Smoking is a major public health problem. All smokers face an increased risk of lung cancer, other lung diseases, and cardiovascular and other disorders. Smoking during pregnancy can harm the health of both a woman and her unborn baby. Currently, at least 10 percent of women in the United States smoke during pregnancy. In the United States and in other industrialized countries, 18 percent of women smoke. Statistics from the United States are compelling. According to the U.S. Public Health Service, if all pregnant women in this country stopped smoking, there would be an estimated:
- 11 percent reduction in stillbirths
- 5 percent reduction in newborn deaths
The more a pregnant woman smokes, the greater her risk of having a low-birthweight baby. However, if a woman stops smoking even by the end of her second trimester of pregnancy, she is no more likely to have a low-birthweight baby than a woman who never smoked. A 2003 study suggests that babies of mothers who smoke during pregnancy undergo withdrawal-like symptoms similar to those seen in babies of mothers who use some illicit drugs.
What resources are available for pregnant women?
|A STORY Smoking During Pregnancy|
In 1958 at U.S. Army Tripler General Hospital, Dr. Jay Z., one of my fellow residents in the Obstetrics and Gynecology Residency training program, carried out one of the early research studies on the effects of smoking during pregnancy. At the time 30% of doctors and a larger number of patients smoked and in general, there was little thought about it except it "Could be unhealthy and was a bad habit". Jay read the scarce literature on the subject of smoking and pregnancy and he was motivated to begin what became a five-year study. In 1963, he published a well-accepted smoking survey of 2000 pregnant patients.
Jay felt strongly about his findings, but in those days the editors softened the need for complete abstinence from smoking. They recommended "abatement of smoking" for pregnant smokers who had a history of premature deliveries or repeated abortions. Sadly, Jay passed away at a young age not knowing how well his early message was picked up and carried.
Here is a summary of his findings:
From the study of 2000 consecutive single births of 957 smokers and 1043 nonsmokers, it was found that:
- Women who smoke have infants weighing an average of 229 grams(8 oz) less than those of nonsmokers
- The prematurity rate is 2-1/2 times higher among infants born to women who smoke.
- Women who smoke have a slightly higher incidence of miscarriages than nonsmokers.
No appreciable difference is found in age, parity, blood pressures, pulse rate, weight gained, or incidence of toxemia between pregnant smokers and nonsmokers.
|DEBATES Nicotine as a Subtle Addiction|
|There is a lot of debate regarding the treatment of nicotine addiction and requiring nicotine abstinence at addiction rehab/treatment programs. This section of the newsletter will be used for some of the points of that debate. There are points on either side. |
There may be a subtle, but powerful, silent factor operating in these discussions. That factor is: "Nicotine is not as impactful or destructive as alcohol, meth, heroin etc., in the client's/patient's life at the time they are admitted to our program." In general, smokers in rehab have not yet reached the heart, lung, kidney, vascular disease stages of smoking yet. Right along with that is the practical experience of the patient/client demanding that they be allowed to smoke while at the facility or they won't come!
That silent factor and that kind of experience with the smoker's demands results in nicotine running the recovery program! It also results in diminished respect for the programs because the experienced addict will say once again, "I got away with that one...".
Client/therapist regard and respect for one another is the linchpin of successful therapy. Discipline and consistency are necessary to harness the "self-will run riot" of the addict. Just as in parenting; role modeling, consistency and a clear description of the expectations of the program are necessary.
If a facility and its staff believe nicotine has little impact on recovery for an individual recovering from other addictions, then a careful study of the mental and emotional and behavioral progress of their nicotine using clients during therapy for other drug addictions is necessary. Long term relapse follow up and a study of the latest research data is important, also.
This silent factor, patient/client relations, and a new awareness will probably require what corporate America calls a significant cultural change for the program wishing to change. It is what the father of modern American medicine, Sir William Osler, said in 1911 to arrest the spread of tuberculosis, "It will take a major change in Social Common Sense..."
|RECOVERY TIPS AND WHIMSY
|At the present time, most addiction treatment programs do indeed address smoking. Most of that attention goes toward answering such questions as: "What can we do about the smokers?" (It is more common to use the word "Smoker" rather than "Nicotine Addict") The answer is usually one of "Let's designate an outdoor smoking place, like a nice gazebo, where they can smoke on breaks. |
It is interesting and strange to consider how that would sound if the drug being allowed in a treatment program is not necessarily nicotine but one of the other addictive drugs such as alcohol. The above sentence then becomes, "Let's design and outdoor drinking place, like a nice gazebo, where they can drink on breaks." I imagine the nickname for such places could be "Butt Huts" for cigarettes or "Booze Huts" for alcohol. Perhaps the posted announcement for such a place might be:
KEEP ON A SMOKIN' SUPPORT GROUP"
The "Keep On Smokin'!" support group meets in the Butt Hut before breakfast, during morning break,
after lunch, during afternoon break, before dinner, after dinner, before the meeting and after the evening lecture, and before lights out.
(Please do not smoke in your sleep...)
P.S. "I Don't Smoke!" can be a do it yourself, but not by yourself, stand-alone book. You can get it online, 20% off, at www.hcibooks.com