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Toxic Substances & Harmful Behaviours: the odd one out

Updated: May 23, 2023




Some things are generally accepted to be good for our health (the good old ‘apple a day’ adage dates back to 1866) 1, while other things are known to be detrimental. There are six pillars of lifestyle medicine, five of which focus on positive things that we should aim to do more of to benefit our health, including: eating healthily; moving more; managing stress; prioritising sleep and being socially connected. The final pillar, acknowledges that health cannot solely be achieved by doing more of these beneficial things; we also need to eliminate, or modify our use of substances known to cause ill health.


Typically this pillar has referred to the more obvious toxins including tobacco, alcohol and drugs, yet increasingly we need to consider the potential negative impact of what are, for the most part, good technological advances in the 21st century, that have the potential to cause harm.


This article aims to answer the following questions:


What toxic substances and harmful behaviours should be avoided?

Each of the following behaviours are either definitively risky to our health or potentially risky:

  • Smoking

  • Harmful alcohol consumption

  • Recreational drug use

  • Vaping

  • Problem gambling

  • Excessive internet use


With each, there are benefits or gains which initially make them appealing; these will differ from individual to individual, but examples include:

Often one risky behaviour leads to another. For example, recreational drug use is often mixed with risky levels of alcohol consumption. So, when does it become a problem? What links these things making them risky? With each, there is the risk of addiction. Defining addiction is debated, but in simple terms, addiction is doing something to the point it causes harm and is associated with not feeling able to stop 2. The historical meaning of the word addiction is enslavement.


Addiction doesn’t just happen. Initially, there doesn’t appear to be any harm, the behaviour leads to relaxation, fun, a feeling of trying something different or feeling socially connected. The desire for more of this ‘good stuff’, can lead to a situation where the level of consumption begins to pose a risk to health. In medical terms, at this point this is considered ‘risky substance use’. Further use can subsequently lead to significant impairment or distress, at which point this is considered medically to be a ‘substance use disorder’. The boundary between substance use disorder and addiction is less easy to define, as represented by the blurred boundary in the diagram summarising these relationships below.

Adapted Diagram 3

In the diagram above, the far left acknowledges that use in moderation, of some of the above behaviours, is low risk. Let’s take each of the behaviours in turn and look at the stats and the risks of each.


Smoking

The stats:

  • 6 million adults (almost 14%) in England smoke.

  • In 2019 alone almost 75,000 people in England died prematurely as a direct result of smoking in 2019.

  • Smoking also affects those around the smoker, children are particularly vulnerable 4.

The risks:

Smoking is typically associated with lung cancer, but in addition smoking causes:

  • Heart disease

  • Chronic lung disease (COPD)

  • Other cancers including: lip, mouth, throat, bladder, kidney, stomach, liver and cervix

Smoking additionally increases the risk of:

  • Type 2 diabetes

  • Dementia

  • Bone fractures

  • Poor mental health

  • Fertility problems

  • Poor pregnancy outcomes eg increased miscarriage

Harmful alcohol consumption


The stats:

  • 10.8 million adults in England are drinking alcohol at levels that pose risks to their health.

  • 1.6 million adults in England are thought to have some level of alcohol dependence 6.

  • In 2021 there were over 9,500 ‘alcohol specific’ deaths in the UK, a rise of over 27% since pre pandemic levels 7.


The risks:


Alcohol is typically associated with liver disease, but in addition, harmful use of alcohol is linked to over 200 diseases / injuries including:

  • High blood pressure

  • Obesity

  • Heart disease

  • Depression

  • Dementia

  • Pancreatitis

  • Injuries and road traffic accidents

  • Alcohol poisoning which can be fatal

  • Fetal alcohol syndrome 8


There is evidence that harmful alcohol use is also linked to the following cancers:

  • Liver

  • Mouth

  • Throat

  • Oesophagus

  • Breast

  • Bowel 8

Recreational drug use


The stats:

  • Over 10% of adults aged 16-59 reported drug use between June 2021 and June 2022 in England & Wales.

  • Cannabis is consistently reported as the most commonly used drug; over 16% of 16-24 year olds report using cannabis 9.


The risks:


Illicit drugs are often cut with other similar looking substances or heavy metals to increase the weight and therefore price. It is difficult to know if this has happened or not, but there is the potential that you could be exposed to unknown chemicals such as pesticides.


Cannabis use is linked to:

  • Increased risk of schizophrenia

  • Impaired memory

  • Cough and shortness of breath

  • Increased risk of lung cancer

  • Reduced fertility


Cocaine use is linked to:

  • Fits

  • Heart attacks

  • Strokes

  • Damage to the cartilage in the nose

  • Anxiety and paranoia 10


Vaping


The stats:

  • 2.7 million adults in England vape 11.

  • Although still small compared to tobacco cigarettes, the vaping market is growing rapidly.

  • There has been an increase in vaping amongst teens, thought to be driven by the belief that it is a safer alternative to cigarettes 12.


The risks:


For a chronic smoker, vaping can prove beneficial; in 2017 50,000 smokers stopped smoking with a vaping product.


However, there is increasing concern that promoting vaping as a safe way to quit smoking is inadvertently leading to young non smokers vaping and may lead to nicotine addiction and smoking in the younger population.


In 2019 there was an outbreak of E-cigarette or Vaping product Use-Associated Lung Injury (EVALI) which has raised concerns about the safety of vaping.


The evidence is insufficient: an early report suggested vaping was 95% less harmful than cigarettes, however this has since lead to much controversy and new evidence points to vaping being more harmful to health than initially thought. More evidence is needed to fully understand the health implications of vaping, particularly when considering the long term outcomes 13.



Gambling


The stats:

  • Since gambling migrated to the internet and became readily available on mobile devices, there has been unprecedented growth in commercial gambling 14.

  • Problem gambling is now recognised in the UK as a public health concern.


The risks:


What might be a bit of fun initially can potentially spiral, as losses are chased with further bets. One ex gambler described being “in the grip of something you can’t control” 15.


Problem gambling is associated with:

  • Anxiety

  • Neurotic symptoms

  • Substance use

  • Suicide

  • Financial difficulties


Excessive internet use


The stats:

  • The average daily time spent on the internet in the UK is over 6 hours.

  • The average daily time spent on social media is in excess of 2 hours 16.

  • 5% of young people are thought to be addicted to social media 17.


The risks:


The use of social media has the potential to improve connections with others. However, particularly for vulnerable individuals, excessive use can lead to harm.


There is increasing evidence of links to:

  • Lower self esteem

  • Impact on body image

  • Cyberbullying

  • Low mood and depression

  • Loneliness

  • Online risk-taking behaviours

At present little is known about the impact of internet use and social media on young children, but it is logical to consider that, as with many things in life, avoiding excessive use is likely to be beneficial.



Why is 14 units of alcohol the recommended limit?


Naturally the simplest way of avoiding alcohol associated health risks is abstinence, but is it all bad? There is always a balance of risk and benefits. An expert in lifestyle medicine put it like this “going home from work stressed, a glass of wine will help me relax, for me this is health ...is it better to go to bed stressed or relaxed having had a drink?” 18. The risk of injury and serious illness increases the more you drink on a regular basis. As such in the UK there are guidelines for low risk drinking, based on scientific evidence. The aim is to limit the risk of cancer, liver disease, heart disease, high blood pressure etc by:

  1. Not drinking more than 14 units a week

  2. Having several alcohol free days a week

  3. Avoiding binge drinking (6 or more units on a single occasion for women, 8 or more units on a single occasion for men) 19

To know if you’re drinking within the low risk guidelines requires an understanding of units. One unit contains 10ml (8g) of pure alcohol, ie the alcohol by volume (ABV) is 100%. Alcoholic drinks come in all shapes and sizes and therefore the number of units varies depending on the size of the drink and the strength, measured as ABV. This can become rather confusing as a ‘glass of wine’ can have anywhere between 1.4 units (small 125ml, 11% ABV) to 3.5 units (large 250ml, 14% ABV). To confuse things further, we rarely pour pub measures when at home and it quickly becomes easy to incorrectly estimate how much alcohol we are consuming.


It’s good to have some idea of units, so one approach is to keep things simple with the below generalised rules. If you think you could be drinking too much or are keen to be more accurate a unit calculator such as this one is a useful tool.



Once you know how many units you’re drinking, by answering three simple questions 18 you can gauge if you’re a low (total score 0-4), moderate (total score 5-10) or high (total score 11-12) risk drinker.

It can be surprising to discover your score, especially as physical symptoms of alcohol related disease typically only become apparent at late stages of disease. As an example, in alcohol related liver disease, severe damage occurs before any symptoms are experienced.


If you're concerned about your score it is a good idea to speak to your GP or seek help via the later link.


How to start making changes


The first step is identifying a need for change, yet it can be hard to recognise when a problem has become a problem. In fact, it’s often easier to think there isn’t one at all. Sometimes, the realisation is too late, at which point it is much more difficult to make a change, because of the addictive nature, for example, nicotine in cigarettes.


Reflecting on where you are now and considering how easy or difficult it would be to make a change can be helpful starting point. This week, could I not have a drink if I chose?...stay off social media?...not place a bet? Other questions can highlight a potential problem. Have you ever felt guilty about eg drinking, gambling? Has anyone else appeared concerned? Do you find yourself feeling stressed or anxious about ...? The best time to make a change, is while it is still possible to do so.


Sometimes we don’t like to admit to ourselves that there might be a problem, but those around us might share their own concerns. It’s not uncommon to feel angry in this situation.


Besides the addictive nature of toxins that can make it difficult to stop, it is important to remember that these behaviours have often become coping strategies when things are difficult. As examples: the habitual response to a hard day at work of a strong drink, or a cigarette as a way to remove yourself from a situation and get some air. Part of making a positive change is planning what strategies you might adopt instead, in order to cope with stressful situations, feeling down or lacking confidence. These will differ according to the individual, but might include: participating in sport, talking to someone about your feelings, getting out in nature or breathing exercises.


Another challenge for many, is opposing societal norms that place expectations on us. As an example, for some, ‘wining and dining’ is a given part of the role in which they work and can seem impossible to avoid.


One strategy that can help is to consider what might be gained by making changes. Often, these habits are expensive. By reducing or avoiding spending on these things, can you save towards something that excites you, a holiday, a new item of clothing or something else that would make you feel good in a different way. Or perhaps, could the benefit of waking feeling well rested, with a clear head, persuade you to opt for the alcohol free alternative drink. Avoidance of most of these behaviours has the potential to gain more of the elusive commodity that is time. Consider what you might do if gifted with 2 extra hours in the day, that you previously spent ‘scrolling’ on the internet.


If and when you recognise the need for change the next step is to set a SMART goal. Below is an example and explanation of what makes a goal smart.

Change can be hard. Smart goals recognise this and try to avoid common pitfalls. A measurable goal allows you to see the progress you’ve made. After making a positive change you will begin to see health benefits and it is an important part of the process to reflect on these. Besides having more time and energy for positive things in your life, you will also be reducing your risk of chronic physical and mental health problems.


Where to find support if you feel concerned about yourself or a loved one?


It’s important to remember you are not alone and there is support available.

  • You can find your local stop smoking service here. There is good evidence that the success rate of quitting is much greater when supported than trying solo.

  • If you’re concerned about how much alcohol you are drinking there is support here.

  • Worrying about someone else’s drinking, visit drinkaware.

  • For information and to get help when concerned about drug use visit talk-to-frank.

  • For information, a free helpline and messaging service to support those concerned about gambling visit: gamcare

Are you keen to look holistically at your health?


To get a deeper understanding of your how your lifestyle choices can impact your health, book a Well Woman or Well Man check today for a holistic health check with a lifestyle plan personalised to your results.





References

  1. Davis, M.A., Bynum, J.P. and Sirovich, B.E. (2015) “Association between Apple consumption and physician visits,” JAMA Internal Medicine, 175(5), p. 777. Available at: https://doi.org/10.1001/jamainternmed.2014.5466.\

  2. Is alcohol addictive? (no date) Alcohol Change UK. Available at: https://alcoholchange.org.uk/alcohol-facts/fact-sheets/is-alcohol-addictive (Accessed: December 28, 2022).

  3. Heilig, M. et al. (2021) “Addiction as a brain disease revised: Why it still matters, and the need for consilience,” Neuropsychopharmacology, 46(10), pp. 1715–1723. Available at: https://doi.org/10.1038/s41386-020-00950-y.

  4. Smoking and tobacco: Applying all our health (no date) GOV.UK. Available at: https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health (Accessed: December 28, 2022).

  5. Kelly, J. and Shull, J. (2019) The Lifestyle Medicine Board Review Manual. 2nd edn. Chesterfield: American College of Lifestyle Medicine.

  6. Health matters: Harmful drinking and alcohol dependence (no date) GOV.UK. Available at: https://www.gov.uk/government/publications/health-matters-harmful-drinking-and-alcohol-dependence/health-matters-harmful-drinking-and-alcohol-dependence (Accessed: December 28, 2022).

  7. Butt, P.B.and A. (2022) Alcohol-specific deaths in the UK: Registered in 2021, Alcohol-specific deaths in the UK - Office for National Statistics. Office for National Statistics. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/alcoholspecificdeathsintheuk/2021registrations#:~:text=Consistent%20with%20previous%20years%2C%20the%20alcohol%2Dspecific%20death%20rate%20for,100%2C000%20females%3B%203%2C293%20deaths (Accessed: December 28, 2022).

  8. Alcohol: Balancing risks and benefits (2022) The Nutrition Source. Available at: https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/drinks-to-consume-in-moderation/alcohol-full-story/ (Accessed: December 28, 2022).

  9. Jones, P. (2022) Drug misuse in England and Wales: Year Ending June 2022, Drug misuse in England and Wales - Office for National Statistics. Office for National Statistics. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingjune2022 (Accessed: December 28, 2022).

  10. Drugs A to Z (no date) FRANK. Available at: https://www.talktofrank.com/drugs-a-z (Accessed: December 28, 2022).

  11. McNeill, A. et al. (2021) Vaping in England: an evidence update including vaping for smoking cessation. London: Public Health England.

  12. Jonas, A. (2022) “Impact of vaping on Respiratory Health,” BMJ [Preprint]. Available at: https://doi.org/10.1136/bmj-2021-065997.

  13. Besaratinia, A. and Tommasi, S. (2019) “Vaping: A growing global health concern,” EClinicalMedicine, 17, p. 100208. Available at: https://doi.org/10.1016/j.eclinm.2019.10.019.

  14. Abbott, M.W. (2020) “Gambling and gambling-related harm: Recent world health organization initiatives,” Public Health, 184, pp. 56–59. Available at: https://doi.org/10.1016/j.puhe.2020.04.001.

  15. Life changing, I stole €1.75 million from work to feed my gambling habit. (2021) BBC Radio 4. BBC. Available at: https://www.bbc.co.uk/programmes/m000v61m (Accessed: December 28, 2022).

  16. United Kingdom (UK) Social Media Statistics 2022: UK's popular platforms (2022) The Global Statistics. Available at: https://www.theglobalstatistics.com/uk-social-media-usage-statistics/ (Accessed: December 28, 2022).

  17. Anxiety, loneliness and fear of missing out: The impact of social media on Young People's Mental Health (no date) Anxiety, loneliness and Fear of Missing Out: The impact of social media on young people's mental health | Centre for Mental Health. Available at: https://www.centreformentalhealth.org.uk/blogs/anxiety-loneliness-and-fear-missing-out-impact-social-media-young-peoples-mental-health (Accessed: December 28, 2022).

  18. Sidossis, L. (2022) “Traditional Mediterranean Lifestyle: Millenia in the making and as healthy as it gets?,” British Society of Lifestyle Medicine Conference. London: Tottenham Hotspur Stadium, 24 November.

  19. Department of Health and Social Care (2016) Alcohol consumption: Advice on low risk drinking, GOV.UK. GOV.UK. Available at: https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking (Accessed: December 28, 2022).

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