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31. Epidemiology and prevention of addictions

  • Addiction = Chronic problem which causes drug seeking, despite harmful consequences
  • Addictions cause accidents, violence, abuse
  • Epidemiology
    • 6% of the world
    • Most drug-related deaths are in North America
  • Physical dependence
    • Avoidance of withdrawal
  • Psychological dependence
    • Drug-seeking behaviour
  • Comorbidity of addiction
    • Depression
    • Suicide
    • Antisocial personality disorder
    • Infections

Smoking

  • Epidemiology
    • One of the most important public health issues
    • Most smoking in Eastern Europe
      • Greece
      • Serbia
      • Croatia
      • Etc.
    • Male > female
    • Almost all adult smokers had their first cigarette before 20
  • Risk factors
    • Low socioeconomic status
    • Peer pressure
    • Family who smokes
  • Fagerstrøm nicotine dependence scale
  • 5 A of smoking cessation
    • Ask – about tobacco use
    • Advise – tobacco users to quit
    • Assess – readiness to attempt quitting
    • Assist – with quitting
    • Arrange – follow up care
  • 5 R’s – for patients unwilling to quit at this time
    • Relevance – tailor advice to each patient
    • Risks – inform of risks of continuing
    • Rewards – inform of rewards of stopping
    • Roadblocks – identify roadblocks
    • Repetition – repeat messages
  • Prevention
    • Primary
      • Campaigns
      • Ban advertisements
      • Decrease availability
      • Encourage cessation
      • Decrease second hand smoking
      • School programs
    • Secondary
      • Ask patient about substance disorder
    • Tertiary
      • Support groups
      • Bupropion
      • Nicotine replacement

Alcohol

  • Epidemiology
    • Alcohol consumption causes 3 million deaths every year
    • Excessive alcohol consumption is the 2nd most important epidemiological problem after smoking
    • More common in minorities
    • Peak incidence 20s – 30s
    • Male > female
  • AUDIT test – alcohol use disorders identification test
    • Gives points based on risk
  • There is no safe amount of alcohol
  • Risk factor
    • High and low socioeconomic status (not middle)
    • Depression
    • Anxiety
    • Abuse of other substances
  • Prevention
    • Legislation
    • Taxes
    • Mental health promotion
    • No ads
    • Awareness campaign

Other drugs

  • Designer drugs
  • 4% of worlds adult population used psychoactive substances
  • Cannabis, amphetamines, cocaine, opioids