a sponsor—someone with longer experience in OA who serves as a mentor.
• Instead of acting on impulse, pause to pray or meditate.

You can learn more about OA by going online to www.oa.org. The Web site explains how to find OA meetings and related resources near you. The above quotes from OA members are samples from “Hearing Is Believing: OA Members Speak,” a recording available from OA on CD or cassette.

The following books may also be of interest:

• “Overeaters Anonymous, second edition” (Overeaters Anonymous World Services, Inc., 2001).
• “The Twelve Steps and Twelve Traditions of Overeaters Anonymous” (Overeaters Anonymous World Services, Inc., 2002).
• “Compulsive Overeater: The Basic Text for Compulsive Overeaters” by Bill B. (Hazelden, 1981).
• “Twelve Steps for Overeaters: An Interpretation of the Twelve Steps of Overeaters Anonymous” by Elisabeth L. (Hazelden, 1993).

Alive & Free is a health column that offers information to help prevent and address addiction and substance abuse problems. It is provided by Hazelden web site at www.hazelden.org.

Report Explores Barriers to Treatment

Although people recognize that they have a problem with alcohol, a survey finds that many don’t seek treatment because they’re not ready to stop using, according to the US Substance Abuse and Mental Health Services Administration (SAMHSA).

The SAMHSA report, “Reasons for Not Receiving Substance Abuse Treatment,” also found that many people fail to seek out treatment because they think they can’t afford it.

Of the 761,000 individuals who recognized that they needed treatment for alcohol addiction, 49 percent were not ready to stop drinking and 40 percent thought the cost of treatment was prohibitive.

“It is tragic that a major reason people continue to abuse alcohol is that they do not believe they can afford appropriate treatment,” said SAMHSA Administrator Charles G. Curie. “President Bush has proposed a three year ‘Access to Recovery’ program to provide $200 million more each year for substance-abuse treatment. This program would provide someone in need of substance-abuse treatment with a voucher to pay for the services. We really need this program if we are to provide treatment to the large numbers who say they cannot afford it.”

The report was developed from SAMHSA’s National Survey on Drug Use and Health.

There are two benefits from recovery: we have short-term gains and long-term gains.

The short-term gains are the things we can do today that help us feel better immediately.

We can wake up in the morning, read for a few minutes in our meditation book, and feel lifted. We can work a Step and often notice an immediate difference in the way we feel and function. We can go to a meeting and feel refreshed, talk to a friend and feel comforted, or practice a new recovery behavior, such as dealing with our feelings or doing something good for ourselves, and feel relieved.

There are other benefits from recovery, though, that we don’t see immediately on a daily or even a monthly basis. These are the long-term gains, the larger progress we make in our life.

Over the years, we can see tremendous rewards. We can watch ourselves grow strong in faith, until we have a daily personal relationship with a Higher Power that is as real to us as a relationship with a best friend.

We can watch ourselves grow beautiful as we shed shame, guilt, resentments, self-hatred, and other negative buildups from our past.

We can watch the quality of our relationships improve with family, friends, and spouses. We find ourselves growing steadily and gradually in our capacity to be intimate and close, to give and receive.

We can watch ourselves grow in our careers, in our ability to be creative, powerful, productive people, using our gifts and talents in a way that feels good and benefits others.

We discover the joy and beauty in ourselves, others, and life.

The long-term progress is steady, but sometimes slow, happening in increments and often with much forward and backward movement. Enough days at a time of practicing recovery behaviors and piling up short term gains leads to long-term rewards.

Today, I will be grateful for the immediate and long-term rewards of recovery. If I am new to recovery, I will have faith that I can achieve the long-term benefits. If I’ve been recovering for a while, I will pause to reflect, and be grateful for my overall progress.

From The Language of Letting Go by Melody Beattie.

Teenage girls in the United Kingdom consume more alcohol than their male peers, the Western Mail reported.

According to a survey conducted by the Schools Health Education Unit, 44 percent of girls aged 14 and 15 had at least one alcoholic drink a week, compared with 42 percent of boys. While boys generally drank more beer, girls consumed more wine, spirits, and alcopops. Teen girls were also more likely to smoke.

The researchers attributed the increase in drinking to teen girls trying to emulate the behavior of older peers and to outdo their male counterparts.

“They are going out and losing control as a result of alcohol and we are seeing them then putting themselves at risk through casual sex and all the infections that go with it,” said Baroness Finlay of Llandaff, a professor at the University of Wales College of Medicine. “We know chlamydia is on the increase. My impression from talking to students is there is a culture that to have a good time you have to go out and get smashed. There’s this huge peer pressure that you are only having a good time if you are drunk. Some of these girls look so grown up. They are so provocatively dressed, it’s quite difficult for somebody running a bar or pub to know if they are under-age.”

The survey was based on responses from 15,500 children from 196 primary and secondary schools across the UK.

Aim: Women have a higher susceptibility to alcohol-induced liverdisease (ALD) than men. Gender-related differences in food preferencewere described in previous studies for several populations,but not in alcohol abusers. As certain micronutrients are reportedto take influence on the development of ALD in animal experiments,the hypothesis of the present retrospective cross-sectionalstudy was that gender-dependent (micro-) nutrient intake inpatients with ALD may cause the higher susceptibility of womento this disease. Methods: In 210 patients (male: 158, female:52) with different stages of ALD (ALD1: mild stage of liverdamage; ALD2: moderately severe changes of the liver with signsof hepatic inflammation; ALD3: severely impaired liver function)and in 336 controls (male: 208, female: 128), nutrient intakewas determined by a computer-guided diet history, and relatedto the severity of ALD in dependence on the sex of the patients.Results: No significant differences between males and femaleswith ALD were calculated for the intake (per kg body weight/day)of protein, carbohydrates, fat, and the intake (per kg bodyweight/day) of most micronutrients. In females with ALD, higherintake was found for vitamin C (ALD3), calcium (ALD2), iron(ALD1 and ALD2), and zinc (ALD1), but the consumption of noneof these micronutrients seems to contribute to a higher susceptibilityto ALD in females. Conclusion: Though the present study confirmsthe higher susceptibility to ALD in women, the data of calculateddaily macro- and micronutrient intake do not suggest any explicitinfluence of gender-specific nutrition in the development ofALD.

Detachment and recovery from alcoholism

Like alcoholics themselves, the families and friends of alcoholics display symptoms

• denial,
• anxiety,
• guilt and
• require treatment.

Al-Anon groups have proved to be an excellent resource for these people.

But Al-Anon’s central concept, that of detachment, is resented and rejected by many prospective members of Al-Anon.

Detachment involves realizing that the family member or friend

• cannot control the alcoholic’s behavior,
• accepting this powerlessness, and
• separating one’s self from the behavior though not from the person.

It also means that family life must not revolve around the alcoholic’s problems and behavior and that the alcoholic must be allowed to take the consequences of his or her behavior.

It does not mean a block in communication; in fact, as a family practices detachment it will learn to let the alcoholic know its feelings.

Reddy, Betty; McElfresh, Orville H. (1978), Detachment and recovery from alcoholism. Alcohol Health & Research World. Vol 2(3), Spr 1978, 28-33.

Nicotine addiction slashed in test of new cigarette smoking strategy
November 14, 2007 -  Scientists are reporting the first successful strategy to reduce smokers’ nicotine dependence while allowing them to continue smoking. The study provides strong support for proposals now being considered in Congress to authorize FDA regulation of cigarette smoking, according to the research team.

The key to the clinical trial’s success was providing smokers with cigarettes of gradually decreasing nicotine content over a number of weeks. If such cigarettes were federally mandated, smokers would find it easier to quit, and more young smokers could avoid addiction, according to the scientists. Tobacco company products marketed as low-nicotine alternatives, in fact, do not change the level of nicotine taken in by smokers, they added.

The research was carried out by scientists at UCSF and San Francisco General Hospital Medical Center and is reported in the November 14 issue of the journal "Cancer Epidemiology, Biomarkers & Prevention."

Legislation giving the FDA authority to regulate tobacco products is currently being considered in Congress. Such regulatory authority would empower the agency to develop and enforce standards to make cigarettes less harmful — including the reduction of the nicotine yields so that cigarettes would be less addictive, said Neal Benowitz, MD, leader of the study team and an expert on the pharmacology and health effects of nicotine and other smoking products.

Smoking and health experts have been concerned that reducing the nicotine content of cigarettes would lead to smoking a greater number of cigarettes and therefore increased exposure to other tobacco smoke toxins, as is seen in smokers of the currently marketed low-nicotine yield cigarettes, Benowitz said. The new research on reduced-nicotine content cigarettes strongly counters that prediction.

In the study, 20 healthy adult smokers smoked their usual brand for a week and then followed a six-week regimen of smoking cigarettes with progressively decreased nicotine content.

At the end of this period, they were free to return to their usual commercial cigarette brand, and most of them did. When tested one month later, they were smoking about 40 percent fewer cigarettes per day, with a comparable reduction in nicotine intake, compared to when the study began. Even more promising, one fourth of the smokers quit smoking entirely while the study was in progress, the researchers found.

"This study supports the idea that if tobacco companies were required to reduce the levels of nicotine in cigarette tobacco, young people who start smoking could avoid becoming addicted, and long-time smokers could reduce or end their smoking, Benowitz said.

"This could spare millions of people from the severe health effects of long-term smoking," he added.

Benowitz is a UCSF professor of medicine, psychiatry and biopharmaceutical sciences, and chief, Division of Clinical Pharmacology and Experimental Therapeutics at SFGH.

In 1994, Benowitz and colleague Jack Henningfield proposed in the "New England Journal of Medicine" that federal regulations should require cigarette manufacturers to gradually reduce nicotine content of all cigarettes sold in the U.S.

Scientists have conducted studies to test nicotine-reduction strategies, using commercial low-yield cigarettes. Such cigarettes do reduce nicotine yield when tested by smoking machines because manufacturers have engineered the cigarettes to burn faster, and they have used highly porous paper and ventilation holes above the filter. These cigarettes contain significant levels of nicotine and such "cigarette engineering" does not lead to decreased nicotine intake, because smokers are easily able to obtain the nicotine by taking more frequent and bigger puffs, Benowitz and his co-authors noted.

In contrast, in the new study, the absolute content of nicotine in the tobacco was reduced so that it was very difficult or impossible to compensate by smoking more intensely.

In addition to the reduced smoking and nicotine levels, the UCSF scientists looked for changes in exposure to carbon monoxide, tobacco smoke carcinogens and cardiovascular disease risk factors. All these remained stable or decreased, indicating that smokers were not exposed to higher levels of tobacco smoke toxins when they switched, and therefore would not be put at risk by a nicotine reduction intervention.

Benowitz and his colleagues are now conducting a much larger and longer clinical study on the effectiveness and safety of reducing nicotine levels in cigarettes. They plan also to examine whether reduced-nicotine cigarettes result in reduced addiction potential among adolescent experimental smokers.

University of California - San Francisco