Quitting Smoking: Which Is Better, Abruptly Stop, or Taper?

A study in the prestigious Journal of the American Medical Association (JAMA. 2013;310(1):91-92. doi:10.1001/jama.2013.6473) found that whether a smoker stops "cold turkey", or attempts to quit by cutting down on the number of cigarettes, with the goal of abstinence, does not significantly affect the quit rate. Outcomes in terms of staying stopped from smoking using either abrupt cessation or a taper are poor. In a review of ten randomized controlled studies from 1978 to 2010, involving 1528 men and 2108 women, in four countries (U.S. Spain, Austria, Switzerland), with the outcome, using either abrupt or gradual smoking cessation, being staying abstinent for at least six months, here are the quit success rates:

-Gradual quit success rate for at least 6 months = 14.1%
-Abrupt cessation quit success rate for at least 6 months = 15%

Other research suggests that, while use of medication (e.g., Chantix, bupropion) to quit smoking may be associated with slightly better quit success outcomes, long term abstinence rates are still poor. Use of nicotine substitutes (what I call "nicotine maintenance") certainly do help lessen lung damage and other medical problems (if the individual stops smoking) but often the individual finds it difficult to stop the nicotine replacement. Although this post may seem discouraging for those wishing to quit smoking, remember that if a method for stopping smoking works for you, it is 100% successful, and that statistics are just numbers; the individual can achieve long term abstinence. I myself have 33 years abstinence from smoking, using tools learned in my recovery from alcohol and sedative addiction. As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 07/23/2013.

Men and Women May Use AA Supports Differently

Research looking at "whether women engage and benefit from AA as much as men have found that women become as, or more, involved, as their male counterparts, and also benefit as much or more than men", but may have differing ways in which they get help from AA. In  a recent study (Kelly, JF, et al. (2013). Does Alcoholics Anonymous work differently for men and women? A moderated multiple-mediation analysis in a large clinical sample." Drug and Alcohol Dependence, Volume 130, Issues 1–3, 1 June 2013, Pages 186–193), researchers found in a study of over 1700 men and women attending AA meetings the following:

1) The Fellowship or social, non-drinking relationships were significant in men's recovery. "AA may help men more by facilitating reductions in high risk drinkers in favor of new sober friends while simultaneously boosting ability to cope with what may be more commonly encountered “male-specific” high risk situations (e.g., when attending or watching sporting events at friends’ homes...). While these mechanisms also appear to be some of the ways in which women benefit from AA, for women these risky social contexts may be less frequently encountered, and, consequently, women do not benefit as much in this way.  ...the majority of the effect of AA on reducing drinking intensity for men was by facilitating recovery-supportive social-changes and may reflect the greater need for men to find new ways of coping with common social risks.

2) The social aspects (or Fellowship) of AA were less important for recovering women. For women the ability to handle feelings of depression, anxiety, loneliness was more important than learning to deal with high risk social situations without drinking.

The researchers concluded: "Viewed more broadly, these findings suggest there may be gender-related differences in relapse precipitants with women generally more susceptible to negative affect and men more susceptible to cue-induced social precursors." In other words, women in recovery need to learn to deal with negative feelings without drinking, more so than men. The latter, according to this study, seem to need more social support to handle situations that may invite relapse, such as a football or baseball game, or eating crabs. As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 07/22/2013.

Cutting Back on Cigarettes Does Not Reduce Death Risks from Smoking

Just a brief research note for those of you who still smoke cigarettes. A recent study in the American Journal of Epidemiology (Am. J. Epidemiol. (2013). doi: 10.1093/aje/kwt038) indicates that just cutting down on the number of cigarettes smoked does not reduce the mortality risks from smoking. The authors of the study, conducted in Scotland, stated that: "In this long-term prospective study of both working and general population cohorts, we were unable to detect a significant overall long-term survival benefit among smokers who reported reducing their daily consumption of cigarettes..." This study confirms findings of most other studies that reducing the number of cigarettes smoked does not reduce mortality associated with smoking, but found that such a reduction can be helpful in pursing eventual abstinence from smoking. Thus the study concluded: "Existing research does not provide useful guidance for the level of reduction of cigarette consumption required to confer meaningful health benefits. On the other hand, continued smoking, even at low levels, clearly carries substantially increased health risks. Reducing the frequency of smoking should thus primarily be recommended as a short-term step toward cessation."

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com. 07/18/2013.

Are There Any Sleep Medications That Do Not Endanger Recovery?

My answer is, "Probably Not", but with explanation. Generally speaking, individuals in recovery from drug or alcohol addiction tend to develop dependence-like problems with use of any substance or behavior that results in feeling good, from candy (for ex., chocolate turtles, my favorite), to ice cream, to gambling (a few wins seems to ignite interest), to sex, to video games, to golf, to you name it. Sleep problems, however, are common and potentially serious problems in early recovery and beyond. I can say categorically that recovering individuals should not use any of the following central nervous system depressants as sleep aids: benzodiazepines (for ex., Xanax, Ativan); the newer medications like Ambien, Lunesta, Sonata; older medications such as the barbiturates (for ex., Nembutal and Seconal) and what we used to call "nerve pills", meprobamate (Miltown, Equanil). These substances have been called freeze dried alcohol or alcohol in pill form and have the same (usually greater) effects as alcohol and clearly endanger the recovery of the alcoholic or addict, whether the drug is prescribed by a physician, or not. The central nervous system of the alcoholic or addict does not react to why the drug is taken but just whether it IS taken. But, you say, what about some medications that I have heard are not addictive, such as, diphenhydramine (found in Benadryl and Tylenol PM, and other over-the counter (OTC) drugs), Trazadone, and Ramelteon? My research of these drugs reveals that Trazadone, an antidepressant, and Ramelteon, a melatonin triggering drug (melatonin is a naturally occurring chemical in our brains that regulates the sleep cycle) are not considered addictive, are not regulated as controlled substances, and may be safe from an addiction potential standpoint to treat insomnia in the recovering alcoholic or addict. Diphenhydramine is also not regulated as a controlled substance, seems to have low addiction potential, but has a long-acting sedative effect that could cause problems with drowsiness and confusion the next day, especially in the elderly.

I just have a few comments and cautions. First of all, before taking any medication, even OTC medications (melatonin is available OTC at low cost), please check with your doctor and be sure to tell him/her about all the medications you take. Second, I suggest that before taking any sleep medication you make every effort to find non-chemical ways to sleep. Click herer for a website has great tips on learning to sleep: National Sleep Foundation. Third, be aware that addiction is sneaky and that, if you decide to use a sleep aid, be sure that you are not, by doing so, opening the door in your mind to use of other drugs (for example, some consider marijuana a good sleep aid). This is a controversial topic that I have raised before. As always, I invite comments. Jan Edward Williams, www.alcoholdrugsos.com. 07/15/2013. 

Reaction to Sweets May Be An Indicator of A Risk for Alcoholism

A recent study, summarized in ScienceDaily for July 10, 2013, and to be published in the December 2013 issue of the Journal Alcoholism: Clinical & Experimental Research, suggests that pathways in the brain that respond to ingestion of sweets may be the same as those activated by ingestion of alcohol. The study found that individuals with binge drinking patterns (drank more than just a few) have an intense brain response to sweets. One of the authors of the study explained the background important to understanding the implications of the current study:

"It has long-been known that animals bred to prefer alcohol also drink considerably greater quantities of sweetened water than do animals without this selective breeding for alcohol preference. More recently, it has become clear that animals bred to prefer the artificial sweetener, saccharin, also drink more alcohol. Although the data in humans are somewhat more variable, some studies do show that alcoholics, or even non-alcoholics with a family history of alcoholism, have a preference for unusually sweet tastes. Thus, while the precise reasons remain unclear, there does seem to be significant evidence suggesting some link between the rewarding properties of both sweet tastes and alcohol. This is the first study to examine the extent to which regions of the brain's reward system, as they respond to an intensely sweet taste, are related to human drinking patterns.”

The researchers summarized: "In a more practical sense, the findings are compelling evidence that the brain response to an intensely sweet taste may be used in future research to test for differences in the reward circuits of those at risk for alcoholism.”

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 06/10/2013.

Freedom from Addiction: Fitting Theme for July 4

Happy Fourth of July everyone. I think it fitting on Independence Day to reflect on recovery from the bonds of addiction. Addiction is by definition an enslavement to a disease that binds the individual spiritually, emotionally and physically. Recovery frees the alcoholic or addict not only from slavish use of alcohol or other drugs but also from the “bondage of self.” Here are a few quotes from AA and NA literature about freedom from addiction.

"If we are painstaking about this phase of our development, we will be amazed before we are half way through. We are going to know a new freedom and a new happiness." (Alcoholics Anonymous, page 83)

"God, I offer myself to thee - to build with me and do with me as Thou wilt. Relieve me of the bondage of self, that I may better do Thy will." (Alcoholics Anonymous 63:2 original manuscript)

"Our message is that an addict, any addict, can stop using drugs, lose the desire to use and find a new way to live. Our message is hope and the promise of freedom." (Narcotics Anonymous, Basic Text, 5th Ed., p 65)

I am fond of this quote attributed to the French writer Jean-Paul Sartre: "Freedom is what you do with what's been done to you.” How freeing it is to discover that no matter what seemingly inexcusable behavior from your drug or alcohol using past that you feel burdened with, there will come a time in your recovery when sharing that behavior with another alcoholic or addict will help that individual and aid in your own healing. Moving from the bondage of self is simple (not to be mistaken for "easy") for the person in recovery: Don't drink or drug, find a source of spiritual strength, and help another alcoholic, addict, or any other suffering human being. As always, comments are invited. Jan Edward Williams, 07/04/2013.

Use of Addictive Substances by Those in Alcoholism and Drug Addiction Recovery

I am going to briefly introduce a subject I have referred to here before, namely, use of substances with addiction potential (alcohol and other drugs) by those in recovery from alcoholism and those in recovery from drug addiction and hopefully others will chime in on this complicated and, at times, controversial topic. I will not address (except as mentioned in AA's position on Drug Use and Sobriety, copied below) an even more difficult topic for those in recovery, namely, use of physician prescribed substances that affect the central nervous system in ways similar to drugs of abuse, including alcohol. So, I'll just pose a few questions to open the discussion. Should an individual who has an alcohol addiction (alcoholism) and is seeking recovery, and who has no history of a problem with any other drug of abuse (for ex., marijuana), use such a drug of abuse? Should a drug addict, say with an addiction to heroin or amphetamines, and who is seeking recovery, and who has no history of a problem with alcohol, use alcohol?

Hopefully, most would agree that an individual who is an alcoholic and also has a (another) drug addiction, should, in order to maintain recovery and abstinence from either addiction, abstain from use of alcohol and all other drugs. As soon as I wrote this, I started thinking about some individuals I know in recovery from both a drug and alcohol addiction who would not consider marijuana as an addictive substance that they need to avoid, but that is another subject. I also think it is fairly well established that a drug addict, that is, an individual who has crossed the line into addiction (pattern of use in the face of adverse consequences and loss of control, with or without, physical dependence), no matter what the substance, who values his/her recovery, should not use any type of addictive drug. However, the question of the use of alcohol by a recovering drug addict without alcoholism has been enough of an issue for Narcotics Anonymous to issue a position on the matter:

"The only way to keep from returning to active addiction is not to take that first drug. If you are like us you know that one is too many and a thousand never enough. We put great emphasis on this, for we know that when we use drugs in any form, or substitute one for another, we release our addiction all over again. Thinking of alcohol as different from other drugs has caused a great many addicts to relapse. Before we came to NA, many of us viewed alcohol separately, but we cannot afford to be confused about this. Alcohol is a drug. We are people with the disease of addiction who must abstain from all drugs in order to recover (NA White Booklet, Narcotics Anonymous. Copyright © 1976, 1983, 1986 by Narcotics Anonymous World Services, Inc. )."

Here is AA's position on Drug Use and Sobriety, including use of physician prescribed medication:

"Some A.A. members must take prescribed medication for serious medical problems. However, it is generally accepted that the misuse of prescription medication and other drugs can threaten the achievement and maintenance of sobriety. *** From the earliest days of Alcoholics Anonymous it has been clear that many alcoholics have a tendency to become dependent on drugs other than alcohol. There have been tragic incidents of alcoholics who have struggled to achieve sobriety only to develop a serious problem with a different drug. Time and time again, A.A. members have described frightening and sobriety-threatening episodes that could be related to the misuse of medication or other drugs. Experience suggests that while some prescribed medications may be safe for most non-alcoholics when taken according to a doctor’s instructions, it is possible that they may affect the alcoholic in a different way. It is often true that these substances create dependence as devastating as dependence on alcohol. It is well known that many sedatives have an action in the body similar to the action of alcohol. When these drugs are used without medical supervision, dependence can readily develop. "Many A.A.s who have taken over-the-counter, nonprescription drugs have discovered the alcoholic’s tendency to misuse. Those A.A.s who have used street drugs, ranging from marijuana to heroin, have discovered the alcoholic’s tendency to become dependent on other drugs. The list goes on and will lengthen as new drugs are developed (The A.A. Member-—Medications and Other Drugs (Revised 2011), Copyright © 1984, 2011. Alcoholics Anonymous World Services, Inc. Pages 4-5)."

A final point--I have had individuals in recovery from alcoholism or another drug addiction, wonder why, if they have had no history of a problem with another substance, cannot they use that substance and still maintain their abstinence/recovery from their drug or alcohol addiction? One answer can be phrased as a question: Does an alcoholic or addict need to try every drug of abuse now or hereafter developed to see if he/she can use the drug without developing an addiction or relapsing into use of their original drug of choice? Here are some reasons I have for taking the position, as I do, and as does NA, that complete abstinence from all psychoactive substances is necessary for ongoing recovery from addiction:

1. Use of any drug will result in impaired judgment (may lead back to drug of choice (DOC)).

2. Substitution—the person may develop a new addiction.

3. Use of any drug will have an adverse effect on already damaged neurotransmitter systems in the reward pathway of the brain.

4. The resulting high from the new substance will not be the effect of the person’s DOC (not the high desired).

5. Recovery is an all or nothing proposition; either you’re sober or clean or you’re not.

As always, comments are invited. Jan Edward Williams, 06/28/2013.