Archive for September, 2011

Smokers Need Not Apply

Thursday, September 1st, 2011

One of the largest health insurance providers in the country, Humana, is now including nicotine testing in with their pre-employment urine drug screening. Citing its purpose of promoting wellness and health, they are starting with their own employees since smokers aren’t considered a protected class in Arizona. Free assistance will also be provided to help existing employees kick the habit, although the organization isn’t requiring them to quit. Other Arizona companies have also picked up on this trend, with one county’s health plan requiring employees to submit saliva samples to test for nicotine and providing those who tested negative with insurance premiums $480 less than the premiums for tobacco users or those who weren’t tested. These same rules won’t apply to Humana’s headquarters in Kentucky since the state prohibits employment discrimination based on tobacco use.

Can People in Recovery Kick the Smoking Habit?

Thursday, September 1st, 2011

Smoking has devastating consequences for those addicted to it. Smoking is nothing more than a slick delivery system for nicotine into the blood stream. It is fast, efficient, and deadly. And smoking is a widely accepted habit for many drug treatment and rehabilitation programs in America. It is especially evident in many mental health programs which are treating people with serious mental illness. Smokers have an increased risk for cancer, lung disease, and cardiovascular disease. And on average, they die many years sooner than those who do not smoke.

In the drug treatment setting there is broad sentiment that smoking is a stimulus that calms and soothes people at a time where environmental and emotional stressors are apt to trigger a relapse. In other words, it is an anti-drug drug. Mentally ill patients and recovery populations commonly smoke. The connection appears to be tightly interwoven. Twenty years ago, the Joint Commission on the Accreditation of Healthcare Organizations (JACHO), now called the Joint Commission, advanced a nationwide ban on tobacco use in hospitals. Quite a battle ensued. Advocacy groups for the mentally ill argued that the banning of cigarettes would result in mass insurrection in treatment institutions. These protests caused JACHO to back down and exempt psychiatric hospitals from the rule. For those hospitals that voluntarily complied with the ban, there was little or no disturbance in patient behaviors.

In the drug treatment community, smoking is still widely accepted. And only recently have institutions begun to offer quit-smoking assistance to those who want it. The first obstacle in this initiative is to admit people in recovery actually do want to quit. There is little to doubt this population has the same desire to quit smoking as the general population. Typically, between 20-25% of smokers state that they intend to quit in the next 30 days. That number gets higher the further the time frame is pushed out. But efforts to assist patients with smoking cessation are weak. And smoking is an expensive habit. With a pack of cigarettes costing more than a gallon of gas, many people in recovery from substance abuse disorders are saddled with the additional financial burden of smoking.

Drug treatment programs should be encouraged to engage with patients and discuss smoking habits. They should provide resources and information needed to act on a tobacco dependency. Barriers to lifestyle changes are already down in the treatment setting, thus the opportunity to introduce smoking cessation initiatives are greatest at that time. But smokers have to be ready to quit, and building a foundation towards that willingness can take time, patience and resources. But with the tools and assistance available in the treatment setting, there are abundant reasons for making the effort to stop smoking. The fact that the recovering addict is more likely to die from smoking than he or she is to die from the addiction is a sobering fact. The time has come to provide effective smoking cessation resources to all who are seeking treatment for substance abuse disorders.

Does Adult-Supervised Drinking Teach Kids to Consume Alcohol Responsibly?

Thursday, September 1st, 2011

A number of U.S. adolescent drug use experts have proposed a different approach towards reducing the harms of adolescent alcohol abuse. This technique would give parents an opportunity to teach their kids to drink alcohol responsibly. Given a reality that kids are exposed to alcohol at a relatively early age by way of advertising and society-wide consumption, this proposal would increase parental shaping of values and behaviors with the initiation of parentally supervised alcohol consumption by kids as early as the eighth grade. This harm-minimization hypothesis was put to the test in a recently published study that compared the experiences of teenagers in Washington to a similarly constituted population of students “down under” in Victoria, Australia.[1] The kids in Washington were subjected to a zero-tolerance abstinence-based program of policies and laws. The Australian cohort operated in a system where responsible drinking was taught and allowed as part of a larger harm minimization program.

The instant study involved an in-school survey for students starting in the seventh grade and continued through completion of the ninth grade. In the seventh grade, family factors involved with alcohol consumption, such as familial substance abuse and parental attitudes towards alcohol abuse, were evaluated. In the eighth grade, the incidence of alcohol use with adult supervision was assessed. And in the ninth grade, alcohol use and harmful consequences of drinking (engaging in violence, being unable to stop drinking alcohol, and having regrettable sexual encounters) that occurred in the past year were documented and evaluated.

For seventh graders, lifetime alcohol use was significantly greater in the Australian cohort (59% vs. 39%). When considering ninth graders the spread was even greater (71% vs. 45%). In the eighth grade, Australian students revealed significantly greater incidence of parent supervised alcohol consumption (66% vs. 35%). For ninth graders, Australian participants reported alcohol-related harms more frequently as well (36 vs. 21%). When data was controlled for both family factors and alcohol use in seventh grade, the survey showed that greater opportunity to use alcohol under adult supervision was linked to drinking more often and the reporting of more alcohol-related harms for students in both countries.

These results bolster other smaller studies where parental supervision as a harm-minimization strategy seems to be ineffective in reducing alcohol use and the problems that result from teenage drinking. Alcohol use by teenagers is a troublesome social problem. Supervised parental supervision is not a wise answer to this challenge.