Saturday 10 December 2016

Understanding the harm behind substance use

Nina Byrnes

Published 13/09/2016 | 02:30

(Stock photo)
(Stock photo)

Advice from our GP on substance use and addiction, and on how antibacterial products have the potential to do harm.

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Q. I started smoking pot when I was a teenager. I'm now in my early 20s and what started as a pastime now seems to be a habit I can't break. Could I be addicted?

Dr Nina replies: Addiction involves continued use of a substance or behaviour despite experiencing adverse consequences associated with it. The substance or behaviour is initially used for pleasure but over time one comes to depend on it to feel normal.

There are many kinds of addiction These include alcohol, drugs (both illegal and prescription), gambling, sex and pornography. There are varying opinions as to whether addiction is a disease or behavioural problem. It is likely that a combination of genetics, personality and cultural and social experience all play a role.

An addictive behaviour initially is associated with pleasure. This is due to the fact that when we experience pleasure, our brains release a hormone called dopamine. Certain drugs and behaviour result in a huge surge in dopamine giving the high that addictive behaviour provides. The feeling is so intense an individual will seek out the behaviour in order to feel good. These are cravings.

As time passes the body reduces the amount of dopamine it produces, normally resulting in an inability to feel pleasure, unless exposed to the addictive substance or behaviour. As the addiction becomes stronger, the addict seeks out the substance or behaviour just to feel normal, or requires much higher levels of exposure to reach the same high (tolerance).

Addictions become destructive and all-consuming and can destroy the lives of the addict and those around them. The first step in recovering from addiction is recognising that a problem exists. Families and loved ones of addicts are usually acutely aware of the problem and often go to extreme lengths to try and encourage an addict to enter rehab or seek help. Facing up to addiction requires courage and motivation.

Successful treatment requires motivation on behalf of the individual to change, and this is often lacking or waning. It can often take facing a crisis or hitting rock bottom for reality to sink in.

Addiction can change over time. If an addict is considering change, having access to the right advice and help can help motivate them. Treatment may include in-patient rehabilitation, talking therapies, education and group therapy. It's important to recognise that relapse is a part of the treatment cycle for addiction but with every new attempt at quitting success is more likely.

Many experts in addiction therapy would now say that addiction requires chronic treatment and surveillance just like other chronic diseases such as blood pressure, diabetes or cholesterol. Once successfully rehabilitated, maintenance therapy will help prevent further relapse.

Addiction affects all races, classes and nationalities. Families face the pain and devastation that addiction brings today and every day in Ireland and across the world. Whether you consider addiction a disease or disposition, it's important to realise that it is treatable and options are available.

The most important step is to acknowledge the problem and reach out for help. You have nothing to lose.

Q. It seems like everywhere I go soap is being labelled  antibacterial. Marketing says they protect us from bacteria and harm. Should I be buying these and are they more effective than soap and water?

Dr Nina replies: It is a common misconception that products labelled antibacterial or antiseptic somehow clean better and protect us from germs and harmful bacteria. This is not the case — and in fact some of these products may do more harm than good.

There is little scientific evidence to back up the claims that these products are any better than washing with old-fashioned soap and water.

The FDA in the USA has just banned the sale of these products. About 40pc of them contain the chemical triclosan and tricloban. The ruling applies to only liquid soaps and hand and body washes. Triclosan does have antibacterial action, but it takes several hours to be effective, long beyond the duration of the average hand-wash. Concern has been mounting over the last few years at the increasing number of products that these antibacterial agents were being used on and the possible long-term consequences of the increased exposure to these.

Animal studies have suggested that excessive exposure to these chemicals can cause changes in metabolism and reproductive hormones. The effect on humans is still under investigation. There is also a concern that the release of these products into the environment through water-waste may, in the long-term, increase the level of bacterial resistance to antibiotics, causing more harm than good.

Cleanliness and hand washing are essential in the prevention of the spreading of disease and infection, but the message is clear. Washing properly with normal soap and water is effective. Antibacterial products don’t add any benefit and have the potential to do harm.

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