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.
For people who are obese, the operation known as gastric bypass surgery has been hailed as something of a miracle. In addition to rapid weight loss, it can reverse diabetes and reduce the risk of heart disease. A new study reveals potential darker side—an increase in alcohol abuse. In a presentation at yesterday’s annual meeting of the American Society for Metabolic and Bariatric Surgery, researchers reported that almost 11% of nearly 2,000 men and women who underwent gastric bypass surgery (the most common type of obesity surgery) got in trouble with drinking by the second year after surgery. About 7% drank too much before the operation, representing a 50% increase. This finding shouldn’t steer people who could benefit from gastric bypass surgery away from the procedure. But it should prompt them—and their doctors—to be on the lookout for changes in alcohol use or abuse afterward.
Drinking in the workplace may be an emerging trend, but it isn’t necessarily a healthy one. Although drinking on the job may not be as widespread as portrayed on the hit TV show Mad Men, it is still with us. About 8% of full-time employees report having five or more drinks on five or more occasions a month, and one survey showed that 23% of upper-level managers reported drinking during work hours in the prior month. In the United States, excessive drinking costs $223 billion a year. Some of these costs are generated by the nearly 18 million Americans who are alcoholics or have alcohol-related problems. But some also comes from a nearly invisible group, “almost alcoholics.”
It’s hard for someone who has never battled an addiction to understand how or why a person can’t break free of one. An exchange on the radio about pop star Whitney Houston’s addictions underscores the misconceptions many people have about addiction. Addictions retrain the brain in a way that couples liking something with wanting it. There are important gender differences in addiction. Although men are more likely than women to become addicted to drugs or harmful behaviors, women who have an addiction face tougher challenges.
We tend to think that stopping an addictive behavior means joining a group, seeing a therapist, going to a treatment center, or taking a medication that helps with cravings. Some people manage to break an addiction without any help. These “natural recoverers” tend to take two key steps: They find a new hobby, challenge, or relationship to help fill the void left by the addiction. And they start exercising. Exercise is important because it acts as a natural antidepressant. It also prompts the body to release its own psychoactive substances—endorphins—that trigger the brain’s reward pathway and promote a feeling of well-being. Natural recovery isn’t a sure thing, and the more severe the addiction, the harder it is to do.
Eating disorders don’t afflict only adolescents and young women, but plague older women, too, and may be shrouded in even greater shame and secrecy. Many women don’t seek help, especially if they fear being forced to gain weight or stigmatized as having a “teenager’s disease.” As reported in the February 2012 Harvard Women’s Health Watch, clinicians are reporting an upswing in requests from older women for help with eating disorders. For some of these women, the problem is new; others have struggled with anorexia, bulimia, binge eating, or another eating disorder for decades. Eating problems at midlife and beyond stem from a variety of causes, ranging from grief and divorce to illness, shifting priorities, and heightened awareness of an aging body.
Many people have trouble quitting smoking even after learning they have cancer, according to a new study from Harvard-affiliated Massachusetts General Hospital. Five months after learning they had cancer, just over one-third (37%) of smokers diagnosed with lung cancer and two-thirds (66%) of those with colorectal cancer were still smoking. The results underscore how difficult it can be to quit smoking. A diagnosis of cancer can be a powerful motivator, but it isn’t always enough—extra help is often needed to quit. Kicking a smoking habit is good for health anytime. It is even more important after a diagnosis of cancer.
With Veterans Day and Halloween behind us, we are moving full steam ahead to the holidays, the stretch from Thanksgiving to New Year’s Day (or Super Bowl Sunday, depending on your perspective). The holidays can be a wonderful time, full of friends, family, and fun. But they can also generate pressures and situations that undermine health. To help you enjoy a healthy and happy holiday season, Harvard Health Publications is offering three Special Health Reports that focus on common holiday challenges: depression, overuse of alcohol, and healthy eating.
The manslaughter trial of Michael Jackson’s personal physician, Dr. Conrad Murray, focused a lot of attention on a powerful anesthetic agent called propofol. Propofol is sometimes called the “milk of anesthesia” because it comes in a white, oily solution. Propofol is used as an induction agent—the drug that causes loss of consciousness— for general anesthesia in major surgery. Propofol is also a very good anesthetic for milder sedation used for outpatient surgery because it puts people in a semi-conscious, drowsy state. It starts acting quickly, but also wears off quickly. Like many sedating anesthetics, propofol lowers blood pressure and suppresses breathing, so the heart function and breathing of patients need to be constantly monitored. With a lot of propofol around, opportunities exist for abuse, with possibly fatal consequences.
Although current recommendations call for pediatricians to ask their adolescent patients about alcohol and drug use at every visit, many don’t. To make it easier for doctors and nurses to do this, the American Academy of Pediatrics has just published a set of questions to guide the confidential conversation, along with advice on what to do with the answers. The first question is a simple one about drug or alcohol use. If the answer is no, the health care provider should praise the teen and encourage him or her to continue making good decisions about health and safety. If the answer is yes, six follow-up questions called the CRAFFT questions) can help separate those who are experimenting from those who may be headed for serious trouble and need more in-depth help.