Tag: Addiction

Alcohol and Cancer

The Irish legislature, the Oireachtas, is considering adding a warning label about drinking and cancer to alcoholic beverages. Ireland would be the first country to have such a  warning label. America has had labels that warn about drinking while pregnant and driving while intoxicated since 1988. Wine labels  also inform the consumer that the bottle contains sulfites.

In Ireland the issue is pitting Alcohol Action Ireland, public health advocates against the liquor industry represented by the Alcohol Beverage Federation of Ireland (ABFI). Alcohol Action is presenting the legislation  as necessary to protect public health and safety while the industry is concerned about the effect the legislation would have on the economy, including tourism. This is the perennial tension that has existed in America since the end of Prohibition.

A warning label that mentions cancer could be the first sign that public perception about  drinking is moving in a more negative direction. Alcohol, particularly  beer, has gained a seemingly ever increasing integration into American society. Recently both craft beer and craft distilled spirits have captured the public’s attention.

In the 19th century smoking and drinking were both considered vices. In the first few decades of the 20th century tobacco gained market share while alcohol endured Prohibition. Since the 1960’s the two industries’ fortunes reversed.  Access to tobacco became severely curtailed while alcohol gained greater cultural acceptance and societal integration.

Since the 1960s the wine industry has pushed for labels that would state the heart health benefits of drinking the product. It is possible that the tide would change again if the claim that drinking is implicated in breast and other cancers becomes more widely known.

Drinking Responsibly

Someone recently wrote a letter to the editor of The Roanoke Times complaining about the ubiquity of beer related stories in the paper. Writing from a public health perspective, Mr. Klein found it bewildering that a women’s health event that a local clinic was sponsoring was being held at a brewery. He wrote, “Have we really gotten to the point as a society where alcohol is so pervasive that it has to be used to entice people to every social event even those designed to promote a healthy lifestyle.”

Klein finds the integration and normalization of alcohol throughout society troubling. This was a big point of contention for the public health activists on the Massachusetts Alcohol Tax Force sub-committee that I served on. They were all people who were working to prevent underage drinking. They also felt that the presence of alcohol at so many community events sends mixed messages. This is something Klein also pointed out.

Klein reminded readers that alcohol consumption can lead to addiction; something that is overlooked in the promotion of events. He apparently lives in Blacksburg, Virginia which is a college town. I also live in a college town where students periodically drink to excess.

There were seven comments in response to Klein’s letter. One pointed out that college students are probably not drinking craft beer which has a higher price point. Most of the other comments focused on the economic benefits of beer to the local economy This is the perennial tension between the public health movement and officials seeking economic development.

Understanding Addiction

Last Thursday I attended a seminar on “Understanding addiction.” The Institute for Natural Resources sponsored the one day seminar which was a way for nurses and other medical professionals to collect continuing education credits.

Much of the material was familiar to me and I don’t think I learned that much that was new. One interesting thing is that alcohol, tobacco, and even caffeine are now seen as drugs with psychoactive properties similar to the illegal drugs such as opioids or cocaine. In fact the legal drugs cause more societal problems than the illegal drugs. The seminar handout states that alcohol and tobacco costs the United States over $400 billion a year  due to crime, lost work productivity, and healthcare. Costs associated with Illegal drugs are about $181 billion a year.

There is an opioid crisis but the speaker did not spend that much time on it. He made the point that at different times different drugs are in fashion. Unfortunately heroin seems to be in vogue right now. It is clear that the War on Drugs has failed and we need to invest much more money on treatment. We also need to find a balance between maintaining pain medicines for people with chronic pain while reducing the more casual prescribing of opioids.

 

 

Methylated Spirits

Denatured alcohol
Denatured alcohol

At the Alcohol Drugs History Conference, Under Control?, held in London from June 20 to June 23, Stella Moss gave a very interesting and somewhat horrifying talk about “Methylated spirit consumption and the control of deviant drinking in interwar Britain.” Methylated spirit is denatured alcohol. Hospitals and businesses use this product for cleaning and other things.

In Britain, the Customs and Excise department regulates methylated spirits. Denatured alcohol is not meant to be drunk. In fact it contains methanol and other additives to prevent consumption. It is 19 per cent alcohol. At the present there are about 500 prosecutions a year in Britain for meths drinking.

Drinking denatured alcohol can cause blindness and other problems. During Prohibition many people drank denatured alcohol which is poisonous and I imagine tastes awful.

Methylated spirits is a surrogate drink; other products that serve this functional are antifreeze and hand gel. What all these products have in common are that they are cheap, relative to commercially produced alcohol.

Denatured alcohol is a byproduct of the tax code. Because states tax ethanol, drinkable alcohol, it would be too expensive for business to use ethanol for industrial purposes.

Restrictions on pubs and British drinking during World War 1 had led to moderate drinking during the 1920s. Because habitual drinkers had less access to alcohol in mainstream establishments they turned to methylated spirits.

Often people mixed the meths with other substances, using some form of ethanol. A red biddy was red wine and meths while a red Lizzie was meths mixed with Lisbon wine. Most meths drinkers were very poor.

There seems to have been lot of compulsion associated with drinking methylated spirits. Because it is a purple color the meths drinker had a distinctive look with purple lips.

Society saw the meth’s drinker as deviant, as other. This is very similar to the current portrayal in America of the crystal methamphetamine user.

 

Cirrhosis and Liver Cancer

Several times a year I listen to CancerCare telephone workshops on different aspects of cancer research and treatment.  Today’s workshop was an “Update on the Treatment of Liver Cancer.” One of the speakers discussed the various risk factors for liver cancer. Cirrhosis underlies 50 to 60 percent of all the liver cancer cases in the United States. Hepatitis C and alcohol abuse are the most frequent causes of cirrhosis. According to the speaker, one can never ignore the degree of underlying damage to the liver when considering treatment for liver cancer. A patient would have the symptoms from the cirrhosis, such as ascites and varices, as well as the cancer symptoms. A few years ago, I wrote a post, “Your Liver on Drugs” which looked at some of the issues connected to maintaining good liver health. I am linking to it again because it still seems relevant.

Heroin Maintenance

The Alcohol and Drugs history site has a item about a new book that looks at how Britain has treated heroin addicts in the twentieth century. I find it interesting that the British maintain heroin addicts with heroin. In the United States we use methadone for maintenance of heroin addicts. I worked for four years in a methadone maintenance treatment program (MMTP)

Tobacco Legislation

Last week, Congress passed and President Obama signed legislation that greatly enhances federal regulation of the tobacco industry. As a historian, I generally think change happens slowly but the rapidity with which American society has transformed from cultural acceptance, even approval of smoking, to a completely negative view is starling.

When I was growing up, my parents and almost all the adults, I knew smoked. As a teenager and young adult smoking was both everywhere – bars, restaurants, public events and arenas – and heavily advertised on television. In the forty-five years since the Surgeon General’s report on the harm smoking causes, there has been a warning label, a ban on television advertising, the creation of smoke-free indoor space and, recently, smoke-free outdoor spaces.

The newspaper stories discussing the pending legislation use the term “addiction” to describe the practice of smoking. This also represents significant change. For much of American history, society has characterized nicotine, caffeine, and alcohol as legal, primarily harmless habits. Alcohol was usually the most problematic of the three. Now, nicotine, although legal, falls under the broad category of psychoactive, addictive substance, similar in their effects on the body.

Moralists have always viewed smoking as undesirable behavior. This attitude kept women from smoking for many years. When smoking and exposure to second-hand smoke became a public health issue, the battle lines changed. If alcohol use and or abuse ever became predominantly a public health issue rather than one of individual choice or morality, brewers and distillers could face more of an uphill battle to maintain the legitimacy of their industry.

Beyond Amethyst: The Conference

This past Friday I attended a conference at Hampshire College about the drinking age and whether it should be changed. Alex Torpey, a graduating student , organized the conference as part of his Division III, or senior project.

Ralph Hexter introduced the keynote speaker and indicated that he feels the issues around the drinking age and drunk driving hinge on responsibility. President Hexter is a signer of the Amethyst Initiative which called for lowering the drinking age to eighteen. Continue reading “Beyond Amethyst: The Conference”

New Drug Czar

Yesterday Vice President Joe Biden announced the appointment of Gil Kerlikowske as the country’s drug czar. Kerlikowske is the Chief of Police in Seattle, Washington. Both the city and the state have been in the forefront of harm reduction. Although Kerlikowske has not been a strenuous advocate of such policies, he has not opposed them.

In 2008 drug policy reformers sought lessons from  Prohibition and Repeal and hope from the election of Barack Obama. Many now feel that the appointment of Kerlikowske justifies that hope. Activists might have preferred a public health expert as  the new czar, but  Kerlikowske’s neutrality represents a significant change in policy from the Bush administration.

Most of the money the federal government spends on preventing illegal drug use is on the supply side rather than on treatment. For four years,I worked as a  nurse  in a  methadone clinic. That experience convinced me that education, support, and ongoing treatment are the keys to reducing our country’s drug addiction problem.

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