Why Meths Drinkers?

For a long time now, my most widely viewed post has been the one I wrote almost 10 years ago about methylated spirits. I had heard a paper at an Alcohol and Drug History Society conference about people in Britain in the 1950s and 60s who became addicted to methylated spirits.

About two years, I had a sudden and brief uptick in views, and they were all of that original post. You can read about that here. On April 3 of this month, I had 1,151 views of which 1,120 were of the original post on methylated spirits. I believe this huge increase was due to a Call The Midwife episode which aired that Sunday and was about a meths drinker who was nearing the end of his life.

The episode described the symptoms of prolonged drinking of methylated spirits. They include rotting flesh, ulcers, gastritis, and gangrene. The show was preaching tolerance and understanding, even love, for the homeless, many of whom were meths drinkers.

For a few days following the episode, I had many more than usual views and visitors. By this week it is settling down, but I still am having slightly increased viewership. I really don’t understand why this is my most popular post, but I guess it is a topic that interests a lot of people.

Many years ago, prior to writing the post on methylated spirits, my most popular post was one I did on seeing a production of Mary Poppins in Israel. I also never understood why that was so popular. There is no accounting for what people will be interested in and try to seek more information about on the Internet.

Of course, posting this will probably lead to another temporary uptick in views. Maybe I should  find a way to stick the term “methylated spirits” in all my posts.

 

https://www.pbs.org/show/call-midwife/

 

See google console for past 28 days

Smoking


Any practicing nurse in Massachusetts has to renew his or her license every two years. As part of the license renewal process every nurse has to have done 15 hours of continuing education credits otherwise known as CEU’s. Before I retired it was very easy for me to acquire those 15 hours because of trainings and in service workshops that the agency I worked for provided.

This year the renewal process snuck up on me and I had to figure how to meet the CEUs requirement. There are places online that allow you to fulfill the requirements by reading scholarly articles on various topics and then filling out a questionnaire. One of the essays I chose was about tobacco and smoking cessation.

I found the article informative. Something that stood out is that young people are continuing to become smokers. This is concerning because once you have the habit it is very hard to break it. Reading the essay about tobacco reminded me that in 2009 I had written a blog post about the liquor industry facing new regulations that the Obama administration had passed. I am reposting it below.

The interesting thing about the original post was that I discussed how tobacco’s fortunes had fallen while brewers and distillers were enjoying a great deal of public support. Public health advocates were not gaining much traction in their attempts to convince the public to drink less.

Society approval of the liquor industry, particularly beer, has only continued to increase in the 13 years since I posted about those tobacco regulations. Not only did the liquor industry get a tax break from the Trump legislation but most municipalities are thrilled to have a craft brewery in their town or city.

Neither the article I read for my CEUs or the blog post from 2009 talk about marijuana, but marijuana has also gained in public approval as many states including Massachusetts where I live now have recreational sale of THC.

Tobacco Legislation

6/16/2009

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 startling.

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 substances, 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.

 

Methylated Spirits Revisited

On Sunday my site got 155 views. On Monday  121. That is a lot more views than I usually get. Most of them were to read my post on methylated spirits which is almost seven years old. I don’t really get it since when you google “methylated spirits” my post doesn’t come up.

I was going to tweet about this, but since Twitter still won’t let me tweet my URL, I decided to write a short post about it instead. The problem with Twitter is over 2 years old. I don’t think it will ever get fixed.

I am little afraid that the sudden increase in views  was some kind of hack, but everything seems okay. If anyone knows why there would suddenly be so much interest in methylated spirits, please let me know.

Denatured alcohol

Social Drinking

Can you be a social drinker? I recently read an article in The New York Times that would suggest the answer was no. The article itself was interesting and the comments were even more interesting. The vociferousness of the comments that defended drinking indicates that drinking in America has been normalized. The recent Atlantic article that asked why there is no anti-alcohol movement explored some of the reasons for that normalization. When I was at my writing retreat this fall, one of the other attendees was a woman who has recently stopped drinking and has a blog about it.

Prior to Prohibition, the temperance movement saw drinking as being both a moral and societal issue. They sought a civil response to the problems of drinking. Although prohibitionists counseled individuals to have the moral and individual strength to stop drinking, the movement sought to remove drinking from society through political and legislative means.

Since Prohibition, the liquor industry has been very successful in framing drinking and the serious issues it can cause as an individual disease. There have been some moments where the public health analysis of alcohol and the society-wide problems it causes, have been in ascendance. Both the movement to decrease drunk driving and the 1991 tax increase on alcohol had public health components.

Today the liquor industry is completely in control and health information detailing problems with liquor go nowhere. On television you see public service announcements on tobacco and vaping. There are none about drinking.

Here is a picture of a cirrhotic liver as one example of the damage excessive drinking can do to your body and health.

Cirrohotic Liver

Cirrhosis

Cirrhosis of the liver is on the rise, according to the New York Times. From 1999 to 2016, deaths increased 65%. The largest increase in deaths was in the population group aged 25 to 34. From 199 to 2008, in some groups including Native Americans and African Americans cirrhosis rates stayed steady or decreased. After 2008 both groups saw increase in  cirrhosis deaths.

The author of the study cited in the newspaper article hypothesizes that the increase can be attributed to the Great Recession and economic despair among young men.  He does acknowledge, however, that “almost every one of these deaths, particularly in the young, is completely preventable.”

Cirrhosis deaths are usually preventable because alcoholic abuse is the major cause of the illness. I have written about this in a previous post which you can read here.

This is the picture from that post.

Addiction Treatment

Yesterday I listened to Preet Bharara’s podcast, Stay Tuned with Preet. The topic was the opioid crisis. The guests were Susan Salomone, a parent advocate and Dr. Abigail Herron, a psychiatrist who works with addicts.

Part of the discussion was on treatment and what is available to help addicts. Salomone believes that currently there are not enough days for treatments. When I worked in an inpatient detox unit, the addicts were only there for 5 days and then placed in outpatient care.

Dr. Herron discussed the medical treatments that are available. There are three.

Methadone is the oldest treatment available. It is dispensed in licensed clinics and the clients usually attend every day. After a certain number of clean random drug screens, some people can get take-home privileges and reduce the number of days they have to attend the clinic.

Because methadone is an opioid and can be abused, methadone as treatment for addiction is controversial. If a person wants to stop taking methadone they will suffer withdrawal symptoms just like heroin. However, when I worked at a methadone clinic I saw many people whose lives were saved by being on methadone

Naltrexone is an opioid inhibitor. It can be used for alcohol addiction as well as opioid addiction. It reduces cravings. Unlike methadone which stays in the body for a long time, naltrexone only works if you take it. There are no withdrawal symptoms. It is available as a pill or inject-able. The injection, which is very expensive, is supposed to last for thirty days but often wears off before that period is up.

50 mg is the usual dosage for the oral medication. Low dose naltrexone, approximately 4.5 mg, is used for a variety of illness including ALS, urinary issues and Crohn’s disease.

Buprenorphine is an opioid but only partially attaches to opioid receptors. With this drug there is supposedly no euphoria. Physicians are required to take a special course before prescribing buprenorphine. Because it is an opioid, stopping the drug does cause withdrawal symptoms.

All three of these treatments have some negative aspects. It is clear that a drug alone will not prevent a relapse. I think you would have to also be under the care of a therapist and attend support groups regularly. Many people believe that addiction causes brain changes that are difficult to undo. Addiction is a disease of relapse. Just ask anyone who has tried to stop smoking.

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.

 

 

Russian Beer Taxes

This post is in honor of the issue that has been dominating the news cycle for at least a week: Russia  and its role in the presidential election. I don’t know if you can correlate  a decrease in drinking beer with an increase in nefarious behavior but it is a fact that beer production in Russia has declined significantly since 2010.

In 2010 the Russian government decided to raise beer excise taxes by 200 percent. Before this, beer was not legally considered alcohol. It was an attempt to curtail drinking and a response to alcoholism in the country. In 2010 Russian brewers produced 1 billion deciliters, about 630,000 barrels (31 gallons to a barrel). In 2015, they produced 659.5 million deciliters. Production has steadily gone down.

Since 2010, the Russian government has increased the excises taxes on beer every year.This year the Russian government once again raised taxes. Although overall production has decreased, the largest brewers have been losing market share to craft beer.

It is not clear that the high excise taxes have produced any decrease in alcoholism rates.  The taxes, however, contribute money to the national budget. Beer excise taxes are 1.3 percent of the budget and 45 percent of the overall alcohol excise taxes.

Although most people  would assume that Russians are heavy vodka drinkers, the drink of choice is beer. Russia ranks 26th in world-wide beer consumption. The United States is 17th.

States can often have two motives for taxing alcoholic beverage – financial and sumptuary. Governments need to find a balance since deeply curtailing consumption can hurt the bottom line. Russia’s tax policy for beer seems to be more weighted towards public health and decreased consumption.

For more information about Russian beer, see this USDA report.

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