SMOKING - Blog

Alcoholism may be a disease of isolation, but it is rarely an individual problem.

Understanding how “enabling” works is the first step in helping both the alcoholic and the co-dependent seek help.

Enabling is any action by another person or an institution that intentionally or unintentionally has the effect of facilitating the continuation of an individual’s addictive process.

Who Is An Enabler?

• Most often, enablers are persons who genuinely care about the alcoholic — family, friends, co-workers, clergy.
• Their love and concern, unfortunately, often leads them to do things that actually help the alcoholic stay that way.
• They “cover” for the alcoholic, inventing excuses for absenteeism, tardiness, or inappropriate behavior.
• They “save” the alcoholic by taking on the alcoholic’s responsibilities or sharing in the denial of the problem.

Yet, in their attempts to “help,” they are in fact encouraging alcoholic behavior by shielding the alcoholic from the consequences of his or her drinking.

Games Enablers Play

There are Many Ways to Enable an Alcoholic

As the saying goes, you are not the cause of someone else’s drinking problem, you cannot cure it and you can’t control it.

But there are ways that you may be contributing to the problem.

Before placing the blame for all the problems in your family or your relationship on his (or her) drinking, it might be wise to examine how the other person’s drinking may have affected you, and how you have reacted to it. For example, does the following statement sound familiar?

I don’t have a problem with my drinking! The only problem is your attitude. If you would quit complaining about it, there wouldn’t be a problem!

Well, obviously that statement is not completely accurate; after all denial of the problem is one of the more frustrating parts of the problem. On the other hand the statement may not be completely false either.

How do you react to the alcoholic’s drinking? Could your reaction be a part of the overall problem? Have you fallen into “role playing” in the family? Is there anything that you can do to improve the situation?

The following describes an incident that could be an example of alcoholic behavoir, and some examples of reactions to the incident. Does any of these sound familiar?

The alcoholic comes home late and he is drunk, too drunk in fact to get the key into the front door lock. After several futile attempts, he decides that it is a lost cause. Since he does not want anyone in the house to know that he is too drunk to unlock his own door, he makes a brilliant decision that solves his problem. He goes to sleep in the front yard!

How would you react?

The Rescuer

The “rescuer” doesn’t let the incident become a “problem.” Since she has been waiting up for him anyway, she goes out in the yard, gets the alcoholic up, cleans him up, and puts him into bed. That way the neighbors never see him passed out in the flower bed!

She never mentions the incident to him or anybody else. If anyone else mentions it, she denies there is a problem. She lies for him, covers up for his mistakes, and protects him from the world.

As the problems increase and his drinking gets worse, she takes on responsibilities that were once his. She may get a job or work extra hours to pay the bills. And if he gets in trouble with the law, she will move heaven and earth to come up with his bail.

The Provoker

The “provoker” reacts by punishing the drunk for his actions. She either waits for him to wake up the next morning and gives it to him with both barrels, or she goes out and turns the water sprinklers on!

She scolds, ridicules, and belittles. She nags. She screams insults at him loud enough for everyone to hear. She gets on the telephone and tells all her friends he’s a loser. She is angry and she makes sure that the alcoholic and everybody else knows it. Or she gives him the cold shoulder and doesn’t speak to him. She threatens to leave.

She doesn’t let it go, either. The anger and resentment continue to build as these incidents become more frequent. She never lets him forget his transgressions. She holds it against him and uses it as a weapon in future arguments — even months or years later.

The Martyr

The “martyr” is ashamed of the alcoholic’s behavoir and she lets him know it by her actions or words. She cries and tells him, “You’ve embarrassed us again in front of the whole neighborhood!”

She sulks, pouts, and isolates. She gets on the telephone with her friends and tearfully describes the misery that he has caused her this time! Or she is so ashamed of it she avoids her friends and any mention of the incident.

Slowly she becomes more withdrawn and depressed. She may not say much about it to the alcoholic, but she lets him know with her actions that she is ashamed of him. Quietly she tries to make him feel guilty for his behavoir.

Which is the Enabler?

The above examples may be somewhat of an exaggeration, but then again they may be very typical of what goes on in an alcoholic home. The “roles” the nonalcoholic spouse plays in the family may not be as well defined, as they are outlined here. Depending upon the circumstances, the spouse may fall into one of these roles, or may switch back and forth between them all.

So which of the spouses described above is an enabler? Which one is actually helping the alcoholic progress in his disease? Which one, although they are trying to make things better, are actually contributing to the problem?

All of them.

Al-Anon may be of help for you

Sex is supposed to be enjoyable, but for countless women suffering from vulvodynia, that’s not the case. 

Characterized by;

• pain or discomfort with sexual intercourse,
• rawness,
• stinging,
• itching and
• burning in the vagina or vulva,
• vulvodynia is a common condition, but it is often undiagnosed or misdiagnosed.

“The symptoms of vulvodynia mimic those of other, common vulvovaginal infections,” explains Christin Veasley, associate executive director of the National Vulvodynia Association in Silver Spring, Md. “Women are routinely and incorrectly told that they have a yeast or bacterial infection over and over again.”

Vulvodynia is more prevalent than most health practitioners realize. Roughly 16% of women between the ages of 18-64 have experienced chronic vulvar pain for at least three months or more, according to a survey by Brigham and Women’s Hospital in Boston, Mass.

The word “vulvodynia,” literally means “painful vulva,” which is the part of female genitalia that consists of the mons pubis (fatty tissue at the base of the abdomen), the labia (lips), the clitoris and the vaginal opening. Women who suffer from vulvodynia may experience intermittent or constant pain which can persist for months to years.

Making matters worse, vulvodynia is difficult to diagnose. A diagnosis often occurs only after other conditions are excluded. “Vulvodynia is diagnosed when other causes of vulvar pain, such as yeast or bacterial infections, or skin diseases, are ruled out,” Veasley said. The tissue of the vulva region may appear swollen or inflamed, but more often than not, it looks normal.

The cause of vulvodynia is unknown. This is partly because there has been a lack of research on the disorder in recent years. What is known is that vulvodynia is not caused by a sexually transmitted disease. According to the National Vulvodynia Association, potential causes include:

• An injury to, or irritation of, the nerves that innervate the vulva.
• An abnormal response of different cells in the vulva to environmental factors (such as infection or trauma).
• Genetic factors associated with susceptibility to chronic vulvar vestibular inflammation.
• A localized hypersensitivity to yeast.
• Spasms of the muscles that support the pelvic organs.

Currently, there is no cure for vulvodynia, but it is important for women to seek medical attention because the pain can be managed and treated. “Treatment is directed at symptom relief and includes drug therapy to ‘block’ pain signals,” Veasley said. “In women who have associated pelvic floor muscle spasm or weakness, physical therapy, biofeedback and/or Botox injections may be incorporated into the treatment plan.” Because each case is different, treatment tends to be tailored based on individual needs and responses.

Some women find self-care measures to be helpful in alleviating the symptoms of vulvodynia. These include:

• cold compresses,
• anti-histamines,
• the use of lubricants before sexual intercourse and
• avoiding triggers like
• hot tubs,
• tight-fitting undergarments and
• irritating soaps and detergents.

It is highly recommended to work together with a health care provider who can help identify the approach that works best for each individual.  

The National Women’s Health Resource Center also has a number of consumer-oriented materials on vulvodynia available online at http://www.healthywomen.org/.

SOURCES; NIH Office of Research on Women’s Health. “NIH Launches Campaign to Raise Awareness of Vulvodynia, a Painful Disorder Affecting Many Women” (Oct. 24, 2007). http://www.nih.gov/news/pr/oct2007/od-24.htm.

Along with taboo topics such as politics and religion, many people are reluctant to discuss managing a chronic illness with family or friends, according to a new survey of more than 1,000 adults.

The survey found that 82 percent of respondents said they knew someone with a chronic illness, but only 34 percent were likely to suggest ways for this person to better manage their care. That’s about the same number who said they’d debate politics (37 percent) or religion (33 percent) with a loved one or friend.

only 34 percent were likely to suggest ways for this person to better manage their care

Respondents were more likely to;

• discourage friends or loved ones from buying the wrong house (65 percent),
• loan them a large amount of money (56 percent),
• advise them against taking a job they didn’t think was right for the person (48 percent), and
• tell them their spouse was unfaithful (41 percent).

The reasons why many Americans are reluctant to offer advice to chronically-ill friends or family include:

• They think the person has the situation under control (66 percent);
• they are not a health care professional (31 percent);
• they don’t want to seem like a nag (31 percent) or
• rude (29 percent);
• they don’t believe the person would listen to them (27 percent); or
• they didn’t think the matter was that important (15 percent).

Other findings:

• Twenty percent of respondents said their spouse was the easiest person to give advice to about health, followed by a child (20 percent), mother (13 percent), and father (5 percent).
• Most respondents said they’d prefer to receive advice about managing a chronic illness from a health care professional (67 percent), followed by a spouse (10 percent) or parent (7 percent). Men were twice as likely as women (14 percent versus 7 percent) to have their spouse give them such advice.
• Men have an easier time offering health advice to their spouse (28 percent) than women (19 percent). Women have an easier time offering health advice to their children (24 percent) than men (16 percent).
• Thirty-four percent of respondents said the person closest to them with a chronic illness is a parent (34 percent), followed by another relative (16 percent), spouse (14 percent), friend (11 percent), sibling (8 percent), and child (6 percent).

Tips on how to help family or friends, or even patients with a chronic illness:

• Talk to them in order to get an understanding of their goals. Get the conversation started by discussing events or activities they used to enjoy or future events they want to be part of, such as a family reunion. Once you understand their goals, you can help them achieve them along with health care providers, doctors or community service agencies.
• Appoint an “ambassador” — a friend or loved one feels comfortable talking with and respects enough to heed his or her advice. This person can help the ill person manage their condition.
• If you don’t already know, increase your comfort levels by educating yourself about the person’s chronic illness. This will make you feel more comfortable speaking with them about the condition and reinforcing professional advice.

Tuesday 06 November 2007

Health researchers at the University of Otago, Christchurch and the Medical Research Institute in Wellington are arguing that alcohol is a high risk drug according to the national classification regulations. This follows comparative research with another similar, but illegal drug, into its effect on public health.

The results of this study are being presented at the APSAD/Cutting Edge Conference at the Aotea Centre in Auckland on November 7.

“There’s no doubt that alcohol is a potentially dangerous drug when we look at the mayhem it causes in relation to public health, crime, and social disruption,” says principal investigator Professor Doug Sellman, from the University’s National Addiction Centre. “Following this peer-reviewed analysis we think the time has come for a serious reappraisal of the way drugs are classified under the Misuse of Drugs Act (1975)”.

The research consisted of a comparison of alcohol with a similar liquid sedative drug, gamma hydroxybutyric acid (GHB) or ‘Fantasy’, which was scheduled as a Class B1 (high risk) drug under the Act in 2001.

Under the six main criteria for classification under the law they found that the risk to public health from alcohol is at least at the level of GHB, and alcohol could be argued to be a ’somewhat more dangerous drug because of its greater inherent toxicity’. The disinhibited intoxication of alcohol also tends to be of greater duration than GHB.

The researchers point out that the negative influence of alcohol has been recognised for decades, contributing to a significant proportion of the global burden of disease. Alcohol has been linked to more than 60 medical conditions, with half the alcohol-related deaths in New Zealand attributable to chronic diseases, especially cancers. The other half are due to injuries while under the influence, especially amongst young people.

Most studies have concluded that there are no health benefits from alcohol before middle age, and the much publicised cardio-protective effect of drinking only occurs in men over 40 and women post-menopause.

“Despite this we’re not saying that alcohol should be prohibited. We simply want its dangerousness better publicised” says Professor Sellman. “What the results of our analysis can contribute is a more objective perspective on alcohol, especially in relation to other recreational drugs”.

The researchers say that this study highlights the limitations of drug classification in New Zealand and other western countries when alcohol and tobacco, the two drugs we know most about, are excluded from consideration. This is a situation which has been described in one UK report as an ‘un-evidence-based mess’.

Professor Sellman argues that including tobacco and alcohol in the evaluation of drugs and their risks to public health, would hopefully result in a more rational discussion about recreational drug use in general, leading to more effective public policy.

Source of press release

Aims: To evaluate whether rivastigmine, an achetylcholinesteraseinhibitor (AChEl), may be effective in restoring memory in Wernicke-Korsakoff’ssyndrome (WKS). Methods: Five patients treated with rivastigminefor a period of 6 months were compared with five matched controlpatients, who received 6 months’ conventional treatment, butwithout rivastigmine. Memory tests were administered at baselineand after 6 months. Results: Slight improvements were observedin both rivastigmine and control patients, but no significantdifferences in improvements were found between the study groups.Conclusion: Treatment with rivastigmine may not be effectivein restoring memory in WKS patients.

Is fear of gaining weight keeping many women from trying to quit smoking?
November 07, 2007 -  ANN ARBOR, Mich. - Is a fear of getting fatter partly to blame for the fact that nearly one in five American women still smokes, and many don’t try to quit"

Although there are many possible reasons for the stubborn persistence of smoking, fear of weight gain is high on the list for many women, says a University of Michigan Health System researcher who has devoted much of her career to studying this issue.

Several years ago, she and her team reported that 75 percent of all women smokers say they would be unwilling to gain more than five pounds if they were to quit smoking, and nearly half said they would not tolerate any weight gain. In fact, many women started smoking in the first place because they thought it might help them stay slim.

Now, new U-M research findings published in the October issue of Addictive Behaviors show that women who smoke tend to be further from their ideal body image, and more prone to dieting and bingeing, than those who don’t smoke.

Cigarettes are well known to suppress appetite and weight, says Cindy Pomerleau, Ph.D., director of the U-M Nicotine Research Laboratory. "So it’s hardly surprising that women who have trouble managing their weight or are dissatisfied with their bodies are drawn to smoking," she says.

In another recent study, published in August, the U-M team found that overweight women smokers who were overweight as children were far more likely to have started smoking in their early teens than women whose weight problems started later in life. They also had worse withdrawal symptoms when they tried to quit.

Once they make a serious attempt to quit, evidence suggests that most weight-concerned smokers can be just as successful in kicking the habit as others.

"The problem here is getting women who are concerned about their weight to be willing to try to make a quit attempt," says Pomerleau, "and then helping them gain a sense of control over their weight."

Women who are highly concerned about weight tend to be concerned about other aspects of their appearance as well, she notes. What they need to understand, she says, is that smoking has an impact on many aspects of appearance and attractiveness. Among other things, it causes wrinkled skin, thinning hair, cracked fingernails, yellowed teeth and terrible breath.

Pomerleau, a research professor of psychiatry, is working on a book about women, smoking and weight loss that will draw together research findings, helpful tips and real-life examples of women who quit tobacco while also containing their weight.

Some beliefs about smoking and weight are true, she says. For instance, nicotine suppresses the appetite and increases resting metabolic rate. Smokers on average weigh less than people who have never smoked, and that smokers who quit tend to gain weight. Adding to these perceptions are tobacco advertisements that portray female smokers as slim and successful.

Even so, the effect of quitting on weight is often less dramatic than many women fear, Pomerleau says. A rough rule of thumb is that one in four women who quit smoking will gain less than five pounds, and another two out of four will gain five to 15 pounds. Only one in four women who quit will gain 15 pounds or more.

But Pomerleau’s own research suggests that many women smokers start out with an unrealistic image of how they would like their bodies to look. This may make their dread of gaining weight even worse.

In her paper in Addictive Behaviors, she reports the results of a study of 587 women between the ages of 18 and 55, including 420 smokers and 167 women who had never smoked. An equal proportion of both groups was overweight or obese, with a body mass index of 25 or more.

In the study, the smokers and non-smokers were asked to look at silhouette pictures of ten different body types, ranging from thinnest to fattest, and to choose which one their current body type was closest to, and which one they wanted to look most like. They were also asked questions about their self-image and their eating habits, about how concerned they were about gaining weight if they quit smoking, and about how sure they were that they could stay off cigarettes even if they gained weight.

The smokers chose an ideal body shape that was slimmer than the non-smokers chose, and further from how they perceived themselves as looking. They also had more problems with limiting their eating. Smokers who were overweight were especially doubtful about their ability to stay off tobacco if they started to gain weight.

This study, Pomerleau says, suggests that if women smokers are to succeed in quitting, they may need extra help in achieving a more realistic body image and paying attention to unhealthful eating patterns, particularly if they are already overweight.

At the same time, Pomerleau and her team have found that the earlier in life a weight problem starts, the more likely a woman is to start smoking.

In a study of 89 overweight women smokers, those who remembered being overweight before they reached junior high school reported that they had started experimenting with smoking at around age 13 - compared with women whose weight problems didn’t start until junior high or after, who hadn’t tried smoking till they reached age 15.

The women who were overweight as children also reported more nicotine-withdrawal symptoms when they tried to quit smoking, especially symptoms like anger, irritability and trouble concentrating. The study was published in the August issue of Eating Behaviors.

These studies, and others that the U-M team have done, all point to the importance of finding new strategies to help women quit smoking without losing control of their weight. Although severe dieting during a smoking cessation attempt has not been shown to be helpful in either quitting smoking or controlling weight, it may be unrealistic to expect women with strong weight concerns to put these concerns on hold for several weeks or months while they try to quit tobacco.

"What we would like to work for is a kind of compromise strategy, where the focus is on the smoking cessation, but women can also take some passive and active measures to control their weight," Pomerleau says.

Passive measures include things like nicotine patches and gum, and medicines like bupropion, which can help in controlling weight gain while keeping nicotine withdrawal symptoms at bay.

Another option for women is to launch their stop-smoking effort early in their menstrual cycle, so that the bloating that can happen soon after they snuff out their last cigarette won’t be compounded by the bloating that comes along right before their period begins.

Finally, although strenuous dieting is not recommended, Pomerleau says, women can start immediately to rebalance the energy-in/energy-out equation by not substituting eating for smoking, and by increasing their physical activity. Even brief bouts of exercise, such as stretching or walking, can be effective in distracting a woman when the urge to smoke strikes, she says, and they burn a few calories too.

University of Michigan Health System