Opioid painkillers like hydrocodone and oxycodone offer blessed relief from pain. But the body gets used to them, requiring ever-higher doses. They are also addictive, cause side effects, and can kill. A report in the New England Journal of Medicine says prescription painkiller abuse accounts for about 17,000 deaths a year. Doctors are learning to say no to opioids, but have limited scientific guidance on when and how to best use them for chronic pain. Ideally, these drugs should prescribed for the shortest time possible and, if pain persists, a transition made to a non-addictive form of pain control. This may be other medications or specialized counseling from a pain specialist that might include complementary and alternative treatments, like acupuncture and meditation.
Nearly one-third of American adults are “excessive” drinkers, but only 10% of them have alcohol use disorder (alcoholism). Those numbers, published yesterday in a national survey, challenge the popular idea that most people who drink too much are alcoholics. The new study, done by researchers with the CDC and the Substance Abuse and Mental Health Service Administration, found that about 70% of all American adults drink alcohol at least now and then, about 30% report excessive drinking, and 3.5% have alcohol use disorder. It is higher among heavy drinkers (10%) and binge drinkers, ranging from 4% among those who report binge drinking once or twice a month to 30% among those who binge drink 10 times or more in a month. The knowledge that only 10% of heavy drinkers are alcoholic may be reassuring, but that doesn’t mean the other 90% aren’t have problems with drinking. Some are what Drs. Robert Doyle and Joseph Nowinski call “almost alcoholics.”
Breaking a smoking habit can be hard. Nicotine is so addictive that smoking, or using tobacco in other forms, may be the toughest unhealthy habit to break. But it’s possible to quit. Nicotine replacement, in the form of nicotine patches, gum, sprays, inhalers, and lozenges, can help overcome the physical addiction. Medications such as varenicline (Chantix) and bupropion (Zyban) can also help. They can help reduce the cravings for a cigarette, and may also make smoking less pleasurable. Two new studies show that adding one or both of these medications to nicotine replacement can help improve quit rates. This research doesn’t suggest that smokers take varenicline and bupropion as a first step in smoking cessation. But when nicotine replacement alone hasn’t helped, adding varenicline with or without bupropion may lead to success.
For some people, like those with an addiction, any amount of alcohol is too much. For others, drinking alcohol is something of a balancing act — a little may be healthful, while more than a little may be harmful. A new report in the journal Neurology highlights the dual effects of alcohol in men. As part of the Whitehall II study in Britain, researchers assessed the drinking habits of middle-aged men and women three times over a 10-year period. The study participants also took a mental skills test three times over the next 10 years. Compared with men who didn’t drink or who drank moderately, mental decline began to appear one to six years earlier in men who averaged more than 2.5 drinks a day. (There weren’t enough heavy drinkers among women to show any clear differences.) How does a person know if he or she is drinking too much? The CAGE and AUDIT tests can help.
On a Saturday morning 50 years ago tomorrow, then Surgeon General Luther Terry made a bold announcement to a roomful of reporters: cigarette smoking causes lung cancer and probably heart disease, and the government should do something about it. Terry, himself a longtime smoker, spoke at a press conference unveiling Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service. That press conference was held on a Saturday in part to minimize the report’s effect on the stock market. The 1964 Surgeon General’s report, and others that followed, have had a profoundly positive effect on the health of Americans, despite the tobacco industry’s concerted and continuing efforts to promote smoking. By one new estimate, the decline in smoking triggered by the 1964 report and others that followed prevented more than 8 million premature deaths, half of them among people under age 65. But we still have a long way to go. Some 42 million Americans still smoke, and tobacco use accounts for millions of deaths each year around the world.
If you smoke, you’ve probably heard that quitting is beneficial at any age. It’s good for your health, can make you feel and look better, and saves you money. But you also know, from personal experience or the experiences of friends, that quitting is hard. Take heart. Today, there are more ex-smokers than smokers in the United States. There are also more and better tools to help people quit. Each year on the third Thursday of November, the American Cancer Society sponsors the Great American Smokeout. It aims to make smokers and their loved ones more aware of the benefits of quitting and the tools available for achieving that goal. In support of the Great American Smokeout, Harvard Health Publications is giving away free electronic copies of the Harvard Medical School Guide: How to Quit Smoking. This offer ends at midnight tonight (Nov. 21, 2013).
For many people, a late-night “snack” is a daily habit. There are two types of nighttime eating disorders. Sleep-related eating disorder is a highly-publicized though uncommon malady. People with this problem eat while sleepwalking or while in a twilight state between sleep and wakefulness. A better-documented problem is night eating syndrome, in which people do the majority of their eating late at night. It may affect 1 or 2 out of 100 people in the general population. Sleeping and eating are almost certainly connected, given the link between lack of sleep and weight gain. So getting plenty of sleep may be a helpful substitute for nighttime trips to the refrigerator. Being mindful of the problem and trying to identify its triggers, or stress-reduction techniques, may help avert trips to the refrigerator. Some people benefit from talk therapy.
The term “chocoholic,” usually said with a smile, actually nods to a potentially serious question: can a person become addicted to food? There are three essential components of addiction: intense craving, loss of control over the object of that craving, and continued use or engagement despite bad consequences. People can exhibit all three of these in their relationships with food. It’s most common with foods that deliver a lot of sugar and fat — like chocolate — because they trigger reward pathways in the brain. In some animal studies, restricting these foods induced a stress-like response consistent with the “withdrawal” response seen in addiction. Much of the scientific discussion about food addiction has been sparked by the epidemic of obesity sweeping the U.S. and many other countries. Many people who are overweight crave food, lose control over eating, and experience negative health effects that should, but don’t, serve as a deterrent. The influence of stress on eating provides another link between food and addictive behavior.
It’s easy to think of doctors as paragons of the health and wellness they try to restore in their patients or help them maintain. Some are, and some definitely aren’t. One in 10 physicians develop problems with alcohol or drugs at some point during their careers. Those who admit they have an addiction to alcohol or drugs, as well as those who slip up and get reported, usually have to go through an intense substance abuse program before they can practice medicine again. Such physician health programs are pretty effective, helping around 80% of doctors recover from their problems. But these programs raise some ethical questions, according to Harvard Medical School’s J. Wesley Boyd and John R. Knight, who wrote a review of physician health programs in the Journal of Addiction Medicine. They should know, having spent a total of 20-plus years as associate directors physician health programs.
Why is it so incredibly hard to quit smoking—even when you are desperate to do so? For some people, the answer may be in their genes. In a report published online in the American Journal of Psychiatry, a team led by Dr Li-Shiun Chen of the Washington University School of Medicine identified a “high risk” version of a nicotine receptor gene that is more common in heavy smokers. Those with the high-risk gene took two years longer to quit smoking. But there was a silver lining: smokers with the high-risk gene were three times more likely to respond to smoking cessation therapies. The study provides hope for even hardcore smokers. However long it takes, quitting is beneficial. In a study published in the Archives of Internal Medicine, quitting smoking reduced the risk of dying—even in people in their 80s. “Even older people who smoked for a lifetime without negative health consequences should be encouraged and supported to quit,” the researchers wrote.