Nicotine Vapor Now Regulated with Tobacco

Nicotine Vapor Now Regulated with Tobacco
Efforts to create electronic cigarettes date from the 1930s. The first commercially successful devices were produced in China in 2003. Electronic cigarettes were introduced to Europe in 2006 and America in 2007. In the United States, regulation of these and similar products became much more stringent in 2016. The Family Smoking Prevention and Tobacco Control Act became law June 22, 2009, and gave the U. S. Food and Drug Administration (FDA) regulatory authority over the manufacture, distribution, and marketing of tobacco products. The FDA has deemed electronic nicotine delivery systems (ENDS) to be tobacco products and issued regulations that affect not only electronic cigarettes (e-cigarettes) but also other devices that produce an inhalable cloud containing atomized nicotine. Initial stipulations took effect August 8, 2016. Additional requirements are scheduled for 2018. Some ENDS resemble conventional means for smoking tobacco, such as e-cigarettes, e-cigars, electronic pipes, and electronic waterpipes. There are also...
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Unnecessary Debate: Is Addiction a Disease?

Unnecessary Debate:  Is Addiction a Disease?
Imagine two stalwart fans of professional wrestling locked in debate. One holds that the wrestlers are athletes. The other argues that they are not athletes but entertainers, performing in a variety of theater. Both fans are thoughtful and persuasive. Notice that their disagreement is not about the physical attributes of professional wrestlers, or about what they do inside and outside the ring. Their disagreement is about how to name, or classify, the group of people who engage in professional wrestling. Professional wrestlers are what they are and do what they do.  Naming and classifying, however, are conceptual, and therefore somewhat arbitrary.  This arbitrariness is no revelation.  As Shakespeare’s Juliet said:  What's in a name? that which we call a rose By any other name would smell as sweet But when debates about classification heat up, people often think and act as if the issues are absolute rather than arbitrary, especially...
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There’s No Such Thing as a Disease

There’s No Such Thing as a Disease
Healthcare providers are charged with helping individuals who come to them with physical, emotional, and behavioral problems.  As they prepare to help, providers usually follow a routine—they get to know the person and their problem(s), examine the person, and, frequently, obtain additional information such as blood tests or x-rays.  Prior to recommending specific treatment, providers “make a diagnosis,” which then guides providers and patients to treatment options relevant to the problem at hand.     Diagnoses are commonly expressed in terms of the manifestations of a problem (hives, for example) or the cause of a problem (for example, penicillin allergy).  Clinicians sometimes make diagnoses quickly and confidently or, at other times, slowly and tentatively.  They may entertain several candidate diagnoses, “the differential diagnosis,” before settling on a provisional, or working, diagnosis.     A biology professor periodically reminded his students, “Variation is the law of life!”  Clinicians can testify to this.  No...
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From Bar to Bars: Links between Alcohol and Crime

From Bar to Bars: Links between Alcohol and Crime
Crimes related to illegal drugs often make headlines—seizures of substances, arrests of drug lords and dealers, and laws broken to support habits. Crimes related to alcohol are also in the news, but we may have to turn to police logs to find them. Yet alcohol is implicated in 56.6 percent of incarcerations in America, which includes 57.7 percent of inmates who committed a violent crime such as murder, forcible rape, robbery, or aggravated assault. Alcohol has more links to crime than any other single drug. ( Behind Bars II: Substance Abuse and America’s Prison Population ). Consumption of alcohol does not in itself cause crime. But alcohol impairs coordination and judgment, which makes driving dangerous, especially for young, inexperienced drinkers. Estimates vary, but some authorities report alcohol-impaired driving contributes to more than 50 percent of motor vehicle crashes and more than 50 percent of highway fatalities. Driving under the influence...
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Best Ways to Chill Out

Best Ways to Chill Out
We pay attention to our senses, which tell us about our bodies and the people and things around us. We notice our thoughts, movements, and feelings. In response to ailments or other concerns, we narrow our attention to particular body regions, organs, or organ systems—back, skin, or digestive tract, for example. But we rarely contemplate the smallest components of our bodies: the cells and molecules. Yet if you wish to chill out, you may want to take into account your brain cells and gamma-aminobutyric acid (GABA)—a chemical messenger that quiets brain cells down—lest your preferred means of chilling leads to consternation rather than relaxation. GABA, a common neurotransmitter in the human brain, inhibits the firing of mature brain cells by making the electrical charge within those cells more negative. Fluids in large and small compartments throughout the body have electrical charges reflecting the net effect of the positive and negative...
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Curbing Addiction Is Everybody’s Business

Curbing Addiction Is Everybody’s Business
Addiction statistics are scary.  For example, excessive alcohol causes an estimated 88,000 deaths per year in the United States.  Deaths from cigarette smoke exceed 480,000 per year.  In 2013, about 100 Americans per day died from drug overdoses.  The annual cost to this country of addiction and other substance abuse—including healthcare, crime, and lost productivity—is over $600 billion. Such damage ought to prompt interventions that are swift and sure, but that is not the case.  Not only have severe social and economic consequences of addiction been with us for a long time; some measures are getting worse. Conflicts of interest impede the prevention and treatment of addiction by inhibiting individuals throughout society from adopting alternative actions that would reduce the toll of addiction.  If we attribute all responsibility for addiction to addicted persons themselves, we are like a naïve family member who says, “It’s your problem.  Take care of it.”...
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The Way of Recovery is Not Alone - Part 2: Spirituality

The Way of Recovery is Not Alone - Part 2:  Spirituality
“Spirituality”—like “love”—has many interpretations.  Some identify spirituality as their personal sense of connection, meaning, and purpose.  Others identify it is an elusive abstraction they have never experienced. Those who equate spirituality with religion and are not religious themselves may assume spirituality is not relevant to them.  But when spirituality is understood as pertaining to all relationships—with self, with other human beings, and with the rest of the universe including nature and any personal sense of God or higher power—then the concept encompasses much more than religion and is unavoidably relevant to everyone.  Special moments with family, pets, sunsets, trees, rocks, music, or sports teams, for example, become identifiable as spiritual experiences. Scientific research as well as personal experience demonstrates that interpersonal relationships may be helpful , harmful , or a combination of the two.  In a similar way, spiritual connections may be positive, negative, or some of each.  At a...
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The Way of Recovery is Not Alone - Part 1: Science

The Way of Recovery is Not Alone - Part 1: Science
Addiction damages what matters most.  Body, family, career, and citizenship are frequent casualties of the compulsive use of alcohol and other drugs.  How human behavior becomes so self-defeating and how affected individuals change for the better has been described from many perspectives.  Two sources we might expect to have differing views about recovery actually illumine the same path. Science and spirituality both point to positive interpersonal relationships as treatment for addiction.  Many therapeutic factors contribute to recovery, but healthy human connections are fundamental.  This Addiction Medicine Update presents a scientific point of view; the next Update , a spiritual one.  Neurobiology of Addiction Lower centers of the central nervous system (limbic system, brain stem, and spinal cord) give rise to a great deal of human behavior, and these lower centers routinely function independently of higher centers (cerebral cortex).  Simple behaviors that don’t require conscious thought include reflexes, breathing, and body...
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Medications for Alcohol Addiction are Underutilized

Medications for Alcohol Addiction are Underutilized
An estimated 8.9 million Americans live at the severe end of the spectrum of alcohol use disorders.  Regardless of terminology – alcohol addiction, alcohol dependence, or moderate to severe alcohol use disorder – these individuals satisfy diagnostic criteria for a potentially fatal chronic disease characterized by high post-treatment recidivism.  The human and dollar costs of this situation are enormous and touch everyone; yet the magnitude of our collective response fails to match the magnitude of the problem. For example, practical experience backed by brain science identifies  two basic actions as essential to recovery; yet individuals with the disease repeatedly fail to adopt them.  Research demonstrates that recovery rates are highest when addiction treatment that monitors abstinence is continuous ; yet healthcare providers fail to organize for this and for the most part still treat alcohol addiction in discrete episodes.  The FDA has approved three medications for the treatment of alcohol...
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Hope & Caution – for Happy Holidays

Hope & Caution – for Happy Holidays
With November comes the holiday season. In that spirit, we are reprinting the Addiction Medicine Update, Hope & Caution – for Happy Holidays , originally published in November 2012 .  As we approach the holiday season—the time of year from Thanksgiving through New Years when "joy" is the word but not necessarily the reality—it's worth reflecting on ways we can protect ourselves and those we care about from inconvenience and tragedy due to use of alcohol or other mood-changing substances. Start by believing that some measure of holiday joy and fulfillment, provided we are open to it, is available to us all.  Caution is needed. But the holidays evoke strong feelings, and strong feelings often override caution. Strong feelings could include the stress of keeping up with the seasonal parade of expectations and events such as shopping, travel, cooking, social gatherings, and so forth—or the stress of not having any...
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Facing Addiction and The National Council on Alcoholism and Drug Dependence (NCADD) are proud to announce the merger of our organizations – creating a national leader in turning the tide on the addiction epidemic.
The merged organization will be called:

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