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Lecture 4

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University of Toronto St. George
Nevena Simic

Lecture 4 Health-Compromising Behaviours Health-Compromising Behaviours: - Health compromising behaviours: behaviours practiced by people that undermine or harm their current or future health o Abusing alcohol o Smoking o Unsafe sex - When are we most vulnerable? These are adolescent focused... o Peer culture o Self-presentation o Some of these behaviours can be rewarding o These behaviours can be gradually learned Profile: - Higher levels of health-compromising behaviours are often found in adolescents with: o Deviant behaviour o Low self-esteem o Problematic family relationships - Combing long hours at work with school include risk of drug abuse o Those who abuse drugs also tend to do poorly at school - Difficult temperament, poor self control, deviance-prone attitudes Substance Dependence: - Dependent on a substance if repeatedly self-administer it, resulting in tolerance, withdrawal, compulsive behaviour - Physical dependence: state that occurs when body adjusts to substance and incorporates the use of it into function of bodys tissues o Often involves tolerance: body increasingly adapts to use of substance, requiring increased doses to achieve same effect o Craving: strong desire to engage in a behaviour or consume a substance - Addiction: occurs when a person becomes physical or psychologically dependent on a substance following use over time - Withdrawal: unpleasant symptoms experienced when stop taking substance on which on has become dependent o Anxiety, irritable, intense cravings, nausea, headaches, shaking, hallucinations Substance Abuse: - Costs to Canadians (2002) o $40 billion health care resources, law enforcement, loss of productivity at work/home o Smoking accounted for most of this cost (43%) o Alcohol accounted for 37% o Substance abuse = 20% - Harm Reduction: intervention strategy o Public health response to substance abuse problem approach that focuses on the risks and consequences of substance abuse rather than on the use itself i.e. methadone clinics, needle exchange programs 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 i.e. always missing work, substance-related absences, neglect of children 2. recurrent substance use in situations in which it is physically hazardous i.e. driving or operating a machine while impaired 3. recurrent substance-related legal problems i.e. 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 i.e. arguments with spouse physical fights Substance Abuse vs. Dependence: - a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring within a 12 month period: 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 syndrome for the substance The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms 3. Substance is often taken in larger amounts or over a longer period of time than was intended 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use 5. A great 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 (i.e. continued drinking despite recognition than an ulcer was made worse by alcohol consumption) Alcoholism and Problem Drinking: How does Alcohol Abuse Compromise Health? - Alcohol-related deaths = 8000/year - Linked to a # of disorder o High BP o Stroke o FAS o Major sleep disordero Cognitive impairments (often irreversible) - Economically, costs Canadians $15 million in loss productivity, treatments, accidents, fire and crime o $463/Canadian/year - Nearly 20% of Canadians drink at levels that exceed government recommendations Low-Risk Drinking Guidelines: - Maximize life, minimize risk o 0: zero drinks = lowest risk of an alcohol-related problems o 2: no more than 2 standard rinks on any one day o 9: women, up to 9 standard drinks a day o 14: men, up to 14 standard drinks a week - One standard drink = 13.6g of alcohol o 5oz/142 ml of wine (12% alcohol) o 1,5oz/43mL of spirits (40% alcohol) o 12oz/341mL of regular strength beer (5% alcohol) - Origins o Genetic factors (twin studies), M > F o Socio-demographic factors (low SES) o Drinking and stress - Overall, a gradual process involving physiological, behavioural, and socio-cultural variables induces alcohol use (parents and peers shape behaviours) o Stress buffer o Social event = lea
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