Once located in rural towns and on the West Coast, meth has erupted across the United States and is now devastating countless families, children and neighborhoods. Here are some facts you should know about meth:

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What is it?
Methamphetamine is a powerfully addictive stimulant that has a high potential for abuse and dramatically affects the central nervous system. It is a unique drug because it is easy to obtain and relatively cheap to buy. This is all made possible by the fact that meth can be manufactured literally in a person’s backyard from relatively inexpensive, over-the-counter ingredients such as Pseudoephedrine — a common cold medicine, as well as paint thinner, cat litter and lighter fuel.

What does it look like?
Meth is a white, odorless, bitter-tasting powder that easily dissolves in alcohol or water and can be smoked, injected or snorted.
 
Where is it made?
Two-thirds of our country’s meth supply is produced in super labs in Mexico and Southern California run by organized crime and street gangs. The remaining third is made in the U.S. in makeshift meth labs found in basements, bedrooms, kitchens garages, bedrooms and trunks of cars.

How is it made?
Meth is made from a fairly simple recipe found on the internet and can be produced in as few as 6 to 8 hours using apparatus and cookware that can be quickly dismantled and stored or relocated to avoid detection. A mere $200 can buy the ingredients to produce an ounce of meth (enough to get 100 people high). Since cooking meth produces such large amounts of highly toxic waste, there is always a pending danger of explosion or fire which could endanger the lives of children and adults, as well as harm the surrounding environment. 

What are its effects on the user?
Meth can make a user awake and alert, and can keep him or her up for hours and even days. At first it can give him or her a rush and a sense of euphoria, decrease their appetite and provide feelings of confidence. After a "binge," a user will inevitably crash, and can become severely depressed and even suicidal.

Why is it used?
Like most drugs, people use meth for the rush. However, due to its effects on the body, people use it for energy, weight loss or to self-medicate — all of which have serious consequences.

How can I recognize a meth user?
A meth user could be anyone – a teen or parent, urban dweller to city folks, students to professionals — in your neighborhood. If you think someone you know might be using meth, or you’re a parent who thinks their teen might be using, learn the warning signs to look for.

How can meth affect me and my community?
Unfortunately, meth can harm not only those who are addicted to the drug, but their family, friends and neighbors. Issues regarding, safety, law enforcement, health care and social workers can all arise when meth takes over a community. Learn more in How Meth Affects Your Community.

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Methamphetamine is furiously spreading from rural areas, where it’s home-brewed, into our cities and suburbs. Who is vulnerable? Often, exhausted new moms with 24/7 demands. Here’s the cautionary tale of one mom-next-door who fell into addiction and then fought her way back.

This story by Elizabeth Fish as told to Lisa Collier Cool is reprinted, with permission, from the April 2006 issue of Babytalk magazine.

When the police car pulled me over, my first thought was "Why am I getting a ticket?" It was 8:30 p.m. and I was on my way home from Target. My baby girl, Cameren, was asleep in her car seat. After telling me that I was driving five miles over the speed limit, the officer started asking my partner, Derek, a lot of questions. Who was the man who’d talked to Derek in one of the store aisles? We didn’t know — just a stranger who’d said hi. Did we have a walkie-talkie? No, I said, getting more bewildered by the minute.

All of a sudden, five more patrol cars pulled up, their lights flashing. The police ordered us out of our car so they could search it. Derek told me not to worry: The police would realize that they’d made a mistake and let us go. But there was something I’d forgotten. "What’s this?" an officer demanded, holding up a capsule of white powder from my purse.

I’d never been so terrified in my life. I’d just been caught with methamphetamine. I didn’t know it at the time, but the man in Target had been caught shoplifting Sudafed, which contains ingredients used to make meth, and the police thought Derek and I might be running a lab. The officer told me to get into the patrol car with Cameren, while narcotics detectives tested the powder. Soon a female officer got into the car and read me my rights. I burst into tears when she patted me down. How could this be happening? I was barely 20 years old and had never been in any trouble.

By the time I arrived at Linn County Jail, in Cedar Rapids, Iowa, on that March night in 2005, it was close to midnight. I had to get naked in front of a female sheriff for a humiliating body search; then I was given a green jail uniform,

photographed, and fingerprinted. I was escorted to a cell and locked in with three sleeping women. I lay down on a metal bunk bed as quietly as possible. All night long, I shivered under the thin prison blanket. I was afraid I’d just ruined my life — and I nearly had.

Instant Attraction

Derek and I had met in June 2003, at a friend’s birthday party. He was five years older than me, tall, and good-looking. But what immediately attracted me was that he was the quiet one in the crowd, and I’m shy, too. We started seeing each other every day, then moved in together.

After we’d been living together for three months, Derek, who is now 25, told me that he’d been using meth, on and off, for about a year. I was shocked — I’d never taken any drugs, not even pot. A few days later, he showed me a tiny bag of white powder. "Want to try some?" he asked. I hesitated, but I trusted Derek. "Just a little," I said.

He poured the meth onto a piece of foil, held a lit match underneath, and inhaled the smoke. Then it was my turn. The rush was immediate. I was filled with energy and felt like I could do anything. Soon, I was doing meth a few times a week, staying up all night, cleaning the apartment and having intense conversations with Derek. When I took meth, shyness disappeared; I could talk for hours. It was like life had become one big party.

I began needing more meth to get the high I craved. I gave up my dream of becoming a makeup artist and quit school. I avoided my family. That is, until the day I found out I was pregnant. That changed everything — I was so afraid it would hurt the baby, I quit cold turkey. I had no withdrawal symptoms and didn’t even crave the drug.

Weary — and Weak

Cameren was born on November 23, 2004, healthy and beautiful, with blonde hair, big brown eyes, and dimpled cheeks. I set out to be the perfect mom. I used hand sanitizer before I touched her, and boiled her bottles. But Cameren was waking up every two hours and I was worn out. I knew just what would perk me up — and I started feeling that familiar urge.

I felt guilty when I started smoking meth again, but I also told myself it was helping me be a better mom. A few puffs gave me the energy to clean the apartment, do Cameren’s laundry, run some errands, and still be wide awake whenever she cried. I was very careful, though, never to smoke around Cameren. I’d wait until Derek got home, and the two of us would put our baby down securely in her crib, turn on an air purifer to keep smoke away from her, and go downstairs to light up. I somehow managed to convince myself that by doing it this way, I could take care of my habit — and my baby.

Then I ended up in jail. Because I had such a small amount of meth, I was charged only with a misdemeanor. I was given a court date and released without bail. A few days later, a caseworker from the Department of

Human Services (DHS) arrived at our door. She told us that we had until midnight that night to show up at a nearby hospital for a urine test for meth. We were terrified.

Later that week, the caseworker returned, with a police officer. "We’re here to remove Cameren from your home," she announced. I ran to the crib, screaming, "Why are you doing this?" Derek started yelling that they had no right to take our child. But we both knew what had happened: Our drug tests had come back positive. I was hysterical, crying and asking to hold her one more time.

For five frantic days the only thing I knew was that my baby was in foster care. Then my mother was given custody of Cameren, and I was allowed to visit her a few times a week. It was a relief, but I hated leaving her and coming home to an empty crib. I’d hold her toys and cry, wondering if I’d ever get her back. She got so attached to my mom that there were tim

es when I visited that my baby didn’t even want me to hold her.

Crash-and-Burn Time

Still, I kept on smoking meth. It was crazy: The drug was what had caused all the problems, yet I turned to it to take away the pain. On the bad nights, I stayed up, talking to my mom on the phone, and aching from missing my baby.

My parents helped me find a lawyer, who negotiated a deal: I would enter a drug treatment program, perform 20 hours of community service, and pay a $550 fine. For six months, I’d be on probation, and if I stayed out of trouble, the drug charge would be cleared from my record.

But we still wouldn’t get Cameren back. In fact, DHS assigned us a new caseworker. She immediately suspected that I was still on meth, and warned me that if I didn’t get my act together, I could lose my parental rights permanently. That scared me enough to say, "Just tell me what to do." The caseworker felt it would be easier for Derek and me to get sober if we didn’t live together, so he went to live with his parents, and I moved in with my grandmother. She also told me about an Iowa self-help group called Moms Off Meth. I took her advice and went.

At my first meeting, on May 25, 2005, I was high. When it was my turn to talk, I was surprised at how emotional I got. Tears were streaming down my face as I shared my story about being arrested and losing my daughter. I was overwhelmed with the guilt and shame of admitting, for the first time, that I’d become an addict — and was in danger of losing Cameren forever.

Then other women told me that they’d all been down that road, they’d dealt with it, and they’d stopped using. Nearly every mom in the room had seen her child put into foster care thanks to meth addiction. I looked at these moms and thought, "If they can do it, by God, so can I."

Withdrawal made me feel miserable this time. You want to lie in bed, you’re very tired. You sweat. You feel nauseous. But every Wednesday, I went to Moms Off Meth. It was inspiring to hear what the other women were doing to stay clean. And I told them something that worked for me. One night the craving got so bad that I called my mom in tears. "Why don’t you come over?" she said. Although it wasn’t one of my scheduled visits, she figured that the caseworker wouldn’t mind. How could it be bad, if seeing my daughter helped remind me of why I had to stay sober? I played with Cameren, and hearing her laugh and coo helped so much. I put her down to sleep and lay down next to her. "I love you," I whispered. Getting my child back would be better than any drug, I thought. By the time I left that night, the craving had vanished.

When Derek saw my success at staying off meth for several months, he joined a treatment program, too. We began dating again, and helped each other stay sober. In September 2005, I went back to college. The next month, I completed probation — and rejoiced when the drug charge was officially wiped off my record.

Soon I had much more to celebrate. On January 20, 2006, Cameren moved back home with me. If I stay clean, I’ll regain full custody later in the year. That’s a challenge I’m up for: This whole mess made me realize that I need to be with my daughter. Getting a second chance to be Cameren’s mother is the greatest gift of all.

Lisa Collier Cool is an award-winning medical writer and mother of three in Pelham, New York.

Alcoholism is a term with multiple and sometimes conflicting definitions to refer to the consumption of alcoholic beverages. In common and historic usage, alcoholism refers to any condition that results in the continued consumption of alcoholic beverages, despite health problems and negative social consequences. Modern medical definitions[1] describe alcoholism as a disease and addiction which results in a persistent use of alcohol despite negative consequences. In the 19th and early 20th centuries, alcoholism, also referred to as dipsomania[2] described a preoccupation with, or compulsion toward the consumption of, alcohol and/or an impaired ability to recognize the negative effects of excessive alcohol consumption.

Although not all of these definitions specify current and on-going use of alcohol as a qualifier for alcoholism, some do, as well as remarking on the long-term effects of consistent, heavy alcohol use, including dependence and symptoms of withdrawal.

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While the ingestion of alcohol is, by definition, necessary to develop alcoholism, the use of alcohol does not predict the development of alcoholism. It is estimated that 9% of the general population is predisposed to alcoholism based on genetic factors.[citation needed] The quantity, frequency and regularity of alcohol consumption required to develop alcoholism varies greatly from person to person. In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, stress,[3] emotional health, genetic predisposition, age, and gender have been identified. For example, those who consume alcohol at an early age, by age 16 or younger, are at a higher risk of alcohol dependence or abuse. Also, studies indicate that the proportion of men with alcohol dependence are higher than that of the proportion of women, 7% and 2.5% respectively, although women are more vulnerable to long-term consequences of alcoholism. Around 90% of adults in United States consume alcohol and more than 700,000 of them are treated daily for alcoholism.[4] Professor David Zaridze, who led the international research team, calculated that alcohol had killed three million Russians since 1987.[5]

Definitions and terminology
The definitions of alcoholism and related terminology vary significantly between the medical community, treatment programs, and the general public.

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Medical definitions
The Journal of the American Medical Association defines alcoholism as "a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking."[6]

The DSM-IV (the standard for diagnosis in psychiatry and psychology) defines alcohol abuse as repeated use despite recurrent adverse consequences.[7] It further defines alcohol dependence as alcohol abuse combined with tolerance, withdrawal, and an uncontrollable drive to drink.[7] (See DSM diagnosis below.)

According to the APA Dictionary of Psychology, alcoholism is the popular term for alcohol dependence.[7] Note that there is debate whether dependence in this use is physical (characterised by withdrawal), psychological (based on reinforcement), or both.

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Terminology
Many terms are applied to a drinker’s relationship with alcohol. Use, misuse, heavy use, abuse, addiction, and dependence are all common labels used to describe drinking habits, but the actual meaning of these words can vary greatly depending upon the context in which they are used. Even within the medical field, the definition can vary between areas of specialization. The term "dipsomania" is used in medical and psychiatric circles to identify a condition which is characterized by the uncontrollable craving for alcohol or other intoxicants, which manifests for unknown reasons, and can be confused with alcoholism.

Use refers to simple use of a substance. An individual who drinks any alcoholic beverage is using alcohol. Misuse, problem use, abuse,[8] and heavy use do not have standard definitions, but suggest consumption of alcohol to the point where it causes physical, social, or moral harm to the drinker. The definitions of social and moral harm are highly subjective and therefore differ from individual to individual.

Within politics, abuse is often used to refer to the illegal use of any substance. Within the broad field of medicine, abuse sometimes refers to use of prescription medications in excess of the prescribed dosage, sometimes refers to use of a prescription drug without a prescription, and sometimes refers to use that results in long-term health problems. Within religion, abuse can refer to any use of a poorly regarded substance. The term is often avoided because it can cause confusion with audiences that do not necessarily share a single definition.

Remission is often used to refer to a state where an alcoholic is no longer showing symptoms of alcoholism. The American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking. They further subdivide those in remission into early or sustained, and partial or full.

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Etymology
 
1904 advertisement describing alcoholism a disease.The term "alcoholism" was first used in 1849 by the physician Magnus Huss to describe the systematic adverse effects of alcohol.[9]

In the United States, use of the word "alcoholism" was largely popularized by the founding and growth of Alcoholics Anonymous in 1935[citation needed]. AA’s basic text, known as the "Big Book," describes alcoholism as an illness that involves a physical allergy[10]:p.xxviii and a mental obsession.[10]:p.23[11] Note that the definition of "allergy" used in this context is not the same as used in modern medicine.[12]

A 1960 study by E. Morton Jellinek is considered the foundation of the modern disease theory of alcoholism.[13] Jellinek’s definition restricted the use of the word "alcoholism" to those showing a particular natural history. The modern medical definition of alcoholism has been revised numerous times since then. The American Medical Association currently uses the word alcoholism to refer to a particular chronic primary disease.[14]

A minority opinion within the field, notably advocated by Herbert Fingarette and Stanton Peele, argue against the existence of alcoholism as a disease. Critics of the disease model tend to use the term "heavy drinking" when discussing the negative effects of alcohol consumption.

Epidemiology
 
Total recorded yearly alcohol per capita consumption (15+), in litres of pure alcohol[15]Substance use disorders are a major public health problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol."[16] In the United Kingdom, the number of ‘dependent drinkers’ was calculated as over 2.8 million in 2001.[17] The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence.[18][19]

Within the medical and scientific communities, there is broad consensus regarding alcoholism as a disease state. For example, the American Medical Association considers alcohol a drug and states that "drug addiction is a chro

nic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences. It results from a complex interplay of biological vulnerability, environmental exposure, and developmental factors (e.g., stage of brain maturity)."[14]

Current evidence indicates that in both men and women, alcoholism is 50-60% genetically determined, leaving 40-50% for environmental influences.[20]

A 2002 study by the National Institute on Alcohol Abuse and Alcoholism surveyed a group of 4,422 adult alcoholics and found that after one year some were no longer alcoholics, even though only 25.5% of the group received any treatment,[21] with the breakdown as follows:

25% still dependent
27.3% in partial remission (some symptoms persist)
11.8% asymptomatic drinkers (consumption increases chances of relapse)
35.9% fully recovered — made up of 17.7% low-risk drinkers plus 18.2% abstainers.
In contrast, however, the results of a long term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School indicated that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence."[22] Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."

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Identification and diagnosis
Multiple tools are available to those wishing to conduct screening for alcoholism. Identification of alcoholism may be difficult because there is no detectable physiologic difference between a person who drinks frequently and a person with the condition. Identification involves an objective assessment regarding the damage that imbibing alcohol does to the drinker’s life compared with the subjective benefits the drinker perceives from consuming alcohol. While there are many cases where an alcoholic’s life has been significantly and obviously damaged, there are always borderline cases that can be difficult to classify. Unless they have M.C. type symptoms, and in these cases are probably alcoholics, no diagnosis needed.

Addiction Medicine specialists have extensive training with respect to diagnosing and treating patients with alcoholism.

Screening
Several tools may be used to detect a loss of control of alcohol use. These tools are mostly self reports in questionnaire form. Another common theme is a score or tally that sums up the general severity of alcohol use.

The CAGE questionnaire, named for its four questions, is one such example that may be used to screen patients quickly in a doctor’s office.
Two "yes" responses indicate that the respondent should be investigated further. The questionnaire asks the following questions:

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?[23][24]
The CAGE questionnaire, among others, has been extensively validated for use in identifying alcoholism. It is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE are frequently implemented for such a purpose.
The Alcohol Dependence Data Questionnaire is a more sensitive diagnostic test than the CAGE test.[25] It helps distinguish a diagnosis of alcohol dependence from one of heavy alcohol use.
The Michigan Alcohol Screening Test (MAST) is a screening tool for alcoholism widely used by courts to determine the appropriate sentencing for people convicted of alcohol-related offenses,[26] driving under the influence being the most common.
The Alcohol Use Disorders Identification Test (AUDIT) is a screening questionnaire developed by the World Health Organization. This test is unique in that it has been validated in six countries and is used internationally.[27] Like the CAGE questionnaire, it uses a simple set of questions – a high score earning a deeper investigation.
The Paddington Alcohol Test (PAT) was designed to screen for alcohol related problems amongst those attending Accident and Emergency departments. It concords well with the AUDIT questionnaire but is administered in a fifth of the time.[28]

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Genetic predisposition testing
Psychiatric geneticists John I. Nurnberger, Jr., and Laura Jean Bierut suggest that alcoholism does not have a single cause—including genetic—but that genes do play an important role "by affecting processes in the body and brain that interact with one another and with an individual’s life experiences to produce protection or susceptibility." They also report that fewer than a dozen alcoholism-related genes have been identified, but that more likely await discovery.[29]

At least one genetic test exists for an allele that is correlated to alcoholism and opiate addiction.[30] Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymorphism. Those who possess the A1 allele (variation) of this polymorphism have a small but significant tendency towards addiction to opiates and endorphin releasing drugs like alcohol.[31] Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism, and some researchers argue that evidence for DRD2 is contradictory.[29]

DSM diagnosis
The DSM-IV diagnosis of alcohol dependence represents one approach to the definition of alcoholism. In part this is to assist in the development of research protocols in which findings can be compared with one another. According to the DSM-IV, an alcohol dependence diagnosis is:

…maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae.

Urine and blood tests
There are reliable tests for the actual use of alcohol, one common test being that of blood alcohol content (BAC). These tests do not differentiate alcoholics from non-alcoholics; however, long-term heavy drinking does have a few recognizable effects on the body, including:

Macrocytosis (enlarged MCV)1
Elevated GGT²
Moderate elevation of AST and ALT and an AST: ALT ratio of 2:1.
High carbohydrate deficient transferrin (CDT)
However, none of these blood tests for biological markers are as sensitive as screening questionaires.

Effects of long term alcohol misuse
Main article: Long-term effects of alcohol
The primary effect of alcoholism is to encourage the sufferer to drink at times and in amounts that are damaging to physical health. The secondary damage caused by an inability to control one’s drinking manifests in many ways. Alcoholism also has significant social costs to both the alcoholic and their family and friends. Alcoholics have a very high suicide rate and studies show between 8% and 21% of alcoholics commit suicide. Alcoholism also has a significant adverse impact on mental health. The risk of suicide among alcoholics has been determined to be 5,080 times that of the general public.[32]

Physical health effects
It is common for a person suffering from

alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption may include cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources. Severe cognitive problems are not uncommon in alcoholics. Approximately 10% of all dementia cases are alcohol related making alcohol the 2nd leading cause of dementia.[33]

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Mental health effects
Long term misuse of alcohol can cause a wide range of mental health effects. Alcohol misuse is not only toxic to the body but also to brain function and thus psychological well being can be adversely affected by the long-term effects of alcohol misuse. Psychiatric disorders are common in alcoholics, especially anxiety and depression disorders, with as many as 25% of alcoholics presenting with severe psychiatric disturbances. Typically these psychiatric symptoms caused by alcohol misuse initially worsen during alcohol withdrawal but with abstinence these psychiatric symptoms typically gradually improve or disappear altogether.[34] Psychosis, confusion and organic brain syndrome may be induced by chronic alcohol abuse which can lead to a misdiagnosis of major mental health disorders such as schizophrenia.[35] Panic disorder can develop as a direct result of long term alcohol misuse. Panic disorder can also worsen or occur as part of the alcohol withdrawal syndrome.[36] Chronic alcohol misuse can cause panic disorder to develop or worsen an underlying panic disorder via distortion of the neurochemical system in the brain.[37]

The co-occurrence of major depressive disorder and alcoholism is well documented.[38][39][40] Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that are secondary to the pharmacological or toxic effects of heavy alcohol use and remit with abstinence, and depressive episodes that are primary and do not remit with abstinence. Additional use of other drugs may increase the risk of depression in alcoholics.[41] Depressive episodes with an onset prior to heavy drinking or those that continue in the absence of heavy drinking are typically referred to as "independent" episodes, whereas those that appear to be etiologically related to heavy drinking are termed "substance-induced".[42][43][44]

Social effects
The social problems arising from alcoholism can be massive and are caused in part due to the serious pathological changes induced in the brain from prolonged alcohol misuse and partly because of the intoxicating effects of alcohol.[33] Being drunk or hung over during work hours can result in loss of employment, which can lead to financial problems including the loss of living quarters. Drinking at inappropriate times, and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior. An alcoholic’s behavior and mental impairment while drunk can profoundly impact surrounding family and friends, possibly leading to marital conflict and divorce, or contributing to domestic violence. This can contribute to lasting damage to the emotional development of the alcoholic’s children, even after they reach adulthood. The alcoholic could suffer from loss of respect from others who may see the problem as self-inflicted and easily avoided.

Alcohol withdrawal
Main article: Alcohol withdrawal syndrome
Alcohol withdrawal differs significantly from most other drugs in that it can be directly fatal. For example it is extremely rare for heroin withdrawal to be fatal. When people die from heroin or cocaine withdrawal they typically have serious underlying health problems which are made worse by the strain of acute withdrawal. An alcoholic, however, who has no serious health issues, has a significant risk of dying from the direct effects of withdrawal if it is not properly managed. Drugs which have a similar mechanism of action to alcohol also have a similar risk of causing death during withdrawal, including barbiturates and benzodiazepines.

Alcohol’s primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. Thus when alcohol is stopped, especially abruptly, the person’s nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include anxiety, life threatening seizures, delirium tremens and hallucinations, shakes and possible heart failure.

Acute withdrawal symptoms tend to subside after 1 – 3 weeks. Less severe symptoms (e.g. insomnia and anxiety) may continue as part of a post withdrawal syndrome gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system makes adaptations to reverse tolerance and restore GABA function towards normal. Other neurotransmitter systems are involved, especially glutamate and NMDA.

Treatments
Treatments for alcoholism are quite varied because there are multiple perspectives for the condition itself. Those who approach alcoholism as a medical condition or disease recommend differing treatments than, for instance, those who approach the condition as one of social choice.

Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support in order to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed in order to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. The treatment community for alcoholism typically supports an abstinence-based zero tolerance approach; however, there are some who promote a harm-reduction approach as well.[16]

Effectiveness
When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.[45] A year after completing a rehab program, about a third of alcoholics are sober, an additional 40 percent are substantially improved but still drink heavily on occasion, and a quarter have completely relapsed.[46]

Detoxification
Main article: Alcohol 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.

Detoxification 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. These rehabilitations (or ‘rehabs’) may take place in an inpatient or outpatient setting.

Group therapy and psychotherapy
 
A regional service center for Alcoholics Anonymous.After detoxification, various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as provide relapse prevention skills.

The mutual-help group-counselin

g approach is one of the most common ways of helping alcoholics maintain sobriety. Many organizations have been formed to provide this service. Alcoholics Anonymous was the first group, and has more members than all other programs combined. Some of the others include LifeRing Secular Recovery, Rational Recovery, SMART Recovery, and Women For Sobriety.

Rationing and moderation
Rationing and moderation programs such as Moderation Management and DrinkWise do not mandate complete abstinence. While most alcoholics are unable to limit their drinking in this way, some return to moderate drinking. A 2002 U.S. study by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed that 17.7% of individuals diagnosed as alcohol dependent more than one year prior returned to low-risk drinking. However, this group showed fewer initial symptoms of dependency.[47] A follow-up study, using the same NESARC subjects that were judged to be in remission in 2001-2002, examined the rates of return to problem drinking in 2004-2005. The major conclusion made by the authors of this NIAAA study was "Abstinence represents the most stable form of remission for most recovering alcoholics".[48]

Medications
A variety of medications may be prescribed as part of treatment for alcoholism.

Antabuse (disulfiram) prevents the elimination of acetaldehyde, a chemical the body produces when breaking down ethanol. Acetaldehyde itself is the cause of many hangover symptoms from alcohol use. The overall effect is severe discomfort when alcohol is ingested: an extremely fast-acting and long-lasting uncomfortable hangover. This discourages an alcoholic from drinking in significant amounts while they take the medicine. A recent 9-year study found that incorporation of supervised disulfiram and a related compound carbamide into a comprehensive treatment program resulted in an abstinence rate of over 50%.[49]
Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. Alcohol releases endorphins, hence when naltrexone is in the body drinkers no longer get any pleasure from consuming alcohol. Naltrexone is used in two very different forms of treatment. The first treatment uses naltrexone to decrease cravings for alcohol and encourage abstinence. The other treatment, called pharmacological extinction, combines naltrexone with normal drinking habits in order to reverse the endorphin conditioning that causes alcohol addiction. This results in a reduced desire to drink that persists after naltrexone use is discontinued, as long as the patient always takes naltrexone before drinking.
Naltrexone comes in two forms. Oral naltrexone (originally but no longer available as the brand ReVia) is a pill that must be taken one hour before drinking to be effective. Vivitrol is a time-release formulation that is injected in the buttocks once a month.
Acamprosate (also known as Campral) is thought to stabilize the chemical balance of the brain that would otherwise be disrupted by alcoholism. The Food and Drug Administration (FDA) approved this drug in 2004, saying "While its mechanism of action is not fully understood, Campral is thought to act on the brain pathways related to alcohol abuse… Campral proved superior to placebo in maintaining abstinence for a short period of time…"[50] The COMBINE study was unable to demonstrate efficacy for Acamprosate.[51]
Topiramate (brand name Topamax), a derivative of the naturally occurring sugar monosaccharide D-fructose, has been found effective in helping alcoholics quit or cut back on the amount they drink. In one study heavy drinkers were six times more likely to remain abstinent for a month if they took the medication, even in small doses.[52][53] In another study, those who received topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received the placebo.[54] Evidence suggests that topiramate antagonizes excitatory glutamate receptors, inhibits dopamine release, and enhances inhibitory gamma-aminobutyric acid function. A 2008 review of the effectiness of topiramate concluded that the results of published trials are promising, however at this time, data are insufficient to support using topiramate in conjunction with brief weekly compliance counseling as a first-line agent for alcohol dependence. [55]

Dual addictions
The AMA definition of alcoholism refers to a disease entity involving the use of alcohol and any cross-tolerant sedative-hypnotic, including barbiturates and benzodiazepines. As discussed above, the DSM-IV definition of alcohol dependence refers to alcohol only, and DSM-IV uses sedative dependence to refer to the disease entity involving non-alcohol sedative agents. Alcoholics may also require treatment for other psychotropic drug addictions. The most common dual addiction in alcohol dependence is a benzodiazepine dependence with studies showing 10 – 20% of alcohol dependent individuals having problems of dependence and/or misuse problems of benzodiazepines. Note that using alcoholism’s definition, there is no dual addiction if one uses both alcohol and any solid sedative. Dependence on other sedative hypnotics such as zolpidem and zopiclone as well as opiates also occurs as well as illegal drugs. Benzodiazepine withdrawal can like alcohol be medically severe and include the risk of psychosis and seizures if not managed properly.[56] Benzodiazepine dependency requires careful reduction in dosage to avoid a serious benzodiazepine withdrawal syndrome and health consequences. Benzodiazepines have the problem of increasing cravings for alcohol in problem alcohol consumers. Benzodiazepines also increase the volume of alcohol consumed by problem drinkers.[57]

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Women and alcoholism
Alcoholism has a higher prevalence among men, though in recent decades, the proportion of female alcoholics has increased.[58] It is important to articulate the different biological and social ways alcoholism manifests in women in order to understand barriers to treatment and effective recovery strategies.

Biological differences and physiological effects
Biologically, women have symptom profiles from their alcohol use that differ in important ways from men. They experience a telescoping of physiological effects from alcohol use. Equal dosages of alcohol consumed by men and women generally result in women having higher blood alcohol concentrations (BACs).[59] This can be attributed to many reasons, the main being that women have less body water than men. A given amount of alcohol, therefore becomes more highly concentrated in a woman’s body. Besides this fact, women also become more intoxicated, which is due to different hormone release.[60]

Women develop long-term complications of alcohol dependence more rapidly than do alcoholic men. Additionally, women have a higher mortality rate from alcoholism than men.[61] Examples of long term complications include brain, heart, and liver damage[62] and an increased risk for breast cancer. Additionally, heavy drinking over time has been found to have a negative effect on reproductive functioning in women. This results in reproductive dysfunction such as anovulation, decreased ovarian mass, irregular menses, amenorrhea, luteal phase dysfunction, and early menopause.[63]

Psychological and emotional effects
Psychiatric disorders are generally more prevalent among those with alcohol disorders. This is true for both men and women, however the disorders differ depending on gender. Women who have alcohol-use disorders have co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men wi

th alcohol-use disorders more often have co-occurring diagnosis of narcissistic and antisocial personality disorders, bipolar disorder, schizophrenia, impulse disorders and attention deficit/ hyperactivity disorder.[64]

Women with alcoholism are also more likely to have a history of physical or sexual assault, abuse and domestic violence than those in the general population.[65] This trauma can lead to higher instances of PTSD, depression, anxiety, and a greater dependence on alcohol.

Societal barriers to treatment
Attitudes and social stereotypes about women and alcohol can create barriers to the detection and treatment of female alcohol abusers. Such beliefs stigmatize women who drink by characterizing them as "both generally and sexually immoral" or the "fallen women." Fear of stigmatization may lead women to deny that they are suffering from a medical condition, to hide their drinking, and to drink alone. This pattern, in turn, leads family, physicians, and others to be less likely to suspect that a woman they know is an alcoholic.[66]

In contrast, attitudes and social stereotypes about men and alcohol can lower barriers to the detection and treatment of male alcohol abusers. Such beliefs reward men who drink by characterizing them as "both generally and sexually moral" or the "risen men." Reduced fear of stigma may lead men to admit that they are suffering from a medical condition, to publicly display their drinking, and to drink in groups. This pattern, in turn, leads family, physicians, and others to be more likely to suspect that a man they know is an alcoholic.

Women also tend to have a greater fear that the negative implications from the stigma will reflect poorly on their families. This may also keep them from seeking help.[67]

Therefore, men also tend to have less fear that the negative implications from the stigma will reflect poorly on their families. This may encourage them to seek help.

Implications for treatment
Research has indicated a lack of adequate training for practitioners both in problematic alcohol use in general, and in relation to women’s issues.[68] The complexity of alcohol use disorders, particularly with gender-related issues, indicates that the need for practitioners’ knowledge, insight and compassion is enormous.[69] Better education and awareness surrounding the gender implications of alcoholism will help care providers to adequately treat women who suffer from alcoholism. Early intervention will also increase the probability of recovery.

Societal impact
The various health problems associated with long-term alcohol consumption are generally perceived as detrimental to society, for example, money due to lost labor-hours, medical costs, and secondary treatment costs. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. Beyond money, there is also the pain and suffering of the individuals besides the alcoholic affected. For instance, alcohol consumption by a pregnant woman can lead to Fetal alcohol syndrome,[70] an incurable and damaging condition.[71]

Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country’s GDP.[72] One Australian estimate pegged alcohol’s social costs at 24 per cent of all drug abuse costs; a similar Canadian study concluded alcohol’s share was 41 per cent.[73]

A study quantified the cost to the UK of all forms of alcohol misuse as £18.5–20 billion annually (2001 figures).[17][74]

Stereotypes
 
Depiction of a wino or town drunkStereotypes of alcoholics are often found in fiction and popular culture. The ‘town drunk’ is a stock character in Western popular culture.

Stereotypes of drunkenness may be based on racism or xenophobia, as in the depiction of the Irish as heavy drinkers.[75][76] In Australia, Canada, and the United States, Aboriginal people have similarly been stereotyped as alcoholics.

On the other hand, studies by social psychologists Stivers and Greeley[77] attempt to document the perceived prevalence of high alcohol consumption amongst the Irish in America.

Alcohol related crime
See also: drug-related crime
Of the adult population at least three- fourths are drinkers, so about 6 percentage of the total group. The alcoholism rate runs about 8 percent to 12.Many reports state that about 73 percent of felonies are alcohol-related. A survey shows that in about 67 percent of child-beating cases, 41 percent of forcible rape cases, 80 percent of wife-battering, 72 percent of stabbings, and 83 percent of homicides, either the attacker or the victim or both had been effected by drinking. If we include alcohol abusers the best estimate is 10.5 of the working Americans.[78]–Cassie100 (talk) 15:02, 22 June 2009 (UTC)

In film and literature
In modern times, the recovery movement has led to more realistic depictions of problems that stem from heavy alcohol use. Authors such as Charles R. Jackson and Charles Bukowski describe their own alcohol addiction in their writings. The disjoined narrative of Patrick Hamilton’s Hangover Square reflects the alcoholism of its central character. A famous depiction of alcoholism, and the psychology of an alcoholic, is in Malcolm Lowry’s widely acclaimed novel Under the Volcano, which details the final day of the British consul Geoffrey Firmin on the Day of the Dead in 1939 Mexico and his choice to continue his extreme alcohol consumption instead of returning to the wife he loves.

Films like Bad Santa, Days of Wine and Roses, My Name is Bill W., Withnail and I, Arthur, Leaving Las Vegas, Shattered Spirits and The Lost Weekend, chronicle similar stories of alcoholism.

Politics and public health
Because alcohol use disorders are perceived as impacting society as a whole, governments and parliaments have formed alcohol policies in order to reduce the harm of alcoholism. The World Health Organization, the European Union and other regional bodies are working on alcohol action plans and programs.

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Drug rehabilitation, for dependency on psychoactive substances such as alcohol, prescription drugs, and illicit drugs such as cocaine, heroin or amphetamines

Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or amphetamines. The general intent is to enable the patient to cease substance abuse, in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme

Two-fold nature
Drug rehabilitation tends to address a stated twofold nature of drug dependency: physical and psychological dependency. Physical dependency involves a detoxification process to cope with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal or otherwise, the brain gradually adapts to the presence of the drug so the desired effect is minimal. Apparently normal functioning of the user may be observed, despite being under the influence of the drug. This is how physical tolerance develops to drugs such as heroin, amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed to get the same effect with regular use. The abrupt cessation of taking a drug can lead to withdrawal symptoms where the body may take weeks or months (depending on the drug involved) to return to normal.

 Psychological dependency
Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment. In particular, patients are generally encouraged or required not to associate with friends who still use the addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol or other drugs, but to examine and change habits related to their addictions. Many programs emphasize recovery is a permanent process without culmination. For legal drugs such as alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse—is also emphasized ("One is too many, and a thousand is never enough.") Whether moderation is achievable by those with a history of abuse remains a controversial point but is generally considered unsustainable.

Types of treatment
Various types of programs offer help in drug rehabilitation, including: residential treatment (in-patient), out-patient, local support groups, extended care centers, and recovery or sober houses. Newer rehab centers offer age and gender specific programs.[1]

In a survey of treatment providers from three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring the treatment provider’s responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics AA identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider’s responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or the free-will model addiction).[2]

Pharmacotherapies
Certain opioid medications such as methadone and more recently buprenorphine are widely used to treat addiction and dependence on other opioids such as heroin, morphine or oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of stabilizing an abnormal opioid system and used for long durations of time though both may be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an experimental medication proposed to interrupt both physical dependence and psychological craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some antidepressants also show use in moderating drug use, particularly to nicotine, and it has become common for researchers to re-examine already approved drugs for new uses in drug rehabilitation.

 Criminal justice
Drug rehabilitation is sometimes part of the criminal justice system. People convicted of minor drug offenses may be sentenced to rehabilitation instead of prison, and those convicted of driving while intoxicated are sometimes required to attend Alcoholics Anonymous meetings. There have been lawsuits filed, and won, regarding the requirement of attending Alcoholics Anonymous and other twelve-step meetings as being inconsistent with the Establishment Clause of the First Amendment of the U. S. Constitution, mandating separation of church and state.[3][4]

 Diseased person model
Some psychotherapists question the validity of the "diseased person" model used within the drug rehabilitation environment. Instead, they state the individual person is entirely capable of rejecting previous behaviors. Further, they contend the use of the disease model of addiction simply perpetuates the addicts’ feelings of worthlessness, powerlessness, and inevitably causes inner conflicts that could be resolved if the addict were to approach addiction as behavior that is no longer productive, the same as childhood tantrums.

Counseling
Traditional addiction treatment is based primarily on counseling. However, recent discoveries have shown those suffering from addiction often have chemical imbalances that make the recovery process more difficult.

 Historical Approaches to Substance Abuse Treatment

Disease Model and Twelve-Step Programs
The disease model of addiction has long contended the maladaptive patterns of alcohol and substance use displayed by addicted individuals are the result of a lifelong disease that is biological in origin and exacerbated by environmental contingencies. This conceptualization renders the individual essentially powerless over his or her problematic behaviors and unable to remain sober by himself or herself, much as individuals with a terminal illness are unable to fight the disease by themselves without medication. Behavioral treatment, therefore, necessarily requires individuals to admit their addiction, renounce their former lifestyle, and seek a supportive social network who can help them remain sober. Such approaches are the quintessential features of Twelve-step programs, originally published in the book Alcoholics Anonymous in 1939 [5]. These approaches have met considerable amounts of criticism, coming from opponents who disapprove of the spiritual-religious orientation on both psychological [6] and legal [7] grounds. Nonetheless, despite this criticism, outcome studies have revealed that affiliation with twelve-step programs predicts abstinence success at 1-year follow-up [8].

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Client-Centered Approaches
In his influential book, Client-Centered Therapy, in which he presented the client-centered approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary and sufficient conditions for personal change: unconditional positive regard, accurate empathy, and genuineness. Rogers believed the presence of these three items in the therapeutic relationship could help an individual overcome any troublesome issue, including alcohol abuse. To this end, a 1957 study [9] compared the relative effectiveness of three different psychotherapies in treating alcoholics who had been committed to a state hospital for sixty days: a therapy based on two-factor learning theory, client-centered therapy, and psychoanalytic therapy. Though the authors expected the
two-factor theory to be the most effective, it actually proved to be deleterious in outcome. Surprisingly, client-centered therapy proved most effective. It has been argued, however, these findings may be attributable to the profound difference in therapist outlook between the two-factor and client-centered approaches, rather than to client-centered techniques per se [10]. The authors note two-factor theory involves stark disapproval of the clients’ “irrational behavior” (p. 350); this notably negative outlook could explain the results.as in some other cases

 Psychoanalytic Approaches
Psychoanalysis, a psychotherapeutic approach to behavior change developed by Sigmund Freud and modified by his followers, has also offered an explanation of substance abuse. This orientation suggests the main cause of the addiction syndrome is the unconscious need to entertain and to enact various kinds of homosexual and perverse fantasies, and at the same time to avoid taking responsibility for this. It is hypothesised specific drugs facilitate specific fantasies and using drugs is considered to be a displacement from, and a concomitant of, the compulsion to masturbate while entertaining homosexual and perverse fantasies. The addiction syndrome is also hypothesised to be associated with life trajectories that have occurred within the context of traumatogenic processes, the phases of which include social, cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of self-soothing. [11] Such an approach lies in stark contrast to the approaches of social cognitive theory to addiction—and indeed, to behavior in general—which holds human beings regulate and control their own environmental and cognitive environments, and are not merely driven by internal, driving impulses. Additionally, homosexual content is not implicated as a necessary feature in addiction.

 Cognitive Models of Addiction Recovery

 Relapse Prevention
An influential cognitive-behavioral approach to addiction recovery and therapy has been Alan Marlatt’s (1985) Relapse Prevention approach. [12]. Marlatt describes four psychosocial processes relevant to the addiction and relapse processes: self-efficacy, outcome expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to one’s ability to deal competently and effectively with high-risk, relapse-provoking situations. Outcome expectancies refer to an individual’s expectations about the psychoactive effects of an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs relapse to drug use is a result of internal, or rather external, transient causes. Finally, decision-making processes are implicated in the relapse process as well. Substance use is the result of multiple decisions whose collective effects result in consumption of the intoxicant. Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions—may seem inconsequential to relapse, but may actually have downstream implications that place the user in a high-risk situation.

Consider Figure 1 as an example. As a result of heavy traffic, a recovering alcoholic may decide one afternoon to exit the highway and travel on side roads. This will result in the creation of a high-risk situation when he realizes he is inadvertently driving by his old favorite bar. If this individual is able to employ successful coping strategies, such as distracting himself from his cravings by turning on his favorite music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of positive outcomes will increase, and he may experience a lapse—an isolated return to substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation Effect, characterized by guilt for having gotten intoxicated and low efficacy for future abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to full-blown relapse. Figure 1 presents a schematic diagram, adapted from Marlatt & Gordon (p. 38) [12], which has been modified to present examples of the cognitive and behavioral processes that may occur at each juncture of the model.

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 Cognitive Therapy of Substance Abuse
An additional cognitively-based model of substance abuse recovery has been offered by Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive Therapy of Substance Abuse.[13] This therapy rests upon the assumption addicted individuals possess core beliefs, often not accessible to immediate consciousness (unless the patient is also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive beliefs that result in imagined anticipatory benefits of substance use and, consequentially, craving. Once craving has been activated, permissive beliefs (“I can handle getting high just this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then the individual will activate drug-seeking and drug-ingesting behaviors. The cognitive therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and thereby demonstrate its dysfunctionality. As with any cognitive-behavioral therapy, homework assignments and behavioral exercises serve to solidify what is learned and discussed during treatment.

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Emotion Regulation, Mindfulness, and Substance Abuse
A growing literature is demonstrating the importance of emotion regulation in the treatment of substance abuse. For the sake of conceptual uniformity, this section uses the tobacco cessation as the chief example; however, since nicotine and other psychoactive substances such as cocaine activate similar psychopharmacological pathways, [14] an emotion regulation approach may be similarly applicable to a wider array of substances of abuse. Proposed models of affect-driven tobacco use have focused on negative reinforcement as the primary driving force for addiction; according to such theories, tobacco is used because it helps one escape from the undesirable effects of nicotine withdrawal or other negative moods. [15] Currently, research is being conducted to determine the efficacy of mindfulness based approaches to smoking cessation, in which patients are encouraged to identify and recognize their negative emotional states and prevent the maladaptive, impulsive/compulsive responses they have developed to deal with them (such as cigarette smoking or other substance use). [16]

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Understanding Stress

What is stress? Signs, Symptoms, Causes, and Effects

Modern life is full of hassles, deadlines, frustrations, and demands. For many people, stress is so commonplace that it has become a way of life. Stress isn’t always bad. In small doses, it can help you perform under pressure and motivate you to do your best. But when you’re constantly running in emergency mode, your mind and body pay the price.

If you frequently find yourself feeling frazzled and overwhelmed, it’s time to take action to bring your nervous system back into balance. You can protect yourself by learning how to recognize the signs and symptoms of stress and taking steps to reduce its harmful effects.