Any NON-Smoker free cruises

[jessemon]

yay! I think that was the purpose of this whole post!

 

I dare everybody to stop posting now. Let this post die!

OK....But let the fun on this "thread" continue....

A non-nonsmoking cruise....I like it.....:D

[FLOTR]

Copied this article from The New England Journal of Medicine. Thought the highlighted sentence hit the nail on the head. We all have our addictions but maybe we should quit making excuses for the choices we make. Note that I am including myself in this reply hence the "we".

 

Patients with Substance Abuse Problems: Effective Identification, Diagnosis, and Treatment

 

 

The diagnosis and treatment of substance-abuse disorders are gaining the attention of physicians, and no wonder — in a given year, 9% of the U.S. population is found to be dependent on or to abuse alcohol, and almost 4% are dependent on illicit drugs. Nicotine dependence, a licit and actually greater cause of illness and death, affects some 20% of the population. Such problems are now discussed in most medical schools.

Psychiatry has a subspecialty certification for expertise in addiction, and there is a growing body of knowledge concerning how clinicians can and should bring their patients from the stage of pre-contemplation to the stage of action in dealing with addiction. This approach, based on motivational interviewing, has been shown to be effective when used by generalists as well as addiction specialists. Furthermore, material advances are being made in the field of biomedicine toward understanding the pathophysiology of addiction; clarification of the neurologic mechanisms of dependence and craving is especially important. For example, in imaging studies, drug-seeking can be seen to cause activation of the prefrontal cortex, and glutaminergic projections from the prefrontal cortex to the amygdala and nucleus accumbens are now understood to be instrumental in conditioned drug craving.

The authors of Patients with Substance Abuse Problems, both of whom are psychiatrists, set out to write a coherent, relatively brief overview of the field of substance abuse. They have dedicated their effort to the American Academy of Addiction Psychiatry, but the book will be useful to any practicing physician — whether an internist or a family-medicine practitioner — and to general psychiatrists as well. The book is not ponderous but is actually quite readable, and it expresses the engaging voice of the authors rather than the diverse and less consistent orientations often found in edited multiauthored books.

The authors review a good deal of the salient medical literature concerning the basics of addiction and usefully detail specific procedures such as detoxification schedules for alcohol, anxiolytic and hypnotic agents, and opioids. All this material is written with attention to understanding the patient's denial, the physician's need to maintain a positive perspective, and the importance of what the authors call "staying with the patient." Because the book is brief, however, the authors do not go into detail about the genetics of addiction or specific approaches to treatment, such as facilitation of a 12-step program, contingency management, family and network therapy, and methadone maintenance.

The authors understand the need to relate effectively to the patient. This is perhaps the most important role of the physician who encounters a patient with an addiction, because it is the mainstay of what the physician can do at this point in our understanding of alcohol and drug abuse. Consider the treatment of alcoholism. Naltrexone, an opioid antagonist, has been shown to diminish the alcohol consumption of patients. Even with concomitant counseling, however, the effect of oral naltrexone is modest relative to placebo, and the recently approved depot naltrexone has only limited acceptance among patients with alcoholism. There are also questions regarding acamprosate, another drug recently approved for the treatment of alcoholism. One major study, completed after this book was written, failed to show a difference in outcome between active acamprosate and placebo. Other medications that have been studied off-label for use in the treatment of alcoholism, such as topiramate and ondansetron, have been of little use.

In the treatment of opioid addiction, buprenorphine, an opioid partial agonist, has been found useful for both detoxification and maintenance. It is being used to reduce dependence on narcotic analgesic pills and heroin, but it cannot be prescribed without appropriate psychosocial treatment. Federal regulations require that its use be accompanied by such treatment, but physicians need to hone their skills in this area; many who are certified to prescribe it appear to offer little, if any, of the required counseling. We have no systematic observations from community-based practitioners on the long-term outcome of the use of buprenorphine, and without proper, continuing psychosocial treatment, patients may relapse to opioid use or continue the abuse of other unrelated substances. Furthermore, buprenorphine is subject to illicit diversion, a problem in some countries where it is widely prescribed.

The concept of addiction as a disease is appealing because it has countered the widely held view of addiction as a willful behavior with moral implications. Likening addiction to hypertension and diabetes is also appealing because of addiction's chronicity and vulnerability to breakthrough symptoms. The rehabilitation of patients with substance-abuse problems has, however, been handled largely by nonphysicians who work closely with their patients; physicians have been more inclined to treat the somatic consequences of addiction. The medicalization of addiction can therefore distract the physician from the importance of treating the addicted patient on the basis of a well-conceived, helpful relationship. In tone and intent, the authors of this book address this important issue.

 

Marc Galanter, M.D.

New York University Medical Center

New York, NY 10024

marcgalanter@nyu.edu

[sharecruises]

Y'all can laugh for now, but we'll see who gets the last laugh! Eventually, slowly but surely, things will turn our way!! I quit 15+ years ago because I was starting to feel like such a social outcast!

 

LOL>>> so true

 

I wonder if the same "pro-active" smokers will be as active in getting help with wheelchairs/oxygen tanks in the future??

 

When COPD forces them to lug around some oxygen machine then they won't want the smoke around them

 

but who knows?? I knew a guy (sadly he is now dead, died at 51)

who would unhook his oxygen and wheel out to the patio for a (forbidden) smoke

 

really a very hard addiction to break I guess

 

who can forget the visual of that poor smoker smoking thru the hole in their throat??? eeek

[legalwife]

LOL! And the real coughs are not annoying:p Especially the ones that sound like they are coughing up a lung:eek:

 

Had smoking loogie cougher on last cruise beside us on balcony. GROSS!!!!!! :eek:

[boaterette]

I still vote for the non non-smoking ship.:D