Whelehans Health News

Signs and symptoms of Addiction

Substance dependence

Substance dependence is addiction to a substance, such as a drug, alcohol or nicotine. The person can no longer control use of the substance due to intense cravings. With addictions, most often the he person takes the substance over and over and cannot stop. Often at least one serious attempt was made to give up but the person relapsed.

Signs and symptoms include:

Withdrawal symptoms occur when the drug goes out of the system and the person will experience unpleasant physical and emotional symptoms. They include cravings, moodiness, ill-tempered behaviour, poor focus, depression, sense of emptiness, frustration, anger, bitterness and resentment.

Physical symptoms can include an increased appetite, especially an urge for sugary and fatty foods (occurs with the likes of cannabis use or heroin use) or an inability to eat due to nausea and vomiting in the case of withdrawal from the likes of opiates (eg) heroin. Insomnia is a common symptom of withdrawal especially with withdrawal from illegal drugs. Constipation or diarrhoea are common both during use of many drugs and withdrawal. With some substances, withdrawal can trigger violence, trembling, seizures, hallucinations, and sweats.

Addiction continues despite health problems – due to the addictive nature of the substance the person continues taking the substance regularly despite developing illnesses due to its use. (eg) some smokers continue smoking despite developing smoking related diseases such as lung cancer or heart problems and alcoholics often continue smoking despite developing liver disease

Social and/or recreational sacrifices - some activities are given up because of an addiction to something. An alcoholic may miss out on family or work engagements as they would prefer to get drunk or are too hung-over or a smoker may avoid situations or people where smoking is not possible. Also, the financial difficulties caused funding an expensive addiction may reduce ability to ability to take part activities you once were able to afford (eg) going on a holiday, going for a meal

Maintaining a good supply - addicts will always make sure they maintain a good supply, even if they do not have much money. Sacrifices may be made in other areas (eg. food, clothes) to make sure they have sufficient supply.

Taking risks – risk taking occurs to enable getting his/her substance of choice including stealing, violence, trading sex for money/drugs etc. Being under the influence of substances like alcohol or drugs can lead to a person engaging in risky activities which they wouldn’t dream of when sober (eg) drink driving, violence

Obsession – the addiction causes the person to spend more and more time and energy trying to get hold of the addictive substance and causing damage to other areas of life (family, work, finances, etc)

Secrecy and solitude - in many cases the addict may take their substance alone and in secret (often due to shame)

Denial – many addicts are not aware, are in denial or refuse to admit that they suffer from an addiction.

Excess consumption - for addictions such as alcohol, drugs and even nicotine, excessive use pretty much goes hand in hand with the problem. This leads to blackouts due to alcohol or drug binges and both physical and mental health problems

Dropping hobbies and activities - as the addiction progresses the person often stops doing things he/she used to enjoy (eg. sports, clubs etc. This may because they are physically not able to take part in the activity (due to the damage drugs, alcohol or smoking does to the health), they can no longer afford to take part (addiction eats up all available funds) or the addiction takes up to much time (ie) Trying to get the substance or using the substance such as drinking means time for other activities is limited

Having stashes - the addicted person may have small stocks of their substance hidden away in different places (eg. house, car, work) and often in unlikely places. This is to help ensure they never run out.

Consuming an initial large dose - this is often seen with alcoholism. The person may gulp the first drink down to get that feeling of “relief” and to get drunk and feel good quickly (and take away the emotional and physical pain of withdrawal quickly)

Problems with the law is common as drug, alcohol and gambling addictions can be expensive so the person may need to steal or deceive to fund an expensive habit. Substance abuse can impair judgment and leads to the person taking risks and engage in illegal behaviour that is out of character and wouldn’t engage in when sober. For example the likes of assaults and drunk and disorderly offences can occur even in those who would never dream of breaking the law when sober.

Financial difficulties – the addicted individual may sacrifice a lot to make sure its supply is secured. Even cigarettes, which are currently over €11.50 for a packet of twenty (2016 budget) meaning a 40-a-day smoker will spend €700 per month or nearly €8,395 per year on smoking (which equates to over €11,000 pre-tax income).

Behavioural addiction

Behavioural addiction is addiction to a behaviour such as gambling or video gaming.  The physical signs of drug addiction do not occur in behavioural addiction. Behaviorally addicted individuals have certain symptoms and will undergo many of the same consequences brought about by addiction to alcohol and drugs as well as other obsessive behaviours (eg) money problems, relationship breakdowns, guilt, etc

Community Alcohol and Drug Service (CADS)

The HSE Community Alcohol and Drug Service offer counselling and treatment services for adults suffering from addiction to alcohol, drugs and gambling. CADS have centres in Mullingar, Athlone and Longford. CADS provides counselling and treatment to help people get over their addiction. You can contact them at 04493 41630.

To be continued….next week

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.

    This Is the first of three articles in the Topic on addiction. Addiction is a strong and uncontrollable urge to take substances like drugs or alcohol or carry out activities like gambling or sex. The urge to use or carry out an activity often takes precedent over other areas of the person’s life despite causing harm physically, emotionally or socially.  Common addiction is to alcohol or drugs, but can be anything from gambling to “less harmful” products such as fizzy drinks or addiction to the likes of work or the internet. Thus addiction can be substance dependence (e.g. alcohol or drug addiction) or behavioural addiction (e.g. gambling, sex, work, and video game addiction). 

     Addictions develop due to a complex web of factors including genetic, social, personality, brain response to pleasure, past experience and many other factors. Addiction causes feelings of guilt, shame, hopelessness, despair, failure, rejection, anxiety and humiliation.

What causes Addiction?

     Causes of addiction are varied and complex and due to a combination of mental, physical, circumstantial (eg. being introduced to a drug when young and prone to peer pressure) and emotional factors. Repeated use of an addictive substance is thought to change the way the brain experiences pleasure. The substance or activity (drug, alcohol, gambling etc) leads to changes in certain nerve cells (neurons) in the brain leading to feelings of euphoria, known as a “buzz” or a “high” which can lead to the urge for further and more frequent use

Tolerance increases

  With time, regular and frequent use or participation leads to the person not experiencing the same pleasure they initially would have experienced and the person needs to keep increasing the dose as the body will develop tolerance to the effects of the addictive substance.  To give an example of something as (deceptively) simple as coffee; those that consume large quantities of coffee have an increased tolerance to the effects of caffeine, whilst someone who rarely drinks it would get a huge kick from an espresso. Eventually, the addict will not experience “highs” from using and simply takes the substance to feel “normal” by preventing withdrawal symptoms. It is the tolerance to the substance or activity that increases the risk of addiction. Tolerance means the addicted person requires increasing amounts of addicted to in order to gain the same effect or to prevent unpleasant withdrawal symptoms. 

Difference between habits and addictions

A habit is something has a choice over meaning a person can when choose to stop and can successfully stop if they want to (eg) having a few sociable drinks at the weekend. With an addiction there is a psychological/physical compulsion to continue using/doing the substance/activity; the person is no longer able to control the addiction without help because of the mental or physical components.

What are the risk factors for Addiction?

Anybody, no matter what age, sex or social status can potentially become an addict; there are certain factors which may increase the risk:

• Genetics(family history) – those with a close relative with an addiction problem has a higher risk of eventually developing one themselves.  For example, alcoholics are six times more likely than non-alcoholics to have blood relatives who are alcohol dependent. Some of this is down to “normalization” of a certain activity (eg) copying what your parents do such as drinking heavily
• Family life– Young people who do not have a strong attachment to their parents and siblings have a higher risk of developing addiction problems compared to people with deep family attachments. (ie) do not have the guidance they need to follow the right path and more susceptible to the “desire” to belong to a group so can get more easily drawn into gangs or “wrong crowd”.
• Gender– Men suffer from addictions more than women. Statistics indicate males are twice as likely as females to experience drug addiction problems.
• Link with mental health problems– those with mental health problems like depression, bi-polar disorder, ADHD (attention-deficit hyperactivity disorder) and other mental disorders suffer from higher rate of addiction to the likes of drugs, alcohol or nicotine. In some cases the mental health disorder leads to addiction but in others it is the addiction that causes the mental health problem (alcohol or drugs)
• Peer pressure– Sometimes considered the biggest cause of addiction especially in younger people, especially addictions (and many addictions start young). The use of harmful substances is a way of conforming and gaining acceptance with peers.
• Loneliness- can lead to increased use of the likes of alcohol and nicotine as a means of coping leading to addiction.
• The nature of the substance- some substances, such as heroin or cocaine can bring about addiction more rapidly than others.
• Age when substance was first consumed- studies of alcoholism have shown that people who start consuming drugs, alcohol and nicotine earlier in life have a higher risk of eventually becoming addicted, than those who started later.
• Stress– evidence indicate certain stress hormones are among the causes of alcoholism. High stress levels make a person more prone to use the likes of alcohol to attempt blank out problems and relieve stress.
• How the body metabolises (processes) the substance- with alcohol, those who require a higher dose to achieve an effect have higher rates addiction. Some populations have a lower tolerance to alcohol (due to lower levels of the enzyme that breaks down alcohol) and this is blamed for higher alcohol addiction rates in these populations (eg) native Indian population in America and Aborigines in Australia.

Community Alcohol and Drug Service (CADS)

The HSE Community Alcohol and Drug Service offer counselling and treatment services for adults suffering from addiction to alcohol, drugs and gambling. CADS have centres in Mullingar, Athlone and Longford. CADS provides counselling and treatment to help people get over their addiction. You can contact them at 04493 41630.

To be continued….next week

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.

Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. Over the last two weeks I discussed causes. This week i discuss diagnosis and treatment.

Diagnosis

If ED has persisted for more than a couple of weeks, an appointment with the GP is the first step. ED that happens all the time may indicate an underlying physical cause, whereas, if it occurs only when attempting to have sex, this might suggest the problem is more psychological.

With evidence of a direct link between Cardiovascular Health and ED, your GP will likely assess this during the consultation. Even in cases of men with mild ED, indications are that they may be 25% more likely to experience heart disease. Furthermore, severity of ED is being increasingly taken as a more positive indicator of potential heart disease than traditional flags such as family history, smoking or high cholesterol.

Treatment

Once ED has been diagnosed, the course of action taken thereafter will depend on the cause. If ED is caused by one of the underlying health conditions already discussed, the priority will be to treat that first.  

Positive changes include: -Quitting smoking; Losing Weight; Starting and maintaining an exercise plan; Stress reduction strategies; Reduction in alcohol intake

Medication

If appropriate, the GP may prescribe medication to treat the ED directly. There are a number of ED drugs available. Known as Phosphodiesterase-5 inhibitors (PDE-5), they came on the market in the last 20 years (Viagra^® being the first and most famous) and they work by temporarily increasing flow of blood to the penis, enabling an erection to be achieved. To work, PDE-5’s are triggered by sexual stimulation and arousal and in general take 30 – 60 minutes to work. Thus, despite common perception in the general public, they will not cause erection without sexual stimulation.

In Ireland, there are three main types of PDE-5:

The first two types work “on demand” with the patient able to have sex for 1 -10 hours after taking the drug. They are: Sildenafil (Viagra^® and other generic equivalents)) and Vardenafil (Levitra^®)

The third PDE-5 class works differently from the others, with the effect of a single dose lasting up to 36 hours. This drug is Tadalafil (Cialis^®). Tadalafil is more suitable if treatment is required for a longer period of time, (eg) over a weekend.

In general, at least 66% of men have improved erections after taking a PDE-5. PDE-5 inhibitor Side effects: Nausea and / or Vomiting; Flushing; Blocked or runny nose; Visual Disturbances (blue tinge to vision or increased light sensitivity); Back and/or Muscle pain; Headaches. They must be used in caution in those with heart disease.

Psychological Help

If the cause of ED is related to depression or anxiety, counselling in the form of Cognitive Behavioural Therapy (CBT) may prove beneficial. If issues like low self esteem, sexuality and / or personal relationships are the cause of ED, sessions with an experienced CBT therapist may help change the patient’s mindset and view on those issues. Relationship therapy with an experienced Psychosexual therapist for individuals and couples may help if the cause of ED is relationship based.

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

Erectile Dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse.

Causes

Causes of ED can be either physical or psychological, or a combination of both. Certain medications, prescribed to treat other conditions can, in some cases, cause ED.

Physical causes

Physical problems leading to ED can be categorised in four ways: -

• Vasculogenic (vascular caused by reduced blood flow))
• Neurogenic (nerve related)
• Hormonal (eg) lack of tesosterone
• Anatomical (eg) due to shape of penis

1. Vasculogenic (ie) reduced blood flow

Conditions of this type affect the blood flow to the penis (70% of physical related causes). Causes include:

Cardiovascular Disease (CVD) –As the blood vessels in the penis are a lot smaller than the blood vessels elsewhere in the body, they are often affected first. Having ED is often considered an early warning sign for cardiovascular disease.

Diabetes – Over 50% of men with diabetes will suffer from erection problems. This is due to circulation problems caused by diabetes thus reducing blood flow in the penis and nerve damage from prolonged incontrolled high blood glucose which disrupts nerve signals between the brain and penis.

High blood pressure – both treated and untreated high blood pressure can be a cause of ED

2. Neurogenic (nerve related)

Conditions of this type relate to the brain and nervous system.

Examples include:

Multiple Sclerosis (MS) – a condition of the central nervous system that affects movement. ED is an often an overlooked common complication for MS sufferers.

Parkinson’s disease –like MS, sexual and erectile dysfunction is common in men with Parkinson’s. It is a symptom which may appear long before more recognised symptoms of the disease appear (eg.) Tremor, slowdown in movement.

Stroke – Whilst stroke in itself is rarely a cause of ED, stress and worry about resuming an active sex life post stroke is more likely to be the cause.

3. Hormonal

The primary hormone related to ED is Testosterone. As men get older, typically, testosterone levels drop. Reduced levels can reduce libido (sex drive), which in turn can have a direct effect on a man’s ability to achieve an erection.

Additionally, too much Cortisol produced by stress will also have a diminishing affect of Testosterone levels. Other related examples include thyroid hormone where either too much (hyperthyroidism) or too little (hypothyroidism) is produced. Other ED related hormone imbalances can come from Liver or Kidney disease. Simple blood tests by your GP can diagnose any of these hormone deficientcies and excesses and once diagnosed are easily treated.

4. Anatomical

Referring to the structure and function of the penis itself there are several conditions which can result in ED, two of which include Hypospadias (relates to the abnormal development of the male urethra which is duct where urine and semen is transferred) and Peyronie’s disease (a hard lump develops within the penile tissue due to injury leading to scarring. For more information on these two conditions check out my full ED article at www.whelehans.ie

To be continued....next week I discuss diagnosis and treatment

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

Erectile Dysfunction (ED) is a common condition which mostly affects older men. ED is age related, with estimates showing that up to 50% of men in the 40 – 70 age range will experience ED to some degree.  Erectile dysfunction (ED) is the inability to get and maintain an erection that is sufficient for satisfactory sexual intercourse. The inability to achieve and maintain an erection caused by an insufficient blood flow to the penis due to narrowing or restriction of blood vessels or damage to nerves that help stimulate blood flow.

If it persists for more than a couple of weeks, a visit to the GP for assessment is essential as the condition can be an indicator of perhaps a more serious underlying health problem (eg. heart disease, diabetes).

Causes

Causes of ED can be either physical or psychological, or a combination of both (as is the case with Diabetes). Certain medications, prescribed to treat other conditions can, in some cases, cause ED.

Psychological Causes

Even men that are “physically healthy” can suffer from ED. When this is the case it is most likely related to a range of negative feelings and emotional issues that are preventing the “trigger” message being sent from the brain when needed. At a higher emotional level, those suffering with depression or anxiety are increasingly likely to experience ED.

An erection starts with a message from the brain, however with psychological disorders and general emotional issues, the chemicals in the brain are unbalanced, so, if the right levels of chemicals are not there when the message comes, the result is erectile failure.

The causes could include:

• Self esteem issues
• Sexual Performance issues
• Relationship problems or perhaps a new relationship
• Condition related stress (eg. Diabetes)
• Past sexual history or relationships,
• Negative feelings of guilt.

Medication related ED

Certain medicines prescribed for a variety of conditions, may cause ED. If concerned or have experienced ED since starting a new medication, check with your GP or pharmacist whether it is a possible cause. In most cases there will be suitable alternatives. Do not stop taking prescribed medication unless your GP or other doctor advises to do so.

Medicines types that can cause ED include: -

• Diuretics (to reduce fluid in heart conditions and reduce high blood pressure)
• Anti- Hypertensives (to reduce blood pressure)
• Fibrates (for cholesterol; statins are more commonly used nowadays)
• Anti-psychotics (used to treat mental health conditions, such as schizophrenia and bi-polar disorder (eg. Risperidone)
• Anti-depressants (more common with the older types less commonly used nowadays)
• Corticosteroids (used to control inflammatory conditions such as rheumatoid arthritis, bronchitis)
• H2 – Antagonists (reduces stomach acid for likes of heartburn; newer PPIs types are used more nowadays)
• Anti- Convulsants (for epilepsy)
• Anti – Histamines (for allergies)
• Anti-Androgens (for hormone disorders)
• Cytotoxics (chemotherapy medication used to kill cancer cells)

It is important to note the ED is a rare side effect with most of these medicines.

To be continued.. causes and diagnosis next week

Disclaimer: Please ensure you consult with your healthcare professional before making any changes recommended

For comprehensive and free health advice and information call in to Whelehans, log on to www.whelehans.ie or dial 04493 34591.