What Are the Health Risks of Smoking vs. Alcohol Drinking?

• Smokers have a greater risk of dying from various cancers such as lung, throat, mouth, bladder, and esophagus than non-smokers.
• Smokers also have a greater risk of heart attack, respiratory illness (emphysema, COPD, pneumonia), high blood pressure, stroke, heart disease, peripheral vascular disease, and aortic aneurysms. Smoking while pregnant can increase the risk of low birth weight babies.
• Alcohol problems vary in severity from mild to life threatening and affect the individual, the person's family, and society in numerous adverse ways. Excessive alcohol used contributes problems such as failure to fulfill obligations at work/school/home, recurrent use in hazardous situations such as driving or operating machinery, legal problems, continued use of alcohol despite having problems caused by drinking, and despite negative outcomes from drinking, the alcoholic continues to drink to try to attain the feeling of euphoria they first experienced when they started drinking.
• Alcohol dependence, a more serious kind of alcohol use disorder, may include tolerance, withdrawal symptoms following a reduction or cessation of drinking, loss of control over drinking, inability to cut down or stop, spending a lot of time drinking or recovering from its effects, giving up activities in favor of using alcohol, and continuing to drink despite knowing alcohol use has caused or worsened problems.
• Withdrawal from alcohol is much more dangerous than withdrawal from heroin or other narcotic drugs.
• Signs and symptoms smoking and tobacco related diseases may include shortness of breath due to damage of the lungs, chest pain, hoarseness, difficulty swallowing, cough, frequent colds and upper respiratory infections, change in exercise tolerance, sudden weakness on one side of the face or body, difficulty speaking, leg pain while walking that goes away when at rest, unexplained weight loss, persistent abdominal pain, and blood in the urine.
• Alcoholism is a disease. Alcohol use disorder is associated with a broad range of medical, psychiatric, and social effects, as well as legal, occupational, economic, and family problems. Certain behaviors and signs indicate someone may have a problem with alcohol, including insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, weight loss, or frequent automobile collisions.
• Smoking cessation programs can help a person quit smoking. Methods to help with smoking cessation include nicotine replacement therapy (gum, patch, lozenges, inhaler, or nasal spray), medications, and counseling.
• Treatment of alcoholism can be divided into three stages. First, stabilization, next, detoxification process, then long-term abstinence and rehabilitation. The stabilization stage may involve medications, IV fluids, and vitamin supplementation. The detoxification stage involves stopping alcohol consumption, which often involves use of some medications. Short- and long-term residential treatment programs aim to help rehabilitate people who are more severely dependent on alcohol develop skills not to drink, to build a recovery support system, and to work on ways to keep them from drinking again (relapsing).

Alcohol problems vary in severity from mild to life threatening and affect the individual, the person's family, and society in numerous adverse ways. Despite the focus on illegal drugs of abuse such as cocaine, alcohol remains the number-one drug problem in the United States. Nearly 17 million adults in the U.S. are dependent on alcohol or have other alcohol-related problems, and about 88,000 people die from preventable alcohol-related causes.

In teenagers, alcohol is the most commonly abused drug. Thirty-five percent of teens have had at least one drink by age 15. Even though it is illegal, about 8.7 million people 12 to 20 years of age have had a drink in the past month, and this age group accounted for 11% of all alcohol consumed in the U.S. Among under-aged youth, alcohol is responsible for about 189,000 emergency-room visits and 4,300 deaths annually.

Withdrawal, for those physically dependent on alcohol, is much more dangerous than withdrawal from heroin or other narcotic drugs. Alcohol abuse and alcohol dependence are now grouped together under the diagnosis of alcohol use disorder.

• What was formerly called alcohol abuse refers to excessive or problematic use with one or more of the following:
  • Failure to fulfill major obligations at work, school, or home
  • Recurrent use in situations where it is hazardous (such as driving a car or operating machinery)
  • Legal problems
  • Continued use of alcohol despite having medical, social, family, or interpersonal problems caused by or worsened by drinking
  • Despite negative outcomes resulting from drinking, the alcoholic continues to drink to try to attain the feeling of euphoria they first experienced when they started drinking.
• Previously called alcohol dependence, this aspect of alcohol use disorder refers to a more serious kind of alcohol use disorder and involves excessive or maladaptive use leading to three or more of the following:
  • Tolerance (need for more to achieve the desired effect, or achieving the effect with greater amounts of alcohol)
  • Withdrawal symptoms following a reduction or cessation of drinking (such as sweating, rapid pulse, tremors, insomnia, nausea, vomiting, hallucinations, agitation, dizziness, shaking, anxiety, or seizures) or using alcohol to avoid withdrawal symptoms (for example, early morning drinking or drinking throughout the day)
  • Drinking more alcohol or drinking over a longer period of time than intended (loss of control)
  • Inability to cut down or stop
  • Spending a great deal of time drinking or recovering from its effects
  • Giving up important social, occupational, or recreational activities in favor of using alcohol
  • Continuing to drink despite knowing alcohol use has caused or worsened problems

Binge drinking (consuming several drinks over a short period of time) can occur at any level of alcohol use disorder.

Cigarette smoking is a leading contributor to death and illness among Americans.

Significantly fewer than half of all American adults smoke. Slightly more men smoke than women. Hispanics and Asian Americans smoke less than whites or African Americans. Fewer than one third of people ages 25 to 44 are current smokers.

Since 1964, when the Surgeon General issued the first report outlining the health dangers of smoking, the prevalence of smoking has dropped among adults. The incidence of lung cancer, chronic bronchitis, and emphysema would become significantly less common if people would stop smoking.
Compared to a nonsmoker, a smoker faces these risks:

• fourteen times greater risk of dying from cancer of the lung, throat, or mouth;
• four times greater risk of dying from cancer of the esophagus;
• two times greater risk of dying from a heart attack;and
• two times greater risk of dying from cancer of the bladder.

Use of other tobacco products such as pipes, cigars, and snuff is less common; however, the health effects of these products are similar to those of cigarettes - particularly their association with cancers of the mouth, throat, and esophagus.

Increasing attention has been devoted to publicizing the dangers of second-hand (environmental) smoke, the association between tobacco marketing and initiation of smoking among youth, and the development of strategies and medications to help smokers quit. According to the CDC, about 126 million non-smoking Americans are exposed to secondhand smoke and put at risk for tobacco-related problems such as lung cancer, heart disease and respiratory infections. In addition, a new problem termed "third-hand smoke" has been recently investigated. Cigarette smoke generated carcinogens lodge in clothing, carpets, drapes and other materials and can be absorbed through human skin, especially that of children and infants. These carcinogens can also be ingested and inhaled in dust.

Cigarette smoking has been linked strongly to the following illnesses:

• heart disease
• stroke
• hypertension (high blood pressure)
• other diseases of blood vessels (such as poor circulation in the legs) and aortic aneurysms (potentially life-threatening disruptions in the wall of the aorta)
• respiratory illness, including the following:
  • lung cancer
  • emphysema
  • bronchitis
  • pneumonia
• cancers, including:
  • lip or mouth
  • pharynx or larynx (voice box)
  • esophagus (food pipe)
  • stomach
  • pancreas
  • kidney
  • urinary bladder
  • cervix
  • ovary
• peptic ulcer disease
• burns

Smoking

Signs and symptoms of cigarette smoking are frequently obvious even to a casual observer. Besides the confirmatory evidence (a person actually smoking a cigarette in public view), nicotine-stained fingers and teeth, the characteristic smell of smoke impregnated clothing and household items, the chronic "smokers cough," the gravelly voice, and often the visible pack of cigarettes and lighter in a person's pocket or purse are signs and symptoms that a person smokes. However, new (teenage) smokers or "infrequent" smokers may exhibit few or none of these signs and symptoms. In addition, many teens will try to "cover up" any evidence of cigarette use for any number of reasons (for example, the legality regarding their age and the purchase of cigarettes or their parents forbid smoking).

Signs and symptoms of tobacco related diseases often depend on the specific illnesses they cause. (There are many other symptoms of tobacco-related diseases, and those listed here are simply examples.)

• Shortness of breath may be a sign of emphysema or heart disease.
• Chest pain may signal angina pectoris caused by insufficient blood flow to the heart or a heart attack.
• Difficulty swallowing, or persistent hoarseness, may signal a cancer in the mouth or larynx.
• Painless bloody urination may signal bladder cancer.
• The presence of any of the following common symptoms associated with tobacco use should prompt a visit to the doctor or hospital's emergency department:
  • chest pain
  • shortness of breath
  • persistent cough
  • coughing up blood
  • frequent colds and upper respiratory infections
  • persistent hoarseness
  • difficulty or pain on swallowing
  • change in exercise capacity
  • sudden weakness on one side of the face or body; or difficulty speaking
  • leg pain while walking that goes away when at rest
  • unexplained weight loss
  • persistent abdominal pain
  • blood in the urine

Drinking

Alcoholism is a disease. It is often diagnosed more through behaviors and adverse effects on functioning than by specific medical symptoms. Only two of the diagnostic criteria are physiological (tolerance and withdrawal symptoms).

• Alcohol use disorder is associated with a broad range of medical, psychiatric, and social effects, as well as legal, occupational, economic, and family problems. For example, parental alcoholism underlies many family problems such as divorce, spouse abuse, child abuse, and neglect, as well as dependence on public assistance, and criminal behaviors, according to government sources.
  • The great majority of individuals with alcoholism go unrecognized by physicians and health-care professionals. This is largely because the person with alcohol use disorder is able to conceal the amount and frequency of drinking, deny problems caused by or made worse by drinking, there is gradual onset of the disease and effects on the body, and the body has the ability to adapt to increasing alcohol amounts up to a point.
  • Family members often deny or minimize alcohol problems and unwittingly contribute to the continuation of alcoholism by well-meaning behaviors such as shielding (enabling) the person with alcohol dependence from adverse consequences of drinking or taking over family or economic responsibilities. Often the drinking behavior is concealed from loved ones and health-care professionals.
  • Individuals with alcohol use disorder, when confronted, will often deny excess consumption of alcohol. Alcoholism is a diverse disease and is often influenced by the alcoholism sufferer's personality as well as by other factors. Signs of a drinking problem and symptoms often vary from person to person. There are certain behaviors and signs that indicate someone may have a problem with alcohol, including insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, weight loss, or frequent automobile collisions.
  • Symptoms of intoxication include slurred speech, reduced inhibitions and judgment, lack of muscle control, problems with coordination, confusion, or problems with memory or concentration. Continued drinking causes a rise in the blood alcohol content (BAC) and high BAC can lead to breathing problems, coma, and even death.
  • Signs of a drinking problem and symptoms often vary from person to person. There are certain behaviors and signs that indicate someone may have a problem with alcohol, including insomnia, frequent falls, bruises of different ages, blackouts, chronic depression, anxiety, irritability, aggression or lack of restraint, tardiness or absence at work or school, loss of employment, divorce or separation, financial difficulties, frequent intoxicated appearance or behavior, self-destructive behavior, weight loss, or frequent automobile collisions.
  • Signs and symptoms of chronic alcohol abuse include medical conditions such as pancreatitis, gastritis, (liver) cirrhosis, neuropathy, anemia, cerebellar (brain) atrophy, alcoholic cardiomyopathy (heart disease), Wernicke's encephalopathy (abnormal brain functioning), Korsakoff's dementia, central pontine myelinolysis (brain degeneration), seizures, confusion, malnutrition, hallucinations, peptic (stomach) ulcers, and gastrointestinal bleeding.
• Compared with children in families without alcoholism, children of alcohol-dependent individuals are at increased risk for alcohol abuse, substance abuse, conduct problems, violent behavior, anxiety disorders, compulsive behavior, and mood disorders.
• Alcoholic individuals have a higher risk of psychiatric disorders and suicide. They often experience guilt, shame, loneliness, fear, and depression, especially when their alcohol use leads to significant losses (for example, job, relationships, status, economic security, or physical health).
• Many medical problems are caused by or made worse by alcoholism as well as by the alcoholic's poor adherence to medical treatment.

Smoking

Smoking is recognized as a medical diagnosis called Tobacco Use Disorder.

Doctors should ask people about tobacco use at every visit and provide counseling about quitting.

Most people who smoke admit doing so, in part because smoking carries less social stigma than use of other substances, such as alcohol or illicit drugs. Smokers should not underestimate how much they smoke and for what length of time (for example, a pack a day since age 16), as this information helps the doctor understand the risk for tobacco-related disease.

Children from smoking households are more likely to begin smoking than children from nonsmoking households.

• Much attention has been focused on the influence of tobacco company advertising on encouraging young people to smoke.
• Although cigarette commercials have been banned from television for over 30 years, tobacco products remain among the most heavily marketed products. According to the American Lung Association, the tobacco industry spent an estimated $12.49 billion on advertising in 2006. Some states place restrictions on the type and locations of tobacco advertising, and legislation enacted in 2009 gave the U.S. FDA strong authority to regulate tobacco products. The FDA requires prominent health warnings on all cigarette packaging and advertisements in the United States.
  • Studies have shown that youth are particularly susceptible to tobacco marketing campaigns.
  • In the past, cigarette use by actors in popular films was a means to portray smoking as sophisticated and glamorous.
  • Although denied by tobacco companies, the use of cartoon animals and the like in advertising campaigns appeals to youngsters.
  • Counter-advertising by various antismoking advocacy groups may provide some balance, but their advertising budgets pale beside those of tobacco companies.
  • Schools generally provide education on the use of tobacco, alcohol, and other substances, but their impact is unclear.
  • Increasing the taxes on cigarettes, and hence their price, has been shown to reduce tobacco consumption, especially among adolescents.

Drinking

The cause of alcoholism is not well-established. There is growing evidence for genetic and biologic predispositions for this disease. First-degree relatives of individuals with alcohol use disorder are four to seven times more likely to develop alcoholism than the general population. Research has implicated a gene (D2 dopamine receptor gene) that, when inherited in a specific form, might increase a person's chance of developing alcoholism.

Usually, a variety of factors contribute to the development of a problem with alcohol. Social factors such as the influence of family, peers, and society, and the availability of alcohol, and psychological factors such as elevated levels of stress, inadequate coping mechanisms, and reinforcement of alcohol use from other drinkers can contribute to alcoholism. Also, the factors contributing to initial alcohol use may vary from those maintaining it, once the disease develops.

While it may not be causative, twice as many men are alcohol dependent. One study showed one-third of men age 18-24 met the criteria for alcohol dependence, and those who start drinking before age 15 are four times more likely to develop alcohol dependence. Men are more likely to engage in binge drinking or heavy drinking. They are also more likely to be involved in behaviors that harm themselves or others such as alcohol-related violence, using other drugs such as marijuana and cocaine, having sex with six or more partners, and earning mostly Ds and Fs in school grades.

Smoking

Treating tobacco involves helping the individual successfully stop smoking. This often requires integrated steps.

Smokers must partner with their doctors, families, spouses, friends, even employers, to make quitting successful.

Quitting is not easy. Many smokers try to quit, but only a few succeed.

Treatment consists of two broad areas:

• The medical conditions caused by smoking - respiratory illness, heart disease, circulatory disease, cancer, ulcers - need to be treated. In addition to stopping smoking, any associated medical condition, if one is present, needs to be addressed by the patient's doctor. Smokers need to discuss treatments for their individual diagnosis with their doctor.
• The nicotine addiction also must be addressed and generally consists of a combination of the following:
  • Nicotine replacement therapy (gum, patch, lozenges, inhaler, or nasal spray): Some nicotine replacement products (gum, patches, and lozenges) are available over the counter, under several brand names, but are best used in conjunction with a doctor. Others (nasal sprays and inhalers) require a prescription. The non-prescription products are less expensive and work as well as the prescription products.
  • Varenicline (Chantix) is a prescription drug approved by the U.S. FDA to help adults quit smoking. Chantix acts on the nicotine receptors in the brain, stimulating these receptors and blocking the ability of nicotine to attach to these receptors. Chantix is taken seven days prior to the date an individual desires to quit smoking, and most people will keep taking Chantix for up to 12 weeks.
  • Group or behavioral counseling. The most successful quitting programs use combinations of drug treatment and counseling and have success rates of 5% after 1 year.
  • The prescription antidepressant bupropion (Zyban, Wellbutrin) has also been shown to help some people quit smoking.
• Smokers trying to quit need lots of support and encouragement to help handle the inevitable urges to light up.
• Doctors, although trained in the diagnosis and treatment of smoking-related illnesses, may be less comfortable in providing the counseling and drug treatment smokers need to quit.
• Call your local chapter of the American Lung Association for further advice about smoking cessation programs.

Other Treatments

Treatment of the many diseases and conditions associated with smoking is dependent upon the extent and severity of the condition. Treatments are numerous, varied and are best done in consultation with the individual's primary care physician and associated caregivers (for example, cardiologist, oncologist). Smoking cessation products are available (see medical treatment previously) for home use for people interested in quitting smoking.

Drinking

A team of professionals is often needed to treat the alcohol-dependent person. The physician usually plays a key role in medical stabilization and facilitating treatment entry, but others are routinely needed beyond the initial management (for example, alcoholism counselors, social workers, physicians specializing in psychiatry, family therapists, and pastoral counselors).

Treatment of alcoholism can be divided into three stages. Initially, the person has to be medically stabilized. Next, he or she must undergo a detoxification process, followed by long-term abstinence and rehabilitation.

• Stabilization: Many medical and surgical complications are associated with alcoholism, but only stabilization of alcohol withdrawal and alcoholic ketoacidosis are discussed here.
  • Alcohol withdrawal is treated by oral or intravenous (IV) hydration along with medications that reverse the symptoms of alcohol withdrawal. The most common group of medications used to treat alcohol withdrawal symptoms is the sedative group, also called the benzodiazepines such as lorazepam (Ativan), diazepam (Valium), and chlordiazepoxide (Librium). They can be given by IV, orally, or by injection. Diazepam also comes as a rectal suppository. Chlordiazepoxide generally takes longer to have an effect than diazepam or lorazepam and is therefore less commonly used in withdrawal emergencies. Pentobarbital is another medication occasionally used to treat alcohol withdrawal. It has an effect similar to benzodiazepines but is more likely to slow down breathing, making it less attractive for this use. Occasionally, the agitated and confused person may have to be physically restrained until he or she becomes calm and coherent.
  • Alcoholic ketoacidosis is treated with IV fluids and carbohydrates. This is usually done in the form of sugar-containing fluid given by IV until the person can resume drinking fluids and eating.
  • People with alcoholism should receive supplemental thiamine (vitamin B1), either by injection, IV, or orally. Thiamine levels are often low in alcohol-dependent people, and deficiency of this important vitamin could lead to Wernicke's encephalopathy, a disorder characterized initially by the eyes looking in different directions from each other. If thiamine is given in a timely fashion, this potentially devastating disorder can be completely reversed. In the emergency setting, thiamine is customarily given as an injection. Folate (a vitamin) and magnesium are often given to individuals with alcoholism, as well.
• Detoxification: This stage involves stopping alcohol consumption. This is very difficult for an alcohol-dependent person, requires extreme discipline, and usually requires extensive support. It is often performed in an inpatient setting where alcohol is not available. The person is treated with the same medications discussed in the treatment of alcohol withdrawal, namely benzodiazepines. During detoxification, the medication is measured carefully to prevent physical withdrawal symptoms and is then gradually tapered off until no physical withdrawal symptoms are evident. This usually requires a few days to a week. As physician-assisted outpatient detoxification has become popular, it may become more difficult to obtain coverage for in-hospital detoxification.
• Rehabilitation: Short- and long-term residential programs aim to help people who are more severely dependent on alcohol develop skills not to drink, to build a recovery support system, and to work on ways to keep them from drinking again (relapsing).
  • Short-term programs last less than four weeks. Longer programs last for a month to a year or more and are often referred to as sober-living facilities. These are structured programs that provide therapy, education, skills training, and help develop a long-term plan to prevent relapsing.
  • Outpatient counseling (individually, in groups, and/or with families) can be used as a primary treatment method or as a "step-down" for people as they come out of a residential or structured day program.
  • Outpatient counseling can provide education on alcoholism and recovery, can help the person learn skills and self-image not to drink, and spot early signs of potential relapse.
  • There are several very effective individual treatments delivered by professional counselors in outpatient treatment clinics. These treatments are Twelve-Step Facilitation Therapy, Motivational Enhancement Therapy, and Cognitive-Behavioral Coping Skills. A well-known self-help program is Alcoholics Anonymous (AA). Other self-help programs (for example, Women for Sobriety, Rational Recovery, and SMART Recovery) allow alcoholics to stop drinking and remain sober on their own.

Smoking

For smokers, quality and length of life depends on the number and severity of smoking-associated illnesses they may develop and if they have other medical conditions such as diabetes or high blood pressure. Other lifestyle factors, for example, use of alcohol or other drugs also make a difference in long-term outcomes for smokers. For smokers who quit, projected health and life expectancy improve markedly at any age of life.

• Smokers who quit before age 50 years have half the risk of dying in the next 15 years compared with those who continue to smoke.
• Quitting smoking substantially decreases the risk of lung, larynx, esophageal, oral, pancreatic, bladder, and cervical cancers. For example, 10 years after quitting, an ex-smoker has lower risk of lung cancer compared to a continuing smoker. Continued smoking abstinence continues to lower the risk.
• Quitting lowers the risk for other major diseases including coronary heart disease and cardiovascular disease. The increased risk of coronary heart disease halves after 1 year of abstinence. After 15 years, the risk of coronary heart disease approximates that of someone who never smoked.
• Women who stop smoking before pregnancy, or during the first 3 or 4 months of pregnancy, reduce their risk of having a low birth weight baby to that of women who never smoked.
• The health benefits of quitting far exceed any risks from the average 5-pound weight gain that may follow quitting.

Drinking

Remaining alcohol-free is a very difficult task for most people with alcohol use disorder. Individuals who do not seek help after detoxification tend to have a high relapse rate.

• Four key factors may increase the relapse rate:
  • Less education about addiction and ways to resist urges to relapse
  • Higher levels of frustration and anger
  • More extensive history of cravings and other withdrawal symptoms
  • More frequent consumption of alcohol prior to treatment
• If a person continues to drink excessively after numerous or ongoing treatments, their prognosis is very poor. Persistent heavy drinkers will often succumb to the effects of alcohol.
• Alcohol use disorder is a chronic disease not unlike diabetes or congestive heart failure. If alcoholism is considered a chronic disease, a treatment success rate of 50% is similar to the success rates in other chronic illnesses.