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Lecture 5

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Nevena Simic

LECTURE 5 – Health-Compromising Behaviors  Health Compromising Behaviors: Behaviors practiced by people that undermine or harm their current or future health -Abusing Alcohol** -Smoking** -Illicit dug use -Unsafe sex -Risk-taking behavior Substance Dependence  Dependent on a substance if repeatedly self-administer it, resulting in tolerance, withdrawal, compulsive behavior  Physical dependence: state that occurs when body adjusts to substance and incorporates the use of it into normal function of body’s tissues  -Often involves tolerance: body increasingly adapts to use of substance, requiring increased doses to achieve same effect  -Craving: strong desire to engage in a behavior or consume a substance  Addiction: occurs when a person becomes physically or psychologically dependent on a substance following use over time Psychological dependence: cognitive dependence on substance. Example: thinking you need a glass of wine or you cant sleep, thinking you need a smoke to do work  Withdrawal: unpleasant symptoms experienced when stop talking substance on which one has become dependent  -Anxiety, irritability, intense cravings, nausea, headaches, shaking, hallucinations  Costs to Canadians (2002)  -$39.8 billion health care resources, law enforcement, loss of productivity at work/home  -Smoking accounted for most of this cost (43%)  -Alcohol accounted for 37%  -Substance abuse = 20%  Harm reduction: intervention strategy  -Public health response to substance abuse problem  -“Approach that focuses on the risks and consequences of substance use rather than on the use itself”  -Ex) methadone clinics, needle exchange programs Limit # of cigarettes, nicotine patches, condom use (STDs), supervise injection facilities Substance Abuse vs. Dependence  A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: 1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, home -E.g., repeated absences or poor work performance related to substance use -Substance-related absences, suspensions, or expulsions from school -Neglect of children or household Not meeting needs Social conflict between drug abuser and spouse makes social life impaired 2. Recurrent substance use in situations in which it is physically hazardous -E.g., driving an automobile or operating a machine when impaired by substance use 3. Recurrent substance-related legal problems -E.g., arrests for substance-related disorderly conduct 4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance –E.g., arguments with spouse about consequences of intoxication –Physical fights 1) Tolerance, as defined by either of the following: -A need for markedly increased amounts of the substance to achieve intoxication or desired effect -Markedly diminished effect with continued use of the same amount of substance 2) Withdrawal, as manifested by either of the following: –The characteristics withdrawal syndromes for the substance -The same (or a closely related) substance is taken to relive or avoid withdrawal symptoms 3) Substance if often taken in larger amounts or over a longer period than was intended 4) There is persistent desire or unsuccessful efforts to cut down or control substance use 5) A greatly deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects 6) Important social, occupational or recreational activities are given up or reduced because of substance use 7) Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption) Alcoholism & Problem Drinking How Does Alcohol Abuse Compromise Health?  Alcohol-related deaths = 8000/year  Linked to a number of disorders: -High blood pressure -Stroke cirrhosis of the liver -Some forms of cancer -Fetal alcohol spectrum disorder -Major sleep disorders -Cognitive impairments (irreversible often)  Economically, costs Canadians $14.6 billion in loss productivity, treatments, accidents, fire, and crime -$463/Canadian/year  Nearly 20% of Canadians drinks at levels that exceed government recommendations Low-Risk Drinking Guidelines  Maximize Life, Minimize Risk -0: zero drinks = lowest risk of an alcohol-related problem -2: no more than 2 standard drinks on any one day -9: women: up to 9 standard drinks a week -14: men: up to 14 standard drinks a week  One Standard Drink = 13.6 g of alcohol -5 oz./142 mL of wine (12% alcohol) -1.5 oz./43 mL of spirits (40% alcohol) -12 oz./341 mL of regular strength beer (5% alcohol)  Origins -Genetic factors (twin studies), M>F -Socio-demographic factors (low SES)  Overall, a gradual process involving physiological, behavioral, and socio-cultural variables induces alcohol use (parents and peers shape behaviors) -Stress buffer -Social event = learned early  Appears to be TWO windows of vulnerability -Chemical dependence usually starts between 12 & 21; peaks 18 to 25 -Late Middle Age; coping method for managing stress Treatment of Alcohol Abuse  10-20% of alcoholics stop drinking on their own Going cold turkey  32% stop with minimal help -“Maturing out”; later years of life!  Cognitive behavioral modification programs -BUT 60% dropout rate Problem is relapse  Alcoholics from high SES & are in highly socially stable environments do better in treatment programs -68% success vs. 18% There is still work to be done despite protective factor of high SES and education We know low SES individuals are at risk so how do we figure out techniques, treatments for people who come from socially unstable areas? We need to identify certain factors associated with alcohol abuse and design interventions/programs to stop abusing Pine River Institute  A residential treatment center and outdoor leadership experience for youth 13 to 19 years of age who are in crisis, largely as a result of addictive behaviors  Unique, holistic treatment and educational model, based on the developmental needs of adolescents, and grounded in best practices for substance abuse treatment for youth  Family-centered, individualized, and offers a flexible length of stay with the average being between 9 to 12 months  4 Phrases 1) Outdoor Leadership Experience – Algonquin Park –Students live and work in nature 2) Residence –Live at Pine River Campus -4 hours of academics, 2 hours physical activity, 2 hours group therapy, 1 hour expressive art -Free time & chores  No contact with family 3) Pine River Campus + Home –Transition phase: week on campus, weekends at home 4) Aftercare at Home Some is subsidized; the other has to be paid by parents SMOKING IS THE SINGLE GREATEST CAUSE OF PREVENTABLE DEATH Cigarette Smoking  Causes more deaths than combining -AIDS -Cocaine -Heroine -Alcohol -Auto accidents -Fires -Homicides -Suicide How Does Smoking Compromise Health?  Accounts for at least 45,000 deaths/year -Many are cardiovascular related  Accounts for at least 30% of all cancer deaths  Linked to a number of disorders: -Heart disease -Cancer: lung, oral, bladder, larynx, esophagus, pharynx -Chronic bronchitis -Emphysema -Respiratory disorders -Damage and injuries due to FIRES and ACCIDENTS -Lower birth weight in offspring -Retarded fetal development -Hyperactivity in infants Synergistic Effects of Smoking  SYNERGISTIC = enhances the detrimental effects of other risk factors in compromising health  Smoking + cholesterol -Nicotine stimulates free fatty acids - - -> increases synthesis triglycerides - - -> decreases HDL
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