The other addictions

EXETER – Much attention is focused on the country’s opioid addiction crisis right now, and while there is no denying the importance of the problem, physicians said we should not forget two other addictions, legal ones, cause numerous health problems.

Alcohol and tobacco can be bought easily. Some people are social drinkers and do not have problems curbing their use, but for others drinking is an addiction and difficult to overcome. Tobacco is highly addictive and while most of us know it causes illnesses like cancer and heart disease, people who smoke struggle with their addiction.

Both can cause life-threatening conditions and, in the case of alcohol, legal problems and a potential danger to others through drunken driving accidents and poor decision making.

Dr. Will Torrey, an addiction specialist at Dartmouth-Hitchcock Medical Center, said alcohol is a complicated substance because it is virtually impossible to live in the United States and not encounter it, or people who struggle with its use. He said alcohol is the third most common cause of preventable deaths, 40 percent of the cause of traffic accidents and that it increases the risk of suicide.

Common health problems associated with alcohol include liver damage (cirrhosis), high blood pressure, anxiety and depression. It interferes with sleep patterns and can contribute to stomach issues. For a pregnant woman, dangers to the fetus can include miscarriage, still births and fetal alcohol syndrome. Torrey said the physical and cognitive problems for a child born to a mother who drinks can be lifelong.

Torrey said alcohol can have a devastating impact on the people closest to an alcoholic, impairing relationships because of the lack of control over behaviors.

“It has a huge economic impact on society,” Torrey said. “Accidents, hospitalizations and legal ramifications associated with alcohol are enormous. It impacts drinkers and non-drinkers. Health costs are huge. What is needed is education, treatment and support.”

Torrey said studies show that successful drinking cessation programs decrease emergency room medical expenses.

“Ultimately one-third of people who use alcohol will have potential health risks,” Torrey said. “Nine percent of adults have some problem with alcohol addiction. Twice as many men as women have difficulties. Most of the addictions happen before age 40, with some later in life.”

Dr. David Buono, a family physician for Core Physicians at Exeter Hospital, said the stereotypical alcoholic, a person who drinks every day is not the only person who may have trouble with alcohol.

“Alcohol use disorder is a broader spectrum of conditions,” Buono said. “We also see health risks for the binge drinkers, those who go out and have a lot of alcohol at once. There are potential issues for the person who has three to four drinks a day, more than the recommended one to two drinks a day. These people are risking health problems, including alcohol toxicity. They may be involved in drunk driving accidents because of impaired driving. They can make poor decisions. They may have problems with their liver, their heart or have high blood pressure.”

Alcoholism is not willful misconduct. Torrey said most alcoholics have some predisposition because there is a genetic component for people to abuse alcohol.

“Currently there are medications that can help, but first a person must have the real desire to stop drinking,” Torrey said. “There are multiple paths to recovery, like AA, support groups and sober recreational facilities.”

Stopping cold is not safe for an alcoholic, Buono said. He said there are dangerous withdrawal symptoms and medical intervention is needed.

“It is a real chemical addiction,” Buono said. “Detox is needed, and the person must be in the right place. They must really want to stop because they are facing a lifetime of work. They are going to need to make significant changes in their lifestyle.”

Torrey said tobacco remains the No. 1 preventable cause of death in the United States.

“Twenty-five percent of deaths can be attributable in some way to cigarettes,” Torrey said. “The probability of surviving to age 79 is reduced among smokers. Their life expectancy is 10 years lower. There is a huge economic impact, with 8.7 percent of all health care spending attributed to smoking. That about $170 billion a year.”

Dr. Paul Deranian of Core Pulmonary and Critical Care Medicine at Exeter Hospital oversees respiratory therapy and the Intensive Care Unit. He sees his share of conditions related to tobacco.

“Smoking is an addiction that can cause chronic lung conditions, including lung cancer,” said Deranian. “It can cause COPD (chronic obstructive pulmonary disorder) and can worsen a person’s immune system, their ability to fight off infections. It reduces their ability to clear mucous because the mucous clearing hairs in the airway are the first to go when a person smokes. They are more likely to get pneumonia and it contributes to a variety of cancers.”

Deranian said lung cancer, when it is diagnosed, is often far progressed because lungs have no nerve endings and the person afflicted will not feel pain as a warning sign.

Torrey said smoking contributes to many cancers, including lung, breast, colon and esophageal cancer. It is a factor in heart disease, respiratory infections and increases the risk of stroke. Tobacco can permanently damage the lungs and may increase the progression of osteoporosis.

“When a person stops smoking they will notice the change,” said Deranian. “They will notice they are not coughing as much as they used to. Their skin clears. They can smell better and their food tastes better. They will sleep better.”

Smoking has a negative effect on a fetus if the mother smokes during pregnancy. Torrey said 16 percent of pregnant women smoke, despite being informed of the danger.

“Smoking can lead to ectopic pregnancy, infant mortality and low birth weight,” Torrey said. “Nicotine is incredibly addictive and the pull on people is very strong. There is help and the medications, like Chantix are greatly improved. People using medication find the pleasure they get from smoking will go away. It can be combined with the gum or lozenges. Support through the process is crucial.”

Quitting is rough. Deranian said medications and support can help. He noted the state will provide smoking cessation tools for residents who are concerned with the cost.

“Smoking is a behavior that is ingrained in the people who use tobacco,” Buono said. “They need a game plan for the times they smoke, that morning cigarette, the one while driving and when there is stress. It is important to find new ways to deal with the situations in which they find themselves smoking if they are going to succeed.”

People who smoke are often concerned that if they stop, they will gain weight. Deranian said the weight gain is usually moderate if people are careful.

“They are still far better off than if they continued smoking,” Deranian said. “It’s one of the best things you can do for your health. And the money spent on cigarettes can be better used somewhere else.”

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