Do You Have a Drinking Problem

If you have any doubt about your level of alcohol consumption or your ability to control it, consider these questions:

  • Has a friend or a family member ever expressed concern about your drinking?
  • Has such concern annoyed you?
  • Do you frequently drink alone?
  • Do you try to conceal your drinking?
  • Do you drink to relax, relieve stress, overcome shyness, or go to sleep?
  • Have you ever felt the need to cut down on your drinking?
  • Have you ever felt guilty for drinking?
  • Do you ever have a drink first thing in the morning?
  • Have you ever missed or been late for work because of a hangover?
  • Have you gotten into arguments when you have been drinking?
  • Have you ever had an automobile accident or even a close call when you have been drinking?
  • Have you sprained an ankle or had other injuries while drinking?
  • After drinking, have you had sex with someone you would not have had sex with if you were sober?
  • Have you hit your children or your partner while drinking?
  • Have you gotten sick when drinking?

If you answered yes to any of these questions, you may be addicted to alcohol. If you think that you—or someone you love—has a drinking problem, seek help immediately. Stopping now will significantly improve your life and your health, no matter how long you have been drinking. Here is how you can get help:

Ask your doctor for the name of a healthcare professional who specializes in treatment for alcohol dependency. Call the employee assistance program where you work. Call nearby hospitals or a local mental health center to ask if they provide a program for alcohol addiction.

Call the local chapter of AA, a support group of alcoholics who meet regularly to help each other stop drinking and stay sober.

If you are concerned about the drinking of a family member or a friend, call the local chapter of Al-Anon, a support group for relatives and friends of alcoholics.


Smoking, directly and indirectly, causes more death and illness in the United States than any other single activity. Each year, more than 300,000 Americans die of smoking-related illnesses, including lung cancer, emphysema, and heart disease. Although the incidence of smoking among men has declined to about 32 percent from its peak of 54 percent in the mid-1950s, smoking remains one of the most difficult habits to kick. Much of what is known today about the harmful effects of tobacco was learned from medical studies of the effects of cigarette smoking on the lungs. The effects of smoke from cigars and pipes are also dangerous, although in somewhat different ways.

Harmful Effects of Smoking The risk of developing lung cancer is 10 times greater for cigarette smokers than for nonsmokers. Decades of study in many countries have shown a direct link between smoking and lung cancer. Since cigar and pipe smokers do not inhale as much tobacco smoke, they have a slightly lower risk of lung cancer, but the risk is still significantly higher than it is for nonsmokers. Tar and nicotine, as well as smoke, play a role in the development of lung cancer. The risks for lung cancer increase proportionately with the number of cigarettes smoked, the length of time the person has smoked, the age at which the person started smoking, and the amount of smoke inhaled.

Other types of cancer caused by cigarette smoking include cancers of the throat, esophagus, bladder, kidney, pancreas, and mouth. Pipe and cigar smokers also have an increased risk for cancers of the lip and mouth. Since some of the tars in tobacco are swallowed, there is also an increased risk of stomach cancer.

Respiratory diseases associated with smoking include chronic bronchitis, sinusitis, and emphysema. Each year in the United States, these diseases account for tens of thousands of deaths from respiratory failure. Cigarette smoking slows down the action of the cilia, tiny hairlike projections that line the airways and help clean the lungs. When the cilia are immobilized, dust and dirt particles are able to invade the lungs and cause inflammation. As a result, cigarette smokers also have more chronic coughs, phlegm production, wheezing, and other respi

Staying Healthy ratory symptoms. People with allergies and asthma are particularly vulnerable to the negative effects of cigarette smoke.

For men, the most significant health hazard of smoking is coronary artery disease—the most common cause of death in men in the United States. A young man who smokes 20 cigarettes a day is three times more likely than a nonsmoker to develop coronary artery disease. The risk increases proportionately with the number of cigarettes smoked. Smokers have been shown to have severe and extensive narrowing of their coronary arteries, the vessels that deliver blood to the heart muscle. They also have higher blood levels of LDL (low-density lipoprotein), the "bad" cholesterol, and are more likely to have high blood pressure.

Smoking lowers the threshold for the onset of angina, chest pain associated with heart disease, and is a major risk factor for peripheral vascular disease, which affects the arteries of the legs, causing painful neuropathy (degeneration of the nerve endings). Smoking also affects the arteries leading to the brain, thereby increasing the risk for stroke.

Avoiding Risky Behavior

Physiological Effects of Smoking Scientists now understand the details of how and why smoking is able to exert so many different negative effects on many parts of the body. The smoke from a lighted cigarette contains a mixture of more than 3,000 different substances that are dangerous to living tissue. In addition, tobacco products contain hundreds of chemical additives used as flavors and fillers. No federal agency currently has the authority to require the tobacco industry to reveal the names of these additives, or to remove them from tobacco products if they are found to be harmful. These substances in cigarettes include tars, nicotine, and gases such as carbon monoxide, nitrogen oxide, and hydrogen cyanide. Together, these substances interact to create a huge number of different chemical compounds that have harmful effects on the body. Tobacco tar is made up of hundreds of chemicals that have been shown to cause cancer.

Nicotine is the addictive substance in tobacco. The signs of addiction include tolerance (the need to take larger doses to produce the same effects), physical dependence, continued use despite known harmful effects, euphoric effects, relapses following drug abstinence, and recurrent drug cravings. Nicotine is inhaled, along with tars and carbon monoxide, in tobacco smoke. Nicotine in smokeless tobacco is absorbed through the mucous membranes in the mouth (chewing tobacco) or the nose (snuff). Nicotine acts primarily on the nervous system, often causing an increased heart rate and elevated blood pressure.

Nearly 90 percent of the nicotine found in cigarettes is inhaled and absorbed into the bloodstream. In addition to its effects on the respiratory system and the gastrointestinal system, nicotine also affects the brain, the spinal cord, and the peripheral nervous system. Nicotine can stimulate, then depress, the production

106 of saliva, constrict the air passages in the lungs, and increase cholesterol levels in

Staying the bloodstream.

Healthy Carbon monoxide is a deadly gas that is a by-product of burning tobacco. It is the same pollutant that is found in automobile exhaust. Carbon monoxide is deadly because it displaces the oxygen molecules in red blood cells, making oxygen less available to your muscles, brain, heart, and other organs. It also damages the lining of arteries, causing atherosclerosis (the buildup of fatty deposits called plaque in the inner lining of the arteries that supply blood to the heart). As a result, the heart must pump harder to deliver an adequate supply of oxygen to the cells.

Smokeless Tobacco Smokeless (chewing) tobacco has been making a gradual resurgence in the United States for the past 20 years. Advertisers have presented smokeless tobacco as a healthier alternative to smoking, using the macho image of tobacco-chewing cowboys and athletes to promote their products. Apparently these advertisements have been effective, as indicated by an increase of 52 percent in sales of smokeless tobacco since 1978. It is estimated that 7 million to 11 million Americans, mostly males, use smokeless tobacco.

Smokeless tobacco comes in three forms: loose leaf, plugs, and snuff. Chewing tobacco may be packaged as loose-leaf tobacco, which is sold in a pouch. The user places the tobacco between the cheek and the gum, and when a certain amount of tobacco juice and saliva are accumulated in the mouth, it is spit out. Chewing tobacco also can be found as plug tobacco, which is a solid brick form of tobacco. The user cuts off a piece with a knife and chews it, and again, spits it out. Snuff is a finely ground tobacco, sold in cans, that is put on the back of the hand and sniffed through the nose. It also can be placed between the cheek and the gum.

Despite its macho appeal to men, few women find tobacco chewing attractive. Users of smokeless tobacco may not experience the effects of carbon monoxide, but the substance has plenty of other harmful effects, including:

  • damage to the soft and hard tissues in the mouth
  • excessive abrasion of tooth surfaces
  • presence of nitrosonornicotine, a cancer-causing agent
  • increase in heart rate and blood pressure
  • development of leukoplakia, a disease that results in thick, white patches on the cheek, tongue, and other parts of the mouth
  • cancer of the inner lining of the cheek
  • suppressed immune response
  • increase in the number of dental cavities
  • inflammation of the gums
  • cancers of the pharynx, esophagus, bladder, and pancreas
  • darkened teeth and bad breath

Secondhand Smoke Breathing in smoke from someone else's tobacco presents a significant risk to a nonsmoker's health. Exposure to so-called secondhand smoke (sometimes referred to as passive smoking) is a significant cause of heart disease, stroke, lung cancer, and respiratory problems such as bronchitis.

Two different types of smoke enter the air when a person smokes: exhaled smoke and the smoke that comes directly from the burning tobacco. This second, more dangerous type of smoke is what hovers in the air in smoke-filled rooms.

Secondhand smoke is especially harmful to infants and young children. Smoking by parents is known to worsen asthma in children and even to trigger asthma attacks. Children without asthma whose parents smoke have far more respiratory illnesses—coughs, colds, middle ear infections, pneumonia, and bronchitis—than children of nonsmokers.

How to Quit If you are a smoker, kicking the habit could be the single most important thing you do for your health and your family's health. It's not easy, but millions of people have quit smoking on their own. Many programs are now available to help. The American Cancer Society (800-227-2345) and the American Lung Association (800-LUNG-USA) offer excellent support resources and information for those who want to quit on their own. You can also check your Yellow Pages for listings of other smoking treatment programs and support groups.

Most successful stop-smoking programs suggest that you tackle the job in three stages: preparation, quitting, and reinforcement. The following tips will help you prepare to quit smoking:

  • Choose a target date to quit, such as a birthday or an anniversary, and stick to it.
  • Make a list of reasons for quitting, and review it carefully.
  • Note your smoking habits and routines; plan activities that would disrupt them.
  • Condition yourself physically: start a modest exercise program, drink more fluids, and get plenty of rest.
  • Think of alternative activities to do when the urge to smoke is strong.
  • Go public with your intentions to quit, and gain the support of friends and family.
  • If possible, get someone to quit with you. The following tips will help you quit smoking:
  • Don't be discouraged by the thought of never smoking again; think one day at a time.
  • Clean your clothes to rid them of the cigarette smell.
  • Get rid of all cigarettes, ashtrays, and lighters at home, in your car, and in your office at work.

Avoiding Risky Behavior

On the day you quit, keep busy: go to a movie, exercise, take long walks, buy yourself a treat, or do something special to celebrate. Visit the dentist and have your teeth cleaned.

The first few weeks, spend as much free time as possible in places where smoking is not allowed.

Avoid alcohol, coffee, and other beverages associated with smoking, but drink large quantities of water and fruit juice.

Once you have successfully quit smoking, here are some tips for helping you stay away from cigarettes:

  • Keep healthy substitutes handy, such as carrots, sunflower seeds, raisins, or sugarless gum.
  • Learn how to relax quickly and deeply: make yourself limp; visualize a soothing, pleasing situation; and get away from it all for a moment.
  • Participate in activities that make it hard to smoke such as jogging or swimming.
  • Do things that keep your hands busy such as crossword puzzles or gardening; while watching television, play with a paper clip, a pencil, or a rubber ball.
  • Stretch a lot.
  • Pay attention to your appearance.
  • Never allow yourself to think that "one cigarette won't hurt."
  • Get up from the dinner table as soon as you're finished eating and brush your teeth.
  • If you are concerned about gaining weight, join an exercise group, plan menus carefully, and weigh yourself weekly; don't try to lose weight, just try to maintain your prequitting weight. Keep in mind that the benefits of giving up cigarettes far outweigh the drawbacks of gaining a few pounds.

Most smokers successfully quit only after several attempts. You may be lucky enough to quit on your first try, but if not, don't give up. Try again.

A number of products are now available to help break the smoking habit. These include nicotine patches, nicotine gum, nicotine inhalers, and drugs such as bupropion hydrochloride. The patches and gum provide a low dose of nicotine that can be used to wean your body off the drug. Bupropion hydrochloride is a nicotine-free pill that can help reduce your urge to smoke. Other approaches to quitting smoking include hypnosis, acupuncture, behavior modification, and meditation. Your physician can give you more information on smoking-cessation programs and products.

Illegal Drugs

In addition to the physical and social problems caused by dependence on drugs such as alcohol, people who become dependent on an illegal substance risk penalties for violating drug control laws and their personal safety when procur

Staying Healthy ing drugs. Those who use unsterilized needles also risk exposure to HIV, hepatitis, and other sexually transmitted diseases that are transmitted through contaminated blood. More than other addictive substances, illegal drugs are a powerful force behind criminal activity that destroys families and neighborhoods, and overwhelms prisons.

If you feel you are unable to stop using illegal drugs on your own, you will need professional help to quit. Although quitting is something only you can do, it is not likely that you can quit by yourself. Talk to your doctor, or call your local hospital or clinic to ask about their drug treatment programs.

Cocaine Whether sniffed as a powder, injected as a liquid, or smoked (free-basing), cocaine acts as both a stimulant and a local anesthetic, producing a rush of euphoria and energy. Its effects wear off quickly, often leading users to take another dose in a short time. Cocaine is derived from the leaves of the South American coca bush. Crack cocaine, the purest form of the substance, is especially lethal because its effects are more intense and can lead to cardiac arrest.

The euphoria caused by cocaine use is intense but short-lived and usually followed by depression as the drug wears off. The drug causes the coronary arteries to constrict, boosting blood pressure and, with it, the risk of heart attack, stroke, and seizures. Regular use of cocaine often causes nervousness, insomnia, inability to concentrate, fatigue, depression, or anxiety; some people become aggressive, violent, or paranoid. Side effects include nausea and vomiting, bleeding of mucous membranes, and cold sweats. Cocaine also can cause hallucinations, abnormal heart rhythm, coma, and death.

A very ill person who is dependent on cocaine may need to be hospitalized. All people who are addicted to cocaine should seek counseling and rehabilitation to overcome their addiction.

Club Drugs So-called club drugs such as ecstasy, rohypnol, GHB, and keta-mine are synthetic drugs made in illegal production facilities. These drugs are being used increasingly by teens and young adults as part of a nightlife scene at nightclubs, bars, and "raves." Many young people experiment with a variety of these drugs together. Combining any of these drugs with alcohol can lead to severe reactions and death.

Ecstasy comes in pill form and also can be inhaled or injected. The effects of ecstasy are similar to those of amphetamines and cocaine. Psychological effects include confusion, depression, sleep problems, severe anxiety, and paranoia. Physical effects include muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. Use of the drug is associated with increases in heart rate and blood pressure. Ecstacy also has been linked to long-term damage to those parts of the brain that are critical to thought, memory, and pleasure.

Avoiding Risky Behavior

110 Rohypnol, GHB, and ketamine depress the central nervous system, inducing a

Staying state of dazed relaxation. They have been implicated in cases of date rape;

Healthy because they are often colorless, tasteless, and odorless, they can be slipped easily into an unsuspecting victim's drink. Rohypnol can be fatal when mixed with alcohol or other depressants. Abuse of GHB can produce withdrawal effects such as insomnia, anxiety, tremors, and sweating, and can cause coma and seizures, especially when combined with ecstacy. Sometimes ketamine is used as an alternative to cocaine and usually is snorted.

Heroin Heroin is an opiate, which means it comes from the opium poppy. Like other opiates, it can be eaten, inhaled, smoked, or injected. Because the body quickly builds up a tolerance to heroin, users can become addicted rapidly. The euphoric and tranquilizing effects of heroin come at a high price: regular use can lead to kidney dysfunction, pneumonia, lung abscesses, and brain disorders, depending on how the drug is taken. Those who inject the drug also risk skin abscesses, phlebitis (inflammation of a vein, often accompanied by formation of a blood clot), scarring, hepatitis, and HIV infection.

The drug methadone, itself addictive but much less so than heroin, is often used to treat heroin addiction; the person may need to take it for the rest of his or her life. Methadone treatment is usually given on an outpatient basis under a physician's supervision.

Marijuana The most widely used illegal drug is marijuana, made from the leaves of the hemp plant. The drug is typically smoked in joints (cigarettes). People use marijuana to feel good and to relax. The drug can cause a distorted sense of time and a reduced ability to think and communicate clearly. Other side effects can include problems with depth perception and short-term memory, impaired motor abilities, bloodshot eyes, dry mouth, and—with chronic use— paranoia, panic, and hallucinations.

Like cigarette smoke, marijuana smoke impairs the lung's defenses against infection and can lead to bronchitis and emphysema. Smoking marijuana may pose even more of a cancer danger than cigarettes because marijuana smoke contains more of a potent cancer-causing substance than tobacco smoke and because people who smoke marijuana inhale the smoke more deeply into their lungs.

Heavy, long-term use of marijuana can cause a psychological addiction that can lead to loss of energy, ambition, and drive. People who are psychologically addicted to marijuana tend to have difficulty dealing with normal, everyday stress.

LSD Lysergic acid diethylamide (LSD) is a powerful hallucinogen that induces a wide range of psychological effects, which can be enjoyable, terri fying, or both. "Bad trips" can cause paranoia and panic, but even ordinary 111

episodes of LSD use can involve: Avoiding


  • depressed appetite BEHAVIOR
  • loss of sexual desire
  • distorted perceptions
  • difficulty communicating
  • feelings of paralysis
  • hyperactivity
  • dilated pupils
  • increased heart rate and blood pressure
  • sleeplessness
  • tremors

In whatever form it is taken (blotter paper, sugar cubes, gelatin squares, or small tablets) the effects of LSD are unpredictable, in part because it is impossible to know the exact dose you are getting and in part because the effects are influenced by the user's personality and mood. A single dose of LSD can last for 12 to 18 hours, and many users experience flashbacks—recurring memories of some aspects of their experiences using the drug—for up to a year.

LSD is not considered to be addictive but, like addictive drugs, LSD can produce tolerance, which causes people who use the drug regularly to take increasingly higher doses to get the same effects. In susceptible people, LSD use may contribute to the development of mental disorders such as schizophrenia and severe depression.

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