This document discusses the adverse effects of alcohol and tobacco use and methods for prevention and treatment. It outlines the physical and psychological dependence that can develop from substance abuse as well as the various negative health impacts on multiple body systems. Prevention strategies discussed include educational programs, legal restrictions, and community support groups. Treatment involves detoxification, counseling, psychotherapy, relapse prevention, and helping support networks like family.

1. Alcohol and Tobacco use
adverse effects and prevention
Dr. Vanitha
Dept of Community medicine ,
SRMC &RI

2. Alcohol and Tobacco usage
 Drug abuse – Taking drug for reasons other than
medical reasons in quantity, strength, frequency
and manner which damage the social, physical and
mental functions - results in harm.
 Drug addiction – is the result of drug abuse which
produce both dependence and tolerance.

3. Alcohol and Tobacco adverse effects
and prevention
 Drug dependence – state resulting from the
interaction between a living organism and a drug,
characterized by a response that always makes a
compulsion to take drug continuously /periodically
to experience its psychic effects and often to avoid
the discomfort of its absence.
Types – physical and psychological dependence

4. Physical Dependence
 This state occurs when user's body becomes
accustomed to particular drug - requires the drug, in
increasing doses over a time, for normal functioning/
to obtain the same results as earlier, due- development
of 'tolerance' to drug. (Tolerance - requiring more &
more of a drug to get same effects)
 Abrupt stopping - Withdrawal symptoms.
 Whole life is focused on drug procurement and use

5. Psychological Dependence
 This state occurs when a drug is so central to a
person's thoughts, emotions and activities, that is
extremely difficult to stop using it or even stop
thinking about it.
 Psychological dependence is marked by an intense
craving for the drug'

6. Alcoholism

7. Body system or organ Established or suspected adverse health
effect of cigarette smoking
Lungs
•Lung cancer
•Chronic obstructive pulmonary disease
•Increased severity of asthma
•lncreased risk of developing various
•respiratory infections
Heart
•Coronary heart disease
•Angina pectoris
•Heart attack
•Increased risk of repeat heart attack
•Arrhythmia
•Aortic aneurysm
•Cardiomyopathy
Blood vessels
•Peripheral vascular disease
•Thromboangiitis obliterans
(Buerger's disease)
Skin
•Earlier wrinkling
•Fingernail discoloration
•Psoriasis
•Palmoplantar pustulosis
Cancer
•Lung cancer
•Esophageal cancer
•Laryngeal cancer
•Oral cancer
•Bladder cancer
•Kidney cancer
•Stomach cancer
•Pancreatic cancer
•Vulvular cancer
•Uervical cancer
•Colorectal cancer

8. Body system or organ Established or suspected adverse health
effect of cigarette smoking
Bones
•Disc degeneration
•Osteoporosis
•Osteoarthritis
•Less successful back surgery
•Delayed fracture healing
•Muscoloskeletal injury
Reproduction
•lnfertility
•Impoience
•Decreased sperm motility and density
•Miscarriage
•Earlier menopause
The Unborn Child
•Fetal growth retardation
•Prematurity
•Stillbirth
•Enhanced transmission of HIV to fetus
•Birth defects
•lntellectual impairment
•Sudden infant death syndrome
Brain
•Transient ischaemic attack
•Stroke
•Worsened muttiple sclerosis
Others
•Cataracts
•Macular
degeneration
•Snoring
•Periodontal disease
•Stomach and
duodenal ulcers
•Crohn disease
•Impaired immunity

9. A .Medical :
a.Gastro-intestinal Tract
 Gastritis
 Dyspepsia
 Vomiting
 Peptic ulcer
 Cancer
Adverse effects of Alcohol

10. Gastro intestinal system (continued) -
Reflex-oesophagitis
 Carcinoma of stomach and oesophagus,
larynx, liver, colon
 Fatty degeneration of the liver, interferes with
absorption of vitamin B-complex
 Cirrhosis of liver
 Hepatitis, Jaundice
 Liver cell carcinoma
 Acute and chronic
 pancreatitis

11. b. Cardiovascular System :
 Cardiomyopathy
 Hypertension
 Heart failure or stroke
 High risk for myocardial infarction.
c. Blood :
 Folic acid deficiency anaemia
 Decreased WBC production causes
infections

12. d. Nervous System :
 Confusion, numbness of hands, feet,
disordered thinking
 Depression, depresses vital centers of the brain
 Peripheral Neuropathy,
 Dementia
 Epilepsy
 Head injury
 Cerebellar degeneration
 Wernicke’s encephalopathy coma

13. e. Hormonal :
 Hypoglycemia
f. Muscle :
 Peripheral muscle weakness
 Wasting of muscles g. Bones :
 Interferes with the production of bones
 Thinning of bones, osteoporosis
 Fractures

14. I. Reproductive System :
 Sexual dysfunction in male
 Failure of ovulation in female
 Interruption in menstruation
j. Nutritional Deficiency Diseases :
 PEM
 B complex deficiency-Pellagra, Beriberi

15. k. Pregnancy :
 Fetal abnormalities
 Developmental disabilities- Mental
retardation, Growth retardation
 Low birth weight
 Still birth
 Birth defects
 Foetal alcohol syndrome

16. Social Complications :
 Domestic abuse, divorce,
poor performance in school
and at work.
 Prone for motor vehicle
accidents, susceptible for
accidental injuries, violence
acts,e.g. murder, reduced
productivity.

17. Any rapid decrease in the amount of alcohol
content in blood will produce withdrawal symptom
1 Simple Withdrawal Syndrome :
 Mild tremors, weakness
 Nausea ,vomiting
Irritability , Insomnia,
  Insomnia , Anxiety
 Tachycardia
 Hypertension
 Impaired attention

18. 2 Delirium Tremors
3.ALCOHOLIC PARANOID : characterized by
suspicious nature, decreased sexual potency.
4.ALCOHOLIC HALLUCINATIONS
5.Dementia
6.Wernicke encephalopathy
7. 7.Korsakoff's syndrome: (amnesic-
confabulatory syndrome)is a brain disorder caused
by the lack of thiamine (vitamin B1) in the brain
Withdrawal syndrome (continued)

19. q CAGE questionnaire : named for its four type of
questions, is used to screen patients.
Two "yes" responses indicate that the respondent
should be investigated further. Eg-
 Have you ever felt you needed to Cut down
on your drinking?
 Have people Annoyed you by criticizing your
drinking?
 Have you ever felt Guilty about drinking?
 Have you ever felt you needed a drink first thing in
the morning (Eye-opener) to steady your nerves or to
get rid of a hangover?

20. OTHER SCREENING TEST AVAILABLE :
 Alcohol Dependence Data Questionnaire
 Michigan Alcohol Screening Test
 Alcohol Use Disorders Identification Test
(AUDIT)
Paddington Alcohol Test (PAT)
Urine and blood tests :
 Blood alcohol content (BAC).

21.  Treatment involves the replacement or
supplementation of thiamine by IV or IM
injection, together with proper nutrition
and hydration. However, the amnesia
and brain damage caused by the disease
does not always respond to thiamine
replacement therapy. So in some cases,
drug therapy is recommended

22. De-addiction procedure - steps
 Identification of the drug addicts
 Motivation for detoxification and Medical treatment
 Hospitalization -provide fear therapy, psychotherapy,
counseling
 Change of the environment
 Post-detoxification counseling to prevent relapse
 rehabilitation

23. q Detoxification :
 Alcohol detoxification or 'detox' for alcoholics is an
abrupt stop of alcohol drinking coupled with the
substitution of drugs that have similar effects to prevent
alcohol withdrawal.
 It treats the physical effects of prolonged use of alcohol,
but does not actually treat alcoholism. After detox is
complete, relapse is likely without further treatment.

24. q Drugs used for this are :
 Benzodiazepines – chlordiazep 80-
200mg/day.
 Diazepam 40-80 mg/day
 Thiamine 100 mg IM for 3-5 days followed by
vitamin b administration 100 mg OD
for atleast 6 months.
 Anticonvulsants can be given if necessary.

25.  Used for over 30 years.
 Works on principle of classical
conditioning.
 300-600 mg of drug mixed in alcohol
is given to the client for 6-8 times in a
week.
 fear of recurrence of reaction deters
him from taking alcohol.
 Detoxication to be done in the
hospital only.
 Still relapse rates are high.

26.  Soon after the ingestion of drug, adverse
reaction starts appearing and may last for 30-
120 minutes. Reaction consists of :
 Facial flushing , sweating
 Throbbing headache , Neck pain
 Tachycardia ,Respiratory distress
 Potentially serious drop in B.P.
 Nausea and vomiting.
 In severe disulfram reaction, diphenhydramine
hydrochloride 50 mg IM or IV is given.

27.  It must be taken daily atleast for 6-8 days,
period can last for upto 2 weeks.
 Alcohol containing substances (hidden alcohol) can
trigger the side effects, so these should be avoided.
These are :
 Foods as soups, apple ciders, anything made with wine
vinegar as pickles, flavour extracts used in cooking.

28. Medicines include cold and cough syrups, mouth
washes, vitamin and mineral tonics.
 Skin preparations include alcohol rubs, after shave
lotions, transdermal patches.
 Avoid inhaling fumes, substances that contain
alcohol as paints.

29. q It is an opoid antagonist which is now approved for
treatment of alcoholism. Unlike disulfram, it decreases
the pleasant and reinforcing effects of alcohol without
making the user ill.

30. MOTIVATIONAL INTERVIEWING :
 Explaining the complications and personal risks of
consuming alcohol
 Availability of treatment options to change their
behaviour related to alcohol consumption.

31. q INDIVIDUAL PSYCHOTHERAPY :
 Educate about the effects of alcohol consumption
and the coping strategies to overcome the habit.
 Precautionary measures, diversional activities.
 Methods to prevent occurrence of
complications.
q GROUP THERAPY :
 Observe the problems of alcoholic
 Provide oppurtunities to observe other problems and discuss
with each other.
 Explain them the better ways of coping with problems.

32. q COUNSELLING :
 To find out the problems and to solve them.
To guide about various methods to relax
mind and engaging themselves in productive
activities
q AVERSIVE COUNSELLING : Based on
principle of classical Condition in
 Explain the behaviour pattern which are
pleasurable, pros and cons of alcoholism,
maladaptive behaviour.
 Explain about the complications
of alcoholism and family complications.

33. q COGNITIVE THERAPY :
 Help the client to identify the maladaptive thinking
patterns; evil effects of alcoholism.
 To guide the individual to slowly reduce the dose of
alcohol intake and by understanding the evil effects of
alcohol.

34. q RELAPSE PREVENTION TECHNIQUE :
 It helps the client :
 Identify high risk relapse factors and develop
strategies to deal with them.
 Learn the methods to cope up with cognitive
distortions.

35. q CUE EXPOSURE TECHNIQUE :
Repeated exposures to desensitise the clients to the effects
of alcohol and thus improve their ability to remain abstinent.
q Client is exposed to adverse effects of
excessive alcohol consumption like chemical induced
vomiting, shock etc. thereby develops aversion towards the
evil habbits.
q SUPPORTIVE PSYCHOTHERAPY :
Symtomatic treatment along with educating the individual
about preventive measures against complications.
q BEHAVIOUR MODIFICATION TECHNIQUES:
 Systematic desensitization
 Relaxation techniques
 Operant conditioning

36. q FAMILY THERAPY :
 If the head of family develops
alcoholism, family will be affected with
economic crisis, maladjustment. Thus the
family need to be educated about
various cpoing strategies, evil effects of
alcoholism to children and preventive
measures to adopt.

37. qParents :
 Provide the child with a secure, stable home
environment (lack of love - cause of taking alcohol)
 Keep the child occupied .Provide opportunities for
sports, hobbies and other useful activities that could
stand him away from evil outlets.
 Keep the children informed about hazards of alcohol
addiction and how to stay away from people and
places that can influence him.
Prevention and control of drug abuse

38. Promote a well knit family feeling of interdependence .It
will lead to feeling of being wanted and loved.
Parents should build a relationship of mutual truth and
understanding. A healthy loving parent child relationship
can be a great help to avoid alcohol addiction.
 Individualisation :to establish mutual respect, parents
should began respecting the child as human being in his
own right.

39.  Taking time for recreation: Parents should
spend time with children in regard to their hobbies and
interests.
 Encouragement: Family and friends need to
know the child’s strength and help him to accept his
weakness in order to cope with the realities of life
 Communicating love :Children should be
dealt with love, sympathy, security and sense of well
being.

40. q Encountering alcohol abuse: Family should
not over react when they come to know about the
chemical dependence of the person .
 They should keep all lines of communication
open. Family should speak to his friends ,inform his
teacher and should consult for professional
evaluation.

41.  Accepting the fact: The professionals should
let the person recognize his alcohol depending and
that he is suffering with a disease and needs to be
controlled. Recognizing their reality means half their
battle won.
Confrontation:
If the person does not accept the disease , then
confront him. Family should talk honestly and
without anger, should describe their anger only
when the person can understand it and should be
specific while talking to the client.

42. At Community Level -
 Educational approach: Public campaigns on TV etc.,
Educational programs are arranged-school children.
Make the school and surroundings a drug-free zone.
 Service approach: Teen-centers to be established -
Make them healthy and active by participating in
sports, music, gymnasium, artistic activities, etc. and
prevent them from drifting in to drug taking.
 Self-help groups to be established, consisting of ex-
addicts, who encourage those who want to give up
the habit of taking drugs. They will be influenced and
leave the habit in course of time.

43. At Community Level –
 Legal approach: - Legislation may be directed at
various levels such as manufacture, distribution,
prescription, price, advertisements, consumption etc
 The related Public Health Act is 'Narcotic Drugs and
Psycho-trophtic Substances Act' 1985.

44. Rehabilitation
 changes in environment (home, school, college,
social circles) are important.
 Patient must effect a complete break with his group,
otherwise the chances of relapse are 100 per cent.
 If he has lost his job- given skilled training and
placed in appropriate job - relapses are frequent.
 Vocational training and sheltered work opportunities
are useful - prevent relapse.

45. Antismoking measures are :
q (a) prohibition of sale of tobacco products to minors;
 (b) restriction on sale of cigarettes from vending machines;
 (c) prohibition of smoking in schools and other places
frequented by young people;
 (d) prohibition of smoking in public place
 (e) prohibition of cigarette advertising at times, and in places
and ways, calculated to ensure its maximum impact on
adolescents;

46. Antismoking measures are :
(f) establishment of mandatory public health education on
health consequences of smoking;
(g) insisting on the placing of mandatory health warning on
cigarette packets.
The minimum age at which minors may legally have access
to alcoholic beverages, has been raised in some countries.
There is also legislation controlling the distribution of alcohol
in some countries. Mandatory jail sentences for drunken
driving have not been very effective.