Reducing Risk from Harmful Substances
Tobacco smoking remains a leading cause of death and disability globally. In Ireland, approximately 17% of Irish adults smoke, which translates to approximately 665,000 smokers (1). Smoking remains a major public health issue as half of smokers will die from a smoking related disease; in reality this translates to 100 people in Ireland dying and 1,000 people being hospitalized per week. This has a major detrimental effect not just on Irish health services, but on all aspects of Irish life. In 2016, the estimated annual cost of smoking to the health service was €460 million, and the total annual cost was €10.7 billion (2).
The good news is that quitting smoking can have profound positive effects on all aspects of health. Furthermore, most smokers want to quit, and approximately half have attempted quitting in the last year.
Smoking is linked to an increased risk of several cancers including;
Lung
Head and neck
Oesophagus
Stomach
Liver
Breast
Bowel
Bladder
Kidney
Skin
Tobacco smoke contains over 4000 chemicals, of which many are carcinogenic e.g., benzene, formaldehyde, ammonia, arsenic, cyanide etc. as well as tar, addictive nicotine and poisonous carbon monoxide.
Alcohol misuse is not always just about the amount consumed but also from the pattern of drinking. “Binge” drinking is associated with significant health risks. Alcohol misuse can lead to to many health complications including heart disease, liver disease, anxiety, depression, self harm, diabetes, and certain cancers. Around 30% of suicide and self harm attempts are associated with alcohol use. These health complications account for 1 in 10 of every occupied hospital bed, and a significant burden on our health service when we account for additional costs such as increased lenght of stay in hospital, increased GP visits, and significant use of emergency services (as many as 29% of ED visits on early weekend mornings are related to alcohol). While more than 52% of Irish adults have hazardous alcohol use - 59% feel that they have low-risk or light alcohol use - highlighting a misunderstanding of how much alcohol use is safe or low risk. A study in Ireland found that only 2% of adults know low-risk drinking guidelines. Alcohol use in teen years is associated with additional physical and mental health risks, both short term and long term. Studies have found that parental drinking and attitudes towards alcohol use are among factors that can lead to adolescent alcohol use. The cultural and societal focus on alcohol makes safe drinking difficult for many.
How much is low risk drinking? Use this calculator to check: https://drinkaware.ie/drinks-calculator/
Lifestyle Medicine and Risk Reduction
Lifestyle Medicine is an evidence based approach to improve health and well-being with a patient centred approach to the six pillars of lifestyle, one of which is the reduction of harmful substances — including smoking cessation and reducing alcohol consumption to low-risk levels.
Smoking cessation represents the best health intervention in terms of years added to life, reduction of serious diseases (cancer, heart disease, stroke, COPD and more), benefit to the exchequer and society and that is before considering the benefits of reducing second-hand smoke. Also, as smoking is a driver of widening socio- economic disparities, quitting is a way of reducing health inequalities. Finally, a Tobacco Free Ireland is in fact current government policy, with an adventurous target for Ireland to be tobacco-free by 2025. The 2022 National Clinical Guidelines for smoking advise that all healthcare professionals routinely ask and advise about the harms of smoking and the benefits of cessation (3). Behavioural supports such as Brief Motivation Interviewing, group therapy as provided by the HSE and others, phone or text messaging services, as well as medical treatments such as Nicotine Replacement Therapy, can all significantly increase quit rates. Vaping is not recommended for smoking cessation.
Reducing alcohol intake to low-risk levels (or, for some, a complete cessation of alcohol use) can improve both physical and mental health, and reduce risks of short and long term complications such as heart disease, diabetes, liver disease, pancreas disease, certain cancers. Changes in drinking as a parent can also directly reduce the risk of alcohol use and health risk in children. Some patients who misuse alcohol need or would like support when then want to reduce or stop drinking, which may include counselling, support groups, and/or short term medications. This can greatly increase your chance of success.
References
Department of Health. Healthy Ireland Survey Summary Report 2019.Available from: https://www.gov.ie/en/collection/231c02-healthy-ireland-survey-wave/ Accessed on 27th June 2022.
Department of Health. An Assessment of the Economic Cost of Smoking in Ireland. 2022. Available from: https://www.gov.ie/en/publication/a7ee00-an-assessment-of-the-economic-cost-of-smoking-in-ireland/ Accessed on 27th June 2022.
Department of Health. Stop Smoking (NCEC National Clinical Guideline No. 28). 2022. Available at: https://www.gov.ie/en/collection/c9fa9a-national-clinical-guidelines/ Accessed on 27th June 2022.
Alcohol consumption, alcohol-related harm and alcohol policy in Ireland