Transcript Healthy Living : Smoking, Alcohol & Party Drugs.

Healthy Living : Smoking,
Alcohol & Party Drugs.
By K V Liew, Edmund
Smoking :
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Harms of smoking are well-known. For example :
COAD, cancers (lungs/laryngeal/
oesophagus/bladder), ischaemic heart disease,
CVA, peripheral vascular disease & peptic ulcers.
Why do people still smoke ??!!!
Enhances their feeling of calmness (i.e. decreases
anxiety), improves mood, improves ability to
concentrate/think. ***Addiction.
Notoriously difficult to quit.
As doctors, especially frontline GPs, we have duty
to educate patients, to encourage quitting & assist
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Multiple studies have shown that the
majority of smokers have thought about
stopping (80% in one Australian study).
How to help patients stop
smoking :
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Educate them about the risks to their health &
emphasise the advantages of giving up.
Saves money, live longer, food tastes better, bad
breath improves, decrease frequency & severity of
URTI, better exercise tolerance, less chance of
premature wrinkling of skin/stained teeth,
improved sexual pleasure, early COAD can be
reversed, removes effects of passive smoking on
family & friends.
***Risk of lung cancer decreases. After stopping
for 10-15 years, risk is as low as someone who has
never smoked.
Opportunistic interventions during GP
consultations for other matters.
 If patients say no to stopping, provide
motivational & educational leaflets. Asks
patients to re-consider.
 If patients agree to stop smoking, ask them
to make a definite date to stop (e.g. during a
holiday) & make a mutual contract.
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Practical advice for successful
quitting :
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Eat more fruits & vegetables (citrus fruits can
reduce cravings).
Chewing gum/lozenges/sweets.
Increase your activity level or take up hobbies that
make you forget smoking (e.g. swimming/water
sports).
Avoid smoking situations and seek the company of
non-smokers.
Put aside the money saved & have a special treat.
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For those who find it difficult to stop “cold
turkey”, try smoking lighter cigarettes, less
frequently, stubbing out earlier & gradually
stop completely.
Pharmacological agents to help
stop smoking :
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In general, for light smokers with low
dependence/addiction to Nicotine, use nonpharmacological methods rather than drug
substitute.
Nicotine chewing gum=>chew at least 6 per day,
replacing at regular intervals. Chew slowly, not
more than 1 gum per hour.
Use for 3 months, slowly weaning off.
Transdermal nicotine patch=>useful for moderate
to severe nicotine dependence. Begin use
immediately upon cessation of smoking.
Available as 16-hour or 24-hour patches in
3 different strengths (7, 14 & 21mg).
 Apply to clean, non-hairy & dry skin on
upper outer arm/chest, leave in place for 16/
24hrs. Rotate sites with a 7-day gap for reuse of a specific site.
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Adverse reactions &
contraindications :
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Nervousness, sweating, dry mouth, dyspepsia,
abdominal cramps, angina & cardiac arrhythmias.
Nicotine gum=>hiccoughs, jaw pain, exacerbation
of peptic ulcers.
Nicotine patch=>local skin reaction, sleep
disturbances (especially 24hr. patch).
Contra-indications : pregnancy & breast-feeding,
severe IHD, recent CVA & history of cardiac
arrhythmias.
After-care & relapse prevention :
Arrange Follow-Up, at least monthly
especially during the first 3 months.
 Acknowledge that it is very difficult to quit.
Offer active encouragement & advice from
GP.
 Consider behavioural modification therapy
for those encountering difficulties.
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Alcohol :
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Alcohol use is pervasive in society, especially
Western society.
In suitable quantities, it is a good social lubricant
& makes people more relax and disinhibited.
However, it can interact negatively with
medications, causes and worsens multiple medical
and psychological conditions (e.g. liver cirrhosis/
traffic accidents) & results in addiction if
consumed excessively.
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In one estimation from the Census Department,
90% of adult population in USA drinks alcohol &
~ 60-70% of adult population consumed alcohol
within the past 1 month. Over 40% of the
population has had, or will have a temporary
problem with alcohol during their lifetime.
It is difficult for doctors to accurately assess
whether a patient is addicted/dependent on alcohol.
It is therefore important to be aware of the
problem & maintain a high degree of suspicion.
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Early recognition of the problem means better
potential for treatment & recovery, hopefully
before any permanent damage occur (e.g.
neurological deficits/liver cirrhosis).
Checklist for pointers of alcohol
dependency/addiction includes :
Are you drinking >6 glasses per day ?
Are you drinking in the morning ?
Do you feel a need for alcohol whenever you feel
stressed ?
Do you have any alcohol-related driving offences?
Are you concerned about your own drinking
habits ?
 Has any relatives/friends expressed concern
about your drinking habits ?
 Do you drink frequently during the working
hours ?
 Have you lost a job because of your
drinking habits ?
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Acute effects of alcohol :
Motor performance & cognitive functions
are reduced (e.g. slurred speech, unsteady
gait & nystagmus).
 Judgements are also impaired.
 Mental black-outs occur at higher doses.
 These are memory impairments of all forms
& functions, including long-term, shortterm, recall and acquisition. Patient is
walking, talking but not recording.
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Chronic effects of alcohol :
Wernicke-Korsakoff Syndrome.
 Peripheral neuropathy.
 Mallory-Weiss Syndrome & peptic ulcers.
 Liver cirrhosis, cardiomyopathy &
depressed immune system.
 Fetal alcohol syndrome in babies of
alcoholic mothers.
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Alcohol Withrawal :
Delirium Tremens.
 Acute medical emergency requiring
intensive care.
 Essentially autonomic nervous system
overdrive.
 Treated with supportive measures +
sedation (benzodiazepines) + vitamins.
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Treatment for Alcohol
Dependency/Abuse :
Ideally, treated in detoxification centres for
prolonged period of stay. Multidisciplinary
approach (MSW, Psychiatrist/Psychologist,
Counsellors, etc...), similar to drug
detoxification.
 Important issue of dual diagnosis (chicken
and egg).
 ? No such facilities in Hong Kong.
 Alcoholics Anonymous, tel=25225665.
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Party Drugs @ Psychotropic
Drugs :
Includes Ecstasy, LSD, Marijuana,
Methamphetamine/Ice, Ketamine &
Flunitrazepam.
 Came to prominence & media publicity
with the advent of “Rave” parties.
 “Rave” parties & its “techno” dance
subculture originated in Europe (Germany)
in the 1980s, spread to USA and arrived in
Asia/Hong Kong in the mid 1990s.
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Epidemiology of “party drugs”
abuse in HK :
Data from the Central Registry of Drug
Abuse (CRDA), Hong Kong.
 Prior to the arrival of “Rave” & party drugs,
there was a down-trend in the number of
reported drug abusers (including young
abusers aged < 21) in HK since 1995.
 This downtrend reversed in the first nine
months of 2000 when compared with the
same period in 1999.
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The no. of reported drug abusers rose 7.5%.
 ***The no. of reported young drug abusers
aged <21 rose 51.1%.
 The no. of psychotropic substance abusers
increased 51.5%.
 ***The no. of young psychotropic
substance abusers increased 113.5%.
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Further breakdown of figures :
Of the total no. of psychotropic substance
abusers, 76% were male, 51% were aged
<21, 55% were previously convicted, 41%
were unemployed, 36% have full-time jobs
& 12% were still going to schools. Average
age was 24yrs. old.
 The most common drugs abused was
Ecstasy (40.1%), Cannabis/Marijuana
(26.7%), Ketamine (22.3%) &
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Reported use of Ecstasy rose from 179
cases to 1664 & Ketamine rose from 9 to
926.
 Usually spend <$300 /person/day.
 Reasons : peer influence, seek euphoria/
sensory satisfaction & curiosity. Need to
consider overall socio-economic factors too.
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Methylenedioxymethamphetamin
e (MDMA/Ecstasy) & GHB :
Synthetic amphetamine analog with
stimulant properties.
 In US, illegal only since 1985.
 First patented by Merck in Germany in
1914. ?appetite suppresant/secret military
uses.
 Used by New Age seekers & clinical
therapists in 1960s for its properties of
inducing feelings of
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Well-being/warmth, interpersonal
connection/rapport/empathy, friendliness.
 ***Causes motor agitation/restlessness that
can be pleasurably relieved by dancing.
 Mechanism of action involves stimulation
of serotonin, dopaminergic & many other
neurotransmitter systems.
 Effects : amphetamine-like “rush” initially,
then nausea then plateau of “togetherness”
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For ~3 to 4 hours.
 Side-effects of dehydration, exhaustion,
overheating & seizures. Others include
teeth-gnashing, jaw clenching, decrease
appetite, hot flashes etc…
 After effects of up to few days.
 Usually taken p.o., a “liquid Ecstasy” (GHB)
also exists.
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***NO physiological dependence/addiction.
Just psychological dependence, if at all.
 Neurotoxicity of permanent damage to
serotonin neurons resulting in ?negative
impact on mood, causing/exacerbate
affective disorders.
 Controversial research, yet to have strong
evidence.
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Lysergic Acid Diethylamide
(LSD/psychedelic/speed/acid) :
Synthetic hallucinogen.
 First created by Albert Hoffmann, working
for Sandoz in 1944.
 In US, made illegal in 1966. CIA
experimented with it as “truth serum”.
 Experiences heightened perceptual
sensations & hallucinations. Colours
become more dramatic, synaesthesia
develops.
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Experiences one sensory perception through
the realm of another sense. For example,
smell a colour, taste a sound.
 Perceptual disturbance, “Trails”, develops.
Similar to seeing moving objects under a
strobe/disco light.
 Mechanism of action : very complex, as yet
not understood.
 Side-effects of tremors, weakness, nausea/V
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“bad-trip”, where the hallucination is
unpleasant/nightmare.
 Disorientated behaviour, impaired
judgement of “invincibility”, paranoid
delusions with danger to those trying to help.
 Post-Hallucinogenic Perceptual Disorder,
can last very long time.
 No physiological dependence/addiction.
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Ketamine :
Originally derived from PCP.
 Used as anaesthetic agent in paediatric
patients & farm animals/by veterinarians.
 Feels disassociated from user’s body &
delirium.
 Physiological dependence occurs. Acute
intoxication treated with supportive
measures.
 Tx/detoxification as per any addictive drug.
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Mechanism of action : complex and not yet
known to science.
Flunitrazepam (Rohypnol) :
Short-acting benzodiazepine.
 Drug of Choice for “date-rapes”/ “party
rapes”/robbery.
 Fast onset of action time, in seconds to tens
of seconds.
 Causes somnolence, relaxation,
disinhibition & anterograde amnesia.
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