• Categories
  • Category Archives: Substance abuse

    The mental health and smoking action report

    Despite many years of progress, smoking remains still the single biggest cause of preventable and premature death in England killing almost 80,000 people every year.

    What is more, smoking is a leading cause of inequalities. Smoking rates amongst people with a mental health condition are particularly concerning. Around one third of adult tobacco consumption is by people with a current mental health condition and whilst less than 20% of the general population smoke, this figure is around 40% in those with a mental health condition, and up to 70% in people discharged from a psychiatric hospital.

    This difference in prevalence has dire consequences. People with mental health conditions die on average 10-20 years earlier than the general population and smoking is the single largest factor in this shocking difference. People with a mental health condition are just as likely as other smokers to want to quit, but because they are more likely to be heavily addicted to smoking, they need more support to be successful. This support is sadly lacking: when ASH asked smokers with a mental health condition if anyone providing inpatient care had offered them help to stop smoking two thirds told us no one had. Clearly there is an urgent need for action.

    ASH has published a new report entitled The Stolen Years: The mental health and action smoking report setting out the urgent action needed to get smoking rates falling in this population. The report has been endorsed by 27 leading mental and public health organisations, including Rethink Mental Illness and the Royal College of Psychiatrists and has been informed by a wide range of people, from experts by experience to those working in mental health, public health and the NHS.

    Our ambition is that smoking among people with a mental health condition declines to be less than 5% by 2035, with an interim target of 35% by 2020. This is an undeniably ambitious target and there is no single measure that will help us get there. Key areas identified in The Stolen Years for action include:

    • National targets and leadership to drive action across the country
    • A strong focus on the skills and training of the workforce
    • Availability of evidence-based services alongside peer support for all those who need them
    • Better access to the medications that will help people to quit
    • Improved understanding that electronic cigarettes provide a less harmful alternative to smoking
    • Moving to smokefree mental health settings alongside provision of the right support to smokers

    The publication of this report is only the start of work on this agenda. After decades of stagnation, change is only possible with collective action. If we are to achieve our ambition and drive real change in this area all parts of the health and social care system from national government through to local authorities, the NHS and care providers will need to play their part. Failure to act now would be to condemn thousands of people with a mental health condition to early death and debilitating disease and would widen the already appalling gap in life expectancy.

    ASH is a public health charity that works locally, nationally and internationally to try and achieve a vision: a society free from the harm caused by tobacco. You can access “The Stolen Years: the mental health and smoking action report” here.

    Tagged | Comments Off on The Stolen Years

    Alcohol produces externalities – costs that are imposed on others without their consent. For example, drinking is associated with crime and violence, road traffic accidents, costs to the healthcare system and lower economic productivity. Externalities are problematic because they are not reflected in market outcomes: consumers typically only consider the costs and benefits of drinking to themselves, and fail to consider the impact their drinking has on others.

    According to standard economic theory, externalities should be corrected through taxes which raise prices to reflect the social harm of a product. For example, if a pint of beer typically imposes £1 of costs on others, then a tax of £1 should be levied on each pint to reflect this cost.

    The UK Government has estimated the externalities caused by drinking to be £21 billion a year in England and Wales. This number is controversial, but the economists behind it acknowledge that if anything it is an underestimate. In any case, the Government has reaffirmed this £21 billion figure repeatedly in parliament. Yet alcohol duty only raises £9 billion a year, suggesting that the price of alcohol does not adequately reflect the harm it does to society.

    Some people might object that it is only a problem minority that causes social harm, and worry that duty is a blunt instrument, which negatively affects moderate drinkers at the same time. This is debatable, but even if such a distinction can be drawn, the burden is minimal. Moderate drinkers may have to pay more for their alcohol due to duty, but this money allows the government to fund services and cut other taxes. Taxes may also discourage moderate consumers from drinking, and cause them to switch to less enjoyable products. However, our estimate of this loss of enjoyment suggests that it accounts for at most 2 per cent of market value, £1.2 billion, and likely considerably less, under current levels of duty. Besides, it is dwarfed by the reduction of crime, healthcare and economic costs as a result of alcohol duty – which total at least £4.4 billion. All things considered, many – perhaps most – moderate drinkers could benefit from higher alcohol duty.

    A key implication of all this is that higher alcohol taxes can be justified solely on the basis of the harm that drinking causes to wider society. The argument does not depend on the benefits to the individual drinker. Yet such considerations provide additional reasons to raise alcohol duty.

    There are a number of reasons to suspect that many people make poor choices around alcohol and could benefit from higher duty that discourages excess drinking. Alcohol is addictive and psychoactive, and as a result many consumers drink while dependent or intoxicated. Many people are not fully informed of the risks of drinking, or believe that they are immune – for example, only half of people in the UK are aware alcohol causes cancer. People suffer weakness of will – where they are unable to follow through on their reflective desire to cut down drinking. More generally, myriad non-rational influences encourage people to drink, including habit, availability and social influence. Raising the price of alcohol does not reverse all these effects, but can go some way to mitigating excessive overconsumption.

    Taken together, these arguments make for a compelling case in favour of raising alcohol duty. On the Government’s own estimates, current levels of tax fail to account for the social cost of drinking. Raising rates of duty would address this harm without unduly affecting moderate drinkers. Moreover, higher duty would reduce the private costs to individuals resulting from excessive consumption. Come Wednesday, we will learn whether the Government has taken heed.

    This post is based on the Institute of Alcohol Studies report ‘Dereliction of Duty: Are UK alcohol taxes too low?’ Download the full report from the IAS website here.

    First published on the British Politics and Policy blog

    Tagged , | 1 Comment

    How do they fit into the public health agenda?

    The growing prevalence of non-communicable diseases (NCDs) is triggering substantial policy concern, evident, for example, in the 2011 UN high level meeting on NCDs. Yet, it’s clear that there are very different ways of thinking about this ‘epidemiological transition’. For some, including the current UK government it seems, the rise in such diseases is viewed primarily as a consequence of the choices that individuals make. In contrast, many of those working in public health understand the problem to be largely a consequence of the strategies that corporations pursue. These different views lead to different conclusions about appropriate and effective responses.

    For those who take the view that the growing NCD burden is a consequence of economic development (via, for example, more sedentary and unhealthy lifestyles), then it’s logical to focus policy responses on trying to inform the choices that individuals make. From this perspective, we can all ‘choose to be healthier’ by doing more exercise, eating healthier foods and avoiding, or limiting, our consumption of health-damaging products such as tobacco and alcohol.  The CEO of Pepsi Co, Indra Nooyi, endorses this viewpoint, arguing that PepsiCo is an ‘ethical’ company because it provides consumers with a choice of products, ranging from healthy to less healthy.

    This emphasis is frequently reinforced in the media through advertising, news stories and television programmes that promote the idea that individuals choose unhealthy lifestyles, and via a focus on individual-level solutions to improve health. From this viewpoint, corporate interests involved in the production and marketing of health damaging products should be ‘part of the debate’, or even ‘part of the solution’ to the emerging health crisis (e.g. via reformulated products, changing labelling and implementing self-regulatory codes).

    Yet, if we turn to tobacco, a sector which has been extensively researched for several decades now, a very different approach is evident. Here, the prevailing view in public health and increasingly in policy, is that the tobacco industry is a primary ‘vector’ of the growing NCD burden. Investigative journalism and research centring on internal tobacco industry documents has made public the extent to which senior managers of tobacco companies have (amongst other things): lied about the addictiveness of nicotine, worked to make their products more addictivetargeted young children as ‘new markets’; and worked to limit tobacco control policies.

    Consequently, the political and public legitimacy of tobacco industry actors has plummeted, triggering some desperate efforts to regain a seat at the policy table. Analysis of a European Union consultation on smokefree legislation has demonstrated that we are now at a stage (at least in the EU) where tobacco industry actors are almost entirely separated from public health policy debates – although the rise of e-cigarettes is beginning to challenge the cohesiveness of the tobacco control movement. In part, this reflects public health efforts to ‘denormalise’ tobacco and routine business practices of the tobacco industry; efforts which have gained particular traction in the UK. The clear differences in perception of the tobacco industry, on the one hand, and the food and alcohol industries on the other, warrant deeper consideration: why are these three industries perceived so differently and is this distinction justified?

    How different are the tobacco, alcohol and processed food industries?

    There are two obvious ways in which it might seem appropriate to distinguish between tobacco, alcohol and food industries. First, we might consider that the harms associated with tobacco products are greater than those associated with alcohol and food. Yet, assessments of the contribution of alcohol and obesity to adverse health outcomes (e.g. adverse pregnancy outcomes) suggests they are often as high as tobacco. Likewise, comparative estimates of the costs of alcohol, tobacco and ultra-processed food often suggest the costs are similar and, in fact, probably higher for food-related problems, such as obesity. So this first rationale seems unconvincing.

    A second reason concerns the behaviour of the industries. It is certainly the case that more is known about the efforts of tobacco companies to misrepresent research and to shape policy in their interest than is known about the efforts of alcohol and food companies. But this is beginning to change. For example, in his book Lethal but Legal Nicholas Freudenberg shows that the practices of these industries in marketing, product design, lobbying, and sowing doubts about evidence of harm are remarkably similar.


    How different are the processed food and tobacco industries? (Credit: Alan Chan CC BY-SA 2.0)

    These similarities are also evident in research examining alcohol industry efforts to influence policy in the context of minimum unit pricing debates in the UK. Like the tobacco industry, the alcohol industry pursues highly integrated strategies and employs many of the policy-influencing tactics identified within the tobacco industry, including extensive lobbying at all stages of the policy process, the use of thinks tanks and front groups, attempts to shape the scientific content of policy debates, and to influence public perception of their industry and policy proposals. Again, such tactics are evident in work which has compared, for example, how tobacco and soda companies have used corporate social responsibility campaigns to influence the political landscape. In fact, the soda industry goes even further than tobacco in its explicit goals to increase consumption and target children. This suggests that commercial strategies to influence public and policy debates are very similar across industry sector. Hence, the second rationale (different industry behaviour) doesn’t seem valid either.

    Yet, in interviews I have undertaken over the past four years, the view that tobacco represents a radically different case from alcohol and food seems deeply engrained in the way many policy makers, researchers and advocates think. It seems likely that this is at least partly a result of importance attached to individual-level behaviour in neoliberal economies but it may also reflect the success of ‘tobacco exceptionalism’, a core tenant of which is the idea that other industries are different from tobacco and not necessarily worthy of the same, strict rules to protect public health policies from industry interference. This has worked well for tobacco control advocates in the UK so far but may have unintended consequences for other dimensions of public health.

    A new interlinked public health agenda: assessing the role of industry

    If we are serious about tackling the rising burden of NCDs then we need to revisit the popular and persistent distinction between tobacco, alcohol and food industries. From a research perspective, the following five questions seem like a good place to begin better understanding, and perhaps challenging, widely held distinctions between the various industries involved in producing and marketing unhealthy commodities:

    1. What are the interactions between the actors that constitute each of these industries and how close are these connections?
    2. How similar are food and alcohol industry approaches to influencing public, political and policy debates to tobacco? (Since these industries have not had to provide access to their internal documents on the same scale as tobacco, we need to develop innovative methodologies and find new data sources.)
    3. How do members of the public and key policy actors view each industry and their products and why? Does this appear to vary by context or change when presented with different kinds of evidence?
    4. What are the potential policy alternatives that might contribute to achieving healthier future scenarios and how do these differ across alcohol, tobacco and food?
    5. Reflecting this, to what extent can the case study of tobacco control be used to provide lessons for developing and implementing evidence-based policies to promote and protect people’s health beyond tobacco?

    These suggestions are, of course, simply a means of contributing to this emerging debate. What seems essential is that we begin to develop a new research agenda in public health, and policy and politics more broadly, which frees us from our current silo-based view of these interlinked public health problems.

    First published on the British Politics and Policy blog

    These colleagues contributed to the piece: Professor Oliver Razum, Dean of the School of Public Health at Bielefeld University, Germany; Professor Nicholas Freudenberg, City University New York; Dr Lori Dorfman, University of California, Berkeley, Dr Benjamin Hawkins, London School of Hygiene and Tropical Medicine,Dr Shona Hilton and Dr Heide Weishaar, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.



    Tagged , , | 1 Comment

    In the UK, smoking is the primary cause of premature death and preventable illness, with around 100,000 deaths each year attributed to smoking related diseases. Illnesses such as heart disease, respiratory disease and many cancers are directly linked to smoking, at a cost of over £2 billion per year to the NHS. With the NHS under constant budgetary strain, this represents a sizeable drain on resources.

    Smoking has been a highly visible part of British culture for more than a century, and while the number of people smoking has been in decline since the 1970s, it’s still a habit enjoyed by around 10 million adults in the UK.

    What has been happening over the past 10 years or so, however, is the development of a product which offers a much safer alternative to continuing to smoke tobacco. E-cigarettes, which first appeared back in 2005, are currently being used by around 2 million people in the UK, almost a fifth of the adult population who smoke.

    While e-cigs are currently not regulated by any UK health authority, they soon will be, with the EU’s tobacco product directive coming into force in May 2016. This will require companies trading in the UK to abide by strict testing and record keeping rules, doing away with the concern over the traceability of ingredients used in current products.

    That’s not to say, however, that existing companies do not already test their products. Many do so on a voluntary basis, but these new rules will make it a legal requirement for all e-cig vendors in the UK to follow suit.

    In September 2015, Public Health England issued a report in which they stated that e-cigarettes were at least 95% safer than continued use of tobacco, a move which was widely welcomed by e-cigarette companies themselves, along with campaign groups such as Action on Smoking and Health. They do not contain the same cancer-causing ingredients found in tobacco, are free from tar, carbon monoxide and do not feature any combustion. As a result, they produce a vapour which lacks the carcinogenic elements which are the cause of so many smoking related illnesses.

    For smokers looking to quit tobacco, e-cigarettes becoming an increasingly popular option. Given their relative low cost when compared with cigarettes, they also represent a substantial cost saving. E cig starter kits can range from the inexpensive, right through to high-end deluxe models, so the choice of how much to pay is very much in the consumer’s hands. It’s advisable, however, to stick to reputable vendors who already test their products and who comply with existing consumer goods legislations (CE, RoHS etc).

    With e-cigarettes growing in popularity year on year, they are inevitably going to become much more prevalent among current smokers and those who identify as ‘ex-smokers’. More and more, people are having success quitting tobacco in favour of such devices, which can only be a good thing for future rates of smoking-related illnesses, which in turn should translate to a huge cost-saving to the NHS.

    Tagged | 1 Comment

    Smoking tobacco has led to many illnesses and deaths for decades.  A much disputed habit, government agencies continually place pressure on cigarette manufacturers to reveal the truth regarding the dangers of smoking.  While some people quit cold turkey, use meditation, or try the patch, others have tried ‘vaping.’

    While debates are open and long-term results are pending, a number of people believe that vaping is helping people quit cigarettes.

    Those Who Vape

    Based on a survey, most (72%) ‘vapors’ were former cigarette smokers, with 76% smoking e-cigarettes on a daily basis.  An international survey reported that 72% of those who vaporize admitted that smoking e-cigarettes help them deal with cravings and withdrawal symptoms.  92% report reductions in their smoking when using e-cigarettes, and 10% report they still crave tobacco cigarettes though they have switched to e-cigarettes.  More than 2000 former smokers took the survey, and a whopping 96% reported that e-cigarettes did indeed help them to stop smoking.

    Other Solutions

    As mentioned, traditional smokers seek other ways to kick the habit.  However, most solutions have a negligible success rate, the patch and nicotine gum being two examples.  Those who have battled cigarette addiction have been accustomed to seeing more ‘solutions’ take fruition since the 1980s, when the notion of quitting cigarettes really hit the mainstream, with places of business along with public arenas alienating smokers.

    Vice Versa

    Some parents and vaping opponents fear vaping may have a vice versa effect, meaning that those who first vape may be more susceptible to starting a tobacco cigarette habit.  A study of high school students published in the Journal American Medical Association shows that those who have tried electronic cigarettes are also likely to try traditional cigarettes.

    The research followed more than 2,500 high school students through a six month period.  31% of e-cigarette users tried some other form of tobacco, yet a small number (8%) who did not vape at all tried other forms of tobacco.

    A University of London psych professor interjected, pointing out that e-cigarettes did not create smokers of traditional tobacco, but that those who are likely to smoke (anything at all) will be drawn to multiple forms of smoking.  It’s an important insight and opinion, especially since many believe that vapor cigarettes can help smokers stop for good.

    More Than a Bit Safer

    Advocates of e-cigarettes, featured within, point out that though vaporizers provide nicotine, the addictive ingredient in traditional cigarettes, it’s the burned tobacco that is most harmful to smokers.  E-cigarettes are by no means ‘harmless,’ yet as compared to traditional cigarettes, they are more than a bit better for one’s health.  The British agency, Public Health England, estimate that e-cigarettes are about 95% safer than burned tobacco.

    Level of Control

    Traditionally, some tobacco smokers try to wean off by simply decreasing the number of cigarettes smoked per day.  While 10 cigarettes is obviously better than smoking an entire pack, each cigarette smoked has the same impact, meaning each one contains the same level of nicotine.  However, those who smoke e-cigarettes can control the amount of nicotine included in each puff.  Such a dynamic may be a key ingredient in the recipe for quitting the habit.

    Less Offensive

    Ultimately, those who advocate e-cigarettes think that it’s important to keep users from going backwards, continuing to smoke tobacco cigarettes.  The fact that electronic cigarettes emit the smoke but not the smell of traditional cigarettes is a positive.  Moreover, those around an e-cig smoker will not be offended by the smell or feel threatened by second-hand smoke.  All and all, the more positives e-cigarettes introduce, the more likely vapors will stick to e-cigs rather than going back to tobacco cigarettes.

    It All Matters

    The type of e-cigarette used, how often it is used, and how much nicotine inhaled in each session all matters.  Advocates of e-cigarettes urge researchers not to treat all e-cig users the same.  Another study published in Nicotine and Tobacco Research suggests that those trying to quit are more successful when using refillable tank models.  Such units allow the user to vary the nicotine content along with the flavor.  Only 25% of 587 users had tank models that were used daily.  However, 28% who had such units quit after one year compared to only 13% who did not use such models.

    Do e-cigarettes enable smokers to quit for good?  The question is not easy to answer nor is it readily available.  However, many signals point to a positive association between those who have successfully quit and graduated from tobacco cigarettes to e-cigs.

    Peter Brown has had training as a herbalist and was once a heavy smoker before being able to quit a few years ago. He likes to write about his efforts to quit smoking and share his tips and ideas online. He writes for several lifestyle and health websites.

    Image credits

    Tagged | 1 Comment

    Since 2012, Public Health England has been trying to convince people to stop smoking through their annual campaign Stoptober. During the month of October, smokers are encouraged to sign-up on the official website to receive support.

    The organisers behind the smoking cessation campaign say that quitting for 28 days with a program like Stoptober makes smokers five times more likely to remain smoke-free.

    Smokers looking to harness every available opportunity during Stoptober should consider smoking replacement therapy such as gums and patches. But what about e-cigarettes?

    Even though vaping statistics show that nearly two out of five e-cigarette users are ex-smokers, e-cigs may have become unalluring to those wishing to kick the habit due to the overwhelming negative press they’ve received.

    Are e-cigarettes really that safe?

    A recent review by Public Health England has examined the health risks related with vaping and found that they are 95% safer than cigarettes. Thanks to findings like this, e-cigarettes will be considered an aid to quit smoking, and could be prescribed on the NHS from 2016.

    While e-cigarettes cut the damages of smoking drastically, their long-term impact on health has yet to be verified.

    US researchers found that e-cig vapour could damage the lungs and significantly raise the risks of respiratory infections.

    In addition, an electronic cigarette does not change the addictive effect of nicotine. If e-cigarette smokers were to quit, the withdrawal symptoms would be the same as with standard cigarettes, and the damages on the brain development of younger smokers would be the same.

    The biggest concern related to electronic cigarettes is that they might be a “gateway to smoking” for non-smokers and younger people alike. However, this fear is not currently supported by any official data: a report from the Office for National Statistics on the use of e-cigarettes in the UK found that only 0.14% of non-smokers use e-cigarettes, against 11.8% of smokers and 4.8% of ex-smokers.

    Benefits outweigh risks for smokers, but not for non-smokers

    In the Public Health England review of e-cigarettes, Professor Kevin Fenton, Director of Health and Wellbeing at Public Health England said: “E-cigarettes are not completely risk free but when compared to smoking, evidence shows they carry just a fraction of the harm.”

    Furthermore, in terms of smoking cessation efficacy, recent statistics suggest that e-cigs are fast becoming the preferred form of nicotine replacement therapy.

    Though it would be preferable to see smokers go both smoke and nicotine free, electronic nicotine delivery devices could be the most effective product for smokers trying to get through Stoptober without reaching for tobacco products.

    Tagged | Comments Off on Stoptober: are e-cigarettes a good enough switch?

    Drugs as serious as cocaine and heroin addict no more than 20% of all users who try them; most are able to choose to use only when they want to, and are able to stay away for months when it isn’t convenient. To the 20% who do fall prey to addiction, though, exposure to drugs brings about serious changes to the brain that can never be undone. With these brain-altering changes in place, they tend to lose all control over their relationship with drugs.

    Why does this happen?

    People who tend to become addicted to substance abuse often suffer from multiple genetic flaws that make them extremely vulnerable to the effects of addictive substances. They tend to have low levels of the brain neurotransmitter dopamine, for instance, an essential ingredient feelings of basic well-being. Feeling little of the joy or contentment that most people take for granted, the draw of drug use, to them, can often be irresistible.

    While the specific mode of action of addictive substances tends to vary from one recreational drug to the next, enhancement of the brain’s exposure to dopamine is always part of the equation. When people who suffer from low dopamine levels come across drugs, they tend to feel “right” for the first time. They tend to find it far more tempting to continue use than people with normal dopamine endowment.

    What happens when a person continues with drug use? 

    Excessive exposure to dopamine can be extremely harmful. To begin, such exposure can kill off the brain’s dopamine receptors. With fewer receptors than ever before, they can become truly dependent on drug use for any happiness at all.

    Dopamine exposure also has the effect of physiologically changing the brain: drugs act on the brain’s limbic system, a region responsible for the creation of instinct, and deeply established habit. Once formed, such instinct can be impossible to address with logic.

    Addiction, once formed, can only be managed through active involvement by the patient and his family, often for life.

    Detox doesn’t do much 

    Since US law tends to be lax in its oversight of the rehab industry, most rehab centers tend to offer very little actual care. Addicts often receive detox, and not much more.

    Those who attempt to quit drugs with detox alone tend to relapse at an alarming rate — more than two-thirds of all recovering addicts within the first year. The bulk of the work of addressing addiction is done through the therapy that follows detox. Delivered by highly trained therapists at centers such as ARC, cognitive-behavioral therapy is one of the most critical therapeutic processes involved.

    What is CBT? 

    Addiction is a complex health condition — no one cause can adequately explain it. While genetics do have an important role to play, a number of other factors are involved, as well. Most addicts tend to suffer from serious mental disorders, for instance. With a background of poor mental function, they tend to have be ill-equipped for self-control, the ability to delay gratification, resist peer pressure, muster motivation or even understand the consequences of their actions.

    CBT helps by offering patients sensitive and supportive psychological training in addressing each one of these challenges through cleverly designed sessions in analysis and therapeutic practice.

    The techniques of CBT 

    The processes by which addiction comes about tend to be different for each person. It requires a sensitive and committed therapist to uncover the reasons behind each addiction, and offer CBT specifically aimed at them.

    Visualization techniques: Often, when people relapse after detox, it is for a simple reason: they find it impossible to understand how just giving in once to their cravings could possibly do much harm. The inability to look into the obvious results of an action is a mental limitation.

    Visualization techniques help patients internalize the chain of events that can occur when one uses drugs even once. Patients are made to vividly imagine what happens when they take a drug: they will end up feeling guilty after the pleasure wears off, and feel powerful surges of cravings again. They could end up taking another hit, and end up failing at a drug test. They could lose their jobs, and their family. Repeated visualization can help burn into the brain the fact that drugs are dangerous even when used once.

    Mindfulness therapy: Mindfulness therapy involves the use of deep focus on thoughts as they form, and feelings as they materialize. The aim of the exercise is to help addicts learn to think about their feelings, rather than simply react to them, a difficult act of self-control for recovering addicts used to lives of hedonism.

    Delayed gratification therapy: To addicts battling mental disorders, the draw of instant joy through drug use tends to be irresistible. They often give in simply because they are unable to understand the harm of instant gratification. Gratification therapy involves helping patients take baby steps into progressively delaying gratification in increments. 

    There is so much that can be done 

    Addiction, a habit, can only be adequately addressed through the formation of healthy counter-habit. CBT helps address the challenge one step at a time. It is scientifically proven to be effective with addictions. CBT is only effective, though, when it is delivered by a compassionate and highly experienced therapist.

    Joanie Fellows has worked in adult mental health for a number of years and likes to share her thoughts and insights online. She has previously written for a number of mental health websites.

    Tagged , | 1 Comment

    Yesterday, new regulations came into force that prohibit smoking in cars where children are present. This is a landmark moment in the fight for better public health.

    The new regulations only came about because of a marathon effort from my predecessor as Labour’s Shadow Public Health Minister, Luciana Berger, our health spokesperson in the House of Lords, Philip Hunt and the great work of the British Lung Foundation. The Lords is where Labour forced a vote last year to give the Health Secretary the power to ban smoking in cars with children.

    Following this demonstration of Parliamentary opinion, Ministers tabled their own amendment, laying out how Labour’s proposed ban could be written into law. This concession by the Government put us right on the brink of a precious victory for child health. The Commons voted overwhelmingly in favour of the new regulations, and a Parliamentary committee finally gave the green light in February this year.

    This move builds on Labour’s strong record on public health. After Labour came to power in 1997 we put in place a highly effective comprehensive tobacco strategy. In just a decade the proportion of children who smoke fell by a half and adults by a quarter, a total of two million fewer smokers.

    We showed leadership in bringing about real change on tobacco control. We introduced the smoking ban in pubs and enclosed spaces, ended sports sponsorship and billboard advertising, raised the legal age of purchasing cigarettes and put graphic warnings on cigarette packs.

    Now, Labour leadership has taken us one step further, even though we are in opposition. Some complain that these regulations infringe on their liberties – but if adults wish to smoke when children are not present in the vehicle, then that is their choice. However, what the Commons approved is not a question of adult choice, but one of child protection.

    We know beyond doubt that passive smoking in an enclosed space can do serious harm to a person’s health and that hundreds of thousands of children are being subjected to passive smoking in a car every single week.

    Every child has the right to start their adult life free of avoidable health problems, and that is exactly what we want to ensure. This is not about penalising smokers. This is about sending a message that inflicting smoke on children is not acceptable. We only need to look to the law on wearing seat belts to see the effect it had. Research by the World Health Organisation has shown that the number of people using seat belts rose from 25 per cent to over 91 per cent after it was made illegal not to wear them.

    So I would like to thank Luciana, Philip and the British Lung Foundation for all their campaigning for a car smoking ban over the last few years.

    We have taken a big step forward.

    First published on Labour List

    Tagged , | Comments Off on Car smoking ban – landmark moment for public health

    After the recent report by Public Health England that e-cigarettes are 95% less harmful than traditional smoking, many have called into question whether these devices should finally be recognised by the NHS and included in their stop smoking initiative.

    It was only in June this year that the Anti-Smoking Charity (ASH) confirmed that since their launch in 2003, 1.1 million adults have switched from traditional smoking to using e-cigarettes alone, and in a more current survey detailing the fitness of vapers, 71% of those using the devices commented that they feel fitter and healthier because of them.

    With so many surveys and investigations being in favour of e-cigarettes it’s no surprise that it was recently reported by the BBC that health campaigners have been welcoming the findings and petitioning for the devices to be available on the NHS.

    At present 80,000 people in the UK die every year as a result of traditional smoking, and thoughts are that if these devices became more readily available it would reduce this amount by approximately 4,000 deaths a year.

    Currently GPs and stop-smoking services are not able to prescribe e-cigarettes for medicinal purposes, which is a hurdle that can only be removed with significant research by the government.

    The cost to the NHS for prescription treatments for smokers cost just under £49 million in the year between 2013-2014, but many have argued that the introduction of e-cigarettes would increase this cost, adding additional financial strain.

    As an industry constantly surrounded by controversy it’s without doubt the biggest argument currently putting the spotlight on vapers.

    Many argue that the increase in cost to the tax payer simply puts e-cigarettes at the expense of the public, making it yet another burden.

    The simple fact is, at present the vaping industry has an extensive offering of devices and eliquids, and a complete overhaul would be unthinkable for wholesalers.

    Could the government and e-cigarette brands come to regulations that will benefit the thriving industry but still make it a successful sector? Or would the government take over and attempt to inflict useless regulations.

    There have already been conflicts in this area with a recent legal challenge between the Tobacco Products Directive  and e-cigarette supplier Totally Wicked, as the European Parliament have attempted to inflict unrealistic expectations on the industry that goes against everything that it stands for. With proposed restrictions on advertising in the e-cigarette industry, brands are unable to inform customers to make a health alternative.

    Regular vapers themselves are finding it a hard pill to swallow that the devices and flavours they’ve come to love may become unavailable if they were to be taken on the NHS.

    The argument is now laid bare for the government to consider, but with such strong links to the traditional tobacco industry, it could be a long time until these predictions become a reality.

    Tagged , | Comments Off on Will E-Cigarettes Become an NHS Stop Smoking Tool?

    Current legislation has created an environment where the link between organised criminals and the most vulnerable is strong and almost freely exploitative. Despite all the efforts to reduce the supply and the demand, drug misuse continues, and we must ask: what we can do differently. If the aim is to stop people taking drugs, and stop people committing crime in order to fund their habit, we must follow the evidence and support people to recover rather than send them to prison.


    Enforcement agencies, over time, have had pockets of success in seizing significant quantities of drugs, but this has not limited the long-term supply. This is largely due to the fact that the criminals have altered their supply routes and methods, and exploited changing technologies such as the dark web and postal services (such as track my parcel), and it is now more common for suppliers to exploit the postal service by sending drugs more frequently in smaller quantities- no longer do we see over 100kg seizures of Class A drugs entering the UK.

    As a former police officer, I have lost count on the number of large scale early morning raids that I have participated in. Yet, the simple truth is that these activities-which take months, sometimes years in the planning- do no more than disrupt the supply market for the very shortest of periods. In one undercover policing operation which took 6 months to plan, cost over £0.5 million and saw 30 people arrested for their involvement in the supply of Class A drugs, 2 recovering addicts who had been arrested were asked how long we had strangled the supply of Heroin; one estimated 4 hours and the other estimated 2. The principal reason is supply, demand and profit.  With steady demand from addicted people, dealers move into the market place.

    And even if we do succeed in reducing the supply of drugs, the demand is still there. So I have no doubt that that demand will be filled, possibly by New Psychoactive substances or other chemically produced drugs. We must reduce demand.


    What we need is a means of making the market in controlled drugs less lucrative. This requires a different approach; one that reduces demand for the product. Addicts should be treated and supported into recovery, removing them as consumers. Their entrapment in criminal justice is a waste of police time, a waste of public spend, does not help addicts to recover, provides a continued market to dealers, and dissuades addicts from revealing themselves for treatment for fear of the criminal consequences.

    The strategy of decriminalising addiction, in order to support recovery, would be the most effective in avoiding their route to criminality.  If we take Colorado as an example, since the regulation of cannabis, the state has benefited from a decrease in crime rates, a decrease in traffic fatalities, an increase in tax revenue and economic output from retail cannabis sales, and an increase in jobs.


    The crux of the strategy we are working towards in County Durham and Darlington involves redefining the problem- individual drug addiction- as a health and community safety issue, not a criminal justice issue. The Police already work in partnership with Directors in Public Health to deliver strategies that work whilst continuing to target the organised criminals who seek to make a profit by shattering the lives of others.

    Durham is leading the way nationally for the ‘Drug Test on Arrest’ initiative which is rolled out across all of the force’s custody suites and is using equipment that indicates not only heroin or cocaine use, but other controlled substances as well. It allows the Force to steer a number of users away from the criminal justice system and towards health-based resolutions with the end aim of supporting recovery. Testing is carried out on people arrested for certain “trigger” offences, such as dishonesty crimes including shop thefts, burglaries and robberies. As of 16.02.15, there have been 711 tests completed; within these tests, only 135 people have tested negative for no substances, this represents 19% (1 in 5) of all people tested.

    The Women’s Diversion Scheme in Durham and Darlington offers a credible alternative to prosecution for many low level adult female offenders, focusing on why the subject has offended and seeks to address those issues to prevent reoffending. Out of 158 women who took part in the scheme, 62% have not gone on to reoffend, and of those who failed, a further 64% of those who had been offered the scheme but failed to engage had reoffended.

    Developing this further, Durham Constabulary has introduced Checkpoint. It is potentially a revolutionary way of tackling reoffending.  It is a culture changing initiative for the police and partners. The intention under this initiative is to provide a credible alternative to prosecution by intervening at the earliest opportunity to prevent someone from offending again. The programme offers a ‘contract to engage’ for the arrested person, based on the critical pathways of offending. Specialist navigators will identify underlying lifestyle issues linked to offending and divert them away from the Criminal Justice System by signposting them on to appropriate services. Failure to engage or complete the contract will trigger the prosecution procedures to continue as they would normally do.


    We can’t go on telling kids that if they take drugs it will ruin their lives, with the follow up being that if we catch them taking drugs we will ruin their lives. We must move away from the criminalisation of addicts, and focus on treatment and recovery. We should be focusing on the best way to minimise harm, and help these people recover from their addiction, so that we can improve their life chances, help them make a positive contribution to society, and cut off the income streams of the organised crime groups-the real criminals making money out of others’ misery.

    Tagged | 1 Comment

    Despite what you may believe or expect, the jury is out on vaping. In January the medical world was stunned by research from the New England Journal of Medicine entitled “Hidden Formaldehyde in E-Cigarette Aerosols”, which found the apparent production of lethal chemicals in the e-cigarette vaping process.

    Barely three months later a contradictory study was unveiled in, featuring the work of renowned cardiologist Dr Konstantinos Farsalinos, who believes that the original study was fatally flawed, that e-cigarettes are at least 95% safer than smoking, and that smokers should swap over.

    So what to do? Should all smokers toss away their pack of 20 and reach for their e-cigarette and liquids? Or might the 2.6 million adults in Great Britain who use e-cigarettes be no worse off with tobacco?

    The simple answer, with a complex background story, is: It depends on the chemicals. A basic, common or garden e-cigarette should contain just four basic chemicals: propylene glycol, vegetable glycerine, flavourings and nicotine.

    The glycerin and glycol ethers are used as liquid carriers for the other parts, and are not harmful. In themselves then, these elements should be fine, although of course the addictive qualities of nicotine are well-established.

    One of the main selling points of e-cigarettes is that the purchaser knows exactly how much nicotine is being ‘vaped’, giving a level of control that cigarettes somewhat lacked. Therefore, if created in a responsible manner, by professional, regulated companies, the purchaser should know the chemical construction of their e-cigarette and can easily search online for anything on which they are unsure.

    So one might believe that the only dangerous game being played in this field comes when one gambles with an e-cigarette that looks the part but was produced in a back-alley laboratory, free of regulation and heavy with potentially dangerous substances. And yes, the internet is replete with horror stories of nasty surprises in vaping chemicals and incorrect usage, but the story is not quite as clear-cut.

    For example, In Newcastle diacetyl, which is actually fine to eat but lethal to smoke, was found in a leading e-liquid brand. A recent study reported in the Independent completed by researchers in Portland State university in Oregon found that chemicals used to add flavour to e-cigarettes are fine when eaten, but dangerous when ‘vaped’. Six of 24 identified compounds were recognised as primary respiratory irritants, which could be harmful, even though the products were marketed as safe. Chinese e-juice has a reputation for being manufactured with pesticide-grade nicotine, and a lack of regulation.

    Let’s assume that in such a thriving market the vast majority of e-cigarettes are fine, but for some reason you are concerned about a batch in your possession. It goes without saying that one should not vape if you suspect something may be amiss. If it’s ‘too’ cheap, with fatuous claims and no list of ingredients and poor-quality packaging, then the alarm bells should ring.

    E-liquid testing by EL-Science is one safe option; simply send an e-liquid to the Peterborough-based laboratory which will scan for unwanted chemicals such as diacetyl, acetylpropionyl and acetoin. That also means that if you’ve created your own e-liquid and are keen to put it to market you’ll now have an industry-standard analysis for your labelling, which will give peace of mind. It’s only with rigorous testing such as this that we can be reassured of the quality and contents of an e-liquid. Otherwise take the renegade fluid to a police station or hospital – making sure it goes nowhere near your mouth.

    Tagged , | 1 Comment

    There has been a lot of speculation recently on exactly what impact e-cigarettes are having on teenagers and whether they are becoming an introductory way to smoking. There was an article recently that discussed e-cigarettes becoming the alcopops of the nicotine world and that out of 16000 teenagers, one in five have tried e-cigarettes.

    This has publically sparked a lot of discussion on whether e-cigarettes are in fact introducing teenagers to smoking. The more interesting part was that the survey also found out that the link between trying alcohol and trying e-cigarettes was even higher. This has resulted in a lot of people speaking up and saying that e-cigarettes could be a health issue for teenagers but before a bad light is again displayed on the e-cigarette industry a closer look at the facts from the survey shows it could be otherwise.

    From what was gathered, the main summary from this is that most teenagers that drank alcohol had also tried e-cigarettes. This does not necessarily suggest that e-cigarettes are a gateway for teenagers to start smoking. It more accurately suggests that there is a certain category of “at risk” teenagers that are open to the use of things such as alcohol and cigarettes and this now also could include e-cigarettes. Whilst it is an issue for younger teens to be using e-cigarettes, it means that e-cigarettes are now in the same category as alcohol and should be regulated in a similar fashion. This does not necessarily show that e-cigarettes are a gateway device which a lot of people seem to interpret.

    To summarise the evidence from the survey. There needs to be a far stronger regulation on who can access e-cigarettes and really start to be stricter on ensuring that e-liquid which is the part of the e-cigarette that contains the nicotine substance is not available to anyone under the age of 18.

    I spoke to Darren Sharples who is one of the Co-Founders of Cloudstix who has an online website selling e-cigarettes as well as several shops in the UK:

    “The survey is absolutely correct in that nicotine should not get into the hands of anyone under the age of 18. Since Cloudstix was formed in 2012 we have put measures in place to ensure that all of our staff ID anybody that could be under the age and our website has strict notices on every product. If all vendors were to undertake a similar policy it would certainly help the industry as a whole.”

    This shows that some of the larger e-cigarette suppliers are taking this matter seriously and the rest should consider following soon before the e-cigarette industry gets tarnished with further bad reputation.

    There always seems to be a small percentage of teens that will go against rules and it seems to be the same teenagers that try alcohol will also try e-cigarettes. It is up to the ecigarette suppliers to ensure they have checks in place to make it as difficult as possible for users under 18 to get hold of e liquid.

    E-cigarettes are being thoroughly tested now. There are studies being released that show they are less harmful than smoking but the full tests have yet to be revealed and decided. Now, we can’t deny the fact that there is a decline happening for e-cigs and these handheld vapes are on the rise (Check more information about portable vaporizer). This might just be another way for the smoking community to evolve and have the option to eliminate their smoking habits for a healthier alternative.

    Tagged , | 2 Comments