Perinatal smoking: a struggle to intensify

The fight against perinatal smoking should be intensified, despite the many efforts to improve the management made especially during antenatal, warned midwife tobaccologist CH Bayonne, while reporting the results of a survey in 2003 377 public maternity.

A questionnaire was sent out in late 2003 midwives frames 377 public maternity listed on the website of the Ministry of Health, addressing three themes:

1 / the care of pregnant patients who smoke during pregnancy in the service, to learn about the organization of the consultation cessation practitioner and what it was made;

2 / resumption of smoking in the postpartum period, to assess the valuation services by periods and the frequency of relapses;

3 / relapse prevention after childbirth.

"We received 214 responses of 377, of which 211 are interpreted, including 45% of maternity Level 1 60% Level 2 and 50% Level 3," said the midwife.

Only 20.4% of respondents maternity held specific consultations cessation within their service. "Maternity Level 3 to have nearly half of them (43%) created a specific consultation, against respectively 19% and 14% for levels 1 and 2. This seems logical given the fact that maternity Level 3 are supposed to concentrate the most serious diseases and certainly more aware of the risks of maternal smoking, "noted the health professional.

79.6% in the consultation is not available, 70.6% of patients are referred to a smoking cessation center.

"It is clear from the survey that individual consultations (62.8%) are preferred over group meetings, as well as the method of cognitive behavioral therapy (74.4% of establishments, while 53.5% use drug withdrawal only), "says the midwife CH Bayonne.

The responses show, moreover, that these consultations are for smoking cessation 62.8% under the responsibility of midwives and 41.9% by non Obstetricians tobaccologists doctors. The number of consultations averaged 4 or 5, regardless of the level of motherhood. Consultation time is between 10 and 30 minutes for 37.2% of maternity and becomes greater than 30 minutes for 39.5% of them.

RECOVERY OF SMOKING POSTPARTUM

Only 40.8% of schools responded to the question about the existence of relapse "which proves the ignorance or the lack of interest the problem of post-natal smoking," said the midwife.

Among the responses, 46.5% observed a relapse from the puerperium, 30.2% think it occurs only after two months and 8.1% at 6 months. "We do not see a year follow-up of patients and no statistics on the rate of relapse was provided by maternity hospitals," said the professional.

Consultation on smoking cessation postpartum, few maternity (49 of 211) responded to this question. Where it exists, it is individual for 86%. The length of the longest follow-up was 2 months and corresponds to the date of compulsory postnatal visit: 32% of consultations are conducted by midwives and 60% by tobaccologists doctors inverse proportion to the antenatal period. In addition, a very significant percentage of obstetrician-gynecologists (2%) is involved in this period.

INFORMATION ON PASSIVE SMOKING

In this survey, 74.7% of maternity inform on the risks of passive smoking. "This information is usually provided in the immediate aftermath of layers (79.7%), another special moment corresponding to the meetings of the birth preparation (24%). A written document is used by 21.51% institutions. However, this subject is addressed in the mandatory post-natal consultation in 16.45% of the answers, "said the midwife CH Bayonne.

Information on passive smoking is broadcast in 88.6% of cases by midwives in 33.5% of cases by the nursery, in 30.9% of cases by pediatricians and 25.9% of case by obstetricians.

Finally, of the 211 responses received, 117 or 55.5% have maternity maternity project without tobacco.

"The relatively high response rate for a survey of this kind shows the interest in the problem of the management of smoking pregnant women by health professionals that we are. Recent years have witnessed significant progress in the field of prevention with the creation of a maternity network without tobacco. Nevertheless, too little effort has been made postnatally despite the collective awareness of the harm caused by passive smoking for infants " says the midwife.

According to her, it now remains a need to better inform women about the risks of continued smoking during and after pregnancy, as well as strategies to help stop smoking, as well, to better train caregivers at minimal advice and thus engage in a policy of prevention service.

Impact of smoking on health

Everyone is experiencing the adverse effects of nicotine vis-à-vis the organization.

Complications tobacco appear after 20 to 30 years of use.

The addiction to tobacco does not present specific symptoms because its diagnostic criteria are included in the addiction criteria established by Goodman. However, some significant signs smokers are:

Treatment of smoking

The first approach in the treatment of tobacco addiction is psychological counseling.

Medication

Drug treatments are mainly based on products nicotine replacement (gum, patch, sublingual tablet or inhaler).

Their use and effectiveness are conditioned by the dependence of the subject. Their administration requires medical monitoring of pregnant women and individuals with heart disease.

Currently, there is another drug called Champix, which also aid to smoking cessation. This drug does not produce nicotine but reduces signs of withdrawal by mimicking the effects of nicotine and reduces the sensation of pleasure brought by nicotine.

Antidepressants are sometimes prescribed by doctors during withdrawal.

The side effects of drugs are mainly characterized by nausea, headache, vomiting, flatulence (gas in the stomach), insomnia. Other patients even talk of changing the perception of taste.

Other therapeutic methods have also brought their fruit such as homeopathy and acupuncture.

The maturational psychotherapy and cognitive behavioral therapy are significantly effective.

Smoking prevention

Several countries have taken steps to fight against smoking, including higher taxes on tobacco, which causes an increase in tobacco prices. The adoption of this policy was the cause of a decrease in sales of tobacco and has proven effective for many countries.

Awareness campaigns, communication, information and education are also necessary and useful in the fight against smoking.

In addition, the World Health Organization has required the use of warnings to be shown on cigarette packages. These warnings expose the harm caused by tobacco, and can contribute to a change in consumer behavior.

The strong urge to smoke at any time,

- Emergence of anxiety, nervousness, depressed mood in case of lack.

Studies have shown that there is no threshold level below which tobacco is not harmful to health because few cigarettes a day is enough to cause disease:

- One in three cancer is caused by smoking. The most common are the cancer of bronchus and lung, throat cancer, cancer of the larynx. Others are more rare but serious as cancer of the kidneys or bladder.

- Smoking is also part of risk factors cardiovascular responsible for the occurrence of heart attacks and strokes.

- Smoking is responsible for various respiratory diseases such as chronic bronchitis are the most common.

- The affected eye may be complications with smoking onset glaucoma (optic nerve disease causing a progressive loss of visual acuity).

Nicotine addiction

The addiction to tobacco is the fastest installation dependence (a few weeks).

Each cigarette strengthens tobacco addiction.

Installation of addiction mechanism and effects

The mechanism of tobacco addiction is the result of mechanisms of habit and social pressure.

The main factor is the dependence of nicotine in tobacco is a substance that acts on the brain with stimulation of the reward system encouraging smokers to consume more.

The effect of nicotine in the body occurs rapidly (within 8 seconds) and lasts about 20 to 40 minutes.

The effect of nicotine is easily managed by the subject and is essential in achieving the daily activities and obligations: Nicotine is an antidote to anxiety and stress generated by situations of everyday life. It is a source of fun, relaxation and intellectual stimulation for the consumer.

In addition, smoking introduces usual gestures that reinforce confidence and becomes more and more difficult to control.

Testimony on tobacco addiction

Anne 21 years: I smoke and I smoke ... and I do not eat!

I started smoking at age 12 and then I promised my brother to stop. I even signed a contract with him. Now, I stopped for six months and I am very proud of myself. I used patches and took anxiolytic and antidepressant for a month. I faced my mood swings, my anger, my fears and all my emotions I learned to live with.

I became another, and dedicated myself to reading, other activities. I do not work too but I have good results with partial. I listen more to my needs and I know now that I need to learn to respect them. I gained more confidence in myself now and I'm proud. Now I respect and not destroy my body. I want to live because I have a body "new" and "clean."

Only, I did not pay attention to my line. Since I stopped, I took 6 pounds! However, I did not have complex and I found my beautiful body! I am aware that I have spent years to smoke more to eat less, to stay and forty-seven pounds ... And then I realize that I feel more beautiful with my 6 pounds more!!

Stop smoking, it's magic. This is a great adventure where we discover each day a little more. So for all those who are addicted, stop because you have everything to gain!

Prevention and treatment of alcohol

The alcohol addiction can be treated like any disease. However, the first test of cure is abstinence from alcohol at the beginning of treatment.

Prevention of addiction to alcohol is based on information and education programs in order to achieve changes in behavior early.

Prevention

These information and education programs can also be done as:

- Information through the media to strengthening messages and target groups (distribution documentary about addiction to alcohol)

- Information workplace integrated into the health policy of the employer

- Information and education for young people in schools

- Organization of workshops and public forums to flow more easily posts in the community.

To prevent the onset of addiction to alcohol, it is also important to detect alcoholism in an individual at an early stage that is to say in the absence of physical, psychological and biological complications. This is the role of the physician who is responsible for the clinical and biological evaluation of the state of dependence.

Care and treatment

Given the importance of psychosocial factors in the onset of addiction to alcohol, its psychosocial care greatly involves the presence and support of the environment and should include:

- Couples therapy

- Family Therapy

- Group therapy

- Associations of former drinkers

- Cognitive and behavioral therapies

Drugs, however, are used for the treatment of alcohol dependence and statistics have shown that 30 to 50% of patients who received the drug treatments have become abstinent after one year.

However, the administration of these drugs in the treatment of alcoholism requires medical care associated with taking social and psychological care.

Medication

Different classes of drugs can be used in the treatment of alcohol dependence.

Benzodiazepine class

Painkillers

Reducing signs of withdrawal (tremors, sweating, palpitations)

Prevention of delirium tremens

Class disulfirames

Causes a distaste for alcohol causing unpleasant physical sensations when drinking (palpitations, nausea, vomiting, feeling of impending death)

Class of naltrexone

Remove the desire to drink alcohol

Relapse Prevention

Impacts of alcohol

Alcoholism can cause neuropsychiatric disorders manifested by more or less severe clinical signs of brain damage or encephalopathy, intellectual impairment or alcoholic dementia.

Impact on health

The alcohol addiction for several years resulting in chronic health problems such as

- Cardiac disorders (arrhythmias, heart damage)

- The brain damage with the appearance of lesions in the progressive destruction of brain cells

- Diabetes can occur when alcohol poisoning. The most serious risk is the occurrence of a fatal hypoglycemia when drinking on an empty stomach.

- Hypertension

- Involvement of the liver cirrhosis of the liver

- The gastric damage with the appearance of gastric ulcers and gastritis

- Damage to the nervous system manifested by loss of feeling in the limbs and other parts of the body.

social repercussions

The alcohol dependence may induce social complications especially for young subjects:

- Learning difficulties may arise

- Problems of delinquency deviant behavior vis-à-vis society can lead to a family avulsion and / or professional

- Legal issues in relation to delinquent behavior

The social cost of alcohol addiction is becoming increasingly important. The medical cost of alcohol is 10 to 15% of health spending.

In business, 50% of productivity losses are related to alcohol addiction (absenteeism, behavior problems in the workplace with verbal or physical abuse, craving causing accidents on machinery, ...)

Symptoms of Alcoholism

The alcohol dependency is a disease that slowly progressive course and has two clinical forms.

Signs of addiction

In addition to the criteria of Goodman, addiction to alcohol is manifested by other signs of non-control drinking.

We talk about addiction to alcohol when three of the following signs appear in the subject:

- The subject has a tolerance to alcohol with need higher amount to get the desired effect

- The subject addicted to alcohol knows the risks and negative consequences of alcohol (professional consequences, effects on health, effects on the environment)

- The subject wants to stop but can not do

- Alcohol is taken in the morning early in the day

- The subject is hiding bottles of alcohol on the workplace or at home

- The subject likes to drink alone and sometimes in secret

- Alcohol consumption is the most important topic of occupation by sacrificing other leisure activities and obligations.

Alcoholism: two clinical forms

acute alcoholism

Aggressive states

trough

Coma and confusion and can lead to death

chronic alcoholism

tremors morning

Vomiting, diarrhea, sweating, nervousness

Anguish and anxiety

Visual, tactile and auditory hallucinations

Seizures with disorderly movements (delirium tremens)

Alcohol: installation of a dependency

Addiction to alcohol is often a social problem.

Dependence is evaluated according to specific steps.

Stages of alcohol

- Simple use is occasional or regular and moderate consumption.

- The use of risk is likely to lead to addiction.

- Harmful use is a more advanced stage with repeated use.

- Use with addiction is characterized by a loss of control of the use and appearance of signs of withdrawal in case of lack.

Effects of Alcohol

The effects of alcohol are:

- Changes in behavior: removal of the inhibition social as well as personal (the person talks a lot and feels no discomfort)

- A decrease in anxiety and depression by calming power

- A change in the state of consciousness in order to circumvent and escape realities: the person becomes increasingly forgetful to forget all their problems, reacts badly and loses the ability to make decisions.

Installation mechanism and effects of addiction

Alcohol consumption causes the production of Tetra Hydro Papavéroline or THP at the agency that it is present for about 3 months. As a certain amount of THP is still circulating in the blood, calls for alcohol consumption are important.

Once engaged, the body constantly seeks the presence of alcohol.

However, alcohol is facilitated by psychological, social and cognitive factors, maintaining consumption.

Generally, subjects at risk are people with anxiety disorders who have difficulty managing stress, people who have difficulty communicating with others or individuals often with depressive states.

On the social level, these people are at risk because they are often isolated loneliness is imposed, as in some situations: topics unemployed or marital conflict. In alcohol dependence, the surroundings and the environment plays an important role as a factor of dependence.

Personality traits are found with frequency. It is mostly subjects with low self-esteem and who feel ineffective and weak. They then engage in alcohol and its effects expect positive attitudes towards society.

Support for addiction

It is necessary to assess the level of dependence before starting any treatment.

According to several associations and centers of care for addictions, before any treatment, must be able to recognize his addiction problem and talk openly to the doctor, a trusted person or groups of people who can provide assistance.

Psychosocial care

This psychosocial support is important and is often undertaken by health centers (doctors, social workers and specialists). They can be made, as appropriate, in the form of individual interviews or group therapy (family, friends, children, spouse, other patients).

The group therapy are frequently companies because the notion of a group is an important motivating factor facilitating communication between the subject and the other, helping to treatment.

In psychosocial care, treatment is mainly focused on the motivation for abstinence, and awareness of the subject of the consequences of addiction on him and his entourage.

Several associations and specialized care centers currently operating in the field of addiction to support the addiction disorders dependent subjects.

Therapeutic management

Drug treatments are generally used in addition to psychosocial care.

  The medications vary depending on the type of addiction and are prescribed only by a doctor's care center or an addiction psychiatrist.

Addiction prevention

Addictions have adverse health consequences. They affect the proper functioning of the body and then cause disturbances in several processes including brain function.

However, symptoms vary depending on the type of addiction (addiction to tobacco, alcohol addiction, gambling addiction, ....).

Consequences of addiction

All addictions have repercussions on both the health of the social life of the subject.

Generally, addictions often lead to shame, lies, neglect, aggressiveness, isolation, obsession, loss of control, lack of self-esteem, anxiety and suffering.

Several diseases and complications in the body can also occur as a result of dependence, but vary depending on the type of product or creating behavioral addiction.

Addiction prevention

Addiction prevention involves primarily the individual and requires a balanced life:

- On the social level: conflict management, dealing with the emotional problems

- On a professional level: foreclosure professional overwork, time management and labor

- Biologically: follow a healthy diet, follow the rhythm of sleep, practice exercise, crowding stress.

The prevention of addiction also involves socio-political public health intervention.

It should focus on:

- Monitoring the health of the general population

- Monitoring the quality of life of the population census of the sick, dependent persons, persons with disabilities

- Information and health education of the population (of forums, debates, workshops, programs in the media, ...)

- Identification and monitoring of risk factors related to addiction (environmental factors, working conditions, ...)

- Improved system and health care for effective prevention and treatment of addictions (training of health personnel, ease of access to care centers addictions, good management of addiction in schools health and health centers,

- Deepening of knowledge and research on addictions in order to better prevent and provide adequate and appropriate treatment for addicts.

- Application of laws concerning the consumption of psychoactive products assets

Prevention methods vary for each region and each country, depending on the type of population and location. But generally, prevention programs are based on communication for behavior change. Several centers or associations with specialized health personnel currently working in the management of addiction.

Addictions in figures

It is estimated that 90% of people are victims of any addiction.

This can range from a simple to a complete addiction habit with adverse physical and psychological consequences.

In France and in other European countries, addictions today is a public health problem. Addictions are harmful to the addict but also about have consequences for those around him.

Generally, these are men who are more affected than women, most addictions. Dependence is common between ages 15 and 25 because the behavior of adolescents and young adults makes the risk of addiction from the first experiments with substances or activity.

Alcohol and drugs are the most consumed. Currently, 35% of young people under 17 already use alcohol or cannabis, and one teenager in five takes cannabis more than 10 times a year.

In addition, between 1.5 million and 2 million people are addicted to alcohol in France with an average consumption of 19 liters per person per year for over 15 years.

According to the French Ministry of Health, dependence on psychoactive substances causes over 100 000 deaths from accidents and diseases in France and is responsible for 30% of deaths before age 65.

Psychological mechanism of addiction

Biological and social mechanisms alone are not sufficient to create the phenomenon of addiction.

addictions

For example nicotine alone can not lead to a state of dependency in a smoker or the effect of alcohol alone does not give the state of dependence. Mental characteristics of the subject come into play and are heavily involved in the addiction process.

In the psychological mechanism, the subject tries to replace his lack of affection by an object or activity in order to find pleasure and avoid pain. It is then the result of a loss of control of emotions or difficult to manage positive and negative emotions.

People at risk of addiction are often anxious people, depressed, with a lack of confidence, which is easily engaged with an object or act.

Social mechanism of addiction

The social environment of an individual is also a factor of development of addiction. There is a special environment that fosters addiction such as isolation, boredom, lack of understanding, coping strategies.

Coping strategies are behaviors of an individual who can help to cope with difficult situations or constraints as seek to circumvent a problem occupations, modifying its behavior to hide its weaknesses and feelings (bulimia ), easily take psychoactive substances to face its problems (alcohol, drugs, heroin, cannabis, ...).

Several social mechanisms may be involved in the onset of addiction and yet remain fickle factors:

Insecurity and poverty, poor living conditions causing suffering stress. These situations usually lead susceptible individuals to easily hang on psychoactive substances to circumvent the problems caused.

The social exclusion of people addicted to drugs exacerbates the phenomenon of dependency among these people, causing social complications such as delinquency, incarceration ....

Patterns of behavior that are currently imposed by society with trends

hyperconsumption (excessive consumption and purchase of mobile phones, MP3 players, computers, ...) which initially was entertainment then comes the stage where the feeling of physical security leading to a source of pleasure and addiction appears

adapt to various changes in the competitive world (stay good in all areas, to improve steadily against competitive) then use all means in order to overcome the other, increasing the risk of dependency by making drugs to cope with stress and anxiety produced by the situation ....

The family environment can influence the appearance of addiction among many teenagers and young adults. Indeed, it has been shown that most parents have a high level of education (stress at work, lack of control and supervision of children and young adolescents with frequent output buddies with the appearance of group pressure and negative influences ...) more teens are exposed to resort to addictions.

Biological mechanism of addiction

Several mechanisms of addiction have been described in the biological, social and psychological.

Dependence on a product or an act is related to neurobiological mechanism: everything happens in the brain.

Substances produced by the brain as dopamine and serotonin are involved in the management and control of human emotional states and influence the brain-seeking behaviors of fun, impulsive and aggressive activities.

The mere sight of the product or something reminiscent of an act or object (smell, shape, texture) cause an increase in the secretion of dopamine and serotonin stimulate the brain and have an increased urge to the substance or the completion of the act and motivating the individual to use the product or perform the act. This is the circuit of the reward system.

The reward system of the brain essential for survival is a system that participates in the vital functions acts related to nutrition and reproduction, acts related to the satisfaction and pleasure.

Psychoactive substances (alcohol, drugs, ...) are substances that alter the system by modifying its operation led to the dependence of the body to these substances.

Addiction: definition according to DSM-IV

According to the DSM-IV, an addiction is an inadequate method of substance use leading to functional impairment or clinically significant distress.

Addiction is characterized by the presence of at least three events are as follows, over a continuous period of twelve months.

criteria

Tolerance as defined by either of the following symptoms:

        Need for markedly increased amount to get the desired effect.

        Markedly diminished effect with continued use of the same amount of the substance.

Withdrawal characterized by either of the following events:

        Appearance of characteristic withdrawal syndrome for the substance

        The same substance or a loved one is taken to relieve or avoid withdrawal syndromes.

The substance is often taken in larger amounts or over a longer period than intended.

There is a persistent desire or unsuccessful efforts to cut down or control substance use.

Much time and activities went for the substance.

Social, occupational or recreational activities are given due to the use of the substance.

The substance use is continued, although the person is conscious of his physical or psychological problem caused by this substance.

Addiction: definition according to ICD-10

According to ICD-10 (International Classification of Diseases), we speak of addiction when at least three of these criteria have emerged simultaneously in the first year and persisted for at least one month or have occurred again a shorter or longer period.

criteria

A compulsive desire to consume the product.

Difficulties in controlling its use.

Appearance of a withdrawal syndrome when stopping or taking the product to avoid a withdrawal syndrome.

A tendency to increase the dose to achieve a similar effect.

Adverse impact on daily life.

A continued use despite suffering it causes.

Criteria by Aviel Goodman

Of common diagnostic criteria for addiction have also been established in 1990 by Aviel Goodman, American psychiatrist who gave a definition of addiction.

"This is a process which is carried out in a behavior that can have the function of providing pleasure and relieve internal discomfort, and is characterized by the repeated failure of its control and persistence in spite of negative consequences."

The criteria are similar to those of the defining criteria of the DSM-IV and ICD-10.