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Smoking and Drinking: A Deadly Combination

Smoking and drinking are seen by many as complimentary: two habits that go hand in hand. while people who smoke are more likely to drink and vice-versa, this definitely isn’t a good idea. smoking is dangerous, drinking is dangerous, and doing both is even worse..

Around 8.5 million people die each year as a result of alcohol and tobacco, according to the World Health Organization . Both alcohol and cigarettes represent serious risks to public health, but for many users, there is an unavoidable sense that these two habits are linked, or even complement each other. This perception may be based on a grain of truth, but smoking and drinking in combination are more likely to kill you than either one individually, but there is evidence that smokers drink more than non-smokers and vice-versa. Finding out more about the link between smoking and drinking shows why it’s a combination we should take seriously.

The Link Between Smoking and Drinking

People who both smoke and drink often say that they two habits complement each other, and feel more like smoking when they have an alcoholic drink and vice-versa. This perception is supported by studies – for example, a study looking at the socio-cultural influences on smoking and drinking found that 36.9 % of adults who were current drinkers were also current smokers, compared to just 17.5 % of never-smokers. This study used data from 1997, and it’s worth noting that more recent polls have shown less of a difference between smoking rates between drinkers and non-drinkers, though drinkers were still more likely to smoke.

This may leave you wondering why smoking and drinking appear to be so closely related. Although there isn’t a definite answer on this yet, research does suggest that nicotine enhances the pleasurable effects of alcohol, and this has been confirmed in research. Another important factor is that nicotine and alcohol work on the same brain systems, which may mean they interact when taken together. Finally, the same genes may be responsible for predisposition to both smoking and drinking, so this could make it more likely for a drinker to smoke and vice-versa.

The Health Risks of Smoking

The health risks of smoking are so well-known that they scarcely even need to be repeated. Smoking causes lung cancer, heart disease, stroke, COPD, many other cancers and a multitude of health problems. It’s been called the leading preventable cause of death in the world.

The Health Risks of Drinking

Although drinking is much more socially accepted that smoking, it too carries serious health risks. Drinking heavily is known to cause mouth, throat and breast cancer, stroke, brain damage, heart disease and liver disease. While low-risk drinkers drastically reduce their risk of developing such health problems as a result of their drinking, no level of alcohol consumption can be considered safe.

The Risks of Smoking and Drinking

With plenty of risks associated with the individual substances, the fact that combining alcohol and tobacco creates even bigger risk shouldn’t come as much of a surprise. However, since these conditions have many risk factors (things which increase your risk of developing them), it can be difficult to estimate what the effect of combining smoking and drinking will be.

One area where there is solid evidence is for mouth and throat cancers. Both smoking and drinking increase the risks of these conditions, and studies show that people who do both are much more likely to get mouth cancer. Even worse, the risk of mouth cancer from smoking multiplies the existing risk from drinking, rather than just adding to it.

Other conditions – like cardiovascular disease and liver cancer – are both affected by alcohol and tobacco, but it’s unclear whether the risk is bigger than the risks from drinking and smoking added together. For liver cancer, there is some suggestion that the combined effect is worse than the sum of the individual parts, but for cardiovascular disease there doesn’t seem to be such “synergistic” effects.

Overall, research has shown that people who both smoke and drink increase their risk of all-cause death more than non-smokers and non-drinkers, or people who drink or smoke without doing the other.

Staying Safe: Reducing Your Risks From Smoking and Drinking

The risks of smoking and drinking are serious, especially if you combine the two habits. This is why reducing your risk is essential, and the best approach is to quit one or (ideally) both habits, or at very least cut back or switch to less harmful alternatives.

Quitting smoking is the more crucial goal, particularly if you aren’t a heavy drinker. There are many approaches to quitting, including alternative nicotine products like patches, gums, inhalers, smokeless tobacco or e-cigarettes, and medications such as Chantix. If you want to maximize your chances of quitting smoking, combining one of these strategies with behavioral counseling gives you the best chance.

Although there may be more of a social expectation that you will drink alcohol at some social gatherings, stopping drinking or cutting down is still important to minimize your health risks. If you can’t or don’t want to stop drinking entirely, simple tips like drinking more slowly, alternating between alcoholic and non-alcoholic drinks and drinking with food can help you drink a lot less.

Overall, quitting smoking and drinking is the best thing you can do for your health, but if you can’t do either or both of these, minimizing the risks to your health should be the next big priority.

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Article Contents

Introduction, addiction-related outcomes of co-use, what makes e-cigarettes different: an ever-changing landscape, supplementary material, declaration of interests, authors’ contribution.

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Addiction-Related Outcomes of Nicotine and Alcohol Co-use: New Insights Following the Rise in Vaping

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Jude A Frie, Caitlin J Nolan, Jennifer E Murray, Jibran Y Khokhar, Addiction-Related Outcomes of Nicotine and Alcohol Co-use: New Insights Following the Rise in Vaping, Nicotine & Tobacco Research , Volume 24, Issue 8, August 2022, Pages 1141–1149, https://doi.org/10.1093/ntr/ntab231

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Nicotine and alcohol-containing products are some of the most commonly used substances of abuse and are both leading causes of preventable death. These substances also have significant interactions that have additive and, in some cases, multiplicative effects on the health consequences of their use. Thus, to reduce these negative consequences, it is important to understand the abuse liability of nicotine and alcohol in combination, especially in the most relevant use cases among those who are most vulnerable. Specifically, as tobacco cigarette use is continually decreasing, vaping is quickly replacing cigarettes as the primary mode of nicotine use. This pattern is especially true in adolescent populations in which vaping has grown considerably. Particularly concerning is that adolescents are more vulnerable than adults to the negative consequences of substance use. It is therefore imperative to revisit the literature as it relates to the rising state of co-use of vaping products with alcohol. Here, we review the clinical outcomes of nicotine and alcohol co-use as they relate to the abuse liability of each individually. Special attention is paid to adolescent findings, where available, as well as investigations that use nontobacco nicotine products as these may more accurately reflect the more recent trends of co-use.

Though nicotine alone has previously been considered a proxy for tobacco and tobacco cigarette use, combustible routes of administration have been decreasing. They are, instead, being replaced by e-cigarettes that do not involve other tobacco constituents and contain additional nonnicotine constituents of their own. Unfortunately, the literature remains limited with regard to e-cigarettes and their interactions with other substances, especially their prevalent co-use with alcohol. This review attempts to discuss the current literature on nicotine and alcohol co-use in the context of the vaping epidemic, predominantly focusing on addiction-related outcomes and why e-cigarette use may be unique.

Tobacco and alcohol are the leading and third leading causes of preventable death in the United States, respectively, representing an exceedingly large economic burden and loss of human life. 1 , 2 Use disorders of these substances are also highly comorbid, with 80%–90% of patients with alcohol use disorder being smokers. 3 While each substance has their own associated risks, combined use may have additive effects on substance dependence, as well as negative physical and mental health outcomes including increased prevalence of certain cancers and psychiatric comorbidities. 4 It is therefore vital to understand the interactions between these substances such that the consequences of their use can be minimized both individually and in combination.

To understand this relationship, research must match the dynamic nature of substance use, adapting quickly to the changing landscape—particularly that of nicotine. Cigarette use has been steadily declining, while new forms of nicotine use have been growing at alarming rates, especially among vulnerable populations. 5 , 6 Past 30-day e-cigarette use among middle and high school students has grown from 0.6% and 1.5% to 4.7% and 19.6%, respectively, between 2011 and 2020. 7 , 8 Although adolescent alcohol use has been steadily decreasing during this period, its use remains high with adolescents reporting past 30-day use at 29.2% in 2019. 9 Nicotine and alcohol are also some of the most commonly co-used substances among adolescents, with nearly one in four adolescents reporting past 30-day use of both substances. 10 Despite these facts, there is very little research investigating the interactions specific to e-cigarette and alcohol co-use (for summaries of reported findings, see Supplementary Table 1 ), and investigations in adolescents is even more limited.

Excellent previous reviews have extensively evaluated the genetic, 11 , 12 pharmacological, 3 , 4 , 11 , 13–16 metabolic, 17 , 18 and behavioral, 4 , 11 , 15 , 19 , 20 mechanisms of interactions between nicotine and alcohol in great detail. Here, we have reviewed and updated the current state of knowledge in the field based on the clinical addiction-related outcomes of these interactions, and where available, the impact of sex and gender. Finally, we add our contention that further research must be carefully designed within the specific context of vaping, and how it might differ from previous investigations on the topic. As nicotine vaping and alcohol co-use is the focus, we attempt to give special attention to studies that use nontobacco nicotine routes of administration, though much of the research interchanges tobacco, particularly cigarettes, and nicotine. Throughout, we highlight adolescent co-use, where available, as this population is especially vulnerable to the consequences of substance use and is also where the most growth in vaping has been concentrated. 21–23

Reported Reward

Several studies have found interactions between the subjective experiences associated with alcohol and nicotine. The potentiation of the rewarding effects of nicotine by alcohol and vice versa has been linked to a shared reward pathway, with both substances increasing the perceived rewarding effects of the other via mesolimbic dopamine pathway stimulation (for review, see ref. 16 ).

Nicotine Effects on Alcohol Reward

The effects of alcohol are biphasic; that is, while blood alcohol levels are low and rising, alcohol acts as a stimulant; when they are high and decreasing, alcohol acts as a depressant. 24 Nicotine may increase the positive subjective experience of alcohol by either potentiating the stimulant or attenuating the depressant phases of the blood alcohol curve. 17 Several laboratory studies have investigated the subjective effects of nicotine on alcohol; however, these findings have been somewhat inconsistent and highly methodologically dependent.

When investigating the effects of nicotine without nonnicotine tobacco constituents, pretreatment via transdermal nicotine patches has been found to increase feelings of euphoria and feelings of intoxication 3 hours after acute alcohol consumption in moderate- to heavy drinking daily smokers. 25 Likewise, when light-smoking social drinkers were pretreated with a transdermal patch, ratings of alcohol-induced sedation were potentiated. 26 A similar study, however, found the opposite with transdermal nicotine patch pretreatment leading to a decrease in the reported subjective feeling of alcohol’s effects 6 hours later as measured using the Alcohol Effects Scale—an average of five reported subjective effects (high, like, rush, feel-good, intoxicated). 27 Similarly, nicotine administered by nasal spray reduced feelings of intoxication in a group of moderate drinking smokers. 28 It is important to note that in each of those studies, participants had been deprived of nicotine for several hours prior to experiments; thus, the subjective interactions of nicotine and alcohol may have been confounded by withdrawal and/or craving. When social drinking nonsmokers were administered nicotine and alcohol intravenously, nicotine significantly attenuated feelings of alcohol intoxication. 29 Further, if nonsmokers were administered the nonspecific nicotinic acetylcholine receptor antagonist, mecamylamine, the reports of stimulant and euphoric effects of alcohol were attenuated, consistent with the findings that nicotine increases the euphoric feelings associated with alcohol administration. 30

Ecological momentary assessments of smokers, in which participants are frequently assessed while in their natural environments, show a clearer picture, with smoking evoking a small but significant increase in pleasure following the last drink. 31 Of particular interest, smoking was only associated with enhanced alcohol buzz and excitement when estimated blood alcohol levels were high and descending, suggesting that interactions between alcohol and nicotine on subjective experience are influenced by the biphasic nature of alcohol, possibly explaining some of the contradictions seen in human laboratory findings. 32

Alcohol Effects on Nicotine Reward

Many studies examine the effects of alcohol on tobacco cigarette reward, but none have used pure nicotine, exposing a gap in the literature. Studies investigating these effects provide overwhelming evidence for potentiated subjective hedonic experiences when smoking followed alcohol. In an ad-lib smoking session, previous exposure to a priming dose of alcohol (0.5 g/kg) significantly increased reports of stimulant and calming tobacco effects as well as enhanced smoking satisfaction. 33 Alcohol pretreatment also results in higher ratings of enjoyable taste, 34 satisfaction, 33 , 35 liking, 33 , 36 calming, 33 pleasantness, 37 and greater positive and lower negative affect 36 in response to smoking. Like adults, young adult smokers and experimenters (<100 lifetime cigarettes) report greater pleasure for cigarettes when drinking. 38 Further, in heavy drinking young adults who were experimenting with tobacco, both alcohol and taste-masked placebo increased smoking satisfaction, calm, and taste, suggesting that expectancy of alcohol consumption partially mediates tobacco-potentiated reward. 39 The same study determined that alcohol but not alcohol expectancy resulted in decreased nausea associated with ad-lib cigarette smoking; thus, some of alcohol’s reward-potentiating effects on tobacco may be due to the attenuation of negative smoking affect.

Only two ecological momentary assessments have been conducted on alcohol and cigarette co-use that evaluated subjective feelings associated with tobacco reward. Alcohol use was associated with more frequent reports of good tobacco taste, rush/buzz, and increased smoking satisfaction and pleasantness when drinking in the preceding hour. 40 The authors suggested that alcohol may extend the euphoria associated with cigarette smoking, thus increasing the chances of the rush/buzz still being present when self-reports were conducted. Interestingly, another ecological momentary assessment found no effect of alcohol on smoking satisfaction, although there was a trend when alcohol preceded smoking by 15 minutes. 41 This may suggest that, like nicotine’s effect on alcohol reward, alcohol’s effect on cigarette, and possibly nicotine, reward may be contingent on the timing of the biphasic subjective alcohol experience.

Conclusions

Alcohol and nicotine can potentiate the rewarding properties of each other, and nicotine may attenuate the intoxicating and sedating properties of alcohol, although this effect is less straightforward. There is also evidence for increased addiction liability for each substance when used together, as the positive subjective properties of a drug are involved in the initial motivation for repeated exposures, and the formation of associated cues required for impulsive drug taking. 42 Though no clinical laboratory studies have investigated adolescents to our knowledge, reports from young adults were consistent with findings in older adults. 38 , 39 Unfortunately, the studies that used nontobacco nicotine produced mixed findings 25–29 ; thus, more studies investigating alcohol and nicotine reward that use nontobacco nicotine exposures (vaping, transdermal patch, intravenous infusion, etc.) are required.

Reinforcement

Laboratory studies have shown variable effects of nicotine on alcohol reinforcement, whereas alcohol consistently increases nicotine reinforcement. Further, there is evidence that alcohol consumption predicts nicotine use more strongly than the reverse relationship. 43

Nicotine Effects on Alcohol Reinforcement

Nicotine alone and nicotine from cigarettes increases alcohol reinforcement. Using a progressive ratio task in which participants were required to work harder for subsequent reinforcers, nicotinized cigarette self-administration increased alcohol consumption, compared with denicotinized cigarettes, as well as increased breakpoints in male occasional smokers. 44 Similarly, users of cigarettes with very low nicotine content showed lower alcohol use compared with moderate and normal nicotine cigarettes. 45 Further, there is no evidence of compensatory drinking or binge drinking in response to nicotine reduction, suggesting that reduced nicotine cigarettes could have positive consequences for public health. 45

Many studies, however, show mixed results in male and female participants. Responding for alcohol after daylong ad-lib smoking was significantly greater than after smoking abstinence in men, but not in women. 46 Furthermore, whilst comparing 7 or 14 mg of transdermal nicotine or a placebo on the effects of alcohol self-administration, men (14 mg nicotine) increased alcohol consumption, whereas in women (14 mg nicotine) decreased alcohol consumption, in response to a priming drink (0.2 g/kg). 26 In comparison, in heavy drinking daily smokers it was also found that both men and women participants who were administered 21 mg/day of transdermal nicotine, took longer to start drinking after a priming drink and consumed fewer drinks compared with a placebo patch. 47 It is of note that neither of these studies chose doses of nicotine considering body weight differences, however the former found that neither body weight nor body mass index were correlated with nicotine-induced nausea or with mood changes after nicotine administration, 26 and in the latter study comparisons between genders were underpowered. 47

Importantly, when comparing the use of e-cigarettes to that of combustible tobacco cigarettes, similar results have been found. Self-reported data show that the use of e-cigarettes increases alcohol reinforcement and leads to problematic alcohol use, 48 and heavy drinking. 49 E-cigarette users had increased risk of harmful alcohol use including hazardous drinking, alcohol use disorder, and binge drinking, compared with e-cigarette nonusers. 50 Additionally, combined e-cigarette and tobacco cigarette use was associated with an additive risk of harmful alcohol use, especially in nondaily users. Furthermore, e-cigarette users drink more alcohol than nonusers, but less than tobacco cigarette or dual e-cigarette/cigarette users. 51 In the same study, dual e-cigarette/cigarette users reported a higher number of drinks consumed in the past month than e-cigarette users alone, and they were more likely to meet hazardous drinking criteria at follow up. Both tobacco cigarette users and dual e-cigarette/cigarette users, however, showed higher total drinks in the past month compared with e-cigarette users, and there were no significant differences between cigarette and dual-cigarette users. 51 In contrast, while no differences in alcohol drinking were observed among tobacco cigarette, e-cigarette, or dual users, all three groups had higher rates of heavy drinking than nonnicotine users. 49

In adolescents, there is a bidirectional association, and sex difference, between e-cigarette use and alcohol use. 52 Adolescents who reported e-cigarette use had 3.5 times the odds of initiating alcohol use 6 months later, compared with those who have never used e-cigarettes. This association was found to be stronger in boys than in girls. Further, alcohol users had 3.2 times the odds of initiating subsequent e-cigarette use 6 months later. 52

Overall, these studies provide evidence that depending on dose and type of nicotine-containing product, nicotine appears to increase alcohol reinforcement in men but not women. There is a lack of experimental studies of e-cigarette use and further research is required to examine these effects in adolescents.

Alcohol Effects on Nicotine Reinforcement

Alcohol dependency is positively correlated with the number of combustible cigarettes smoked per session. 53 , 54 Differing doses of alcohol significantly increased cigarette smoking in participants with alcohol dependency compared with those without; however, in nonalcohol-dependent participants, differing alcohol doses had no significant effect on smoking behavior. 54 There were, however, individual differences in the non-dependent group, such that smoking decreased in two participants, increased in two participants, and remained unchanged in a fifth. 54 In comparison, in men with opioid use disorder, drinking alcohol significantly increased the amount and rate of smoking in most, but not in all participants, 55 further demonstrating individual differences in those with other co-occurring substance use disorders.

In moderate-to-heavy smokers who drank alcohol regularly, participants smoked more tobacco cigarettes in the first hour after 0.4 or 0.8 mg/kg alcohol than participants who consumed 0.2 mg/kg alcohol or placebo. 56 Similarly, low doses of alcohol increased cigarette use in daily smokers who were heavy drinkers. After consuming a priming alcoholic drink, participants were less able to resist a first cigarette, initiated smoking sooner, and smoked more cigarettes compared with a placebo beverage. 57

Sex differences also emerge in the effect of alcohol on cigarette smoking. Alcohol increased men’s smoking behaviors compared with placebo, including number of puffs, number of cigarettes, and duration of smoking; however, women’s behavior did not differ between alcohol and placebo conditions. 34 Thus, further consideration for sex differences is required in studying the cross-tolerance of nicotine and alcohol reinforcement.

Although studies generally find that nicotine in both combustible tobacco cigarettes and e-cigarettes increases alcohol reinforcement, and to a lesser extent the converse, further research is required to examine sex differences, adolescent use, and e-cigarette use in controlled laboratory settings, with special consideration for the effects of alcohol on nicotine reinforcement in nontobacco products.

Commonly, patients that have both nicotine and alcohol use disorders have worse treatment outcomes when compared with those with only one. 11 This is likely due to the interactions between alcohol and nicotine cues that contribute to relapse of either, known as the cross-substance cue reactivity theory. 58 These interactions fall into two main overlapping categories: (1) increased craving of one substance following the consumption of the other 19 ; and (2) nonpharmacological alcohol cross-cue provoked urge to use nicotine and vice versa. 20

Nicotine Effects on Alcohol Relapse

Laboratory studies investigating nicotine’s (alone and from tobacco containing cigarettes) effects on alcohol craving have been mixed. In participants who drink alcohol and smoke cigarettes with a broad range of use patterns, alcohol craving increased significantly after smoking a cigarette in heavier drinkers but decreased in light drinkers; though the combination of both low-dose (men: 0.3 g/kg; women: 0.27 g/kg) alcohol and cigarette smoking resulted in greater cravings for alcohol than either alone regardless of drinking patterns. 36 Among a group of occasional smokers, no effect of cigarette smoking was observed on alcohol craving, suggesting that consistent co-use may be required for sufficient cue conditioning. 44 Similarly, cigarette smoking did not evoke a desire to drink in young male and female daily smokers who drank moderate amounts of alcohol. 46 Especially relevant to this review, ad-lib vaping has been found to increase craving for alcohol in light drinkers who vape. 59

Of course, visual smoking cues are also an important factor for relapse, and there is strong evidence that cross-cue conditioning occurs in dual users—though most research to date has focused on the effects of alcohol cues on smoking behavior. Smokers with alcohol use disorder display strong cravings for alcohol when exposed to smoking-related images. 60 Additionally, nicotine withdrawal may increase alcohol craving in response to smoking cues, though results are inconsistent. This effect was only seen in a group of daily smoking hazardous drinkers (those that scored 8 or above on the Alcohol Use Disorders Identification Test) following 6 hours of nicotine deprivation 61 but not in either alcohol-dependent heavy smokers 62 or moderate-to-heavy smoking young adult drinkers 63 at 34 or 5 hours of nicotine deprivation, respectively. 62 , 63

Pretreatment with a transdermal patch containing nicotine alone (21 mg nicotine) increased craving to drink among socially drinking daily smoking men. 25 This finding is important as it divorces visual smoking cues as a factor influencing alcohol craving; thus, nicotine’s subjective effects alone may be enough to act as a conditioned cue for alcohol craving. 64 Interestingly, the same dose of nicotine in women showed no effect on alcohol craving, 65 again highlighting the need to examine sex differences as they relate to dosing regimens and metabolism as well as age.

Alcohol Effects on Nicotine Relapse

Alcohol consumption is strongly associated with smoking relapse. 66 There is extensive laboratory evidence that alcohol increases craving for cigarettes across a variety of use patterns. Following fixed doses of alcohol in laboratory settings, increased urge to smoke has been observed in heavy social drinking light smokers, 67 , 68 heavy social drinking daily smokers, 57 heavy drinking heavy smokers, 25 , 69 young adult heavy social drinking light smokers, 34 occasional drinking daily smokers, 70 nicotine-dependent and non-dependent smokers, 71 and moderate drinking daily and nondaily smokers. 72 No effect of alcohol on the urge to smoke in heavy drinking heavy smokers was found; however, it is suggested that this may be due to subjects being 15 hours smoking abstinent, and therefore, a ceiling effect on cigarette craving was responsible for the finding. 73 Notably, increased craving for cigarettes in heavy drinking light smokers was also found following intravenous alcohol administration; thus, alcohol’s subjective effects may increase craving for cigarettes without any drinking-related cue. 74 An ecological momentary assessment study of daily smokers found that alcohol use predicted smoking and was associated with more frequent reporting of urge to smoke. 40

Unlike with reward, there does not appear to be a relationship between craving and the biphasic effects of alcohol, as cigarette craving evoked by alcohol is maintained throughout the blood alcohol curve. 67 , 68 , 74 , 75 There may also be an effect of gender, with women reporting stronger smoking cravings following alcohol consumption than men, 34 , 75 and women, but not men, having increased urges to smoke following a placebo drink, suggesting that women participants’ urge to smoke may be more cue driven than men. 73 However, there are again inconsistent reports, with both men and women showing increased craving following a placebo beverage. 39 , 71 Notably, alcohol cues have been consistently shown to increase urge to smoke. Among daily smoking alcohol-dependent men, the smell of alcohol promoted the urge to smoke. 58 , 76 Both alcohol- and nonalcohol-dependent daily smokers exhibited substantial increases in urge to smoke following presentations of alcohol-related images, with alcohol-dependent smokers showing equivalent alcohol cue potentiated cravings to those elicited by smoking-related cues. 60

Both alcohol and nicotine consumption, and exposure to their associated cues, increase cravings for each other, though this effect is especially pronounced for alcohol consumption and alcohol cue exposure on urge to smoke. Although, to our knowledge, no studies have evaluated these effects on e-cigarette relapse or vaping’s effect on alcohol relapse, most studies investigating smoking’s effect on alcohol relapse used denicotinized cigarettes as controls. Thus, the primary differences seen were likely mediated by nicotine, though there could be a nicotine and nonnicotine tobacco constituent interaction as well. Overall findings are consistent with epidemiological observations that the use of e-cigarettes is associated with problematic alcohol use in adult, 48 , 51 , 77 young adult, 49 , 78 and adolescent populations. 79 For summaries of all vaping and alcohol co-use findings, see Supplementary Table 1 .

It is difficult to categorize e-cigarettes in existing nicotine use classifications as not only do they differ greatly from current nicotine replacement therapies and tobacco products, but they are also a remarkably broad category of products themselves, making it challenging to establish any consistent conclusions regarding their properties. E-cigarettes vary in many ways, including flavor, nicotine concentration, nicotine type (ie, salt or base), device voltage, primary vehicle constituents and their ratios, and form factor. This variation results in a mixed literature that often neglects to differentiate amongst, or even explicitly state, these properties. Here, we discuss why many of these properties make e-cigarettes a unique category of nicotine products that requires further studies to understand how they affect behavior alone, and in combination with other drugs of abuse, including alcohol. We also point out areas that may overlap (summarized in Figure 1 ) such that some inferences may be made from previously conducted research on alcohol and nicotine co-use.

Properties of tobacco cigarettes, e-cigarettes, NRTs, and their overlapping relationships. For the purposes of this review, e-cigarettes are not considered a NRT. Though the FDA is working to ban menthol in cigarettes, mentholated cigarettes are still currently available; thus, for now all nicotine products have flavors in common. Depending on whether e-cigarettes contain nicotine salt or base, they may be more likely to overlap with cigarettes or NRTs. There is significant overlap between each nicotine product allowing for some understanding of e-cigarette properties to be gleaned from past literature. Past findings, therefore, have validity for directing future clinical and preclinical studies observing the effects of e-cigarettes directly.

Nicotine Type and Concentration

Nicotine’s ability to enter the body depends highly on pH, with higher pH increasing absorption across tissues and being required for efficient absorption through buccal and dermal membranes. 80 For inhalation, however, lower pH results in increased palatability allowing for easier initiation of use and the potential for higher nicotine concentrations; thus, there exists a balancing act for “ideal” ratios of nicotine salt (low pH form) to nicotine base (high pH form) that has created a long history of tobacco companies searching for the perfect combination to evoke the greatest level of consumption. 81 The first generation of e-cigarette liquids (e-liquids) were almost entirely nicotine base, like that of nicotine replacement therapies such as nicotine patches, gums, lozenges, inhalers, and nasal sprays; however, recent e-liquids that are commonly used in pod and disposable devices are now primarily salt based, with a ratio of base to salt of ~0.1, the same ratio used in most cigarettes. 80 , 81

Newer e-liquids also have significantly higher nicotine concentrations, as the more physiological pH of nicotine salt reduces alkaline activated pulmonary protective mechanisms resulting in increased palatability. 82 This is likely why the most popular nicotine base e-liquid concentration is 18 mg/mL, whereas nicotine salt e-liquid is most commonly 59 mg/mL. 83 Thus, there are two separate populations that have often been placed under the umbrella of “e-cigarette users” that are using very different products. These products differ significantly in their pharmacokinetics, with nicotine salt-based e-liquids having near identical pharmacokinetics to that of tobacco cigarettes and nicotine base having a lower blood plasma maximum concentration ( C max ) and time to maximum concentration ( T max ) compared with both. 83 It should be noted, however, that these results were found in adults, which corresponds well with findings showing consistent salivary cotinine, a primary metabolite of nicotine, levels in adults who use JUUL e-cigarettes or smoke tobacco cigarettes 84 ; but, it is not consistent with adolescent urinary cotinine levels that suggest that adolescents who use nicotine salt-based products are being exposed to significantly more nicotine than their tobacco cigarette-smoking counterparts; thus, adolescents are a unique population whose e-cigarette use should be studied independently. 85 , 86 Overall, there is very little consistency across e-cigarettes product to product. Even when simply considering e-cigarettes that primarily use nicotine base, studies cannot agree as to whether they result in greater, equal, or lower nicotine plasma in the blood compared with tobacco cigarettes, likely owing to the differential e-cigarette puff topography by concentration and device voltage. 87 Compared with e-cigarettes and tobacco cigarettes, nicotine replacement therapies, which were designed to be smoking cessation aids, have much slower absorption rates and produce more gradual increases in blood nicotine resulting in lower abuse liability. 88

Nonnicotine Constituents

There are many unique factors apart from nicotine chemistry that differentiate e-cigarettes from tobacco products and nicotine replacement therapies. Though the FDA has banned most flavored cartridge-based e-cigarettes, flavored e-liquids that can be used to refill these devices, as well as menthol cartridges, are still available. 89 There are over 15 000 flavorants available for use in e-liquids, many of which have known pharmacological interactions with nicotine and nicotinic acetylcholine receptors (for review, see ref. 90 ); and, given alcohol’s interaction at nicotinic acetylcholine receptors, it is not unlikely that there are additional complex relationships among alcohol, nicotine, and these flavorants. 16 Flavors such as menthol also alter nicotine metabolism and act as a highly reinforcing sensory cue to smoke (for review, see ref. 91 ), leading the FDA to recently announce a ban on menthol in cigarettes. 92 Therefore, except for limited flavorants in nicotine gum and lozenges, the reinforcement potential of flavors and the novelty of trying new flavors is now exclusive to e-cigarettes.

Like flavors, e-liquids uniquely contain propylene glycol and/or vegetable glycerin that, when vaporized, carry nicotine and flavorants to the mouth, throat, and lungs. The ratio of these constituents in an e-liquid has been shown to affect puff topography and nicotine delivery in experienced users. 93 Because both propylene glycol and alcohol are primarily metabolized by alcohol dehydrogenase in the liver (which becomes saturated at low alcohol concentrations), there are likely metabolic interactions between these substances. 94 For instance, ethanol is known to competitively inhibit propylene glycol metabolism. 95 Additionally, a recent paper validating a rat model of nicotine self-administration found similar responding for nicotine and vehicle vapor (50:50 propylene glycol/vegetable glycerin); the authors suggested that the vehicle itself may have some rewarding properties. 96 This finding could additionally explain why many individuals regularly vape nicotine-free e-liquid. 97

Tobacco cigarettes, too, are distinct in terms of nonnicotine constituents. Cigarettes have over 7000 nonnicotine constituents, most of which have not been studied, and several of which have been shown to have potentiating effects on nicotine reinforcement—some even being reinforcing themselves. 98 , 99 Further, cigarettes contain monoamine oxidase inhibitor constituents, which may also potentiate nicotine reinforcement. 100

Because it is difficult to find consistency in the properties of e-cigarettes, and many properties of other nicotine routes are not shared with e-cigarettes, inferences made from other forms of nicotine exposure (ie, tobacco, nicotine replacement therapies) will only be applicable to a subsection of the properties of a particular type of device/e-liquid. Thus, not only is there need for studies investigating the effects of e-cigarettes on co-use with alcohol, but there is need for studies on each type of e-cigarette/liquid on alcohol co-use to fully understand the addiction-related outcomes of nicotine and alcohol interactions. There is also a need for preclinical research to disambiguate the causal mechanistic underpinnings of nicotine and nonnicotine constituents in their role in co-use. By revisiting this clinical literature using the lens of emerging routes of nicotine administration and its rapid growth amongst more vulnerable populations, preclinical research can then be guided by the existing gaps in knowledge in human studies.

A Contributorship Form detailing each author’s specific involvement with this content, as well as any supplementary data, are available online at https://academic.oup.com/ntr .

Funding related to the review topic include Canadian Institutes of Health Research Catalyst Grant 442011 awarded to JYK and US National Institute of Drug Abuse DA045740 awarded to JEM. JAF was supported by Canadian Institutes of Health Research Vanier Canadian Graduate Scholarship during the preparation of the manuscript.

None declared.

JAF, CJN, JEM, and JYK conceptualized the paper. JAF and CJN wrote initial drafts. JEM and JYK provided manuscript revisions and finalized the manuscript for submission; all authors have given feedback on the final manuscript and approved its submission.

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Essay on Smoking

500 words essay on  smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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Home — Essay Samples — Nursing & Health — Alcohol Abuse — The Impact of Alcohol Abuse: Causes, Effects, and Solutions

The Impact of Alcohol Abuse: Causes, Effects, and Solutions

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On this website, we've put together a database of free paper samples regarding Alcohol And Tobacco. The plan is to provide you with a sample similar to your Alcohol And Tobacco essay topic so that you could have a closer look at it in order to grasp a better idea of what a great academic work should look like. You are also suggested to use the best Alcohol And Tobacco writing practices presented by expert authors and, eventually, come up with a high-quality paper of your own.

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Let's talk alcohol and tobacco

Real-life, real talk, know the facts, think about it, make a difference.

Are you interested in taking some small steps for a healthier lifestyle? Check out our Hi-5 For Health  series to connect with other youth, get tips from experts, join the discussion, and participate in challenges!

First up, let’s talk about alcohol and tobacco.

You can also download these materials in pdf to review them offline and share it with your friends:

"Hey guys, Rasheem here! I’m 22 and I live in Kingston Jamaica. 

Society makes us think that drinking and smoking can make our life better, but does it really as young people, we have the power to be aware and make better choices for ourselves., i know how easy it can be for teens to access and abuse alcohol and tobacco, as it was for me., so i decided to head to the streets of jamaica and talk to other young people about the pressures and influences they see around them today., read my blog here. ".

1. About 70% of young people around the world don’t use alcohol.

Young people around the world recognize that alcohol is not good for our health. In a recent global U-Report poll: 48% of you felt that drinking alcohol is dangerous and damages your health, 34% of you felt that even moderate drinking is dangerous, and 75% of you felt that tobacco is bad for your health. Drinking is not the only solution to make you feel better, help you socialize, or make you fit in. Your generation has the power to change the way we all think about and use alcohol and you are already leading the way!

2. There are a lot of factors that can influence our decision to use alcohol or tobacco.

This includes images and messages of influencers and celebrities, adults that drink and smoke around us, our friends and classmates, or even advertisements that make alcohol and tobacco look cool.

Make sure you know the facts and come up with a few ways to protect yourself from these influences so that YOU can make the choices that you really want. 

3. Drinking alcohol interferes with your ability to do basic things like see, hear, talk, walk, control your emotions, and make decisions.

Zoom in on the image to learn how alcohol affects your brain functions:

4. The human brain doesn’t finish developing until your mid-20s.  

Underage drinking interferes with brain development and can even lead to addiction or alcohol use issues for the rest of our lives. This is why drinking is more harmful to adolescents than adults.

5. We are more likely to take risks when we are around our friends.

You might want to find a buddy who has similar views about alcohol use - having a support system can make a big difference. If you feel like you are being pressured to drink, try one of these 5 ways to say “no”:

6. Media is powerful

We are all bombarded with images of alcohol and tobacco - through advertisements, social media posts, movies, and other digital content that we stream. These images give us the impression that drinking and smoking are normal or even cool... but are they?

7. Have you ever wondered what is actually in a cigarette? 

8. Inhaling these chemicals can damage every part of your body. 

When we first smoke we will probably cough, that’s actually our body’s way of telling us that what we are inhaling is not good for us. Tobacco also weakens our immune system, which makes it harder for us to fight off illnesses like COVID-19. 

It also affects our brain by creating dependency, making it hard for us to go even a few hours without nicotine and causing us to feel the symptoms of withdrawal including difficulty focusing and jitteriness. Tobacco also increases our risk of cancer and heart disease.

Did you know? It takes nicotine only 10-20 seconds to reach our brain from the first puff. Nicotine is highly addictive and wires our brain to crave it throughout our lifetime. 9 out of 10 adult smokers started before they turned 18.

9. The tobacco industry knows young people have caught on to how harmful smoking is.

That's why they are promoting their products in different forms and suggesting that there are “healthier alternatives,” which is not entirely true... 

Different colors and flavors like cotton candy, banana split, watermelon, and many more are being used to entice younger consumers, but it is important to remember that these are still bad for us!

Regardless of if its form, tobacco use has a harmful effect on us all.

Now it's your turn. Here are some options to share your views on alcohol and tobacco with us. 

Picture This!

Use your investigative skills to capture photos of anything around you that tries to make alcohol and tobacco look appealing. This can help you become more aware of the influences around you. Show us what you see by tagging @voicesofyouth on social media.

Express Yourself!

Share your thoughts about alcohol and tobacco by submitting a blog, poem, illustration of other piece of content through Voices of Youth .

Pass it on!

Share something you’ve learned here with one other person and spark a conversation!

Let us know what other ideas you come up with by tagging us or leaving a comment @voicesofyouth ( Twitter and Instagram ). Stay tuned for IG lives, challenges, and more on this!

If you are struggling with alcohol, tobacco, or any kind of substance use, we encourage you to seek help from a trusted adult or search online for available support in your country. Asking for help is a sign of strength ‑ it shows self‑awareness and courage to overcome something difficult.

The content is this learning module was developed by UNICEF in collaboration with the UNICEF-AstraZeneca Young Health Programme Young Leaders. Learn more about their vision for a healthier future  here . Art by Vania Dhianisya and Njung'e Wanjiru .

UNICEF does not endorse any company, product or service.

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The causal impact of mental health on tobacco and alcohol consumption: an instrumental variables approach

• Open access
• Published: 18 August 2023
• Volume 66 , pages 1287–1310, ( 2024 )

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• Francis Mitrou 1 , 2 ,
• Ha Trong Nguyen   ORCID: orcid.org/0000-0002-2240-8942 1 , 2 ,
• Huong Thu Le 1 , 2 &
• Stephen R. Zubrick 1 , 2  

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The reciprocal relationship between psychiatric and substance use disorders is well-known, yet it remains largely unknown whether mental health morbidity causally leads to addictive behaviours. This paper utilises a fixed effects instrumental variables model, which is identified by time-varying sources of plausibly exogenous variations in mental health, and a nationally representative panel dataset from Australia to present robust evidence on the causal impact of mental distress on cigarette smoking and alcohol drinking behaviours. We find that mental distress significantly increases the prevalence and intensity of either cigarette or alcohol consumption. Further analysis reveals that mental distress also substantially increases household monetary expenditures on either tobacco or alcohol. The impact is greater for lower educated individuals or children of smokers, and is slightly higher for males. Our findings highlight the importance of mental health screening and treatment programs, especially among lower educated individuals or children of smokers, to assist in the prevention of addictive activities.

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1 Introduction

Mental health disorders and addictive behaviours Footnote 1 are two public health issues that are estimated to impose significant socio-economic costs to the global economy (OECD 2014 ; Chisholm et al. 2016 ; Prochaska et al. 2017 ; WHO 2017 ). Individuals with mental health disorders disproportionally engage in more addictive behaviours such as smoking, drinking, gambling, or using illicit drugs (Lawrence et al. 2009 ; Moylan et al. 2012 ; Lalanne et al. 2016 ). Addictive behaviours are difficult to manage and even more so for people with mental health problems (Nunes and Levin 2004 ; Kalman et al. 2005 ). To optimize public health interventions and medical treatments it is important to understand whether mental health disorders cause addictive behaviours.

The bi-directional relationship between mental health disorders and addictive behaviours is contended, with inconclusive evidence from different studies using data from various countries and methods (Fluharty et al. 2017 ). Furthermore, it remains challenging to determine the causal impact of mental health disorders on addictive behaviours due to issues of individual unobservable factors, reverse causality and measurement errors. In particular, omitted variables, such as genetic factors, may influence both mental health and addictive behaviours (Volkow and Li 2005 ). Reverse causality may be an issue as individuals with mental health problems are more likely to smoke or drink (Khantzian 1987 ) but consumption of addictive substances may worsen health, including mental health (Volkow et al. 2014 ). Measurement error would be another problem because researchers typically rely on information reported by respondents when using survey data, and this can be subject to participant recall bias and interpretation error in relation to collection instruments. These self-reported addictive behaviours may be influenced by participant mental health status, causing a bias in the estimate of the contribution of mental health to addictive behaviours. Studies in the current literature have not been successful in addressing all three issues at the same time (see Sect. 2 for a literature review), resulting in uncertainty around the interpretation of casual estimates of mental health on addictive behaviours.

In this paper, we employ a fixed effects instrumental variables (FE-IV) model, which is identified by time-varying sources of plausibly exogenous variations in mental health, to estimate the causal impact of mental health on addictive behaviours. We apply this FE-IV model to 18 waves of high-quality Australian longitudinal data to simultaneously tackle the above three research challenges.

Specifically, we employ the death of a close friend as an instrument in mental health equations. This instrument influences many individuals in our data, varies significantly over time for the same individuals and displays a strong causal relationship with subsequent mental health. Moreover, results from a series of robustness tests indicate that this instrument is empirically strong. This study thus improves on most previous research by employing an individual FE-IV model approach to address the endogeneity of mental health and provides more robust evidence on the causal impact of mental health on consumption of alcohol and tobacco.

Our study produces three main results. First, we show that mental distress leads to a measurable increase in the consumption of either cigarettes or alcohol. Second, in line with the mental distress-induced impact on cigarette or alcohol consumption, our results indicate that mental distress also considerably raises household monetary expenditures on tobacco and/or alcohol. Third, the mental distress-attributable impact on smoking and drinking is greater for persons with lower levels of education or those whose parents were smokers, and somewhat higher for males.

This paper proceeds as follows: Sect.  2 briefly reviews the related literature, while Sect.  3 discusses the data. Section  4 details our empirical framework, and Sect. 5 presents the empirical results. Section 6 reports results for various sub-groups and Sect. 7 concludes the paper.

2 Literature review

This paper explores the impact of mental health on addictive behaviours, relating itself to a very rich literature on the connection between mental health and addictive behaviours. Footnote 2 This literature has documented a strong positive association between mental distress and substance use disorders (Lawrence et al. 2009 ; Moylan et al. 2012 ; Lalanne et al. 2016 ). Longitudinal studies in this literature have also explored the bi-directional comorbidity between mental health disorders and addictive behaviours. Footnote 3 Evidence so far suggests positive associations in both directions: some studies found substance use disorders were associated with subsequent anxiety disorders (Johnson et al. 2000 ; Klungsøyr et al. 2006 ; Marsden et al. 2019 ) while other studies reported mental distress was associated with later substance use (Zubrick et al. 2012 ; Katz et al. 2013 ; Kim-Mozeleski et al. 2020 ). Some studies go further to establish a bi-directional relationship between mental health and substance use disorders (Kendler et al. 1993 ; Breslau et al. 1998 ; Needham 2007 ; Leung et al. 2012 ; Ranjit et al. 2019 ).

Although panel studies can establish the reciprocal association between substance use disorders and mental health problems, their findings can be confounded by unobservable characteristics, such as genetic factors or personal traits, that are associated with both substance use and mental disorders (Wooldridge 2010 ). To address the issue of unobservable individual heterogeneity, some studies have employed an individual fixed effects (FE) model (Boden et al. 2010 ; Fergusson et al. 2011 ; Horwood et al. 2012 ). The FE results appear to confirm the bi-directional link between mental health disorders and substance use. While the individual FE model can help address the unobservable individual heterogeneity issue, it cannot deal with the reverse causality and measurement error issues, preventing these longitudinal studies from drawing a definitive conclusion about the causality of any link between substance use and depression.

To provide causal evidence on the impact of substance use, which is dominantly measured by cigarette smoking, on depression, some studies have employed an instrumental variables (IV) method. In particular, Mojtabai and Crum ( 2013 ) used state-level cigarette taxes and public perceptions toward smoking as instruments for smoking behaviours to show that smoking regularly increases the risk for developing mood and anxiety disorders. Furthermore, an increasing number of studies have employed a Mendelian randomization method, using a genotype known to affect tobacco consumption as an instrument for cigarette smoking, to examine the causal impact of smoking in anxiety and depression. Evidence from these studies commonly suggests that smoking does not lead to mental health issues (Lewis et al. 2011 ; Bjørngaard et al. 2013 ; Taylor et al. 2014a ; Skov-Ettrup et al. 2016 ).

Overall, our review of the literature indicates that while several efforts have been made to examine a causal bi-directional link between mental health disorders and substance use, the current literature has not successfully established the causal impact of mental health on addictive behaviours given limitations of the methods used. We extend on these studies to combine both individual FE and IV methods in a unified framework to provide a more rigorous investigation into the causal effects of mental health on the consumption of alcohol and tobacco.

3 Data and sample

Our data source is from waves 2 to 19 (year 2002 to 2019) of the Household Income and Labour Dynamics in Australia (HILDA) survey. Footnote 4 HILDA is a nationally representative annual panel survey from Australia (Summerfield et al. 2019 ). It began in 2001 with a sample of 7,682 households and 13,969 individuals. In each wave, interviews are conducted with all household members who are 15 years of age or older at the survey time. Interviews are administered in-person and by telephone, with supplemental questionnaires collected via mail. The data contain comprehensive information at the individual and household level, including information on mental health and addictive behaviours of surveyed individuals (see Appendix Table A1 for details on variable description and summary statistics).

3.2 Mental health measures

Our main measure of mental health is derived from the Mental Health Inventory (MHI-5), a subscale of the 36-Item Short Form Health Survey (SF-36) (Ware et al. 1994 ). This subscale is constructed from responses to five questions asking the respondents about how often during the past four weeks that they have (1) “been a nervous person”, (2) “felt so down in the dumps nothing could cheer you up”, (3) “felt calm and peaceful”, (4) “felt down”, and (5) “been a happy person”. The respondent could select one of six responses that range from “all of the time” (1) to “none of the time” (6). We construct a mental health index by summing scored responses to these five questions, with reverse coded responses for the first four questions. We then standardize this index to have a mean of zero and a standard deviation of one. By construction, a greater value of this index indicates a higher level of psychological distress, which is associated with poorer mental health. To differentiate with the original MHI-5 index, we name our mental health indicator as “standardized reversed MHI-5” index.

This index is strongly correlated (with the magnitude of 0.81 and the correlation is statistically significant at the 1% level–see Appendix Table A2)) with the commonly used Kessler Psychological Distress Scale (K10) score, which has been collected biennially since wave 7 of HILDA. Footnote 5 This index is also highly associated with a clinically diagnosed depression or anxiety indicator which was collected in waves 9, 13 and 17 of HILDA: the correlation is 0.41 and statistically significant at the 1% level (see Appendix Table A2). This measure has been employed extensively in Australia (Frijters et al. 2014 ; Nguyen and Connelly 2018 ; LaMontagne et al. 2020 ; Yang and Zikos 2022 ) and internationally (Ware et al. 2000 ). We employ this standardized reversed MHI-5 subscale in the main analysis for two reasons: (1) it is available in all waves of HILDA, enabling us to have a sufficiently large sample to implement some sub-group analyses and (2) as demonstrated above, this subscale has been proven to be a psychometrically sound measure of mental health (Berwick et al. 1991 ; Ware et al. 2000 ). In Sect. 5.3 we will test the sensitivity of the results by employing other mental health measures available in the data such as K10 and some variations of mental health measures constructed from SF-36 (ABS 1997 ).

3.3 Addictive behaviour measures

We consider two types of addictive behaviours: tobacco smoking and consumption of alcohol. For smoking behaviours, we use three self-reported measures. The first measure is a dummy variable called “smoker” indicating whether the individual smoked cigarettes or used any other tobacco products at the time of the survey. The second measure denoted by “daily smoker” is an indicator describing whether the individual smoked daily at the time. We further employ the “weekly number of cigarettes” the individual usually smoked each week as the third measure of smoking.

We also employ three self-reported measures to capture drinking behaviours. We first use a dummy variable (referred as “drinker” thereafter) to indicate whether the individual drank alcohol at the survey time. Moreover, we employ an indicator called “daily drinker” which describes whether an individual drank alcohol every day to capture their drinking frequency. Given evidence on potential health benefits associated with low-moderate alcohol consumption (Mukamal et al. 2003 ; Knott et al. 2015 ), it is uncertain whether “drinker” or “daily drinker” variable captures potentially harmful drinking. To further gauge drinking intensity, we use the Australian standard gender-based benchmark for potentially harmful drinking (NHMRC 2009 ) to construct a variable denoted by “excessive drinker” to describe whether the individual usually drank 5 or more (for females) or 7 or more (for males) standard drinks per day. Footnote 6 Thus, by construction (NHMRC 2009 ), this excessive drinking variable captures high risk drinking behaviour reported by individuals in this study.

We restrict the sample to individuals who are observed on at least two occasions during the study period because we mainly use a FE model. We further exclude observations with missing information on any variable that we control for in empirical model. These restrictions result in a final sample, which varies by addictive outcomes, of about 23,6500 individual-year observations from roughly 24,700 unique individuals observed over 18 years.

3.5 Descriptive analyses

Summary statistics for main outcomes and other characteristics by mental health status are presented in Table 1 . Table 1 indicates that individuals with poorer mental health (i.e., individuals with standardized reversed MHI-5 > median) were appreciably different from those with better mental health. Individuals with poorer mental health were more likely to be female, younger, were less likely to be in a marital relationship, were more likely to be Aboriginal or to have come to Australia from a Non-English Speaking Background (NESB) country or were more likely to have lower education. Table 1 also reveals that individuals with poorer mental health were more likely to engage in smoking or harmful drinking, as measured by excessive drinking. By contrast, individuals with poorer mental health were less likely to engage in more moderate drinking patterns, as represented by drinking or daily drinking. However, it is important to note that these relationships between mental health and addictive behaviours could be driven by unobserved characteristics, reverse causality, and measurement errors. We will address these three issues using FE-IV regressions in the following sections.

4 Empirical framework

We use the following model to estimate the impact of mental health \({MH}_{it}\) on addictive outcome \({Y}_{it}\) of individual \(i\) at time \(t\) :

In Eq. ( 1 ), \({X}_{it}\) is a vector of individual characteristics and \({\mu }_{it}\) is an error term. \(\alpha , \beta\) and \(\gamma\) are parameters to be estimated and \(\beta\) is our interested parameter. We include in \({X}_{it}\) a parsimonious list of characteristics of the individuals or their households, including gender, age (and its square), marital status, Aboriginal status, migration status, education, and household size. We also control for temporal differences in addictive behaviours by including dummies for years and quarters of survey time in all regressions. We additionally control for differences in local socio-economic environments which may influence the individual behaviours by including a relative socio-economic disadvantage index, regional unemployment rates, a metropolitan dummy and state/territory dummies.

Equation ( 1 ) which controls for time-invariant individual unobservable characteristics ( \({\delta }_{i})\) helps address the issue of unobservable individual heterogeneity (such as genetic endowments or discount rate) which is correlated with both mental health and addictive behaviours. However, it cannot deal with reverse causality and measurement error issues which originate from the likelihood that unobserved time-variant, individual-specific factors \({(\mu }_{it})\) co-vary with both the mental health and addictive behavioural outcomes. We further tackle the possible endogeneity issue of mental health in Eq. ( 1 ) by employing an instrumental variables approach. In particular, we introduce an auxiliary equation for mental health:

in which \({Z}_{it}\) is a \(1*\mathrm{D}\) vector of instruments \(\left(D\ge 1\right)\) , \({\omega }_{it}\) is an error term, and \(\tau\) and \(\sigma\) are vectors of parameters to be estimated. Instrumental variable(s) in \({Z}_{it}\) must satisfy three conditions (Wooldridge 2010 ): (i) they must be adequately correlated with \({MH}_{it}\) ; (ii) they must be uncorrelated with \({Y}_{it}\) except through \({MH}_{it}\) ; and (iii) they cannot be associated with individual time-varying unobservable factors in the addictive behaviour equation.

We propose to use the death of a close friend as an instrument for the mental health variable in Eq. ( 2 ). This instrument has been successfully employed in previous studies to investigate the causal effects of mental health on labour supply (Frijters et al. 2014 ), educational attainment (Johnston et al. 2014 ), physical health (Yang & Zikos 2022 ) or children’s developmental outcomes (Le & Nguyen 2017 , 2018 ). We thus adopt death of a close friend as the instrument to examine the impact of mental health on addictive behaviours in this paper. As discussed in previous studies (Frijters et al. 2014 ; Johnston et al. 2014 ), the death of a close friend is likely to satisfy the above mentioned three requirements to be a good instrument. Footnote 7 Specifically, the death of a close friend has been found to worsen mental health (Frijters et al. 2014 ; Johnston et al. 2014 ). This instrument is also theoretically sound: the plausibly exogenous Footnote 8 death of a close friend directly affects the individual's mental health, but only indirectly affects their addictive behaviours through the mental health channel. As has been done in previous studies, we will empirically test the strength of this instrument against the criterium (iii) by controlling for numerous time-variant variables, including physical health, which are likely correlated with our instrument in Sect. 5.3 .

We apply an IV model to panel data in an FE-IV model to control for both time-invariant and time-variant unobserved factors. To estimate Eq. ( 1 ), we employ an Ordinary Least Squares (OLS) method. We model all outcomes as linear. Footnote 9 Furthermore, we use a Two-Staged Least-Squares (2SLS) method to estimate the system of Eqs. ( 1 ) and ( 2 ). In all regressions, robust standard errors are clustered at the individual level to account for serial correlation.

5 Empirical results

5.1 main results.

Estimates of mental health as measured by standardized reversed MHI-5 on various addictive outcomes are reported in Table 2 . In Table 2 we report estimates and relevant statistics from four alternative specifications: (i) “Pooled OLS” results estimated from a model similar to Eq. ( 1 ) without controlling for individual heterogeneity, (ii) “FE” results estimated from Eq. ( 1 ), (iii) “Pooled-IV” results estimated from Eqs. ( 1 ) and ( 2 ) without controlling for individual heterogeneity, and (iv) “FE-IV” results estimated from Eqs. ( 1 ) and ( 2 ). We report pooled results to compare with those presented in most of the prior literature which does not account for individual FEs.

Pooled OLS results (reported in columns 1, 5 and 9 of Table 2 ) show strong associations (with the estimates are all statistically significant at least at the 5% level) between mental distress and all six addictive outcomes considered. Furthermore, while mental distress is negatively associated with the probability of drinking, it is positively associated with other five addictive behavioural outcomes. These results suggest that individuals with poorer mental health are less likely to drink. By contrast though, they are more likely to smoke, smoke more frequently (as measured by smoking daily or smoking more cigarettes per week) or engage in potentially dangerous drinking (as represented by drinking daily or drinking excessively). Our pooled OLS results are thus in line with those reported in the previous cross-sectional studies which consistently show that individuals experiencing mental distress disproportionally engage in smoking or harmful drinking (Lawrence et al. 2009 ; Moylan et al. 2012 ).

FE estimates (reported in columns 2, 6 and 10 in Table 2 ) show that controlling for the individual FE changes the results considerably. For instance, accounting for individual heterogeneity reduces the magnitude of the mental distress estimates for all three smoking outcomes and the excessive drinking indicator, with the reduction ranging from 28% (as in the estimate on excessive drinking) to 86% (daily smoking). Controlling for the individual confounders also turns the estimate of mental distress on drinking from negative and highly statistically significant to positive and statistically insignificant.

The above comparisons between pooled OLS and FE estimates suggest that failing to account for individual unobserved characteristics may result in over-reporting the positive association between mental distress and addictive behaviours. One of the unobserved characteristics would be discount rates as individuals with a higher discount rate, who value current consumption more than future consumption, typically tolerate higher risk lifestyles and invest less in their current health (Grossman 1972 ). Another unobserved characteristic could be some generic factors that are correlated with both mental health and addictive behaviours (Wang et al. 2012 ; Pasman et al. 2018 ; Lillard 2020 ). Therefore, the simple regression which does not control for such unobserved characteristics over-estimates the positive effect of mental distress on addictive behaviours. The same pattern is also observed in other studies employing an individual FE model to document the bi-directional relationship between mental health and substance use disorders (Needham 2007 ; Leung et al. 2012 ; Ranjit et al. 2019 ). As discussed above, while the FE estimator helps control for time-invariant individual characteristics, it cannot deal with issues associated with reverse causality and measurement errors. We next turn to results obtained from the FE-IV estimator, which simultaneously addresses all three issues.

FE-IV estimates are represented in columns 4, 8 and 12 of Table 2 . Footnote 10 The lowest first-stage F statistic is 74, rejecting the null hypothesis of a weak instrument (Stock & Yogo 2005 ). Footnote 11 Table 2 also shows that, as compared to a FE-IV model, employing a FE model alone greatly under-estimates the impact of mental distress on all three smoking outcomes and the excessive drinking outcome. In particular, the estimate of mental distress is about 18 (as in the case of excessive drinking) to 28 (as in the case of smoking) times greater in the FE-IV estimator than in the FE estimator while being statistically significant at least at the 5% level in both estimators. In terms of magnitude, the FE-IV estimates indicate that a one-standard-deviation increase in mental distress increases the probability of (i) smoking by 28 percentage points (pp) (corresponding to 105% of the sample mean), (ii) smoking daily by 12 pp (75% of the sample mean), and (iii) drinking excessively by 18 pp (155% of the sample mean). Similarly, a one-standard-deviation increase in mental distress is found to raise the number of cigarettes smoked per week by 11 (equivalent to 75% of the sample mean).

Table 2 additionally represents that the FE-IV estimator turns the estimate of drinking from statistically insignificant to statistically significant (at the 1% level). The FE-IV result thus indicates that mental distress leads to drinking and the estimated impact is relatively large in magnitude: a one-standard-deviation increase in mental distress raises the drinking probability by 16 pp (or 20% of the sample mean). Table 2 also shows the considerable changes in the estimates of mental distress on the above addictive measures are in line with results from a Hausman test which suggest mental distress is endogenous when modelling these outcomes. Therefore, the results indicate that failing to adjust for the endogeneity of mental distress would considerably under-estimate the positive impact of mental distress on these addiction measures.

The FE-IV estimate of mental distress on the daily drinking indicator is not statistically significant at any conventional level. This non-significant estimate is consistent with the result from a Hausman test which indicates that we can model the mental health and daily drinking outcome independently. Thus, the results from two Hausman-styled tests Footnote 12 support the use of a FE estimator to model the impact of mental distress on the probability of drinking daily. As discussed above, the FE results show that mental distress statistically significantly (at the 1% level) increases the chance of drinking daily, albeit at a rather small magnitude: an increase of one standard deviation of mental distress raises the daily drinking probability by 0.34 pp (or 5% of the sample mean).

5.2 Discussion

In summary, we interpret these results to show that mental distress considerably increases the prevalence and intensity of either cigarette or alcohol consumption. Our finding is in line with the self-medication hypothesis, first introduced by Khantzian ( 1987 ), in which individuals engage in these addictive activities to cope with stress. In particular, agonists of nicotinic cholinergic receptors, including nicotine itself, contained in cigarettes can temporarily relieve symptoms of depression and anxiety (Kumari and Postma 2005 ). Much like the effect of nicotine reward pathways, alcohol consumption can help regulate mood symptoms by supporting the release of endorphins, the naturally occurring feel-good opioids which affect regions of the brain associated with reward processing (Bruijnzeel & Gold 2005 ). Alcohol is also a central nervous system depressant, and its long-term use can cause problems with cognition and memory in heavy users (Mukherjee 2013 ). Footnote 13

However, it has also been hypothesized that smoking or drinking to self-medicate depression is associated with the development of cigarette or alcohol dependence (Sloan and Wang 2008 ; Dome et al. 2010 ; Crum et al. 2013 ), which in turn entails substantial health and socio-economic consequences. Thus, our finding when viewed with these hypotheses suggest that depressed individuals may rely on cigarette or alcohol consumption to provide some temporary relief of depression, despite significant costs of such addictions. To this end, our findings support existing evidence that individuals living with mental distress may make life choices that might otherwise be considered irrational and not in their best private interests (Kung et al. 2018 ; Bayer et al. 2019 ; Nguyen et al. 2021 ).

5.3 Robustness checks

To assess the robustness of our results, we check whether our main findings are sensitive to: (i) the choice of mental health variables and (ii) the inclusion of additional time-variant variables. The results (detailed analysis is reported in Appendix B) show that our findings are robust to these tests.

5.4 Characterizing the composition of compliers

As with other IV studies, the IV estimates in this study capture a Local Average Treatment Effect (LATE) of mental distress on additive behaviours (Imbens and Angrist 1994 ). Specifically, the LATE is applicable to individuals who experienced a worsening mental health state because of the death of a close friend (“compliers”). To profile the characteristics of compliers, we use an approach outlined in Angrist and Pischke ( 2008 ). Particularly, we calculate the ratio of the instrument coefficient estimated from Eq. ( 2 ) for sub-groups of individuals relative to the instrument coefficient estimated for the whole population. This relative likelihood provides indicative evidence suggesting which parts of the population are most likely to be affected by the instrument (i.e., the death of a close friend). To address a heretofore unsolved aggregation issue associated with a continuous treatment (Abadie 2003 ), we dichotomize our treatment variable by using the suggested cut-off of 68 points or lower for the original MHI-5 index to define if the individual has any depressive symptoms (Yamazaki et al. 2005 ). We focus on specific sub-groups, identified by gender, age, marital status, education level, previous smoking status and previous mental health state. Footnote 14

Table 3 shows the relative likelihood that an individual with a particular characteristic belongs to the compliers in our data. As compared to the overall population, the compliers are more likely to be female, younger, single, or to have lower qualifications. Moreover, consistent with prior evidence of cigarette dependence (Sloan and Wang 2008 ; Dome et al. 2010 ; Crum et al. 2013 ), we find that individuals with a previous smoking history over-represent among the compliers. Similarly, and in line with prior findings (Zubrick et al. 2012 ; Friedman 2020 ), individuals with previous mental distress are more responsive to the treatment. The over-representation of individuals with a previous smoking history or previous mental distress among the compliers when viewed with an oft observed pattern of a higher prevalence and intensity of cigarette consumption among these individuals explains some relatively high estimates of mental distress obtained from the IV approach. To this end, our IV estimates may provide an upper bound of the Average Treatment Effect for the overall population (Angrist and Pischke 2008 ). The notable differences in these observable characteristics between the compliers and the comparison population suggest that our estimates may not be generalized to the general population. Nevertheless, they are particularly informative for some sub-populations, including those with previous mental distress or history of addiction, who are typically of policy interest (AIHW 2017 ).

5.5 Results on additional outcomes and household expenditure

We next investigate the effects of mental health on other related outcomes. In particular, to capture the potential compounding impact of mental distress on smoking and drinking behaviours (Tauchmann et al. 2013 ; Ren et al. 2020 ), we construct a binary variable describing whether the individual either smoked cigarettes or drank alcohol at the survey time and use it as an additional outcome variable. We also construct a dummy variable which indicates if the individual either smoked daily or drank daily and use it as another dependent variable in the FE-IV model. Results from these experiments, reported in Columns 1 to 4 of Table 4 , suggest that mental distress statistically significantly increases the prevalence and intensity of cigarette or alcohol consumption. Specifically, an increase of one standard deviation in mental distress raises the probability of either smoking or drinking by 13 pp (Column 2). The impact of mental distress on the intensity of addictive behaviours is slightly less pronounced since the same increase in mental distress is found to raise the probability of either smoking daily or drinking daily by 11 pp (Column 4).

We further experiment with using household annual monetary expenditures on tobacco, alcohol or both items. Footnote 15 As mental distress may affect the household expenditure on items other than tobacco and alcohol, we measure expenditure on tobacco, alcohol or both items in a relative terms, as represented by the share of each of these items in the total household expenditure on all reported items. Of note, having a mental distress also impacts other areas of household expenditure. Footnote 16 Results from this experiment, reported in Columns 5 to 10 of Table 4 , reveal two findings of interest. First, consistent with our earlier findings of an impact of mental distress on rising prevalence and intensity of smoking and drinking, the results in this section also indicate that mental distress statistically significantly increases shares of household expenditure on tobacco or/and alcohol. Second, the estimates are sizable, suggesting that mental distress also causes direct and substantial financial costs to the households of individuals with mental health issues. Particularly, the preferred FE-IV estimate suggests that a one-standard-deviation increase in mental distress raises the share of alcohol expenditure in total household expenditure by 1.65% (or 35% of the sample mean, Column 8). Similarly, the same increase in mental distress raises the proportion of tobacco expenditure in total household expenditure by 0.06% (or 2.1% of the sample mean, according to the preferred FE estimate which is statistically significant at the 1% level, as seen from Column 5). To our knowledge, these significant financial costs to households of addictive behaviours of those with mental distress have not previously been documented in the extant literature. Footnote 17

6 Heterogeneity

To further our understanding of the mental health effects on addictive behaviours, we implement a heterogeneity analysis by running separate regressions on two subsamples of individuals, identified by various characteristics. Footnote 18 These variables include gender (i.e., female versus male), age (young versus old, identified relative to the median age of all individuals in the whole sample), marital status (single versus married) and education level (with or without a bachelor or higher degree). For marital status and education level, sub-groups are defined using the value identified at its first appearance in the sample to address a concern that the individuals’ mental health and addictive behaviours may influence the way that we assign them to each sub-group. To explore the potential role of genetic or intergenerational factors in explaining our results, we also compare the impact of mental distress by the respondents’ parental smoking status during their childhood. Footnote 19 For this sub-population investigation, we report results from an FE-IV model if the exogeneity of mental distress is rejected and results from a FE model otherwise.

Heterogeneity. Results for different sub-populations are obtained from separate FE-IV or FE regressions. The model for each sub-population is printed above the sub-population label (Y indicates results from a FE-IV model while N from a FE model). For all binary outcome variables, sample mean, coefficient estimate and its 95% confidence interval are multiplied by 100 for aesthetic purposes. The solid (dash) horizontal line shows the mental health coefficient (95% confidence interval) estimates for the whole population. The sample mean of dependent variable for each sub-population is printed below the bars. Detailed regression results are reported in Appendix Table A7

Estimates on the impact of mental distress by sub-populations for various addictive measures are concisely reported in Fig.  1 . Figure  1 suggests that mental distress appears to have some differential effects, depending on sub-group characteristics and outcomes being considered. For example, the effect of mental distress on tobacco and alcohol consumption appears to be greater for males because the estimates are always higher (i.e., more positive) or typically more statistically significant for them. By the same reasoning, sub-group results by age groups indicate that the effects of mental distress on all smoking outcomes and being a current alcohol drinker are much more apparent for older individuals. By contrast, the impact of mental distress for younger individuals is more pronounced in regard to the excessive drinking outcome since the estimate is greater (about twice as much) and more statistically significant for them. Moreover, Fig.  1 suggests that mental distress appears to have a greater impact on smoking or daily smoking outcomes of married individuals. Conversely, the impact of mental distress tends to be more visible on drinking outcomes for single persons.

Sub-group results by education level reported in Fig.  1 also indicate the effects of mental distress on all addictive outcomes are much more apparent for individuals with lower qualifications because their estimates are greater or more statistically significant. The finding that mental distress has a more pronounced impact for individuals with lower education is consistent with an oft observed pattern, which is also confirmed in our data (see sample mean figures reported below the bars in Fig.  1 ), that lower educated individuals dispportionaly engage in smoking and risky drinking activities (AIHW 2017 ). Turning to the sub-group analysis by parental smoking status, we continue to observe that, with an exception of being a current alcohol drinker, where the estimate is about 42% smaller for children of smokers, the effects of mental distress on all other addictive outcomes are much more pronouned for children of smokers.

Fig.  1 indicates that the impact of mental distress is not statistically significantly different by all characteristics considered above. Footnote 20 However, there are three important exceptions. First, the estimates of mental distress on the number of cigarettes smoked are statistically different (at the 5% level) for males and females, indicating that males statistically significantly smoke more when experiencing negative psychological states. Second, the estimates on daily smoking, drinking and excessive drinking outcomes by education are also statistically different at the 5% level, suggesting that individuals with lower education statistically significantly engage more in these additive activities when facing mental health shocks. Third, the estimates on the probability of daily smoking and the number of cigarettes smoked are statistically different for children of smokers compared with those of non-smokers. To the best of our knowledge, the finding of a much greater impact of mental distress for children of smokers has not been documented the literature. This finding when observed with the observation that children of smokers consume substentially more cigarettes than children of non-smokers (see mean statistics reported below the bars in Fig.  1 ) shows that parental addictive behaviours may not only be transmitted to their children (Mitrou et al. 2010 ) but also influence the way their children respond to mental health shocks.

7 Conclusion

Drawing on a high-quality nationally representative panel dataset we have presented the causal effects of mental health on cigarette smoking and alcohol consumption behaviours of Australians. We find robust evidence that mental distress substantially increases the prevalence and intensity of either cigarette or alcohol consumption. Consistent with this finding, additional analysis reveals substantial monetary costs associated with cigarette and alcohol consumption caused by mental distress. Moreover, the impact is greater for lower educated individuals and children of smokers, and is slightly higher for males.

Our findings on the impact of mental distress on addictive behaviours highlight the importance of controlling for potential endogeneity of mental health when modelling its causal effects on addictive behaviours. Failing to simultaneously address these issues could result in under-estimates of the effect of poor mental health on the increasing prevalence and intensity of either cigarette or alcohol consumption. Our finding of a strong association between life stress events and depression provides an argument for public initiatives that support vulnerable groups to cope with negative psychological events. Such policies may not only reduce the overall prevalence and impact of mental distress but also discourage mental distress-attributable addictive behaviours and hence alleviate their associated socio-economic costs, following our finding of a measurable impact of mental distress on increasing addictive behaviours. Overall, our findings, together with others, highlight the role of mental health screening and treatment programs, especially among lower educated individuals or children of smokers, to assist in the prevention of addictive activities which are costly to both the individual, and to broader society.

We follow previous studies (Frijters et al. 2014 ; Nguyen & Connelly 2018 ; Yang and Zikos 2022 ) which use the same dataset and similar “mental health” measures to adopt the term “mental health” in this paper. Moreover, we employ the terms “mental health disorders”, “mental distress”, “mental illness” or “mental health issues” interchangeably in this paper, mainly because there is no commonly agreed practice on which term to use (Fluharty et al. 2017 ). Furthermore, cigarette smoking and alcohol drinking have been identified as “addictive behaviours” (Grant et al. 2010 ).

This paper is also related to the economic literature on addictive behaviours. See, for example, Sloan and Wang ( 2008 ) for a review on economic theory and evidence on smoking behaviours and Lillard ( 2020 ) on the economics of nicotine consumption.

Potentially due to availability of cigarette smoking information in datasets used and the apparent socio-economic costs of smoking, studies in this literature usually focus on the relationship between cigarette smoking and mental health. See, for instance, Fluharty et al. ( 2017 ) for a recent review on this relationship. A related line of research focuses on the change in mental health after smoking cessation. The dominant evidence from this line of studies suggests that smoking cessation is associated with reduced depression, anxiety, and stress (Taylor et al. 2014b ). Establishing the causal link between mental disorders and addictive behaviours conclusively would require evidence from randomised trials, which is hard to achieve in modern times due to the understandable ethical constraints that surround designs involving human subjects. Following this direction, studies have employed experiments on animals. For instance, Iñiguez et al. ( 2009 ) experimented with varying nicotine exposure to rats to find that nicotine exposure during adolescence causes a depression-like status in adulthood.

We do not use wave 1 of HILDA because information to construct our instrument is only available from wave 2 onwards.

Specifically, K10 is constructed using responses to a set of 10 questions with the preamble “The following questions are about your feelings in the past 4 weeks. In the last four weeks, about how often did you feel: (1) depressed, (2) everything was an effort, (3) so nervous that nothing could calm you down, (4) so restless that you could not sit still, (5) hopeless, (6) nervous, (7) restless or fidgety, (8) so sad that nothing could cheer you up, (9) tired out for no good reasons, and (10) worthless?”. Responses to each question are recorded in a five-point scale, ranging from “all of the time” (1) to “none of the time” (5). As has been done with the MHI-5 subscale, we construct our K10 index by summing scored responses to the 10 questions and standardize it to have a zero mean and a standard deviation of one. Similar to the MHI-5 index, a higher value of our K10 index also indicates a poorer mental health status.

We do not use the current NHMRC alcohol consumption benchmark which was introduced in December 2020 because this new guideline was not available to individuals surveyed during our study period (i.e., 2001 – 2019). Nevertheless, using this new and more restrictive benchmark which suggests “no more than 10 standard drinks a week and no more than 4 standard drinks on any one day” for healthy men and women (NHMRC 2020 ) does not change our findings. We do not use the number of standard drinks per day as an outcome because responses to a question asking about this are recorded in bands (e.g., “1 to 2 standard drinks” or “3 to 4 standard drinks”) and top-coded (i.e., “13 or more standard drinks”). Our data also show that the six measures of addictive behaviours used in this paper are positively and highly statistically correlated (at the 1% level) with one another. Furthermore, each of these addictive measures is positively and statistically significantly (at the 1% level) associated with an indicator describing whether the individual had ever used any illicit drug (see Appendix Table A2). We do not employ illicit drug use as an additional measure for addictive behaviours because the question about drug use is only asked in wave 17 of HILDA.

In HILDA, individuals are asked “Did any of these happen to you in the past 12 months?”. We use the statement about “Death of a close friend” to construct the instrument. We purposely do not use the death of family members or close relatives as an instrument because these deaths may signal genetic risks, lead to windfall income (in form of inheritance from deceased relatives) or directly influence the addictive behaviours of other household members or relatives.

Our empirical framework is akin to that in a recent study by Friedman ( 2020 ). In particular, Friedman ( 2020 ) finds that life stressful events such as death of a non-family member statistically significantly increases subsequent initiation and intensity of smoking among adolescents in the US. The empirical model applied by Friedman ( 2020 ) to explore the impact of these life stressful events on subsequent smoking behaviours is similar to a reduced form of our empirical model in which a similar life stressful event is employed as an instrument for mental health in the first stage regression (Angrist & Pischke 2008 ).

We also employed a Probit model for all binary outcome variables. Appendix Table A3 indicate that pooled Probit results are largely similar to the pooled OLS results (reported in Table 2 ) in terms of the magnitude and statistical significance level, suggesting that our results are not driven by the linearity assumption.

For comparison purposes, we also report pooled IV regression results in columns 3, 7 and 11 of Table 2 . In line with the FE-IV results, the pooled IV results show positive and statistically significant estimates of mental illness on all addictive outcomes except the daily drinking indicator. In our IV approach, pooled IV regressions may provide inaccurate estimates because they don’t control for time invariant unobservable factors which may be associated with the instruments and addictive outcomes at the same time.

First-stage regression results from pooled IV and FE-IV estimator are reported in column 1 and 2, respectively, of Appendix Table A4. The results are largely in line with those documented in other studies (Frijters et al. 2014 ; Johnston et al. 2014 ). For instance, the death of a close friend statistically significantly deteriorates mental health. Moreover, age has an inverse U-shape relationship with mental illness and marital breakdown worsens mental health. Appendix Table A5 reports estimation results of remaining variables from second-stage regressions. The results are largely as expected. For example, smoking (either prevalence or intensity) decreases with age. In addition, while drinking and daily drinking increases, at a decreasing rate, with age, excessive drinking decreases, at an increasing rate, with age. While education has no clear relationship with smoking and drinking behaviours, increased household size consistently decreases these two addictive behaviours.

Specifically, the Hausman-styled test that supports the use of a FE model (over an OLS pooled model) and the one that rejects the endogeneity of mental illness in the FE-IV model.

Moreover, our finding lends empirical support to a prediction from a rational addiction theory in economics proposed by Becker and Murphy ( 1988 ) that anxiety and tensions can cause an addition.

For brevity purposes, we present results estimated from the regression of “smoker” as an outcome. Results for other outcomes are broadly similar and will be available upon request.

Information on household expenditure is available from Wave 5 onwards and reported by all surveyed members who self-identified that they had responsibility for paying household bills. In cases multiple members of the same household provided response (about a quarter of all surveyed households did so), household expenditure amount is averaged across all individuals providing response. Furthermore, because the preamble of expenditure questions asks: “In a typical week, does this household spend money on”, expenditure is calculated at the household level and measured on an annual basis (by multiplying weekly expenditure by 52 (weeks)). Despite some concerns over the quality of expenditure data reported in HILDA (Wilkins & Sun 2010 ), including the fact that HILDA omits several important spending items, household expenditure measures have been employed in previous studies (Wilkins and Sun 2010 ; Nguyen et al. 2020 ). These data limitations, including the small sample size and potential measurement errors, should be considered when interpreting the results in this section.

Unreported results show that mental illness decreases the share of expenditures on Groceries, Clothing and footwear, Private health insurance, Other insurance, and Home repairs. By contrast, mental illness raises the proportion of expenditures on Medicines, Education fees, Public transport, Telephone rent and Electricity bills.

Of note, these household expenditures may be an under-estimate, because our data do not cover all possible addictive substances or behaviours, such as other drugs, gaming or gambling, in sufficient detail.

As discussed in subsection 5.4, this heterogeneity analysis also sheds light on the estimated LATE impact for different subsets of compliers (Angrist and Pischke 2008 ).

Retrospective information on parental smoking behaviour during childhood is constructed from responses to a question asking: “Were any of your parents or guardians smokers at any stage of your childhood?” This question was asked for the first time in wave 9 of HILDA for all respondents and in waves 13 and 17 for new respondents. Consistent with a large literature documenting the intergenerational correlation in risky behaviours, this study also finds that, as compared to children of non-smokers, those of smokers are more likely to engage in smoking and drinking activities (see sub-population mean figures reported below the bars in Fig.  1 ). Unfortunately, there is no retrospective information on parental drinking behaviour in HILDA for us to implement a similar sub-group analysis.

Full estimation results are represented in Appendix Table A7.

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Acknowledgements

This research was partly funded by the Australian Research Council Centre of Excellence for Children and Families over the Life Course (CE200100025). For their helpful comments and suggestions, we thank Editor Subal C. Kumbhakar and anonymous reviewers of this journal, Alexander Ahammer and participants at 2021 Essen Mental Health Workshop. This paper uses unit record data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute.

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Francis Mitrou, Ha Trong Nguyen, Huong Thu Le & Stephen R. Zubrick

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Mitrou, F., Nguyen, H.T., Le, H.T. et al. The causal impact of mental health on tobacco and alcohol consumption: an instrumental variables approach. Empir Econ 66 , 1287–1310 (2024). https://doi.org/10.1007/s00181-023-02483-x

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Tobacco and alcohol

Updated 19 August 2021

Subject Addiction

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Category Food ,  Health

Topic Alcohol ,  Tobacco

Many people are misled into believing that legalizing substances

like tobacco and alcohol, as well as the government's ability to regulate their use, would make them less dangerous to society. Since people have differing viewpoints on various issues in life, every speaker or author should focus on persuading their audience of their point of view. However, depending on the speaker's or author's approach, persuading people can be simple or difficult.

Hari Johann discussed and addressed the problem of addiction from a different viewpoint

in his book "What You Think You Know About Addiction Is Wrong." Hari found out that the idea of punishing addicts as an approach and a reason to change their attitude on drugs to make the victims stop abusing the substance had little to no impact to the addicts and their surroundings. Instead, it made the addicts worse because of constant ridicule and abandonment from individuals and groups that they expected and hoped would help them overcome their problems. Hari’s presentation captured the attention of most viewers because of the application of different elements of an argument such as the use of logos, pathos, humor, ethos, gestures, eye contact, clarity, and vocal coordination among other factors. Any cogent argument analysis should maintain a rational criterion that aims at showing how the premises supported the speakers’ conclusion.

Background of Addiction

Reinarman described addiction as a chronic brain disorder that negatively impacts a person's body through the constant use of substances or the engagement of activities intended for rewarding stimuli but the excessive habit results in adverse consequences (307). Moreover, Reinarman also found out since the beginning of the twenty-first century, people in the western countries view addiction as a brain disease (307). In some situations, some people use the term addiction as a mantra to justify success. For instance, some successful individuals argue that people have to immerse themselves in their works as addicts as a platform to get better rewards than the average person. Even though the idea may sound logical, it still triggers some people to question how much is too much. Over the years, addiction seems to have existed, but its ubiquity did not originate from scientific discoveries. Instead, Reinarman believed that people became addicts as a sense of social accomplishment (308). Nevertheless, Hari had a different view about addiction as he stated that society had a wrong perception of compulsion and that false impression has blinded people's ability to combat this habit efficiently.

Reasoning and Evidence

Hari’s use of reasoning and evidence as elements of arguments made the presentation convincing and clear. The idea behind rationale is to help an audience observe and interpret an issue in the speaker's point of view. For example, Hari engaged the listeners in a thoughtful experiment that required the people to imagine using heroin three times a day for 20 days. At this point, Hari wanted the listeners to imagine themselves as addicts and what they would like society to do towards helping substance abusers overcome their addiction. Such an approach helped Hari disseminate his idea by ensuring the viewer's understood his concept from the speaker's viewpoint. Additionally, Hari centered and supported arguments by the utilization of different forms of evidence. For instance, Hari admitted that just like most people, he realized that he did not understand the meaning of addiction. Therefore, Hari decided to interact with professionals like Bruce Alexander who had conducted experiments and researched more about addiction and also intermingled with crack dealers to understand their perception of the issue. Consequently, such evidence made Hari more convincing because he supported his presentation with real-life reasons to back up his arguments.

Speaker's Presentation

The style in which a person presents himself or herself in front of an audience when giving a speech also speaks a lot about the individual's ability to convince an audience. In this case, Hari utilized a couple of visual elements of speech as an approach to communicate his information and argue his ideas effectively. For instance, Hari mastered the art of and owning the podium while making the presentation. Whenever Hari turned to face any direction, he kept eye contact with the audience all the time. Moreover, the speaker maintained the center position but moved the body in different directions to reduce the chance of giving any of the audience his back. Equally, Hari's stance also signified a sign of confidence that appealed to an audience. Hari also used body language tools such as gestures, and facial expression throughout the presentation to connect with the audience. Gestures reinforce words and ideas conveyed by a speaker, and they also underpin the way a person feels about an issue. Additionally, Hari mainly used symbolic and descriptive gestures to express words, ideas, and enhance his stories. Therefore, that explains why Hari used his hands and arms a lot while speaking. The use of facial expressions also helps in communicating a message to the audience as felt by the speaker. Hari looked concerned when talking about coming from a family that had addicts. Consequently, non-verbal communication techniques help viewers remember or comprehend an argument even after leaving the venue.

Rhetorical Appeals

Speakers need to utilize persuasion strategies also known as rhetorical appeals with the objective of connecting, engaging, and convincing an audience about the subject in question. Hari's aim included assuring the listeners that their knowledge of addiction was wrong and he had to prove that by providing logical explanations in support of his new-found ideologies. In such a case, Hari utilized logos as a rhetorical appeal that emphasizes the use of logic to prove and back up a person's opinion. For example, the speaker conducted intensive research which began by reading several books, articles, and any other print or online material to understand why the approach used by different parties to help people overcome addiction did not produce significant results (Hari). Equally, Hari used ethos to persuade his audience about the scientific proofs of his ideology. For example, the speaker provided evidence of interacting with professionals such as professor Alexander, and Peter Cohen and used their information to back up his arguments.

Over the years, the topic of addiction has been explored and debated upon by different people including Hari with the intention of helping audiences understand the various views and theories associated with the subject. However, the staging approach is the factor that differs from the speakers. Efficient speakers back up their arguments with reason and ethics. In such a case, the speaker must identify a conclusion and later on embark on deduction strategy that incorporates different premises that support the speakers' conclusion. Similarly, an excellent speaker will also employ non-verbal communication strategies such as the use of body patterns to emphasize ideas. Overall, Hari captured the attention of his viewers and deduced his arguments by supporting his ideas towards convincing his audience about his belief.

Works Cited

Hari, Johann. Everything you think You Know about Addiction Is Wrong. TEDGlobalLondon, 2015, https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong. Accessed 24 Nov 2017.

Reinarman, Craig. Addiction as Accomplishment: The Discursive Construction of Disease. Addiction Research & Theory, vol. 13, no. 4, 2005, pp. 307-320.

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Ielts writing task 2 sample 916 - tobacco and alcohol are drugs that cause addiction and health problems, ielts writing task 2/ ielts essay:, tobacco and alcohol are drugs that cause addiction and health problems. therefore they should be made illegal. .

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Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems – IELTS Writing Task 2

Updated On Dec 13, 2023

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Table of Contents

• Band 7 Sample Answer for Writing Task 2 Question – Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems
• Band 8 Sample Answer for Writing Task 2 Question – Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems
• Band 9 Sample Answer for Writing Task 2 Question – Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems

IELTS Writing Task 2 Connectors for Extra Points in the Sample Answers for Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems

Additional resources.

Limited-Time Offer : Access a FREE 10-Day IELTS Study Plan!

Agree Disagree essays, like ‘Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems’, are the most common type of questions in  IELTS Writing Task 2 .

In contrast to classic  Agree Disagree essays , ‘To what extent do you agree or disagree’ questions do not specifically ask you to declare your level of agreement or disagreement with the statement. You can either say for or against the notion or you can partly agree or disagree with it. Once you’ve made up your mind, come up with two or three arguments in favor of it.

Since Writing Task 2 can be challenging for many IELTS candidates, practising topics like The ‘Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems’ will help you acquaint yourself with the format of structuring an IELTS Agree Disagree essays. Also, if you want to practise regularly, check out the  Writing Task 2 practice tests .

Let’s have a look at the Agree Disagree essay – Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems – with three expert-curated sample answers for different IELTS band scores.

You should spend about 40 minutes on this task.

Tobacco and alcohol are drugs that cause addiction and health problems. therefore, they should be made illegal. to what extent do you agree or disagree with this statement, give reasons for your answer and include any relevant examples from your own knowledge or experience., you should write at least 250 words..

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Band 7 Sample Answer for Writing Task 2 Question – Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems

A large percentage of individuals think that alcohol and tobacco should be banned since they are substances that can lead to addiction and health issues. In this essay, I will explain why I agree with this viewpoint.

In the first place, tobacco and alcohol are well-known contributors to multiple health problems, including lung cancer, liver cirrhosis, cardiovascular diseases, and addiction. One of my uncles passed away due to liver cirrhosis, as he used to drink alcohol regularly even when the doctor asked him not to. As a result, supporters of this ban argue that making these substances illegal would result in a significant reduction in the prevalence of such health issues.

Moreover, addictive substances, especially alcohol, are linked to poor judgment and an increased risk of accidents, including drunk driving incidents. Every year, a large number of people meet with deadly accidents due to intoxication. Due to this, a considerable burden on healthcare systems is created. So, people feel that making alcohol illegal could enhance public safety by minimizing alcohol-related accidents and violence.

In the end, even though it is true that alcohol and tobacco have a harmful effect on our health, I believe banning them will not stop the use of these substances. The government will need to check the black market, where the sale of these substances will increase once the ban is applied. Also, individuals should be conscious of the effects and be responsible for regulating their use. (240 words)

Vocabulary 

• Banned (Verb)

Meaning: officially or legally prevent (something) E.g.: He was banned from flying with this airline due to his misbehavior with the airhostess.

• Contributors (Noun)

Meaning: someone who takes part in something or makes a contribution E.g.: Kalika is a regular contributor to the editorial column of the magazine.

• Cirrhosis (Noun)

Meaning: a condition in which the liver is scarred and permanently damaged E.g.: After his father died with cirrhosis, he gave up drinking.

• Prevalence (Noun)

Meaning: the fact of something existing or happening often E.g.: We noticed a prevalence of inappropriate behavior among the new students.

• Addictive (Adjective)

Meaning: something that makes people unable to stop taking it E.g.: Dendrite has an addictive quality and should be kept away from children.

• Intoxication (Noun)

Meaning: the condition of having physical or mental control markedly diminished by the effects of alcohol or drugs E.g.: The police asked him to get down from the car as he was showing signs of intoxication.

• Regulating (Verb)

Meaning: to control or maintain the rate or speed of (a machine or process) so that it operates properly E.g.: The government should make laws for regulating the misuse of labour.

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Band 8 Sample Answer for Writing Task 2 Question – Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems

Alcohol and cigarettes both have adverse impacts on health and can cause severe addiction. I truly believe that the use of alcohol and tobacco should be prohibited since they are addictive and cause other health issues.

To begin with, more than 25 distinct fatal diseases, such as emphysema, bronchitis, and lung cancer, are linked to smoking. Recent data indicates that tobacco-related diseases claim the lives of four million people worldwide each year, or one death every eight seconds. More people are dying from and getting disabled from tobacco use than from any other single factor. Additionally, smoking tobacco affects not just smokers but also those in the vicinity as they inhale the smoke emitted. Accordingly, smoking ought to be restricted to improve public health. A nation could treat more patients with the amount of money it spends annually on treating citizens with diseases linked to tobacco use.

Moreover, the use of alcohol has grown to be a significant issue during the past few centuries. An increasing number of individuals consume alcohol daily, which leads to severe issues like brain damage, divorce from one’s spouse, and dissolution of a family. In addition, consumption of alcohol reduces productivity, which affects the life of the individual as well as the people around him. Thus, alcohol ought to be banned everywhere.

In conclusion, I believe that the two biggest risks to society and our health are alcohol and cigarettes, as they cause several health and social issues. Therefore, the government should make the use of tobacco and alcohol illegal and individuals should behave more responsibly. (261 words)

• Adverse (Adjective)

Meaning: having a negative or harmful effect on something E.g.: Eating fast foods on a regular basis can have adverse effects on your health.

• Prohibited (Verb)

Meaning: not allowed E.g.: Women are prohibited to enter mosques.

• Emphysema (Noun)

Meaning: a lung condition that causes shortness of breath E.g.: Meena’s father is suffering from emphysema.

• Vicinity (Noun)

Meaning: the area near or surrounding a particular place E.g.: No one is allowed to go in the vicinity of that haunted palace.

• Emitted (Verb)

Meaning: produce and discharge (something, especially gas or radiation) E.g.: The government should penalize the factories that emitted harmful gasses.

• Dissolution (Noun)

Meaning: the act or process of ending an official organization or legal agreement E.g.: Everyone is unhappy to learn about the dissolution of the R&D department of the company.

• Productivity (Noun)

Meaning: the rate at which a person, company, or country does useful work E.g.: Productivity and creativity are two important factors that we are looking for in the new candidate.

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Band 9 Sample Answer for Writing Task 2 Question – Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems

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The idea of making tobacco and alcohol illegal is a controversial issue as people are divided in their opinion. In my opinion, although these substances do indeed pose significant health risks and can lead to addiction, banning them may not be the most effective solution. Therefore, I will discuss my viewpoint in the following paragraphs with relevant examples.

It is true that tobacco and alcohol consumption are major contributors to various health problems, including heart disease, liver damage, respiratory issues, and various cancers. Simultaneously, the use of tobacco and alcohol can impair judgment and coordination, leading to accidents and injuries. As a result, supporters argue that prohibiting the use of alcohol would protect individuals from the associated health risks and reduce mishaps. However, history has shown that outright prohibition can lead to black markets, smuggling, and increased criminal activity. The prohibition of alcohol in the United States during the 1920s, for example, led to the rise of organized crime.

Furthermore, supporters of the ban opine that the health consequences of tobacco and alcohol use place a considerable economic burden on healthcare systems worldwide. Likewise, the consumption of these harmful substances is often linked to social problems, including domestic violence, crime, and public disturbances. Nonetheless, some believe outlawing them will not be effective as it is a personal choice. Therefore, individuals must become responsible and consciously try to prevent the damaging effects.

To conclude, I would like to point out that as alcohol and tobacco are detrimental to individuals as well as society as a whole, it is best to implement stricter regulations, education, and harm-reduction strategies. These approaches focus on minimizing the negative consequences of substance use without criminalizing it or increasing organized crime. (284 words)

• Controversial (Adjective)

Meaning: relating to or causing much discussion, disagreement, or argument : likely to produce controversy E.g.: Divorce in backward countries is a controversial topic.

• Impair (Verb)

Meaning: weaken or damage (something, especially a faculty or function) E.g.: The accident impaired his ability to play football.

• Coordination (Noun)

Meaning: the act of making all the people involved in a plan or activity work together in an organized way E.g.: The performance of the group was rated low due to lack of coordination among the dancers.

• Mishap (Noun)

Meaning: bad luck, or an unlucky event or accident E.g.: The burning of the Northern forest was a mishap no one could forget.

• Outright (Adjective)

Meaning: completely or immediately E.g.: Telling him that we have reached the destination is an outright lie.

• Smuggling (Noun)

Meaning: the illegal movement of goods into or out of a country E.g.: The detectives are looking for the group that is involved in smuggling of priceless artifacts.

• Outlawing (Verb)

Meaning: to make something illegal or unacceptable E.g.: People want the government outlawing child labour in the country.

• Detrimental (Adjective)

Meaning: obviously harmful; damaging E.g.: Overconsumption of soft drinks can be detrimental to children.

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Connectors or Linking words helps to bring coherence to your writing and increase your chances of scoring a high band. So, check out the list of  connectors/linking words   used in the sample responses for the IELTS Writing Task 2 – ‘Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems’ given below.

• In the first place/To begin with
• As a result/Due to this/Accordingly
• Moreover/Also/Additionally/In addition/Furthermore
• So/Thus/Therefore
• In the end/In conclusion/To conclude
• In my opinion
• It is true that
• Simultaneously
• However/Nonetheless

It’s time for you to start writing on your own now that you have read through the sample responses on the subject of ‘Tobacco and Alcohol are Drugs that Cause Addiction and Health Problems’. You can use  our FREE evaluation service  or submit your replies in a comment below for that.

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303 Alcohol Essay Topic Ideas & Examples

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• Social Article About Alcoholism Problem by Sanders Russell In his story “Under the Influence: Paying the Price of My Father’s Booze,” author Sanders Russell gives a deeply personal account of the effects of alcoholism in his family as he was growing up. Russell […]
• Alcoholic Industry: Beam Suntory and Diageo Companies In the United States, the beverage industry continues growing: more than 60% of all revenues in the industry are made of the revenues of alcoholic beverages.
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• History of Alcoholics Anonymous (AA) Wilson and Smith went to the Oxford Group to learn the Oxford Group’s techniques of prayer, for example: surrender, guidance, and moral principles.
• Analysis of Alcoholic Products Market in Ireland One of the major threats to the alcoholic drinks industry in Ireland is the increase in the number of coffee shops on the high street.
• Alcoholic Anonymous Reaction Essay The understanding of alcohol abuse and the current resources that exist to curb it, such as AA, is fundamental to understanding the challenge on a medical level.
• Alcoholism and Treatment Options Even though alcohol has been inappropriately abused recently, it is safe to say that the consumption of alcohol is both a tonic and poison, depending on the dose. In India, several states prohibit the sale […]
• Alcohol Use Disorder: Addictive Behaviors Alcohol use disorder is a chronic relapsing brain disease characterized by the following: Compulsive alcohol use Loss of control over alcohol intake Negative emotional state when not using alcohol.
• Understanding and Addressing Alcohol Dependence Alcohol dependence is a chronic condition involving a past or present record of excessive drinking, unending craving for alcohol, and persistent, recurring problems associated with the inability to decide when to use the chemical.
• Pathophysiology of Stress, Processed Foods, and Risky Alcohol Consumption The body starts to see the fats, sugars, and salt in ultra-processed foods as rewards, which leads to increased cravings and overeating.
• Drug and Alcohol Abuse Among Teenagers The thesis statement is: “Conviction is a better way to reduce drug and alcohol addiction among teenagers in the United States”.
• Alcohol and Drug Abuse in Canada Therefore, it contributes as a central factor in the essence of the character, and it is crucial to understand the core definition and the elements that foster the ideology.
• When Alcohol Use Becomes Substance Use Disorder Patients suffering from AUD believe they cannot restrict their alcohol use; however, others who consume alcohol may alter the limit since they are not addicted to the drug.
• Awareness on Alcoholism: What Is It and How to Cope? The availability of these products is a major driver of individual and family problems that many people face. Alcoholism is a form of physical and mental addiction to drinks containing alcohol.
• Comorbid Gambling Disorder and Alcohol Dependence The patient was alert and oriented to the event, time, and place and appropriately dressed for the occasion, season, and weather.
• Alcohol Abuse: Causes, Symptoms, Prevention, and Treatment Alcohol can additionally be the cause of brain damage manifested in the form of impairments in executive functioning, for example, weakening of visuospatial function and working memory.
• Alcohol-Based Sanitizers Preventing Nosocomial Infections Namely, the research papers examine the most prominent strains in the healthcare setting, compare alcohol-based and alcohol-free sanitizers, and prove the effectiveness of the intervention.
• Alcohol Consumption Impact on Graduation Rates One of the most acute problems of our time is the increasingly frequent use of alcohol by minors. Alcohol consumption by school students refers to deviant behavior, and this type of behavior of adolescents is […]
• Alcohol Misuse and Its Impact on Young Drinkers The impact of alcohol use can range from severe and rapid results of a single incident of alcohol impairment, including unexpected accidents and deaths, to cumulative and varied implications of a persistent pattern of drinking, […]
• Alcohol and Aggression: Annotated Bibliography The authors conduct an experiment to examine the alcohol-related cues to aggressive thoughts and violent perceptions in the absence of alcohol or using a placebo.
• Screening Alcoholism With AUDIT Evaluation Method This tool, in turn, could provide some extra explanations for Brian’s drinking and help determine whether he was genetically predisposed to the condition. Thus, AUDIT happens to be the most suitable tool for reviewing Johnson’s […]
• Isopropyl Alcohol in Cosmetics and Medicine Isopropyl is synthesized in two steps: through the reaction of propylene with sulfuric acid and the consequent hydrolysis. In the context of isopropyl alternatives as sanitizers, ethyl alcohol serves as a solid option.
• Drug and Alcohol Addiction: Abby’s Case The amounts of money Abby spends weekly on fulfilling her addictive desires and her long history of drug usage imply that she has an addiction problem.
• Alcohol Consumption: The Key Aspects The quantity of alcohol a person’s body can handle is determined by the type of drink, the person’s weight, and the drink’s serving size.
• Aspects of the Fetal Alcohol Syndrome It is not known when alcohol is most harmful to the fetus during pregnancy and whether there is a safe lower limit for alcohol consumption.
• Impaired Control and Alcohol Consumption The study will focus on the relationship between mood/attitude and impaired control in the context of alcohol consumption. The purpose of the study is to identify whether certain moods or attitudes result in a greater […]
• Alcohol-Induced Chronic Pancreatitis: Population Affected, Side Effects, and Treatment The recurrence of acute pancreatitis is linked to the development of chronic pancreatitis, and it is more prevalent in alcoholics who use alcohol often.
• Evidence of the Success of Alcohol Prohibition in the United States in 1920 Consumption of alcoholic beverages considerably declined as a result of the enactment of prohibition in the United States. As a result, there was a considerable decrease in the number of alcohol-related diseases.
• Alcohol Consumption Among Students: Linear Regression and Correlation 0, the p-value is 0. From the correlations results in table 3.
• Alcohol Consumption Among Students However, the study examines the prevalence of alcohol among college students and the neighborhood surrounding since many studies have not focused on the impact of the environment on alcohol consumption among college students.
• Narcotic Anonymous and Alcoholics Anonymous Groups The desire to change one’s life for the better and look at the world soberly is what many people come to with time, and all of them are united by the desire to return to […]
• Alcohol and Narcotic Anonymous’ Recovery I was impressed by the fact that at the beginning of the meetings the group finds a volunteer who reads an excerpt from the book as a prayer, and the discussion of personal experiences begins.
• Substance Abuse: Drug and Alcohol Treatment National Association of Addiction Treatment Providers: Concentrates on ethical interventions Provides integrated treatment approach Offers cognitive-behavioral methods Reinforces the value of family support Recognizes addiction as a complex issue Prohibits discrimination
• Alcoholism Issue in Miami Gardens The new data also matches tendencies from the summer of 2020, when the coronavirus struck, when many Floridians resorted to alcohol and other narcotics in the face of unpredictable circumstances.
• Alcoholics Anonymous Program Evaluation Program evaluation also assesses the organization’s quality, the efficiency of its methods and identifies aspects of the procedures that can be improved.
• Alcohol Usage Should Be Controlled As such, the current landscape of alcohol production and marketing requires heavier regulation in the form of a number of policy changes.
• The Effects of Drinking Alcohol While Pregnant However, the study revealed an unexpected association between the two conditions and improved awareness of the devastating impact of protean on development and health. The study evaluated the neuropsychological and alcohol exposure parameter as well […]
• Effectiveness of SBIRT for Alcohol Use Disorders in the Emergency Department In this stage, the health practitioner asks the patient three questions regarding the quantity and frequency of alcohol use by employing the AUDIT-C tool.
• Alcoholism Causes: Where Science and Religion Converge Although it is difficult to pinpoint a single cause of alcoholism, it is clear that many internal and external factors serve as raw material in the making of an alcoholic.
• The Cost-Effectiveness of Alcohol Screening, and Brief Intervention Miami is a highly-populated area; According to statistics, 463,347 people reside in it; Approximately 25% of the population suffer from different forms of addiction and alcohol abuse is one of the leading problems on […]
• Alcohol Abuse and Effective Prevention Technique The original presentation and this extended exploration for it discuss the community structure, the essence of the problem and the theory and practice behind the SBIRT approach.
• Media Influence on Alcohol Abuse Consequently, many people are likely to watch the advert, and the ad can increase consumption of the product and limit the fight against alcohol problems.
• Alcohol Addiction: Biological & Social Perspective At the same time, the UK is one of the most drinking countries, as the average number of liters of alcohol per person there was 11. In addition, taking acetaldehyde dehydrogenase inhibitors allows to break […]
• Alcoholics Anonymous Overview When I attended the third meeting, I was among the people who largely contributed to how it is easy to stop taking alcohol.
• Addressing Drug and Alcohol Addiction in Baltimore While a lot of the violence in Baltimore is related to the drug trade, the drugs themselves killed at least 180 more people than homicides in the city as of 2019.
• Alcohol Addiction and the Role of a Community New Horizons Group of Alcoholics Anonymous is a local fellowship to support men and women with alcoholic problems in Miami Springs.
• The Research in the Field of Alcohol Consumption by Adolescents Therefore, at this stage of the discussion, it is important to consider the role of the theory in the five approaches to qualitative research with the purpose to underline the role of theory in our […]
• Alcoholism, Domestic Violence and Drug Abuse Kaur and Ajinkya researched to investigate the “psychological impact of adult alcoholism on spouses and children”. The work of Kaur and Ajinkya, reveals a link between chronic alcoholism and emotional problems on the spouse and […]
• Alcoholic Anonymous Meeting and Impact on Treatment As the name suggests, the meeting was open to alcohol addicts and those who have recovered, members of the public, media, and professionals in different fields.
• Alcohol Addiction Among Women Women are a population of interest because of the increased mortality rates from alcohol-related health complications and the effect of this substance on childbearing. Similarly, to the previous organization, Alcove is a recovery facility that […]
• Alcoholism Problem Overview Alcoholism is one of the major factors affecting the health of individuals and family relations due to the repercussions of the dependence.
• Nuances of Alcohol Using Addiction Despite the traced co-occurrence of criminal activities and alcohol consumption, people argue that there are many positive aspects of drinking moderately, such as relaxation that is useful in many social environments. Goode argues that “for […]
• Alcohol Use Disorder: SBIRT Alcohol is widely known to be a harmful substance, but many people tend to underestimate its dangers due to the slow and incremental nature of its effects.
• Social Work Related to Alcohol and Substance Abuse The social work of this setting offers services to understand the current point of clients and identify the directions to improve their behaviors.
• Predicting Medium-Term Success Among Alcohol and Opiate Dependents The purpose of this project: to establish establish whether the detoxification facility is an important inclusion in the process of getting addicts off drugs.
• The Alcohol Consumption Relapse Issues In the case of my patient, she is highly willing to improve her life, and she understands that it is the only path to happiness.
• Moderate Alcohol Use Disorder: Treatment Plan The primary tool to help determine the disease’s presence are surveys – CAGE-test, Alcohol Use Disorders Identification Test, usage of DSM 5 criteria, and others.
• Effects of Alcohol. Alcohol-Related Statistics It is also a leading cause of death including both for the chronic drinker and the innocent victims of alcohol-related accidents.
• Pinacol Rearrangement and Alcohol Reactions Lab The purpose of this experiment is to use the researcher’s background knowledge on alcohol reactions to explain more complex reactions. The objective of this reorganization is to generate a ketone.
• Alcoholism: A Female Patient’s Drinking Profile It had changed her perspective of reality and destroyed her family in a way that each of her children had a health problem leading to death of one child at the age of 10 years.
• Moderate Alcohol Abuse as DSM–IV–TR Diagnosis The DSM-IV-TR diagnosis in this case is a moderate alcohol abuse ), which requires a minimum of four symptoms as specified in the DSM.
• The Problem of Co-Morbidity: Alcohol and Tuberculosis The problem of alcohol abuse as one of the main factors for the emergence and amplification of tuberculosis is widely discussed in medical circles and social organizations as well.
• The Use of Alcohol During Pregnancy Since you would like to understand if it is important for you to stop drinking alcohol, I would say that in case you want to prevent the emergence of any complications for the baby, it […]
• Reasons of Alcohol Addiction in Teenagers Given the clinical diagnoses, the wide-spread nature of the problem, and the severe consequences impacting the life and health of millions of people, the in-depth investigation of the causes of the disorder is of critical […]
• Alcohol and Substance Abuse There has been “no definitive treatment strategy for alcohol-related intervention with homeless individuals”. Some of the most successful interventions or programs to help homeless individuals with alcohol and substance abuse include the following: Providing both […]
• Alcoholic Anonymous: Its Purposes and General Topics Another primary objective of AA groups is for the members to provide support to each other in the process of healing from alcoholism.
• Alcoholism in Native Americans Theories suggest that the rate at which alcohol is absorbed in the body of a Native American is different from that of the rest of the U.S.population.
• Alcohol Use: Prevalence and Causal Factors Thus, to understand the issue of alcohol use in Australia, this paper examines the prevalence, causal factors, preventive strategies, and then criticizes the effectiveness of these strategies in curbing the use and abuse of alcohol.
• European Alcohol Beverage Industry Crisis The instability of the euro, as a common exchange medium and the financial crisis in the Eurozone, has caused severe problems to the company and harshly affected the profitability.
• Recall Bias in Alcohol Consumption Epidemiological Studies Recall bias is one of the factors that affect the credibility or validity of the research. The correctness of the answer is usually dependent on the memory of the respondent.
• Public Health. Excessive Alcohol Use in the US According to a recent article published in the Center for Disease Control and Prevention, excessive alcohol use in the United States ought to be recognized as a national health problem that is frequently associated with […]
• Fetal Alcohol Syndrome Overview Tait argues that although the level of drinking of the Aboriginal population is higher, findings indicate that many Aboriginals have the ability to abstain from alcohol more than the rest of the Canadian population. Impacting […]
• Reasons People Justify Consumption Drugs and Alcohol The rate of prevalence of drug use is high, and some of the problems that have been quoted in use of these are like high mortality rate and morbidity.
• Excessive Consumption of Alcohol Among Adults The legislation should be targeted at providing funds for federal and state health agencies to operate media campaigns on how to deal with factors mentioned in the lower levels of the socio-ecological model.
• Alcohol Interaction With Medication: Type 2 Diabetes EM is diagnosed with type 2 diabetes and the doctor advises him to take the prescribed drugs, but to keep of alcohol, due to its negative reactionary effects with medications.
• Alcoholism Among the Adult Population in Wisconsin Alcohol dependency, which is an offshoot of excessive alcohol consumption, has been noted to lead to behaviours such as child abuse and neglect, poor dietary habits and absenteeism among the adult population in Wisconsin.
• Alcohol Before and After Military Combat Deployment The conclusion of the article addressed the risk in the new-onset of heavy drinking, binge drinking and the alcohol-related crises among the soldiers who return from war.
• Alcohol Advertising and Youth This has been achieved by analyzing the relationship graphs of alcohol consumption versus advertising, as well as bans on advertising. One of them is that it only focuses on advertising as the only influencer of […]
• Abdominal Pain Caused by Excessive Alcohol Consumption Alcohol can alter the metabolism of various drugs, hence narrowing the choice of drugs that can be used on the patient and this should be explained. The possibility of recurrence should be mentioned and the […]
• Bureau of Alcohol, Tobacco, Firearms and Explosives The mission of this agency is to protect the U.S.from the illegal use of firearms and explosives as well as the trafficking of tobacco and alcohol products.
• Alcoholic Cirrhosis: Symptoms and Treatment The onset of alcoholic cirrhosis is proportional to the amount and period of ethanol intake. Alcohol breakdown in the body occurs in the liver and partly in the alimentary canal.
• Alcohol or Substance Abuse: Diagnostic and Statistical Manual Criteria one deals with tolerance which states that tolerance is a need to consume large amounts of alcohol in order to achieve intoxication, and it is the diminished effect that the substance abuser experiences with […]
• Alcohol Consumption and Pregnancy This is not true and medical research show that all beers and wine do contain alcohol and the difference is the alcohol content in the drink and the amount of drink consumed by the pregnant […]
• Alcoholism and Depression: Intervention Strategies The intention of the research paper is to assess if indeed there is an association between alcoholism as manifested by Jackson, and a case of depression.
• Alcohol Related Fatal Crashes: The Impact of Tennessee’s Emergency Cellular Telephone Program The author of the article used the data that was collected from the cases that were recorded previously over a period of time.
• Examples of Court Cases Involving Alcohol On the day the deed was executed, the plaintiff was driven in an automobile from his farm to Reno, Nevada for the purpose of the plaintiff and defendant being married in said city.
• Teenage Depression and Alcoholism There also has been a demonstrated connection between alcoholism and depression in all ages; as such, people engage in alcoholism as a method of self medication to dull the feelings of depression, hopelessness and lack […]
• Alcohol Abuse, Behaviour, and Types of Personalities Personality type is a process that assists in the determination of people’s behavior; it however assists in the classification of people into distinct category types.
• Social Media Efficiency in Decreasing Youth Alcohol Consumption The purpose of this paper is to discuss the effects and efficiency of social media in raising awareness of alcohol as a health risk factor and decreasing alcohol consumption among youth.
• The Main Problems of Alcoholism Despite the overall advance in treatment, alcoholism is still a challenge due to the lack of successful drug efficacy appraisals and pharmacotherapy personalization in patients with AUD.
• Impact of Alcohol Use Disorder Social workers play a vital role in addressing alcohol use disorder as they can identify people who are at risk of developing it or fit the diagnostic criteria already and refer them to mental health […]
• Prohibition Period in the USA History: Why the Government Was Trying to Ban Alcohol Prohibition was a momentous period in the history of the USA, during which the government was trying to ban alcohol. Naturally, the producers of liquor and owners of saloons protested, but it was surprising to […]
• Advancing Alcohol Research and Treatment: Case Analysis Additionally, in the first stages of the assessment, it became apparent that O.K.is not aware of the causes of her alcohol abuse and lacks the motivation to address the problem.
• The Risks of Maternal Alcohol Consumption During Pregnancy Certainly, the risk of abnormal development of the fetus depends on the number of alcoholic beverages and the frequency of their use.
• Alcoholism and Schizophrenia: Interconnection In addition to its physical effects on the chronic drinker’s body, alcohol is associated with a variety of mental impairments. Alcoholic dementia and Wernicke-Korsakoff syndrome are among the most prominent concerns in the matter. The former is a blanket term for a variety of cognitive deficiencies caused by the substance. The latter is a two-stage […]
• Alcoholic Anonymous Organization Fighting Addiction By accepting the problem and causes, a participant can try to resolve. In the program, participants have to admit their past wrongs and errors to a group and receive support to change.
• A Workaholic and an Alcoholic This happens due to the fact that workaholics and alcoholics both tend to neglect their responsibilities at the family level in favor of their engagements.
• Maternal Consumption of Alcohol During Pregnancy Should Be Unlawful in Canada Supporting the assumption to make maternal alcohol consumption illegal in Canada, it is appropriate to review corresponding articles that are associated with health and women’s rights.
• Personality Issues Among Male People With Alcoholism The main message of the authors is that the personality degradation occurring during alcoholism is directly caused by problems of a socio-psychological nature.
• Counseling Theories in the Management of Alcoholics The amount of alcohol he needs to get drunk has been increasing over the years and he spends much of his income on alcohol.
• Alcoholics Anonymous Meeting After the analysis of a series of data collected over a fixed six months period, by the concerned members globally, in connection to that, 15% of accidents, 36% of deaths due to fire, and 26% […]
• Managing Business Ethics: Alcohol and Marketing The promotion of alcoholic beverages is one of the “highly regulated” form of marketing, and in some countries of the World the direct marketing of alcoholic beverages are completely banned.
• Alcohol and Smoking Abuse: Negative Physical and Mental Effects The following is a range of effects of heavy alcohol intake as shown by Lacoste, they include: Neuropsychiatric or neurological impairment, cardiovascular, disease, liver disease, and neoplasm that is malevolent.
• Alcohol and Domestic Violence in Day-To-Day Social Life My paper will have a comprehensive literature review that will seek to analyze the above topic in order to assist the reader understand the alcohol contributions in the domestic and social violence in our society.
• Should Alcoholic Beverages Be Legalized for All Ages? Alcohol expectations vary across different cultures and this affects the mode of consumption and the age limit to which alcohol is taken. The loopholes in the law should also be amended to prevent any consumption […]
• The Dram Shop Act and Alcohol Consumption Laws were put in place for the accountability to establishments arising out of the self-service retailing of alcohol beverages to clearly drunk patrons or minors. It is clear that the dram act was put in […]
• Alcoholism: Insights from Peer-Reviewed Journals The main issues which are commonly focused on in this article are the criminal justice system on the drugs, overview of both national and international policies concerning alcohol and drugs, the patterns of the drug […]
• Alcohol and Tobacco Advertising History in the American Media This is the promotion of tobacco products by the tobacco industry in the media. In the 1970s the development of color lithography was a boost to the tobacco advisement in the U.S.media.
• Alcoholism as a Psychiatric and Medical Disorder He meets criteria A since he is unwilling to admit that he needs help to fight his dependence, which means that he requires the assistance of an expert to recognize the issue and, therefore, manage […]
• Alcohol and Sexual Assault, Health Problems and Alcohol Among Adolescents The reports of the various studies say that 50% of the sexual assault among adolescents is due to the influence of alcohol.
• Genetic Predisposition to Alcohol: The Appreciation and Therapy for Alcoholism Through family studies it has been established that the likelihood of alcohol dependence and similar complications happening is more in the families of the individuals who have been affected as compared to in the people […]
• Alcoholism: The Disease Is Often Progressive and Fatal According to the definition, the disease is a problem in society, but Colchado argues that if alcoholism is a problem, it cannot be considered a disease.
• How Teenagers Can Avoid Becoming Alcohol Abusers Drinking a glass of wine or a can or two of beer during a social event is acceptable and does not impair the physical ability and senses of a person.
• Alcohol Consumption Factors Among College Students In general, the purpose of the research was to arrive at evidence-based recommendations for university policy and guidance programs that could more holistically help students avoid binge drinking or alcoholism and systematically cope with the […]
• Effects of Drugs and Alcohol Use on Mental Health This paper is a bibliography listing a selection of works discussing effects of drugs and alcohol use on mental health.
• Alcohol and Crime in the U.K., the United States, and Australia The present paper looks at the issues of alcohol and the part that this liquid plays in violent crimes and offences in three major countries of the world: the U.
• Excessive Alcohol Consumption in Adolescents Dynamisms in the family and peer relationships coupled with alterations in cognition and growth related to puberty play a major role in the onset and escalation of the use of alcohol.
• Drug and Alcohol Abuse: A Comprehensive Research Study First, it is necessary to indentify the age groups, most inclined to drug and alcohol addiction, and ascertain the major reasons for it. The research should discuss the problem of addiction from various standpoints therefore […]
• Alcohol Consumption and Cardiovascular Diseases This is necessary to examine the relationship between individual experience of disease and consumption, and, in the population, is essential to the calculation of attributable risk.
• Drugs and Alcohol Effects and Behaviorism Help The problem of alcohol and drug dependency has increased over the years, fueled by factors such as easy accessibility of drugs, high cost of living, poverty, financial instability, and laxity on the part of authorities […]
• Genetic Basis for Alcoholism Further, Genetic studies will help you to understand more about the heritability of alcohol dependence and which will positively help you to explore the correlation of alcoholism to other disorders like major depression.
• Alcohol Addiction Issue in USA In order to do well in the group of Alcoholics Anonymous, it is better if the individual is talkative and open to conversations, as the main way of psychological therapy is telling stories about their […]
• Critical Issues in Education: Drug Abuse and Alcoholism For this case, the ministry concerned has a very hard task of ensuring there are no critical issues that are left unsolved that relate to education, failure to which will affect the performance of students […]
• An Arbitrary Restriction: Current Minimum Age Limits on the Lawful Consumption of Alcohol Are Unreasonable Voting was almost always restricted to men over the age of 21 if only because of the gravity of the responsibility involved.
• Alcoholism: Its Causes and Effects This is because when the levels of CYP2E1 are high, there is a greater level of lipid peroxidation within the liver, thus a lower ability of the liver to fight against the toxins that have […]
• Cirrhosis: Non- and Alcoholic Fatty Liver Disease 27%, is the end result of a hepatocellular injury that leads to both fibrosis and regenerative nodules throughout the liver. The main cause of alcoholic liver disease is the excessive intake of alcohol, whereas the […]
• Single Parents in the Alcoholic Classification In this category, the single parent, either the father or the mother is a chronic alcoholic and heavily uses alcohol and other substances.
• Depression in People With Alcohol Dependence Alcoholic depression in the presence of alcohol dependence is a mood disorder that occurs quite often in the structure of the course of alcohol dependence syndrome during the period of withdrawal syndrome and alcoholic psychoses.
• Alcohol Addiction: Opting for a Correct Referral Method The psychological content of codependency is evidence of the uniqueness of health disorders and personal functioning of a family member as compared with alcohol-related disorders.
• Alcohol Beverage Management Trends This paper aims to review the recent management trends in the alcohol beverage industry that are directed at enhancing the potential of the sector.
• Alcoholic Fermentation and Metabolic Traits Furthermore, researchers intended to investigate the impact of human selection on strains’ food processing in addition to studying both the genetic variability and plasticity of different fermentation products between strains and food processes.
• Alcohol Addiction and Psychological Assistance Smith is a supporter of the Democratic Party like most people in her family and among her friends and colleagues. Smith was asked what goals she wanted to achieve in the course of her treatment.
• Alcohol and Smoking Impact on Cancer Risk The research question is to determine the quantity of the impact that different levels of alcohol ingestion combined with smoking behavioral patterns make on men and women in terms of the risks of cancer.
• Gender and Alcohol Consumption Influence on a Date The third null hypothesis is based on the effect of interaction between the first and second main effects: there is no significant interaction effect between gender and alcohol consumption in terms of the attractiveness of […]
• Reducing the Alcohol Abuse Among the Youth This paper includes a brief discussion of two possible ways to improve the problem and the justification for the use of one of the options.
• Decreasing Overall Alcohol Consumption The long term goal is to eliminate alcohol consumption as part of my list of consumables. One major benefit that one gets from a lack of consumption of alcohol is the reduced chances of contracting […]
• The Problem of Taking Alcohol I had a desire to prove that I had attained the natural maturity age as opposed to the prescribed age of the majority as it is put by the constitution.
• Alcohol Abusers and Their Psychological Treatment The aim of these sessions is to resolve the internal conflict within the clients in order to assist in the making of informed decisions by these individuals concerning their behavior.
• Alcoholic Drinks Market Analysis
• Alcoholism and Related Issues: Treatment Plan
• Alcohol and It Effects on Brain Functioning
• Alcohol & Substance Abuse and Medication Treatment
• Alcohol Marketing Regulation and Its Effectiveness
• Treatments for Alcohol Abuse in the Military
• Restriction of the Alcohol Sale at Outdoor Music Events
• Health Services for Drug and Alcohol Treatment
• Alcoholics Anonymous Observation and Group Therapy
• Alcohol Abuse for Military-Connected
• Pocket Guide for Alcohol Screening
• Prevention of Alcohol Consumption Among Youth
• Child Abuse and Neglect: Drug and Alcohol Problems
• Alcohol as the Most Common Depressant on Earth
• Alcoholism as a Social Issue and Its Effect on Families
• Disease Concept of Alcoholism
• Alcohol, Tobacco, Firearms, and Explosives Regulation
• Alcohol Effects on College Learners
• Alcoholics Anonymous Meetings as Community Agency
• Neural Development and Fetal Alcohol Syndrome
• Should Marijuana Be Treated Like Alcohol?
• Economic Tools: The Alcohol Abuse Problem Solving
• Stereotype of Aboriginals and Alcohol in Canada
• Taxes on Alcohol and Cigarettes as a Healthcare Costs
• Alcohol and Drugs in Fatally Injured Drivers
• Alcohol Effect on Teenagers Health
• Straight Edge Subculture: Hardcore Punk Music and Abstinence From Alcohol
• Alcohol Consumption in the UK
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• College Students Alcohol Drinking Effects
• Healthcare: Excessive Alcohol Consumption Among Adults
• Drinking Alcohol at Arizona State University
• Alcohol Harmful Effects: Are There Any Benefits?
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• The Effects of Energy Drinks and Alcohol on Neuropsychological Functioning
• Ethical and Social Responsibility of the Alcohol Industry in the UK?
• The Effects of Alcohol Use on Academic Achievement in High School
• A New Alcohol and Drug-Abuse Rehabilitation Center in Liverpool Hospital, Sydney
• Women, Alcohol, Self-Concept, and Self-Esteem: A Qualitative Study of the Experience of Person-Centred Counselling
• Effects of Alcohol Abuse on Women
• The Effectiveness of Alcohol Marketing, Regulation and How It Is Can Protect the Consumer From Fake Products
• Definition of Alcohol Misuse (Alcohol Abuse and Addiction) in Youth Population Age 18-29
• Social Observation and Analysis of Alcohol Drinking
• Non-Alcoholic Beverage Industry
• Social Influences on Behavior: Towards Understanding Depression and Alcoholism Based on Social Situations
• Problem of Excess Alcohol Drinking in Society
• Motivational Program and Alcoholics Anonymous
• Alcohol Abuse and the Contribution of Economists to Solving This Issue
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• Effects of Alcohol on African American Teens
• Diseases Caused by Alcohol Abuse and Its Preventions
• How Drugs and Alcohol Affect Pregnancy and a Developing Child
• Alcoholism-Nature vs. Nurture Debate
• Alcoholism: The Rough Road
• Developmental Issues With Adolescents Due to Alcohol Consumption
• Alcohol and Alcohol Dependency
• Feasibility of Introducing Alcohol Made in the U.S. Into the Thai Market
• Alcoholism Disease or Self Will
• Drug and Alcohol Testing
• Why Drinking Alcohol During Pregnancy Occasions Unnecessary Risks to Prenatal Development
• Alcohol: Should the US Lower the Drinking Age to 18?
• Alcohol Problems and Abstinence
• Teenage Alcoholism: Parental Influence and How to Get Rid of Vice
• Should the Government Attempt to Reduce Current Levels of Alcohol Consumption?
• How Does Alcohol Abuse Affect Aging People?
• Should the Legal Alcohol Drinking Age Be Lowered to 18?
• Are Drinking Motives Universal?
• How Has Alcohol Abuse Become Part of the Culture in Many Societies?
• Does Alcohol Use Increase the Risk of Sexual Intercourse Among Adolescents?
• How Does Alcohol Affect the Brain’s Size?
• Is Alcohol Advertising the Cause of Underage Drinking?
• How Does Alcohol and Smoking Affect Erection?
• Does Drinking Location Matter?
• How Does Alcohol Cause Mental and Moral Changes?
• Are Visual Impairments Responsible for Emotion Decoding Deficits in Alcohol-Dependence?
• How Are Drugs and Alcohol Affecting the Teenagers?
• Does Oxidative Stress Induce by Alcohol Consumption Affect Orthodontic Treatment Outcome?
• How Far Will Alcohol Consumption Go?
• Does Repetitive Negative Thinking Influence Alcohol Use?
• How Does Alcohol Depress the Central Nervous System?
• Are Alcohol Excise Taxes Good for Us?
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• Do Employers Have the Right to Submit Employees to Drug and Alcohol Testing?
• How Does Alcohol Make You Drunk?
• Can Alcohol Make You Happy?
• How Many People Have Alcohol Use Disorders?
• Does Alcohol Consumption Reduce Human Capital Accumulation?
• How Similar Are Alcohol Drinkers?
• Which Drug Is More Effective in the Treatment of Alcohol Withdrawal?
• How Does Alcohol Affect the Human Body?
• Should Alcohol and Tobacco Advertisement Be Banned?
• How Similar Are Youth and Adult Alcohol Behaviors?
• Should Alcohol Drinking Age Be Decreased or Increased?
• Abuse Research Topics
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• Juvenile Delinquency Essay Titles
• Poverty Essay Titles
• Substance Abuse Research Topics
• Government Regulation Titles
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Houston gun dealer sentenced for trafficking ‘weapons of war’ notoriously used by drug cartels.

Ahmed Humble , Digital Content Producer

HOUSTON – A known gun dealer from Houston has pleaded guilty to selling guns notoriously known as weapons of choice for Mexican drug cartels.

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According to the U.S. Attorney’s Office in the Southern District of Texas, Nicah Anderson, 44, of Cypress, was the owner and operator of NE Guns located on Northwest Freeway. The business has since shut down but prosecutors say between Dec. 2022 and March 2023, someone bought at least 41 firearms from Anderson’s store.

The buyer didn’t personally purchase the guns but used “straw purchasers” to get the weapons before carrying them out of NE Guns and reselling them. Investigators say Anderson knew about this arrangement beforehand.

EXPLAINER: Facts about straw purchases of weapons, and what’s being done to stop them

The firearms sold were described by prosecutors as “known weapons of choice for Mexican drug cartels.” U.S. Attorney Alamdar S. Hamdani took it further in his press statement, saying “Weapons of war, including a .50 caliber gun, walked out of Nicah Anderson’s gun store in the arms of straw purchasers, and he knew it.”

After executing a search warrant in July 2023, law enforcement officials seized 266 firearms. The arsenal also military-grade sniper rifles, FN SCAR 17S, .308 Caliber rifles, and 9-millimeter pistols. 138,940 rounds of ammunition, 7 silencers as well as NE Guns’ business records were also seized.

SUGGESTED: Texas AG sues Biden administration, ATF for banning private firearm sales

A closer look into the books led investigators to discover between Oct. 2022 - Aug. 2023, NE Guns received $115,000 from suspected straw purchasers.

“Investigations such as these stop illegal firearms trafficking at the source,” Hamdani said. “Because of gun violence in large cities like Houston, there is absolutely no place or patience for gun dealers like Anderson who seek to profit from illegal straw purchases.”

SEE ALSO: NE Houston family loses 2 children after teen accidentally kills 11-year-old before turning gun on himself

“This investigation is a clear illustration of the importance of investigating illegal firearms trafficking,” Special Agent in Charge Michael Weddel of the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) added. “Firearms trafficking is a direct contributor to the gun violence that we fight every day. This defendant chose profit over helping to maintain the safety of the general public and will be held accountable for those repeated decisions.”

U.S. District Judge Keith Ellison accepted Anderson’s guilty plea and the 44-year-old will serve a two-year prison sentence starting October 24. Until then, he will be on bond.

Copyright 2024 by KPRC Click2Houston - All rights reserved.

About the Author

Ahmed humble.

Historian, educator, writer, expert on "The Simpsons," amateur photographer, essayist, film & tv reviewer and race/religious identity scholar. Joined KPRC 2 in Spring 2024 but has been featured in various online newspapers and in the Journal of South Texas' Fall 2019 issue.

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• Alcohol Res Health
• v.24(1); 2000

Health Risks and Benefits of Alcohol Consumption

Alcohol consumption has consequences for the health and well-being of those who drink and, by extension, the lives of those around them. The research reviewed here represents a wide spectrum of approaches to understanding the risks and benefits of alcohol consumption. These research findings can help shape the efforts of communities to reduce the negative consequences of alcohol consumption, assist health practitioners in advising consumers, and help individuals make informed decisions about drinking.

Forty-four percent of the adult U.S. population (age 18 and over) are current drinkers who have consumed at least 12 drinks in the preceding year ( Dawson et al. 1995 ). Although most people who drink do so safely, the minority who consume alcohol heavily produce an impact that ripples outward to encompass their families, friends, and communities. The following statistics give a glimpse of the magnitude of problem drinking:

• Approximately 14 million Americans—7.4 percent of the population—meet the diagnostic criteria for alcohol abuse or alcoholism ( Grant et al. 1994 ).
• More than one-half of American adults have a close family member who has or has had alcoholism ( Dawson and Grant 1998 ).
• Approximately one in four children younger than 18 years old in the United States is exposed to alcohol abuse or alcohol dependence in the family ( Grant 2000 ).

Measuring the Health Risks and Benefits of Alcohol

Over the years, scientists have documented the effects of alcohol on many of the body’s organ systems and its role in the development of a variety of medical problems, including cardiovascular diseases, liver cirrhosis, and fetal abnormalities. Alcohol use and abuse also contribute to injuries, automobile collisions, and violence. Alcohol can markedly affect worker productivity and absenteeism, family interactions, and school performance, and it can kill, directly or indirectly. On the strength of this evidence, the United States and other countries have expended considerable effort throughout this century to develop and refine effective strategies to limit the negative impact of alcohol ( Bruun et al. 1975 ; Edwards et al. 1994 ).

In the past two decades, however, a growing number of epidemiologic studies have documented an association between alcohol consumption and lower risk for coronary heart disease (CHD), the leading cause of death in many developed countries ( Chadwick and Goode 1998 ; Criqui 1996 a , b ; Zakhari 1997 ). Much remains to be learned about this association, the extent to which it is due specifically to alcohol and not to other associated lifestyle factors, and what the biological mechanisms of such an effect might be.

Effects on Physical Health

Cardiovascular diseases account for more deaths among Americans than any other group of diseases. Several large prospective studies have reported a reduced risk of death from CHD across a wide range of alcohol consumption levels. These include studies among men in the United Kingdom ( Doll et al. 1994 ), Germany ( Keil et al. 1997 ), Japan ( Kitamura et al. 1998 ), and more than 85,000 U.S. women enrolled in the Nurses’ Health Study ( Fuchs et al. 1995 ). In research studies, definitions of moderate drinking vary. However, in these studies, most, if not all, of the apparent protective effect against CHD was realized at low to moderate levels of alcohol consumption.

Follow-up of another large U.S. survey, the National Health and Nutrition Examination Survey I ( Rehm et al. 1997 ), found that after an average of nearly 15 years of follow-up, the incidence of CHD in men who drank was lower across all levels of consumption than in nondrinkers. Incidence also was reduced among women, but only in those consuming low to moderate levels of alcohol. In fact, an increased risk was observed in women consuming more than 28 drinks per week.

An association between moderate drinking and lower risk for CHD does not necessarily mean that alcohol itself is the cause of the lower risk. For example, a review of population studies indicates that the higher mortality risk among abstainers may be attributable to socioeconomic and employment status, mental health, overall health, and health habits such as smoking, rather than participants’ nonuse of alcohol ( Fillmore 1998 ).

It is also important to note that the apparent benefits of moderate drinking on CHD mortality are offset at higher drinking levels by increased risk of death from other types of heart disease, cancer, liver cirrhosis, and trauma. The U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (USDHHS), in the U.S. Dietary Guidelines for Americans, have defined moderate drinking as one drink per day or less for women and two or fewer drinks per day for men ( USDA 1995 ). In addition, the NIAAA further recommends that people aged 65 and older limit their consumption of alcohol to one drink per day.

Cerebrovascular disease, in which arteries in the brain are blocked or narrowed, can lead to a sudden, severe disruption of blood supply to the brain, called a stroke. Ischemic stroke, which is by far the predominant type of stroke, results from a blockage of a blood vessel; hemorrhagic stroke is due to rupture of a blood vessel. Alcohol-related hypertension, or high blood pressure, may increase the risk of both forms of stroke. Yet, in people with normal blood pressure, the risk of ischemic stroke may be decreased due to the apparent ability of alcohol to lessen damage to blood vessels due to lipid deposits and to reduce blood clotting. Alcohol’s anticlotting effects, while perhaps decreasing the risk of ischemic stroke, may increase the risk of hemorrhagic stroke ( Hillbom and Juvela 1996 ). These studies are coming closer to providing a clear picture of the relationship between alcohol and risk of stroke.

The relationship between alcohol consumption and stroke risk has been examined in two recent overviews. In a meta-analysis, researchers compared the relationship between alcohol consumption and the risk of ischemic and hemorrhagic strokes ( English et al. 1995 ). They detected no differences in the risk patterns for the two types of stroke, but found clear evidence that heavy drinking was associated with increased stroke risk, particularly in women.

In contrast, the Cancer Prevention Study II found that, in men, all levels of drinking were associated with a significant decrease in the risk of stroke death, but in women, the decreased risk was significant only among those consuming one drink or less daily ( Thun et al. 1997 ). A recent study reported that among male physicians in the Physicians’ Health Study, those who consumed more than one drink a week had a reduced overall risk of stroke compared with participants who had less than one drink per week ( Berger et al. 1999 ).

Among young people, long-term heavy alcohol consumption has been identified as an important risk factor for stroke ( You et al. 1997 ). Very recent alcohol drinking, particularly drinking to intoxication, has been found to be associated with a significant increase in the risk of ischemic stroke in both men and women aged 16 through 40 years ( Hillbom et al. 1995 ).

The relationship between alcohol consumption and blood pressure is noteworthy because hypertension is a major risk factor for stroke as well as for CHD. A national consensus panel in Canada recently conducted an extensive review of the evidence concerning this relationship ( Campbell et al. 1999 ), concluding that studies have consistently observed an association between heavy alcohol consumption and increased blood pressure in both men and women. However, in many studies comparing lower levels of alcohol use with abstention, findings are mixed. Some studies have found low alcohol consumption to have no effect on blood pressure or to result in a small reduction, while in other studies blood pressure levels increased as alcohol consumption increased.

The possibility that alcohol may protect against CHD has led researchers to hypothesize that alcohol may protect against peripheral vascular disease, a condition in which blood flow to the extremities is impaired due to narrowing of the blood vessels. In a 1985 analysis of data from the Framingham Heart Study, alcohol was not found to have a significant relationship, either harmful or protective, with peripheral vascular disease ( Kannel and McGee 1985 ). However, an important recent study produced different results. In an analysis of the 11-year follow-up data from more than 22,000 men enrolled in the Physicians’ Health Study, researchers found that daily drinkers who consumed seven or more drinks per week had a 26-percent reduction in risk of peripheral vascular disease ( Camargo et al. 1997 ).

Two other studies found inconsistent results with regard to gender. One study of middle-aged and older men and women in Scotland showed that as alcohol consumption increased, the prevalence of peripheral vascular disease declined in men but not in women ( Jepson et al. 1995 ). In contrast, among people with non-insulin-dependent diabetes, alcohol was associated with a lower prevalence of peripheral vascular disease in women but not in men ( Mingardi et al. 1997 ).

There is no question that alcohol abuse contributes significantly to liver-related morbidity (illness) and mortality in the United States. The effects of alcohol on the liver include inflammation (alcoholic hepatitis) and cirrhosis (progressive liver scarring). The risk for liver disease is related to how much a person drinks: the risk is low at low levels of alcohol consumption but increases steeply with higher levels of consumption ( Edwards et al. 1994 ). Gender also may play a role in the development of alcohol-induced liver damage. Some evidence indicates that women are more susceptible than men to the cumulative effects of alcohol on the liver ( Becker et al. 1996 ; Gavaler and Arria 1995 ; Hisatomi et al. 1997 ; Naveau et al. 1997 ).

Definitions Related to Drinking

Studies investigating the health effects of alcohol vary in their definitions of “low,” “moderate,” and “heavy” drinking. According to the Dietary Guidelines for Americans , issued jointly by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (USDHHS), moderate drinking is no more than two standard drinks per day for men and no more than one per day for women ( USDA and USDHHS 1995 ). The National Institute on Alcohol Abuse and Alcoholism further recommends that people aged 65 and older limit their consumption of alcohol to one drink per day. Information on drinking levels as they are defined in the individual studies cited in this issue can be found in the original references.

How Much Is a Drink?

In the United States, a drink is considered to be 0.5 ounces (oz) or 15 grams of alcohol, which is equivalent to 12 oz (355 milliliters [mL]) of beer, 5 oz (148 mL) of wine, or 1.5 oz (44 mL) of 80-proof distilled spirits.

Does Abstaining Increase Risk?

Epidemiologic evidence has shown that people who drink alcohol heavily are at increased risk for a number of health problems. But some studies described in this section suggest that individuals who abstain from using alcohol also may be at greater risk for a variety of conditions or outcomes, particularly coronary heart disease, than persons who consume small to moderate amounts of alcohol.

This type of relationship may be expressed as a J-shaped or U-shaped curve, which means that the risk of a disease outcome from low to moderate drinking is less than the risk for either abstinence or heavier drinking, producing a curve in the shape of the letter J or U (see figure ).

By examining the lifestyle characteristics of people who consume either no alcohol or varying amounts of alcohol, researchers may uncover other factors that might account for different health outcomes. For example, gender, age, education, physical fitness, diet, and social involvement are among the factors that may be taken into account in determining relative risk of disease.

Similarly, people may quit drinking because of health problems, or even if that is not the case, former drinkers may have characteristics that contribute to their higher mortality risk, such as smoking, drug use, and lower socioeconomic status. If former drinkers are included in the abstainers group, they may make alcohol appear to be more beneficial than it is. Therefore the best research studies will distinguish between former drinkers and those who have never used alcohol.

Rates of death from all causes, all cardiovascular diseases, and alcohol-augmented conditions from 1982 to 1991, according to base-line alcohol consumption.

SOURCE: Thun et al. 1997 . Reprinted with permission from New England Journal of Medicine , Vol. 337, pp. 1705–1714, 1997. Copyright 1997, Massachusetts Medical Society. Waltham, MA. All rights reserved.

• U.S. Department of Agriculture and U.S. Department of Health and Human Services. Home and Garden Bulletin No. 232. 4th ed. Washington, DC: U.S. Department of Agriculture; 1995. [ Google Scholar ]

Alcohol has been linked to a number of cancers, including cancers of the head and neck (mouth, pharynx, larynx, and esophagus), digestive tract (stomach, colon, and rectum) and breast ( World Cancer Research Fund/American Institute for Cancer Research [WCRF/AICR] 1997 ; Doll et al. 1993 ; International Agency for Research on Cancer [IARC] 1988 ).

Alcohol is clearly established as a cause of cancer of various tissues in the airway and digestive tract, including the mouth, pharynx, larynx, and esophagus ( Doll et al. 1993 ; IARC 1988 ; La Vecchia and Negri 1989 ; Seitz and Pöschl 1997 ; WCRF/AICR 1997 ). An increased risk of gastric or stomach cancer among alcohol drinkers has been identified in several, but not the majority, of case-control or cohort studies. The link between alcohol use and chronic gastritis (stomach inflammation) is clear, although progression from chronic gastritis to neoplasia is less well understood and probably involves other factors in addition to alcohol ( Bode and Bode 1992 , 1997 ).

In addition, a link between alcohol and breast cancer has been suspected for two decades but the nature of this association remains unclear. (For a more detailed discussion of the role of alcohol in breast cancer, see the article in this issue on medical consequences pp 27–31.)

Psychosocial Consequences and Cognitive Effects

Alcohol use plays a role in many social activities, from the “business lunch” and parties to special occasions. The benefits to those who drink during social occasions are greatly influenced by culture, the setting in which drinking occurs, and expectations about alcohol’s effects ( Goldman et al. 1987 ; Heath 1987 ; Leigh 1989 ; Leigh and Stacy 1991 ). Stress reduction, mood elevation, increased sociability, and relaxation are the most commonly reported psychosocial benefits of drinking alcohol ( Baum-Baicker 1985 ; Hauge and Irgens-Jensen 1990 ; Leigh and Stacy 1991 ; Mäkelä and Mustonen 1988 ).

There is extensive evidence indicating that people who suffer psychological distress and rely on alcohol to relieve their stress are more likely to develop alcohol abuse and dependence ( Castaneda and Cushman 1989 ; Kessler et al. 1996 , 1997 ). Because vulnerability to alcohol dependence varies greatly among individuals, it is difficult to assess the risk of dependence in relation to how much a person drinks. Two persons exposed to alcohol in exactly the same way may or may not have the same outcome for many reasons, including genetic differences, personality, behavioral features, and environment.

Most mental disorders occur much more often than expected by chance among people who are abusing alcohol or are alcohol dependent ( Kessler et al. 1996 ). Of these individuals, those who are alcohol dependent are more likely than alcohol abusers to have mental disorders. In fact, alcohol dependence elevates the risk for all types of affective and anxiety disorders ( Kessler et al. 1996 ).

Although the relationship between heavy alcohol consumption and cognitive impairment is well established, the effects of moderate drinking on the ability to perform cognitive tasks, including remembering, reasoning, and thinking, are largely unexplored.

Most studies of the relationship between alcohol consumption and other forms of dementia, notably Alzheimer’s disease ( Tyas 1996 ), have failed to find statistically significant associations. However, several recent studies suggest that moderate alcohol consumption may have a positive effect on cognitive function. In an analysis of baseline data (data collected at the beginning of a study) for persons aged 59 through 71 who were enrolled in the Epidemiology of Vascular Aging Study in France, moderate alcohol consumption was associated with higher cognitive functioning among women but not men after a number of possible confounding variables were controlled for ( Dufouil et al. 1997 ). Another study, which followed 3,777 community residents in France who drank primarily wine, found a markedly reduced risk of the incidence of dementia among moderate drinkers relative to abstainers ( Orgogozo et al. 1997 ).

Effects on Society

Researchers have identified and classified a wide variety of adverse consequences for people who drink and their families, friends, co-workers, and others they encounter ( Edwards et al. 1994 ; Harford et al. 1991 ; Hilton 1991 a , b ). Alcohol-related problems include economic losses resulting from time off work owing to alcohol-related illness and injury, disruption of family and social relationships, emotional problems, impact on perceived health, violence and aggression, and legal problems.

The risk of such consequences for the individual varies widely and depends on the situation. However, researchers have found a general trend toward an increased risk of adverse effects on society as the average alcohol intake among individuals increases ( Mäkelä and Mustonen 1988 ; Mäkelä and Simpura 1985 ).

Alcohol use is associated with increased risk of injury in a wide variety of circumstances, including automobile crashes, falls, and fires ( Cherpitel 1992 ; Freedland et al. 1993 ; Hingson and Howland 1993 ; Hurst et al. 1994 ). Research shows that as people drink increasing quantities of alcohol, their risk of injury increases steadily and the risk begins to rise at relatively low levels of consumption ( Cherpitel et al. 1995 ). An analysis of risk in relation to alcohol use in the hours leading up to an injury has suggested that the amount of alcohol consumed during the 6 hours prior to injury is related directly to the likelihood of injury occurrence ( Vinson et al. 1995 ). The evidence showed a dose-response relationship between intake and injury risk and found no level of drinking to be without risk.

Patterns of alcohol consumption also increase the risk of violence and the likelihood that aggressive behavior will escalate ( Cherpitel 1994 ; Martin 1992 ; Martin and Bachman 1997 ; Norton and Morgan 1989 ; Zhang et al. 1997 ). Alcohol appears to interact with personality characteristics, such as impulsiveness and other factors related to a personal propensity for violence ( Lang 1993 ; Zhang et al. 1997 ). Violence-related trauma also appears to be more closely linked to alcohol dependence symptoms than to other types of alcohol-related injury ( Cherpitel 1997 ).

Patterns of moderate drinking, on the other hand, have been associated with a key health benefit—that is, a lower CHD risk. Research is now in progress to clarify the extent to which alcohol itself, or other factors or surrogates such as lifestyle, diet, exercise, or additives to alcoholic beverages, may be responsible for the lower risk. Broader means of quantifying the relationships between relative risks and specific consumption levels and patterns are needed to describe epidemiologic findings more clearly and simply, and translate them into improved public health strategies.

The Overall Impact

The overall impact of alcohol consumption on mortality can be assessed in two ways ( Rehm and Bondy 1998 ): (1) by conducting meta-analyses using epidemiologic studies that examine all factors contributing to mortality, or (2) by combining risk for various alcohol-caused diseases with a weighted prevalence or incidence of each respective disease.

The meta-analysis approach to assessing overall mortality was used by researchers to examine the results of 16 studies, 10 of which were conducted in the United States ( English et al. 1995 ). In this overview, researchers found the relationship between alcohol intake and mortality for both men and women to be J-shaped curves: the lowest observed risk for overall mortality was associated with an average of 10 grams of alcohol (less than one drink) per day for men and less for women. An average intake of 20 grams (between one and two drinks) per day for women was associated with a significantly increased risk of death compared with abstainers. The risk for women continued to rise with increased consumption and was 50 percent higher among those consuming an average of 40 grams of alcohol (between three and four drinks) per day than among abstainers. Men who averaged 30 grams of alcohol (two drinks) per day had the same mortality as abstainers, whereas a significant increase in mortality was found for those consuming at least 40 grams of alcohol per day.

The proposed J-shaped relationship between alcohol intake and mortality does not apply in all cases, however. For example, because most of the physiologic benefit of moderate drinking is confined to ischemic cardiovascular conditions, such as CHD, in areas of the world where there is little mortality from cardiovascular diseases, alcohol provides little or no reduction in overall mortality. Rather, the relationship between intake and all-cause mortality assumes more of a direct, linear shape ( Murray and Lopez 1996 c ), with increasing consumption associated with higher overall mortality. The same holds true for people under age 45, who have little ischemic cardiovascular mortality ( Andréasson et al. 1988 , 1991; Rehm and Sempos 1995 ).

Quantifying the level of disability and morbidity related to alcohol can be difficult, in large part because few standardized measures exist. One way to quantify the relationship between alcohol and health-related consequences is to use a measure called the disability-adjusted life year (DALY), which may prove useful in summarizing the effects of alcohol on the full spectrum of health outcomes.

In the Global Burden of Disease Study ( Murray and Lopez, 1996 , 1997 b ), the researchers combined years of life lost and years lived with disability into a single indicator, DALY, in which each year lived with a disability was adjusted according to the severity of the disability ( Murray and Lopez 1997 b , c ). The study found tremendous differences in alcohol’s impact on disability across different regions of the world. The most pronounced overall effect was observed in established market economies. The researchers found the smallest effect of alcohol in the Middle Eastern crescent, which is not surprising given the region’s high proportion of abstinent Islamic populations ( Murray and Lopez 1997 a ).

Epidemiologic studies have long provided evidence of the harm alcohol can cause to individual health and to society as a whole. Newer studies have identified an association between low to moderate alcohol consumption and reduced CHD risk and overall mortality. The most significant association with lower CHD risk is largely confined to middle-aged and older individuals in industrialized countries with high rates of cardiovascular diseases. Elucidation of the mechanisms by which alcohol affects CHD risk will clarify the relationship and may enable scientists to develop pharmacologic agents that could mimic or facilitate the positive effect of alcohol on health ( Hennekens 1996 ; UK Inter-Departmental Working Group 1995 ; USDA 1995 ). At this point, research clearly indicates that no pattern of drinking is without risks. However, for individuals who continue to consume alcohol, certain drinking patterns may help reduce these risks considerably.

Among teenagers and young adults in particular, the risks of alcohol use outweigh any benefits that may accrue later in life, since alcohol abuse and dependence and alcohol-related violent behavior and injuries are all too common in young people and are not easily predicted. To determine the likely net outcome of alcohol consumption, the probable risks and benefits for each drinker must be carefully weighed.

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Bureau of Alcohol, Tobacco, Firearms and Explosives

Search form, you are here, atf en español: web team launches public spanish site.

“This has been in the making for a long time, and I’m so proud of this team’s efforts,” said Brian Nickey, chief of ATF’s Digital Media Division (DMD).

Why did ATF need to add a second language to the site?

Issued in 2000, Executive Order 13166 requires organizations that receive federal funding to make their services accessible to persons with limited English proficiency. ATF chose Spanish as its first non-English language based on data from the Census Bureau, which shows that about 41 million U.S. residents speak Spanish at home.

This was no easy task. The Spanish language site took more than three years of hard work to launch.

The Early Stages

ATF began laying the groundwork for the website translation project back in 2015. The initial goal was to translate the top 100 most-visited pages of ATF.gov and create a Spanish “microsite.”

At the time, the Web Media Branch (WMB) had recently finished migrating its website to Drupal, an open-source content management system. Based on their experience, the team thought the Spanish microsite would take less than a year to complete.

“Advocating for the site and explaining the justifications to senior management turned out to be the easy part; we learned soon that we had larger challenges,” said Hadiza Buge, deputy chief of DMD who kick-started the project.

The first obstacle the team had to overcome was their lack of expertise with Spanish language. Luckily, the WMB (which falls under the DMD) already had a native Spanish speaker, developer Mayela J. While Mayela was invaluable in reviewing translations, her main focus was building the site.

For the bulk of the translations, ATF needed to rely heavily on an outside contractor. Since those translators weren’t familiar with the technical terms in ATF’s content, mistranslations were common. For example, “display fireworks cake” was translated as “torta,” which could mean a dessert cake or sandwich depending on which country the word was used.

To solve this, the WMB knew they needed help. They sent out a call to the entire ATF staff looking for native Spanish language speakers to review translations. The team received a great response and the volunteers began editing translations immediately. Many took advantage of ATF’s Foreign Language Award Program managed by the Human Resources and Professional Development Directorate. Others volunteered their time with no additional compensation.

However, as the project continued over the next two years, some volunteers were no longer able to help as their workloads changed. By mid-2018, work on the project had slowed down significantly.

Something needed to change.

Project manager NeKeisha P., who was integral to the project’s success, came up with the idea to recruit new volunteers and hold a “review-a-thon” to breathe new life into the project. The goals were to decide on consistent translations for frequently used terms and to complete the last batch of translation reviews together.

“Over two half-day sessions, we brought in new and experienced volunteers to discuss best practices with one another. They are all experts in different fields and represent several Spanish-speaking countries,” NeKeisha said. “The review-a-thon was a huge success and helped us fix a lot of the inconsistent translations. We were able to use our decisions to create an ATF English-Spanish glossary for the site.”

The Finish Line

With the review-a-thon over, the WMB turned its attention to making final changes to the site before launch. Abigail Bowman, chief of WMB led the development of the Spanish language glossary which team members used to correct older translations on the site.

The project had changed significantly over the three years. The originally planned 100 pages expanded to more than 400. These included landing pages, resources, forms and press releases for the five initial field divisions.

A month before its public release, the Spanish site launched internally giving all ATF employees the opportunity to review and offer feedback.

On July 2, 2019, ATF en Español was officially launched to the public. WMB worked with the Public Affairs Division to post bilingual social media messages about the new site and share information about explosives safety before the Fourth of July holiday.

What’s Next

WMB presented the many lessons they learned during the project at Drupal GovCon , a regional conference for digital and website teams.

During their presentation , NeKeisha and Mayela shared site translation resources, best practices and examples with an audience of state and federal project managers.

To view the Spanish site, go to the ATF.gov homepage and click on en Español . If you have feedback on the site, please let us know through our feedback form .

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• How to reduce the risk of developing dementia

A healthy lifestyle can prevent or delay almost half of cases

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S ome of the best strategies for reducing the chances of developing dementia are, to put it kindly, impracticable. Don’t grow old; don’t be a woman; choose your parents carefully. But although old age remains by far the biggest risk factor, women are more at risk than men and some genetic inheritances make dementia more likely or even almost inevitable, the latest research suggests that as many as 45% of cases of dementia are preventable—or at least that their onset can be delayed.

That is the conclusion of the latest report, published on July 31st, of the Lancet commission on dementia, which brings together leading experts from around the world, and enumerates risk factors that, unlike age, are “modifiable”. It lists 14 of these, adding two to those in its previous report in 2020: untreated vision loss; and high levels of LDL cholesterol. Most news about dementia seems depressing, despite recent advances in treatments for some of those with Alzheimer’s disease, much the most common cause of the condition. Most cases remain incurable and the numbers with the condition climb inexorably as the world ages. That the age-related incidence of dementia can actually be reduced is a rare beacon of hope.

The modifiable risk factors include smoking, obesity, physical inactivity, high blood pressure, diabetes and drinking too much alcohol (see chart). The best way to reduce the risk of developing dementia is to lead what has long been considered to be a healthy life: avoiding tobacco and too much alcohol and taking plenty of exercise (but avoiding those forms of it that involve repeated blows to the head or bouts of concussion, a list which includes boxing, American football, rugby and lacrosse).

It also means having a good diet, defined in one study cited by the commission as: “Eat at least three weekly servings of all of fruit, vegetables and fish; rarely drink sugar-sweetened drinks; rarely eat prepared meat like sausages or have takeaways.” So it is not surprising that LDL cholesterol has been added to its not-to-do list. It is also important to exercise the brain: by learning a musical instrument or a foreign language, for example—or even by doing crossword and sudoku puzzles.

Some physical ailments do not bring heightened risks of cardiovascular disease or cancer but have been shown to make dementia more likely. One is untreated hearing loss. The Lancet commission’s report from 2020 concluded this was the biggest of its 12 risk factors, a conclusion shared by this latest study. People with hearing loss are about twice as likely as others to develop dementia. The wider availability and use of hearing aids would probably be the single intervention most effective in reducing the incidence of dementia.

It is also not surprising that eyesight problems have been added to the latest dementia-risks list. It is unclear why impaired hearing and vision should have such an impact on the risk of dementia. One idea is that they all have a common cause. That hearing aids are very effective in protecting against dementia, however, argues against that theory for deafness. Diabetes, however, is a risk factor for both failing eyesight and dementia.

Others speculate that people straining to understand what is said to them or to navigate a world made hazy by poor eyesight suffer a debilitating increased “cognitive load”. It may also be that these problems inhibit people’s social lives and make them lonelier. Social isolation and depression are also important risk factors.

Against the world

Some of the modifiable risk factors are, in fact, far beyond any individual’s control. For example, it makes a big difference how many years of education someone has had. Broadly speaking, the higher the level of educational attainment, the lower the risk of dementia. Polluted air is another risk factor. And the only guaranteed way to escape that is to move.

Again, the mechanism by which air pollution contributes to dementia risk is disputed. The danger comes from fine particles known as PM 2.5 (defined as those measuring less than 2.5 millionths of a metre in diameter) that, if inhaled, can increase the risk of strokes, heart disease, lung cancer and respiratory diseases—some of which are themselves risk factors for dementia. But a more direct cardiovascular link is also possible: the particles could enter the bloodstream and affect the walls of blood vessels, making them less efficient in clearing the brain of waste.

Longitudinal studies into the causes of dementia take years to run and are complex to organise. They can be controversial and raise ethical problems (randomised-controlled trials, for example, might be possible only if some curable conditions were left untreated). That can make definitive conclusions hard to reach. Many experts, for example, had wanted sleeping disorders added to the list of risk factors. Some studies do, in fact, suggest that poor sleep patterns in middle age may contribute to a higher risk of dementia in later life. But the evidence is mixed, with other studies suggesting that some sorts of insomnia are actually associated with a diminished risk of developing dementia.

Nevertheless, there is plenty of evidence to show that the risk factors outlined by the commission are salient. In rich Western countries, for example, the incidence rate of dementia has declined by 13% per decade over the past 25 years, consistently across studies. Gill Livingston, a professor in the psychiatry of older people at University College London and leader of the Lancet commission, has summed up the evidence of progress in North America and Europe as “a 25% decrease in the past 20 years”. Such rapid and significant change can only be the result of changes in modifiable risk factors.

Despite the upbeat tone of the commission’s report, in some countries, such as China and Japan, the age-related incidence of dementia is climbing. In Japan the overall age-adjusted prevalence rate doubled from 4.9% in 1985 to 9.6% in 2014. And according to the China Alzheimer Report of 2022, the incidence of Alzheimer’s in that country had “steadily increased”, making it the fifth-most important cause of death in the country in that year.

Nobody doubts that the prevalence of dementia is going to climb fast in the next decades as humanity ages. All the more reason for dementia-risk reduction to become a global policy priority. ■

Curious about the world? To enjoy our mind-expanding science coverage, sign up to  Simply Science , our weekly subscriber-only newsletter.

This article appeared in the Science & technology section of the print edition under the headline “Silver linings”

Science & technology August 10th 2024

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Abortion, shingles, extreme heat, and sudden cardiac arrest

By Theresa Gaffney Aug. 14, 2024

Want to stay on top of health news?  Sign up  to get our Morning Rounds newsletter in your inbox.

Good morning! See how I write these newsletter items? Very demure, very mindful. (If you don’t understand what I am referencing here, consider yourself blessedly more offline than me and many of my colleagues.)

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Can scientists improve the odds for surviving sudden cardiac arrest?

It’s the “sudden” in sudden cardiac arrest that makes it so scary — a seemingly healthy person can simply collapse. If they’re lucky, medical help is nearby and can restart their heart before it’s too late. But for decades, only about 10% of people who experience sudden cardiac arrest outside of a hospital have been lucky enough to survive.

There’s bystander CPR and automated external defibrillators. There are implantable cardioverter defibrillators that can shock a heart back to normal within eight to 10 seconds. And of course there are medications for people with heart failure. But none of it is enough.

“It affects a thousand Americans a day,” cardiologist Sumit Chugh told STAT’s Liz Cooney. “But if you look in the community it’s still rare. It’s not like high blood pressure or diabetes. It’s 50 people per 100,000 people.” Read Liz’s deep dive into the confounding condition and how scientists are working both to better understand the risk factors involved and to create better interventions like cell-based therapies.

Most reproductive-age women are worried about abortion access, survey says

One in seven reproductive-age women in the U.S. report that they’ve had an abortion, according to new data from KFF’s nationally representative Women’s Health Survey . Nearly 4,000 women ages 18 to 49 responded to the survey on abortion and reproductive health after the fall of Roe v. Wade. Here are a few takeaways that caught my eye:

• Most reproductive-age women (74%) believe that abortion policies should not be determined at the state level. This is true across political affiliations, with 54% of Republican, 86% of Democrat, and 73% of independent women in agreement.
• More than six in 10 survey respondents are concerned that either they or someone they’re close to would not be able to get an abortion if needed to save one’s life or preserve health.
• The report also looked specifically at Florida and Arizona , where voters may soon see abortion on the ballot. In Florida, only one in five respondents were aware that medication abortion is still legal in the state until the sixth week of pregnancy. In Arizona, just over one in 10 were aware that medication abortion is legal and can be obtained online.
• 17% of respondents in the U.S. reported changing their contraceptive practices as a result of Roe being overturned. This included starting or switching birth control, getting a sterilization procedure, or purchasing emergency pills to have on hand.

How to restore America’s confidence in vaccines

It was only two hours after receiving the second dose of the Covid vaccine that virologist Gregory A. Poland heard a sudden ringing in his ear while driving. “The shock of a sudden loud and high-pitched whistling nearly caused me to veer off the road,” he writes in a First Opinion essay. He’d had intermittent tinnitus before, but never like this. It got even worse after his third dose later that year, and the noise has continued to this day.

As someone who has studied vaccines for 40 years, Poland knows that all types of vaccines have saved millions upon millions of lives. But some number of people like him have also suffered unexpected effects on their health and well-being. Poland argues that understanding how this happens would not only be a first step toward reducing these rare risks, but it would help combat vaccine hesitancy. Read more .

Is ultra-processed food the tobacco of the 21st century?

Oncologist Nicholas DeVito says yes. Ultra-processed foods — which include packaged meals, snacks, candies, sodas and more — are more relevant to his work treating cancer than one might think. An estimated 40% of cancers in the U.S. are caused by risk factors that can be changed like using tobacco products, a sedentary lifestyle, and consuming ultra-processed food.

In a First Opinion essay, DeVito argues that, just like tobacco before it, ultra-processed foods have flooded onto our shelves due to a lack of regulation. And just like increased tobacco use over the 20th century was linked to lung cancer, these foods have emerged as a potential cause for gastrointestinal cancers. Read more .

Airport workers rally to protest dangerous heat conditions

Airport workers in Charlotte, N.C. and Phoenix held rallies yesterday to demand better workplace protections from extreme heat, including easy access to water, cool break rooms, and training on heat illness. Last summer was the hottest the northern hemisphere has seen in 2,000 years , and this year is already predicted to break records again.

“Workers like me have been risking our lives every day in brutal conditions, and we’re quite literally sick and tired,” Cecilia Ortiz, a passenger service agent at Phoenix Sky Harbor International Airport, said in a press release.

Extreme heat can have serious detrimental health effects , especially when it comes to cardiovascular health . Earlier this summer, the Biden administration proposed a new rule for the country’s first-ever federal regulations around heat safety at work. The rule would require employers to evaluate heat risk, develop prevention plans for excessive heat, and to ensure workers have access to cool water and paid rest breaks.

Study: Getting shingles could increase risk of cognitive decline

It’s likely that you and just about everybody you know have either had chickenpox before or received the vaccine. Shingles is a reactivation of the same virus that causes chickenpox, which stays in your body, and can cause painful rashes. But the infection might be more than an unpleasant experience. A study published yesterday in Alzheimer’s Research & Therapy found that getting shingles was associated with about 20% higher long-term risk for subjective cognitive decline (when someone’s memory gets worse or they are getting confused more often).

Researchers at Brigham and Women’s Hospital analyzed survey data from almost 150,000 people to assess the connection. It’s the first large study to look at shingles and the risk of subjective cognitive decline, the authors note. While previous research has shown mixed evidence on a link between shingles and dementia, the authors write that this may be due to study designs that used insurance claims or administrative diagnostic data, which only includes people who received medical attention for their shingles.

The authors don’t know exactly how the virus might be linked to cognition. The study also found that men (not women) who had gotten shingles and carry the APOE4 gene, a risk factor for dementia, had an even higher risk.

The Biden Cancer Moonshot’s next target is surgery

The president and first lady spoke in New Orleans at Tulane University in New Orleans yesterday, announcing $150 million dollars in ARPA-H awards to develop technologies that will improve cancer surgeries. Tulane University is one of the first eight grantees to receive one of these awards, and the funding will go towards the creation of methods that will allow surgeons to determine if a cancer surgery successfully removed all of a tumor in real time.

“There are no good technologies that can help determine during the surgery whether it has been successful, but rather days later when it is already too late to change the surgery,” J. Quincy Brown, a biomedical engineer at Tulane University, said in the moonshot announcement in New Orleans. “We should at least be able to give surgeons and patients the peace of mind and positive health benefits of a successful surgery every time. That’s the goal our team is working towards.”

This program will also require the new technology to be deployed in rural hospitals at the end of the project, Brown added during his remarks. “So, we can’t build a million-dollar device,” he said.

—  Angus Chen

What we’re reading

Hot summer threatens efficacy of mail-order medications, New York Times

California bill would require state review of private equity deals in health care, KFF Health News

• The politics of mifepristone in the 2024 election, STAT
• Her son died of an overdose in his dorm room. Where was the Narcan? NPR
• Illumina lays out plan to boost growth by helping scientists interpret sequencing data, STAT
• Following national funding cuts, ‘July was pure hell’ for abortion funds, Rewire News Group

About the Author Reprints

Theresa gaffney.

Morning Rounds Writer and Podcast Producer

Theresa Gaffney is the lead Morning Rounds writer and a podcast producer at STAT.

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• OU Homepage
• The University of Oklahoma

TSET Health Promotion Research Center Expands to Tulsa

April Wilkerson

Media Contact

Diane Sarantakos (405) 630-7835 [email protected]

TULSA, OKLA. – The TSET Health Promotion Research Center (HPRC), a component of OU Health Stephenson Cancer Center, is expanding to the OU-Tulsa campus. The expansion will provide an additional site for HPRC’s mission of reducing the burden of disease in Oklahoma by addressing modifiable health risk factors such as tobacco use, sedentary lifestyle, poor diet, cancer screening and risky alcohol and substance use through research, novel intervention development, and dissemination of research findings.

Stephenson Cancer Center, Oklahoma’s only National Cancer Institute-Designated Cancer Center, recently announced its expansion to Tulsa to bring NCI-level care and clinical trials to people throughout northeastern Oklahoma. The work of HPRC, supported by the cancer center and the Oklahoma Tobacco Settlement Endowment Trust (TSET), complements Stephenson’s mission with its research and educational programs.

HPRC-Tulsa will ultimately be staffed by 12 faculty members and additional support staff. Hiring has begun, and five new faculty members will begin work this fall. They will occupy offices and shared laboratory space at the Schusterman Center in midtown Tulsa at 41 st and Yale. Currently, HPRC has 27 faculty members — five in Tulsa and 22 in Oklahoma City.

In collaboration with HPRC faculty in Oklahoma City, HPRC-Tulsa will support a substantial increase in health promotion research in northeastern Oklahoma. HPRC-Tulsa plans to recruit researchers with expertise in areas such as Native American health inequities, cancer survivorship (including pain), community-engaged research (especially with rural communities), physical activity, obesity, nutrition, opioid misuse, health behavior change (especially around smoking, substance use, physical activity and diet), and health services/implementation science.

The Tulsa site will also be the home of an advanced pain research laboratory supporting the work of Jamie Rhudy, Ph.D., OU’s site director for HPRC-Tulsa, and his collaborators. Rhudy, a professor of health promotion science in the OU Hudson College of Public Health, has over 25 years of research experience in affective neuroscience, studying how the brain processes emotions, specifically focusing on the interface of emotion and pain processing. His research examines the psychological, sociological/environmental, and biological mechanisms that contribute to chronic pain risk.

For the past decade, Rhudy’s work has focused on understanding health risk mechanisms in Native Americans. Nearly one in three Native Americans reports experiencing chronic pain and approximately one in seven reports chronic pain that disables them on most days.  

About the University of Oklahoma

Founded in 1890, the University of Oklahoma is a public research university located in Norman, Oklahoma. As the state’s flagship university, OU serves the educational, cultural, economic and health care needs of the state, region and nation. OU was named the state’s highest-ranking university in  U.S. News & World Report’s  most recent Best Colleges list .  For more information about the university, visit  ou.edu .

Recent News

Ou college of dentistry launches state’s first pediatric residency.

This summer, the University of Oklahoma College of Dentistry launched the state’s first pediatric dental residency, a two-year program that trains new dentists in the care of children, with a special emphasis on those with medical complexities and developmental conditions.

OU SCIPP Team to Bring Climate Expertise to New Skilled Workers Training Program

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International Research Team Awarded Fellowship for Coronavirus Research

An international team led by Daniel Becker, an assistant professor of biology at the University of Oklahoma, has received a Long-Term Fellowship from the Human Frontier Science Program. This award will foster collaboration between OU and interdisciplinary researchers from India and Canada to study coronaviruses in fruit bats.

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