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October 7, 1998

Smoke and Spirits: The Substance Abuse Dilemma

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JAMA. 1998;280(13):1190. doi:10.1001/jama.280.13.1190-JMS1007-2-1

Since antiquity, people have experimented with plant substances for their psychogenic effects. Long before the health effects of alcohol were known, it was commonly recognized that alcohol could not only enhance one's sense of well-being, but also could cause "social harms."1 Research now shows direct links with the abuse of certain substances and defined pathology. For example, the alcoholic can expect a predisposition toward cirrhosis, and cigarette smokers can count on a greater incidence of coronary artery disease.2

Over 1.4 million people in the United States sought formal treatment for their alcohol and drug abuse problems in 1995,3 and countless more individuals are addicted to harmful substances. With so many people affected, one is compelled to ask whether our current treatment strategies are effective in addressing substance-related health problems. Medical students Nathaniel Gunn, Chase White, and Ramya Srinivasan assert that the current "war on drugs" approach does not reach the core of the substance abuse problem. In this issue of MS/JAMA the students describe the principle of harm reduction as a means toward addressing the problem of addiction and illustrate its application in a newly created student health clinic for intravenous drug users.

While medical students and physicians may help patients resolve substance dependency, they themselves are not immune to these temptations. Richard Mangus, Claire Hawkins, and Michael Miller studied the medical student population and report their findings on tobacco and alcohol use among 1996 medical school graduates.

The United States is not alone in its addiction woes. Martin Makary and Ichiro Kawachi argue that this country is to blame for some of the problems currently experienced abroad. As Makary and Kawachi point out, US tobacco companies are aggressively targeting international markets using promotional tactics Americans would find reprehensible. In their essay, the authors give suggestions on how medical professionals can protest the surge of tobacco marketing overseas.

Lowering the prevalence of substance abuse and reducing the adverse health consequences are challenges that will likely remain for some time. Intense federal efforts are being directed toward stemming addiction, and there has been some progress on the domestic tobacco front. From the ban in 1989 on smoking aboard domestic airline flights to this year's Congressional drama with the failed McCain tobacco control bill (S, 1415), it is apparent that cigarette smoking in this country is becoming less acceptable. Spurred by the Liggett Group's admission in 1997 that smoking is addictive and that the tobacco industry sought to sell its products to children as young as age 14,4 the tobacco industry has had to pay billions of dollars to state governments to reconcile smoking-related Medicaid costs.5

While there is no magical cure for solving substance abuse, steps toward preventing addiction may be the key. In their relationships with patients, medical students and physicians can play an important role in reducing addiction.

Nencini  P The rules of drug taking: wine and poppy derivatives in the ancient world, III. wine as an instrument of aggressive behavior and of ritual madness. Substance Use Misuse. 1997;32361- 367Article
Cotran  RSKumar  VRobbins  SLSchoen  FJPathologic Basis of Disease. 5th ed. Philadelphia, Pa WB Saunders Co1994;381- 383857- 861
US Department of Commerce,Statistical Abstracts of the United States 1997. Washington, DC US Dept of Commerce October1997;table 219.
Famighetti  RThe World Almanac and Book of Facts 1998. Mahwah, NJ World Almanac Books1998;48
Collins  G Settlements cut deeply into tobacco profits—Philip Morris takes charge, as does RJR. New York Times. October22 1997;D4