When we think of people dependent on drugs, we often think of illegal drugs like
heroin and marijuana. But drugs such as alcohol and tobacco can affect us all, and
are probably a greater health problem for the community.
The facts
If you've ever had a problem with alcohol, cigarettes, or tranquillisers, you're
not alone. But you should be aware that abuse of any of these legal substances can
seriously damage your health. Every year, about 20,000 Australians die from diseases
caused by smoking.
At the same time, The National Drug and Alcohol Research Centre estimates 6.5% of
Australians over the age of 18 have an alcohol use disorder while 2.9% of all Australian
deaths are alcohol-related.
While the abuse of pharmaceuticals is largely hidden, the Australian Drug Foundation
says that an astounding 185 million prescriptions were dispensed in 1998. That is,
an average of 10 prescriptions for each man, woman and child in the country.
"When you lose control over your ability to decide when you want to stop using a
drug, you have a dependency problem," says Dr Louisa Degenhardt, a lecturer at the
National Drug and Alcohol Research Centre.
That dependency can be both psychological and physical, she says. For many of us,
legal drug use is associated with pleasure. Any attempt to quit or cut down can
seem like a loss of enjoyment.
"Physically, if we use any drug long enough and often enough we will also suffer
withdrawal symptoms when we attempt to stop using it," says Dr Degenhardt.
It's not surprising then, that to give up a drug you'll not only need to alter your
attitude to drug use but get support over the physical symptoms.
How do you know if you have a dependency?
If your habit is:
- damaging your health and/or mental wellbeing
- affecting your ability to function at work
- upsetting your relationships with family and friends, or
- taking over your life
it's time to seek help.
Tobacco
What's in cigarettes?
An average smoker, on one packet a day, inhales more than half a cup (150ml) of
tar from cigarettes each year.
Tar is the main cause of lung and throat cancer in smokers and it also aggravates
bronchial and respiratory disease.
As well as this toxic substance, a smoker gets an addictive shot of nicotine. It
takes only 7.5 seconds for this poison to act on the brain, followed by a relaxed
feeling about half an hour later.
Besides these two toxins, small amounts of more than 4,000 other substances can
be found in cigarette smoke, including 43 that have been identified as causing cancer.
Every day, one in four Australians draws these substances into their lungs. While
statistics show that the number of Australians who smoke is declining, from 37%
of the population in 1977 to 24% now, medical experts say that number is still too
high.
What will smoking do to my health?
Smoking is related to an increased risk of emphysema (a chronic, progressive disease
which destroys lung tissue); cancer of the mouth, larynx, oesophagus, bladder, kidney,
pancreas and cervix; increased risk of stomach ulcers and of pneumonia; cardiovascular
disease, depression, diabetes, peptic ulcers, osteoporosis, and even Alzheimer's
disease.
Men who smoke may suffer impotence and women who smoke may take longer to conceive
and be more likely to have a miscarriage.
Children whose parents smoke are more likely to get pneumonia and bronchitis in
the first year of life, suffer from more frequent and severe asthma attacks and
become regular smokers themselves.
Smoking can also damage your looks, by depleting skin of collagen, leading to accelerated
ageing.
What if I give up?
The day you quit smoking, the carbon monoxide levels in your body drop dramatically.
Within seven days your blood becomes less sticky and your risk of dying suddenly
from a heart attack starts to decline. Four to five years later, the chance you
will have a heart attack falls to nearly that of someone who has never smoked.
Best of all, your risk of dying from lung cancer starts to fall towards that of
a non-smoker.
According to The Cancer Council NSW, your accumulated risk of death from lung cancer
if you stop smoking around the age of 40 is only 2% higher than someone who has
never smoked. That compares to a 12% higher risk of getting lung cancer by age 75
than someone who has never smoked - if you continue to smoke cigarettes.
I need some help
Most smokers want to give up - 75% of smokers have tried to cut down or quit altogether.
But they need help.
Nicotine addiction is a severe drug dependency, says Renee Bittoun, of the Nicotine
Addiction Unit at the University of Sydney.
"We shouldn't just expect people to manage to quit on their own," she says.
"Some kind of pharmacological assistance, in the form of nicotine patches, gums,
inhalers or sprays, is 100% better than cold turkey."
Your GP can offer advice on support medication available. Understanding your nicotine
addiction, knowing why you smoke - it could be because of emotions, pleasure, social
pressure, or habit as well as addiction - and having a quitting plan will also increase
your likelihood of success, according to QUIT.
"While nicotine patches may help you wean yourself off cigarettes, increasing your
glucose intake during the quitting period may also help ease withdrawal symptoms,"
says Ms Bittoun.
"You become hypoglycaemic (low levels of sugar in your blood) while you are quitting
nicotine so many people find an emergency packet of jelly beans much more helpful
than being told to chew on carrot sticks."
Ms Bittoun says the first two weeks of giving up smoking are crucial.
"If you can make it past that, you are more than halfway there in the struggle (to
becoming a non-smoker.) After three months, you really have made it!"
Alcohol
In Australia, a cold beer, or a glass of chardonnay is part of our culture.
After all, 'moderate' drinking, is supposed to have benefits including a reduction
in heart disease and stroke, lower levels of stress and even possible protection
against Alzheimer's disease.
Researchers tell us that alcohol increases blood levels of high density lipoprotein
(good) cholesterol and decreases the likelihood of blood clots. Red wine also contains
high levels of antioxidants called flavonoids that protect against ageing free radicals.
But how many of us are really aware of what 'moderate' drinking is? In reality it's
no more than two units of alcohol for women and four for men a day, with two alcohol-free
days a week. Any more than this and the beneficial effects of alcohol are lost.
In the short-term alcohol abuse can lead to headaches, dehydration, nausea, vomiting
and diarrhoea, sleeping difficulties and depression. In the long-term, heavy drinking
can lead to liver disease, cancer of the oesophagus, brain damage and dementia,
hypertension and stroke, diabetes, pancreatitis, impotence and inflammation of the
stomach lining.
Alcohol can also interfere with night vision, affect judgment and lead to falls
or accidents. Consuming just one drink a day also increases the risk of breast cancer
in women by 10%.
Heavy drinking has other effects, too - up to a quarter of patients taken to casualty
departments with injuries are there because of drinking.
I need some help
If you suspect you have a problem, keep a diary of your drinking habits and ask
yourself to what extent drinking is influencing your life. Some people find help
in Alcoholics Anonymous, or other self-help organisations. Remember: the first step
to dealing with the problem is recognising it, then resolving to deal with it.
How can I drink safely?
To stick to healthy limits, you need to be smart:
- Monitor how much alcohol you drink. A standard drink is 30ml of spirits, 100ml of
wine, 285ml of regular beer and 375ml of low alcohol beer. If you are served a drink
at a party or in a big glass, then you're probably drinking more than a standard
drink
- Make sure you have appealing non-alcoholic drinks in the fridge
- Don't let people refill your glass the moment you take a sip
- Eat before or while you are drinking: eating slows your pace
- Avoid salty snacks that will increase your thirst
- Start with a soft drink to quench your thirst before you start drinking alcohol
Pharmaceuticals
Do we take too much medication?
Australians use a vast number of over-the-counter and prescription drugs.
In 1998, 3.3 million prescriptions were written for Temazepam alone, one of the
most common sleeping tablets, and another 4 million for codeine (used for pain relief).
At the same time, Australians bought millions of over-the counter painkillers, cough
medicines and cold remedies.
"Culturally we are brought up to self-medicate as much as to go to the doctor,"
says Bill Stronach, Chief Executive of the Australian Drug Foundation.
"We are a pill-popping nation," he says. "It creates the mindset that whenever we
have a twinge, we can take a drug without thinking. If you have kids, they get into
that mindset too."
Paracetamol, under the trade names of Panadol, Tylenol, Tempra and other names,
is a powerful painkiller that is sold in supermarkets.
"It is comparatively safe, except in large doses," says John Bell, Principal Adviser
to Pharmacy Self-Care, a program run by the Pharmaceutical Society of Australia.
If the dose is exceeded continuously or a huge number of tablets are swallowed,
permanent damage to the liver can result.
Put paracetamol together with codeine and the result is an even more powerful drug.
Codeine is a respiratory depressant and can cause constipation.
Other painkillers, such as Ibruprofen (Nurofen, ACT 3, Brufen, Actiprofen) and aspirin
(Aspro Clear, Disprin, Alka-Seltzer) have gastrointestinal (relating to the stomach
or intestinal tract) side effects and can cause ulcers if misused. "There are many
drugs that don't mix with alcohol either," says Mr Stronach. "In fact combining
them can cause damage to the liver. Yet people think one drink won't hurt."
What you can do
Jay Hooper, President of the Australian Pharmaceutical Society, says pharmacists
can play a valuable role in advising customers on the use of medicines and, importantly,
on which medicines interact with others.
For example, many cough and cold preparations (anything containing pseudoephedrine)
should not be taken by people who have high blood pressure and who are on medication
for it.
Mr Hooper warns that people buying medication off the internet should make sure
these drugs are approved by the Therapeutic Drugs Authority and they should also
check with their pharmacist about the safe use of them.
Of course, knowing how to use a drug doesn't make it risk free.
Most drugs have possible side effects that your GP or pharmacist should tell you
about and, especially in the case of painkillers or tranquillisers, have the potential
to be addictive.
According to the Australian Drug Foundation, the proportion of Australians using
tranquillisers/sleeping pills for non-medical purposes has doubled from 3% in 1995
to 6% in 1998.
While the media often portrays these drugs as being used mostly by older people,
surprisingly the average age at which people first use tranquillisers is 23.4 years.
The danger of high doses of benzodiazepines, the largest group of tranquillisers,
is that they can cause drowsiness and over-sedation.
This is especially hazardous for people who have to operate machinery, or drive
a car.
Slurred speech, impaired judgement, loss of memory, blurred or double vision and
dizziness, mood swings and aggressiveness are also possible side effects; and feelings
of shakiness and excitability often become evident as the effects of large doses
of benzodiazepines wear off.
TRANX, an organisation that helps people who are dependent on tranquillisers, regularly
advises on benzodiazepines and can offer tips on getting to sleep and reducing anxiety
without medication.
