Some Experiences..

Advertisements on TV show that alcohol & tobacco bring in lot of joy, happiness, succees and makes a person look smart. We also often see people enjoying in parties. But the damage and pain which they cause in people’s lives, occurs outside the field of vision of most people and doesn’t receive any publicity on TV. So here are a few snippets from real life, so that one can judge for himself, what is the impact of these addictions in people’s lives?

( you can also share with us an experience of these addictive poisons which you have undergone or witnessed. We will post with or without your name or per your wish. Collectively let us build the awareness.)

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There was a Chief Medical Officer in a hospital. Used to drink alcohol to enjoy quite regularly. After some years, he used to be seen in the campus in shabby clothes, begging to various medical students and his Professor friends for some money, giving silly excuses…. He had become the laughing stock in the campus. Alcohol may have given him great joy for many years. But now it had taken away his job, his respect, his everything…

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A particular gentleman used to drink occasionally in parties without it causing any trouble to him or his family. His family was very happy with him. One day while returning from a party, his judgement failed and he met with an accident. He was treated in ICU for 2 weeks. As he was drunk, the insurance company did not pay his bills. The family lost 10 lakhs. And after his deaths, now they have given one room on paying guest basis and his wife now runs a mess at home to manage the house finances….. No one in his family had imagined that just party drinking can have such devastating implications! (shared by Dr. Dharav Shah)

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There was a medical student in a particular college who binged in a party –> vomited in the night –> under intoxication aspirated the vomitus into the lungs –> Was immediately shifter to the ICU but died in few days (Shared by Dr. Shreyas Godbole, Mumbai)

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Another student of a medical college binged in a party and then drove back on his bike. Ended up speeding and banged against a pole. His head got chopped off and fell on the other side of the road. Died Instantly. (Shared by Mr. Prajwal, a medical student)

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A medical friend of mine told me one day morning, “Yesterday night after the party, I didn’t know where my bike was going. Thank God, no one died!” (Shared by Dr. Dharav Shah)

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A medical friend of mine was returning from a party intoxicated. He was trying to talk to a beggar sitting on the road. The beggar got frightened of him and ran away. He tried to explain his positive intentions and tried to follow him. Happened to drop his wallet and cell in the whole process… Luckily for him we were there to pick them up :-) (Shared by Dr. Dharav Shah)

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A 42 yrs old, apparently healthy male in my building, who used to go for walking daily, died of a sudden heart attack. Everyone was shocked how can he get a heart attack. The whole building knew that he had a habit of chewing gutkha. But because no one knew the association, they couldn’t understand…Similarly, because our knowledge about alcohol and tobacco is restricted to liver damage and cancer, we are not aware of the pain, suffering and deaths that they are causing all around us. (Shared by Dr. Taru Jindal, Mumbai)

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One of my very good friend’s father, a surgeon, was a smoker and died at the age of 35 due to a heart attack. My friend had to grow up without a father. (Shared by Dr. Dharav Shah)

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There was a person who got job in Dubai; celebrated that by drinking with friends, next day morning while driving back home misjudged at the turn, both his legs were cut  job was lost and his engagement was broken… (Shared by Dr. Dharav Shah)

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In a particular psychiatry set up, resident doctors decided to have a party in the night and drink. Next day, the morning notes were not put for any patient. The consultant came and found the file of 1st patient without any notes for that day. He patiently wrote the notes himself. On opening the 2nd file he found the same thing….checked that the state was same in all the files….threw the files to the ground and left the ward…. (A huge proportion of work absenteeism is due to alcohol consumption in parties. And this is applicable to people of all socio-economic strata). (Shared by Dr. Dharav Shah)

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In a particular unit in a gynecology department of a medical college, all male residents would drink in parties. So most of the new residents who joined also started drinking. Those who were taking it the 1st time ended up drinking excessively. Their lecturer scolded them and said something like, “You don’t have to drink like an illiterate person like this; look at me. Learn to drink in control like a gentleman”. After few months, that unit faced an emergency in the operation theatre. So the residents called up the lecturer. But his phone was switched off. One of them ran around the campus to find him and finally found him in his friend’s room intoxicated; not in a position to be of any use for the emergency. This person who took pride in his controlled drinking was intoxicated on his emergency duty day and couldn’t discharge his duty… However he continued with his ‘controlled’ drinking, till I was there in the hospital….

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Understanding tobacco – going beyond cancer…

We call it one of the biggest enemies of mankind, because

  • Tobacco is the largest cause of preventable premature deaths across the world!
  •  10% of premature male deaths in age bracket of 30-44 yrs and 19% of premature male deaths in age bracket of 45-59 yrs are attributable to tobacco use!   (WHO Global Report, mortality attributable to tobacco, 2012)
  • On an average, tobacco smokers end up dying around 10 years earlier than non-smokers!

These premature deaths are very painful for the family members to accept; because a lot of active life years are lost and because these death were avoidable. Also, the person has to undergo pain and disability for a lot of months before death finally arrives…

 

Sounds impossible! But these statistics have been derived from large, authentic studies. Have a look at some of them:

  1. In a 20 yrs prospective study of over 1 million people, conducted by the American Cancer Society, in 1960s, tobacco alone was found responsible for:

30% of Cancer deaths

22% of deaths due to heart attacks

27% of deaths due to strokes and

72% of deaths due to COPDs (Chronic obstructive lung diseases).

Just imagine, the prevalence of cancers can decrease by 30% in 1 shot; if only mankind gave up its habit of using tobacco !

  1. After 1965, with increasing awareness about its dangers, its use has decreased significantly. But still as per 2004 statistics: In men,

    most oral cancers

    78% lung cancers

    16% heart attacks

    10% deaths due to brain strokes

    9% of TB deaths and

    49% of deaths due to COPDs (chronic obstructive pulmonary diseases – diseases resulting from damage to the internal structure of lungs)

    are attributable to tobacco! Infact 50% of premature heart attacks in males (age group 30-44yrs) are attributable to tobacco!

    -          WHO global report: mortality attributable to tobacoo. WHO, 2012.

     

  2.  According to a 50 year follow up study on British doctors, more than half of the long term tobacco smoking doctors (>50%) died earlier than their expected life span! On an average they lost 10 years compared to non-smokers. Those who died in middle life lost around 20 years.

  1. According to a huge study, which included 11 lakh homes from different parts of India,

  • Smoking is responsible for 20% male deaths and for 5% female deaths which occur prematurely between the ages of 30 and 69 years.
  • For men, the rate of premature deaths in smokers was 1.7 times that in nonsmokers of similar age, educational level and alcohol status. For women who smoked, the chances of a premature death got doubled
  • With increasing severity of smoking, the risk of premature death also increases. This dose response relationship is a strong proof of the causative association between smoking & deaths.

    Dose per day

    Relative risk of premature death

    1-7 bidis /day

    1.3
    ≥ 8 bidis /day

    2.2

  1. Dose per day

    Relative risk

    of premature death

    1-7cigarettes /day

    1.8

     ≥8 cigarettes /day

    2.9

    Oral Cancer: It is a rare cancer in western countries.However in India, because of our favourite habit of chewing tobacco & supari, it has become the most common cancer! India has become the oral cancer capital of the world; with 86% of the world’s cases recorded in our country! (Remember supari is also carcinogenic, not just tobacco.) Tobacco damages the genes. This leads to uncontrolled cell division, giving rise to various cancers.

  1. Besides oral and lung cancers, tobacco is responsible for a large proportion of cancers of upper respiratory tract, oesophagus, urinary bladder, kidney, pancreas, blood cells & stomach also.

  1. 50% of the heart attacks occurring in young males in the age group of 30-44years are just because of tobacco!

Alcohol and tobacco damage the inner lining of arteries, making them more prone for deposition of cholesterol, hardening and narrowing – a process called atherosclerosis. This ultimately results in the arteries getting blocked completely. When the artery to the heart is blocked and the heart muscle dies out, we call it a heart attack.

  1. Smoking damages the lungs badly. And then the damaged lungs easily catch various infections. Hence deaths from tuberculosis, pneumonia, etc. are common in smokers.

  1. Tobacco alone causes more than 10,00,000 deaths/ year in India! What is more disturbing is that 10% of these, i.e. 1,00,000 deaths are amongst innocent near & dear ones of smokers due to passive smoking!

You might be getting a question which I had got – If tobacco and alcohol are such big killers, how come we don’t know about it? This is because:

1. Our awareness about tobacco is limited to oral & lung cancer and our awareness about alcohol is limited to liver cirrhosis: Besides cancer, tobacco kills through many other diseases also; like COPDs (emphysema, bronchitis, etc.), heart attacks, brain strokes, TB, pneumonia, etc. It causes cancers of many organs like lung, mouth, oesophagus, stomach, kidney, liver, urinary bladder, cervix, blood, etc. What the mind doesn’t know, the eyes don’t see! Because we are not aware about all these causes, we dont realise the magnitude of deaths tobacco is causing. 

2. Because there is a lag period between the onset of regular smoking and the resulting death.Yes, It doesn’t kill immediately; but studies have proven beyond doubt that it kills for sure. And be it cancer, heart disease, stroke, or respiratory disease – its a slow painful death involving a lot of pain, disability and dependency.

3. Dead bodies cant speak: People who take alcohol & tobacco keep claiming for many years that they have not had any health consequences because of their addiction. However, after they get struck by a disease they don’t keep publicising their pain with equal enthusiasm and after they die their souls are not able to communicate with us what happened! Consequently, the damage done by these addictive poisons doesn’t come to our attention; unless we are working in a hospital.

Another interesting paradox about tobacco is that though it is regarded to be a minor addiction by most Indians, it is the most addictive and all other drugs!

According to values given in Stephen Stahl’s Textbook of Psychopharmacology, one of the most authoritative textbooks in Psychiatry, Out of every 100 people who touch addictive substances, percentage of people who get trapped in the addiction is as follows:

Substance

Percentage of people who get addicted on using it

Alcohol

15%

Cocaine

17%

Heroin

23%

Tobacco

32%

Inspite of tobacco being the most addictive substance known to mankind and inspite of it killing so many people 47% adult males in our country take it!! Are they fools? I don’t think so. Its sheer lack of ignorance about what this addictive poison actually is; because of which people themselves give tobacco to their near & dear ones.

Is it not the duty of the educated class to take these facts to our less privileged brothers & sisters in India; and protect them from this addictive poison?

Ever imagined how many people get killed by our “cool party drink” ??

1 person every 10 seconds !!

Can’t believe it??

Read the facts below given in WHO – Global status report on alcohol, 2014

  • Alcohol caused around 33,00,000 deaths in 2012, which is more than the deaths caused by AIDS, tuberculosis and violence combined!
  • Alcohol caused 7.6% of all global male deaths and 4.0% of female deaths!
  • We find this surprising because liver cirrhosis is the only mode of death which we generally associate with alcohol. But in reality, liver cirrhosis accounts for just 15% of the alcohol attributable deaths.
  • Distribution of alcohol-attributable deaths, as a percentage of all alcohol-attributable
    deaths by broad disease category, 2012
  • Alcohol caused around 33,00,000 deaths in 2012, which is more than the deaths caused by AIDS, tuberculosis and violence combined!
  • Alcohol caused 7.6% of all global male deaths and 4.0% of female deaths!
  • We find this surprising because liver cirrhosis is the only mode of death which we generally associate with alcohol. But in reality, liver cirrhosis accounts for just 15% of the alcohol attributable deaths.

Distribution of alcohol-attributable deaths, as a percentage of all alcohol-attributable deaths by broad disease category, 2012

         Mode of death Proportion of deaths attributable to alcohol
Heart attacks 33.4 %
Unintentional injuries

(Accidents, falls, drownings, hypothermia, choking, animal bites, etc.)

17.1 %
Liver Cirrhosis & pancreatitis 16.2%
Cancers 12.5 %
Intentional injuries

(Murders, suicides)

8.7 %
Infectious diseases (TB, HIV/ AIDS, etc.) (due to decreased immune capacity) 8.0 %
Neuropsychiatric disorders

(Epilepsy, strokes, alcohol use disorders)

4.0 %
Fetal alcohol syndrome 0.1 %

                                                                                        (WHO Global status report on alcohol, 2014)

So while you think of alcohol, keep in mind that Unintentional injuries, heart attacks, strokes & cancers are also common ways in which it kills us.

 

Even in developed countries, alcohol has been consistently found to be the cause of a huge proportion of road traffic accidents…..

Percentage of all road traffic accident fatalities involving alcohol

2001

2004

2007

2008

2009

France

31%

31%

30%

28%

USA

41%

40%

38%

37%

38%

Cananda

30%

31%

32%

34%

32%

                                   ( Source: WHO Global Information System on Alcohol and Health)

Someone will ask, “why to blame the poor alcohol for the accidents/ rapes/ murder which irresponsible people do?” Yes, alcohol is not the sole factor responsible for these crimes. But it is a major contributor in a large proportion of these crimes. It is physiological property of alcohol to impair your eye-motor co-ordination and to impair your judgement – your sense of right & wrong. Being its physiological property, these effects are bound to be seen in anyone who drinks it. Anyone who drives under intoxication is bound to make accidents. In the Delhi gang rape case, intoxicated men got crazy enough to shove a rod up into the vagina. But later when out of intoxication, one of them committed suicide and another accepted before court that for the kind of crime he has done, he deserves to be hanged till death. There are a lot of husbands who assault their wives only on the days that they are drunk and never when they are not drunk! Hence, these crimes are attributable to alcohol.

 

Like tobacco, alcohol also causes a lot of cancer deaths… It has been established in scientific studies that alcohol causes cancers of mouth, pharynx, larynx, esophagus, colon-rectum, liver & breast.

 

As per WHO, around 22% of all suicide deaths and 22% of deaths due to violence are due to alcohol!

The issue of farmers suicide has received a lot of attention recently. But not many are aware that behind a lot of farmer suicides, alcohol addiction is a bigger reason than crop failure. A person who is trapped in this addiction is frequently absent at work, soon loses his professional skills and ultimately loses his job. However, the expenditure over alcohol & the illnesses it brings continue. Soon the family loses all their property & savings and ends up under a debt. This along with the domestic violence which accompanies it, makes life hell for the entire family. Suffocated by the inability to come out of the addiction and ashamed of himself, the person starts finding suicide to be the best solution. Or frustrated by the violence & poverty, the wife takes that route.

 

According to ‘Global burden of Disease, injury and risk factors study, 2010’,

  • Alcohol has now become 3rd leading risk factor for death & disability!
  • In the young age group of 15-49 yrs, it has become the most common risk factor for death & disability!
  • Proportion of alcohol-related DALYs lost (disease burden) rose from 3.5% to 5.5% over the past 20 year period

And yet alcohol continues to be perceived as a harmless party drink even by the well-educated! Paradoxically, centres of higher education are becoming breeding grounds for the spread of substance abuse! Increasingly, the heroines in films are shown to be drinking alcohol. Till now only drinking amongst males was being normalised through marketing strategies. Now as female drinking is also being projected as normal; young girls are also getting tempted to experiment with it in large numbers. One market analyst told us that, the sector of alcohol consumption by women in India is claimed to be growing at a rate of 40-45% every year!

 

Hence it is has become very imperative that we empower ourselves and youngsters around us with above mentioned research evidence.

Understanding the tobacco epidemic – Going beyond Cancer

This talk is part of the HELP Talk series at HELP, Health Education Library for People, the worlds largest free patient education library.

Speaker: Dr. Dharav Shah, Consultant Psychiatrist, DPM, MD (NIMHANS)
Organised by: HELP – Health Education Library for People
Date: 27-February-2010
Dr.Dharav Shah can be contacted on dharavshah@gmail.com

Part 1:

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