The human body is the precious and matchless machinery created by the Almighty and we must try never to damage it; instead we should take care of it, utilize it properly for the betterment of humanity so that the world is a better place when we leave it. In this chapter I am discussing the Health hazards of Smoking, alcohol and Drug abuse in accordance with guidelines laid by National institute of drug abuse USA.
Health Hazards of Smoking
Smoking is a major risk factor for heart disease and it accounts for about one-fifth of all deaths from heart disease in the United
States. Compared with non-smokers, smokers have a two- to fourfold higher rate of coronary artery disease, and about a 70 percent higher death rate from coronary artery disease. It accounts for millions of deaths, all over the world, which could potentially be prevented.
Smoking causes atherosclerosis — the buildup of fatty substances in the arteries which occurs when the normal lining of the arteries deteriorates and thickens. These deposits of fat and plaque block the flow of blood through the arteries and affect various organs in the body. In coronary artery disease, the arteries that supply blood to the heart become severely narrowed, thus decreasing the supply of oxygen-rich blood to the heart, especially during times of increased activity. Extra strain on the heart may result in chest pain (angina pectoris) and other symptoms. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur.
Smoking also decreases the exercise tolerance in an individual. Lack of sufficient exercise is another way of increasing the risk of the development of coronary artery disease and potential heart attacks. In peripheral artery disease, atherosclerosis can affect the arteries that carry blood to the arms and legs. As a result, the patient may experience painful cramping of the leg muscles when walking (a condition called intermittent claudication). Peripheral artery disease also increases the risk of stroke.
Cigarettes contain multiple poisons, including addictive nicotine, carbon monoxide, “tars” and hydrogen cyanide. 4,000 other chemicals of varying toxicity can be present as well, including 43 known cancer causing chemicals. Smokers have an increased risk of developing lung cancer, throat cancer, chronic asthma, chronic bronchitis and emphysema.
Cigarette smoke does not just affect smokers. When you smoke, the people around you are also at risk of developing health problems, especially children. Environmental tobacco
smoke (also called passive smoke or second-hand smoke) affects people who are frequently around smokers. Second-hand smoke can cause chronic respiratory conditions, cancer and heart disease.
The American Heart Association estimates that each year, about 37,000 to 40,000 people die from heart and blood vessel disease caused by other people’s smoke.
Now that you know how smoking can be harmful to your health and the health of those around you, here’s how quitting smoking can be helpful.
If you quit smoking, you will:
• Prolong your life. According to the American Heart Association, smokers who quit between ages 35-39 add an average of 6-9 years to their lives. Smokers who quit between ages 65-69 increase their life-expectancy by 1-4 years.
• Reduce your risk of cardiovascular disease. Quitting smoking reduces the risk of repeat heart attacks and death from heart disease by 50 percent or more. Quitting smoking also reduces your risk of high blood pressure, peripheral artery disease and stroke.
• Reduce your risk of developing a variety of other conditions including lung cancer, throat cancer, emphysema, chronic bronchitis, chronic asthma, ulcers, gum disease and many other conditions.
• Feel healthier. After quitting, you won’t cough as much, have as many sore throats and you will be more energetic. Quitting can help you prevent face wrinkles, get rid of stained teeth, improve your skin and even get rid of the stale smell in your clothes and hair. It also improves your sense of taste and smell, and can save you a lot of money!
Now you agree to quit smoking. Great!!!
How can you quit smoking?
There’s no one way that works for everyone. To quit smoking, you must be ready emotionally and mentally. You must also want to quit smoking for yourself, and not to please your friends or family. Plan ahead. All you need is will power.
Many people have quit smoking after years of being addicted, without any problems in life.
• When you decide to quit, get rid of all cigarettes and put away all smoking-related objects, such as ashtrays.
• If you live with a smoker, ask that person not to smoke in your presence. Better yet, convince them to quit with you.
• Don’t focus on your cravings. Reinforce your will to quit smoking.
• Write down when you smoke, why you smoke and what you are doing when you smoke, in order to learn what your smoking “triggers” are. When you get the urge to smoke, take a deep breath. Hold it for ten seconds and release it slowly. Repeat this several times until the urge to smoke is gone.
• Stop smoking in certain situations (such as at your work break or after dinner) before actually quitting.
• Make a list of activities you can do instead of smoking.
• Visualize yourself as a nonsmoker.
• Tell your family and friends about your plans to quit and ask them for their support. Ask your family members who smoke to quit with you.
• Keep yourself busy! Review your list of activities which can be undertaken instead of smoking.
• Change activities that were connected to smoking. Take a walk or read a book instead of taking a cigarette
• Whenever you can, avoid places, people and situations associated with smoking. Hang out with non-smokers or go to places that don’t allow smoking, such as the movies, museums, shops or libraries.
• Don’t substitute food or sugar-based products for cigarettes. Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew gum when the urge to smoke strikes so that you can avoid weight gain.
• Exercise regularly. Exercising has many benefits and will help you relax.
You may be asking yourself – “How will I feel if I quit?”
You may crave cigarettes, be irritable, feel very hungry, cough often, get headaches, or have difficulty concentrating and perhaps experience constipation. These symptoms of
withdrawal occur because your body is used to nicotine, the active addiction agent within cigarettes.
When withdrawal symptoms occur within the first two weeks after quitting, stay in control. Think about your reasons for quitting. Remind yourself that these are signs that your body is healing and getting used to being without cigarettes.
Remember: these withdrawal symptoms are only temporary. They are strongest when you first quit but will go away within
10 to 14 days. Remember also that withdrawal symptoms are far easier to treat than the major diseases that smoking can cause. Don’t yield and boost your motivation.
Here are some interesting observations of what happens after you have given up smoking.
• After 20 minutes: You stop polluting the air
• After 8 hours: The carbon monoxide level in your blood returns to normal, Oxygen levels in your blood increase
• After 24 hours: Your risk of heart attack decreases
• After 48 hours: Nerve endings adjust to the absence of nicotine
• Your ability to taste and smell begin to return
• After 2 weeks to 3 months: Your circulation improves
• Your exercise tolerance improves
• After 1 – 9 months: Coughing, sinus congestion, fatigue and shortness of breath decrease, and your overall energy level increases
• After 1 year: Your risk of heart disease decreases to half that of a current smoker
• After 5 – 15 years: Your risk of stroke is reduced to that of people who have never smoked
• After 10 years: Your risk of dying from lung cancer drops to almost the same rate as a lifelong non- smoker
• You decrease the incidence of other cancers — of the mouth, larynx, esophagus, bladder, kidney and pancreas
• After 15 years: Your risk of heart disease is reduced to that of people who have never smoked.
If you start smoking again (called a relapse) do not lose hope. Seventy-five percent of those who quit relapse. If you relapse, don’t give up! Review the reasons why you wanted to become a nonsmoker and try hard to develop within yourself the will to quit smoking again. Plan ahead and think about what you will do next time you get the urge to smoke.
Health Hazards of Alcohol
Fermented grain, fruit juice and honey have been used to make alcohol (ethyl alcohol or ethanol) for thousands of years. Alcohol is a health hazard because it can be the direct cause of many health problems, and indirectly due to the state of drunkenness.
Certain cancers, including breast cancer and cancers of the mouth, pharynx, larynx and esophagus have all been found to be more frequent in alcoholics. The latest dietary guidelines make it clear that no one should begin drinking, or drink more frequently on the basis of potential health benefits. So don’t feel pressured to drink alcohol.
The absorption of alcohol starts as soon as it reaches the stomach (20%) and (80%) via small vessels of small intestine.
Within minutes of drinking alcohol, it travels from the stomach to the brain, where it quickly produces its adverse effects, slowing the action of nerve cells. It is a central nervous system (CNS) depressant. Imagine a person with depressed nervous system driving; he becomes a threat not only to himself but to others on the road as well. The world over, the majority of the road accidents that occur, occur when the driver is drunk.
Alcohol is also carried by the bloodstream to the liver, which eliminates the alcohol from the blood by means of metabolism and converts it to a nontoxic substance. However, the liver can only metabolize a certain amount at a time, leaving the excess circulating throughout the body. Thus the intensity of the effect on the body is directly related to the amount consumed. When the amount of alcohol in the blood exceeds a certain level, it depresses the respiratory (breathing) system markedly, and can cause coma or death, because oxygen no
longer reaches the brain.
Furthermore, alcohol kills more teenagers than all other drugs combined. It is a factor in the three leading causes of , death among 15- to 24-year-olds: accidents, homicides and suicides. Today, an estimated 15 million Americans suffer from alcoholism and 40% of all car accident deaths in the US involve alcohol.
Alcoholism predisposes people to other illegal drugs as well. It has been estimated that young people who drink are 7.5 times more likely to use other illegal drugs and fifty times more likely to use cocaine than young people who never drink.
A US Department of Justice study found that as many as 40% of violent crimes occur when the perpetrators are under the influence of alcohol. According to one study, of the 490 million people in the European Union, more than 23 million are dependent on alcohol. In Europe, alcohol contributes to nearly one in ten of all cases of illness and premature deaths each
year. Depending on how much is taken, and the physical condition of the individual, alcohol can cause:
1. Slurred speech, drowsiness, vomiting
2. Headaches, breathing difficulties, distorted vision and hearing
3. Impaired judgment, decreased perception and coordination,unconsciousness and even coma
The long term effects of alcohol can be any of, or a combination of, the following, especially where as binge drinking and continued use in excessive amounts are concerned. (Binge drinking is defined as four or more drinks within two hours for women and five or more drinks within two hours for men.)
• Unintentional injuries such as car crashes, falls, burns, drowning
• Intentional injuries such as firearm injuries, sexual assault, domestic violence (Alcohol spoils domestic life and is one the major causes of broken relationships.)
• Liver disease, nerve damage, sexual problems
• Permanent damage to the brain
• Cancer of the mouth and throat
Females are particularly susceptible to the bad effects of alcohol because of differences in their metabolism. Alcohol affects most of the organs in the body. Its intake can cause
pancreatitis and can be even be life threatening. People with pre-existent cardiovascular disease are prone to sudden death.
Heart muscle damage (alcoholic cardiomyopathy) leading to heart failure and progressive shortness of breath can also occur.
Other deleterious effects of excessive alcohol consumption, are:
• Liver disease: Alcohol causes fatty deposits in the liver and the spectrum of fatty liver turns into cirrhosis over a period of time Once cirrhosis develops, only a liver transplant can prevent further complications.
• Brain damage and other problems in an unborn child: Pregnant women who consume alcohol can damage the brains of their unborn children and cause other congenital problems.
It has cruel arms and once a person falls into its trap, it is difficult to escape, and the person becomes dependent on alcohol.
Alcohol dependence (alcoholism) consists of four symptoms
1. Craving: a strong need, or compulsion, to drink.
2. Loss of control: the inability to limit one’s drinking on any given occasion.
3. Physical dependence: When alcohol use is stopped after a period of heavy drinking, withdrawal symptoms, such as nausea, sweating and anxiety, occur. Serious dependence can lead to life-threatening withdrawal symptoms including convulsions, starting eight to twelve hours after the last drink. The person can even become
agitated and develop hallucinations. The phenomenon is called delirium tremens (D.T.’s). It begins three to four days later.
4. Tolerance: With the passage of time, the person develops a need to drink ever increasing amounts of alcohol in order to get high. Alcohol withdrawal syndrome is a potentially life-threatening condition that can occur in people who have been drinking heavily for weeks, months, or years and then either stop or significantly reduce their alcohol consumption. The symptoms can begin as early as two hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (also called DTs). The death rate from DTs — which are characterized by confusion, rapid heartbeat, and fever — is estimated to range from 1% to 5%. Because alcohol withdrawal symptoms can rapidly worsen, it’s important to seek medical attention even if symptoms are seemingly mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs.
It’s especially important to see a doctor if you’ve experienced previous alcohol withdrawal episodes or if you have other health conditions such as infections, heart disease, lung disease, or a history of seizures. Severe alcohol withdrawal symptoms are a medical emergency. If seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur, either take the patient to an emergency room.
Causes of Alcohol Withdrawal Syndrome
Heavy, prolonged drinking — especially excessive daily drinking — disrupts the brain’s neurotransmitters, the brain chemicals that transmit messages. For example, alcohol initially enhances the effect of GABA, the neurotransmitter which produces feelings of relaxation and calm. But chronic alcohol consumption eventually suppresses GABA activity, so that more and more alcohol is required to produce the desired effects, a phenomenon known as tolerance.
Chronic alcohol consumption also suppresses the activity of glutamate, the neurotransmitter which produces feelings of excitability. To maintain equilibrium, the glutamate system responds by functioning at a far higher level than it does in moderate drinkers and nondrinkers.
When heavy drinkers suddenly stop or significantly reduce their alcohol consumption, the neurotransmitters previously suppressed by alcohol are no longer suppressed. They rebound, resulting in a phenomenon known as brain hyperexcitability.
So, the effects associated with alcohol withdrawal — anxiety, irritability, agitation, tremors, seizures, and DTs — are the opposite of those associated with alcohol consumption.
If you have mild to moderate withdrawal symptoms, your doctor may prefer to treat you in an outpatient setting, especially if you have supportive family and friends. Outpatient detoxification is safe, effective, and less costly than inpatient detoxification at a hospital or other facility.
However, you may require inpatient treatment if you don’t have a reliable social
network, are pregnant, or have a history of any of the following:
• Severe withdrawal symptoms
• Withdrawal seizures or DTs
• Multiple previous detoxifications
• Certain medical or psychiatric illnesses
The goals of treatment are threefold: reducing immediate withdrawal symptoms, preventing complications, and beginning long-term therapy to promote alcohol abstinence.
Prescription drugs of choice include benzodiazepines, such as diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax). Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures
and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine(Tegretol) may be an effective alternative to benzodiazepines, because it is not sedating and has low potential for abuse.
To help manage withdrawal complications, your doctor may consider adding other drugs to a benzodiazepine regimen.
These may include:
• An antipsychotic drug, which can help relieve agitation and hallucinations
• A beta-blocker, which may help curb a fast heart rate and elevated blood pressure related to withdrawal and reduce the strain of alcohol withdrawal in people with coronary artery disease.
Relatively brief outpatient interventions can be effective for alcohol abuse, but more intensive therapy may be required for alcohol dependence. If you have alcohol dependence, your doctor may prescribe other medications to help you stop drinking. He or she also may recommend joining therapy.
Author is a MD. DM (Gastroenterology) FACP, FACG Consultant Gastroenterologist & Associate Professor at Yenepoya University, Mangalore.