Stories of Substance Abuse and the Pain It Causes

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Addiction: Prescription Pills

By: Nancy Nall Derringer

Throw a pebble in a pond — no, just a single tablet, say, a 30-mg OxyContin pill — and watch the ripples spread. Maybe this metaphor is wrong, but let’s run with it for a while. Let’s assume the pill is legally and legitimately prescribed, by a doctor, for relief of pain. OxyContin, when it came on the market in 1996, was considered a breakthrough medication for those with moderate to severe pain, the sort that puts patients on a roller coaster of misery. Take a pill, the pill wears off, take another pill, etc. OxyContin, formulated in a time-release formula by Purdue Pharma, needed to be taken only once every 12 hours, leaving people with severe arthritis, bad backs, injuries that left their sufferers in a world of pain, free to live with a lot less of it.

Only it didn’t work out that way. It wasn’t long before people figured out the drug could be crushed and snorted and its time-release qualities nullified, for a powerful high. It’s an opioid drug, after all, the same chemical family as morphine and heroin, delivering the mellow, warm euphoria users have sought for as long as opium poppies have been cultivated for their medicinal properties. In fact, “hillbilly heroin” soon became one of the drug’s nicknames, for its prevalence in Appalachia, a region full of people living with lots of pain and not much income.

The popularity of the drug for both legitimate and illegitimate uses made it widely prescribed and tempting for patients to sell their unused pills to others, although that wasn’t enough to stem the demand. Sometime around 2000, drugstores started being hit by stickup thieves who demanded nothing but OxyContin. The street value of prescription Oxy is at $1 per milligram, so our 30-mg dose — considered moderate strength (the dosages go up to 80-mg) — is a $30 purchase for those who want to abuse it.

But it’s plentiful. Oxy and narcotic pain relievers like it — Percoset, Vicodin, others — are the most widely prescribed in the United States, which takes 80 percent of the world’s opioids and 99 percent of its hydrocodone. Doctors might prescribe 30 for a patient who takes five or 10 to get through the aftermath of shoulder surgery and sticks the rest in the medicine chest, just in case he sprains an ankle down the road and needs something stronger than Tylenol. Those extra pills have a way of being found — by teenagers looking for party drugs, by house burglars looting more than the jewelry box. And soon our Oxy is out on the street, being swallowed or ground and snorted for recreation, not relief.

Let’s say today it’s inhaled by one of those among us predisposed to addiction, whose nervous system reacts to these substances — alcohol, drugs — differently from the rest. For these people, the message received by the brain is very simple: You complete me.

“We’re taught at an early age to take medicine to feel better,” says Dr. Mark Menestrina, until recently chief medical officer at Brighton Hospital. “But for people with that predisposition, when we use substances, we have a very different response. We feel a lot better. We get extreme reinforcement. It’s the answer to all of our problems.”

Menestrina says “we” because he’s an addict himself, a disease he describes as “a genetic predisposition with environmental exposure.” Or, to put it in layman’s terms: Genetics loads the gun and substances pull the trigger. Menestrina had a long history of alcoholism in his family; he liked to drink himself. As a practicing family physician, he knew a drunk doctor was a problem, but in the magical thinking of addicts, decided the problem wasn’t his drinking, but the smell of liquor on his breath. So he switched to drugs.

“The only drugs I haven’t used are ones that weren’t invented when I was out there using,” he says today, with evident good cheer. Although, as you might expect, the 14 years it took him to get clean weren’t a very cheerful time.

“I lost my [medical] license, my job, my wife, my car,” he says. “I lost everything.”

It’s a common story in recovery, the only story, the one everyone knows. But this story is about that OxyContin pill. When it was swallowed by the future addict, or disappeared up that person’s nose, or into their arm, it was no longer a substance for relieving specific pain in the back or knee, but one to relieve a more amorphous sort — of addiction. Depending on who ingested it, it might have been only the first tickle of a growing dependence or just one more quickly passing high in a years-long habit. Now the ripples are moving.

Prescription-drug addiction is approaching crisis levels around the country. In 2009, the last year for which data are available, approximately 7 million Americans used “psychotherapeutic drugs taken non-medically,” the National Institute on Drug Abuse reports. Psychotherapeutic drugs target the central nervous system, and include pain relievers, tranquilizers, stimulants, and sedatives. The problem is being driven by a complex and interwoven collection of forces that encompass everything from a lousy economy to savvy marketing by pharmaceutical companies (these are medicines, after all) to the Internet’s Wild West marketplace to libertarian social policy.

“You can get a fair amount of this over the Internet,” says Tom Ghena, administrative director of Henry Ford Behavioral Health’s Maplegrove Center. “It doesn’t take a lot. An addict can be very adept at getting significant quantities of Oxy and Vicodin sent to him over the Internet. They’re good at finding docs who are selling prescriptions.”

Other doctors, Ghena says, “aren’t crooked but are overwhelmed.” Faced with large patient loads and ever-shrinking time to spend with them, some respond by reaching for the prescription pad.

“I talked to a doctor who is taking over a practice, and was just astounded at how many patients were on these drugs,” Ghena adds.  Doctors treating patients with chronic pain need to be aware of the potential for abuse and dependence, and carefully manage their prescriptions accordingly.

Ghena cautions that there’s a difference between addiction and dependence. The latter can be created by treating a condition long-term; patients can develop dependence and need to be nursed through withdrawal. Addiction is increased tolerance combined with a compulsive using style, the more-more-more that leads the user down the familiar spiral. What prescription-drug addiction does, however, is collapse the time frame, sometimes drastically.

“In some ways, the addiction field hasn’t changed at all,” Ghena says. “The way we understand it is the same as it was 20, 30, 40 years ago. What’s different is, the average age is dropping, due to neurochemistry. It takes a good 10 years to develop an alcoholic pattern of drinking, but opiate addiction can develop in six months.”

Once it does, here’s what happens: Prescription pills, as easy as they can be to get, are expensive, and addicts are often cash-poor. Before long, they’re looking for something cheaper.

Again, a tangled web of factors is making a par- ticular opiate widely available at a bargain: heroin.

Those who might think of this as the ultimate opiate, the last word in hard-drug use, confined to ghettos, homeless encampments, and other nihilistic venues, should talk to Diane Montes, a Livonia youth pastor whose son, Brian, overdosed and died in his bedroom five years ago.

“Heroin? People under a bridge in Detroit do heroin,” she says today, speaking of her disbelief at the time. “Not young men in close, loving families who eat dinner together.” The Montes family was devastated to discover, too late, that Brian, a Michigan State student between his junior and senior years, had been experimenting with it.

Heroin is in abundant supply around the world, most of it entering the country via Mexico. And it’s not all being shot under bridges in the city. More than one-quarter of those seeking heroin treatment in Genesee County are under 29. Even affluent suburbs like Grosse Pointe are seeing the drug turning up in their communities.

“We’re well aware of heroin here,” says Dan Jensen, police chief in Grosse Pointe Farms, where last year one of his officers arrested a teen boy who admitted having recently used the drug. “His sister said, ‘Well, he only uses it recreationally,’ ” Jensen says.

The spreading ripples haven’t been confined to users and their families. Drugs are the driving force behind theft, petty and otherwise, throughout the area, Jensen says. Residents who fail to lock car doors, or leave their garage doors up while they run to the store, are coming home to find small electronics and lawn-care equipment missing. It frequently makes a short hop across Mack Avenue, to a drug house or a dealer, to be traded for whatever the user can get for it. These mini-crime waves come and go, and nearly always have an addict behind them.

 

The Specter of Heroin

When Diane Montes’ son, Brian, died of an overdose in his bedroom six years ago, she and her husband had no idea he was using hard drugs. They knew Brian, a Michigan State student between his junior and senior year, was an occasional binge drinker, but so are many college students. They knew “something was wrong” the summer of 2006, but they didn’t know what.

“I was picking up glasses he’d been drinking from and taking sips,” thinking maybe he was drinking on the sly, Diane says. They sent him to a doctor, concerned that he might be depressed. But until that terrible day in June when she walked into his bedroom to find him already cool to the touch, she had no idea he was using heroin.

She vowed that she would do her best to make sure it didn’t happen to anyone else. Twelve young people in Livonia died of drug overdoses that same year, and other small suburbs have had similar death tolls in recent years. Montes was instrumental in founding the Save Our Youth Task Force, aimed at educating young people and parents about the law, the risks, and the resources available to them.

“The idea was not just to educate young people, but bring all stakeholders to the table and get people working together,” Montes says. “Not enough is being done. People have the attitude that drugs will always be around, and there is nothing you can do.”

The task force first published a resource guide for parents, then, in cooperation with law enforcement, a pamphlet that briefed parents on what they needed to know about laws and consequences.

But they find their most powerful help from speakers. “Young people in recovery will share the things they did as a result of their addiction,” Montes says, adding that the message is the same throughout: There’s always hope.

Her own message to parents is to trust their instincts.

“You know your children better than anybody,” she says. “If something is up, it’s up. If they say they’ve used once, they’ve used more often. If they say [the drugs] are someone else’s, it’s theirs.

“Don’t overreact, but I want to warn parents this is out there. Who would in a million years think your child would use heroin? Don’t be one of those parents who says my child would never do this.”

— Nancy Nall Derringer

Information: saveouryouthtaskforce.com.


 

As common as drug abuse has become in this country, our strategies for dealing with it lag badly. Ghena says the classic inpatient treatment period of 28 days, followed by outpatient care and 12-step meetings, is quickly becoming passé.

“It’s the economy of it,” he says. “Addiction treatment is funded by insurance, which gets into health care, and gets into employment. Huge numbers of people are unemployed and don’t have insurance.” Plus, insurance companies are always trying to find less-expensive options, and more are switching to acute care for the four-day initial detoxification period before switching to outpatient.

“Funding for adolescent alcoholic and drug treatment is nil,” says Menestrina, who regained his medical license after recovery at Brighton and changed his specialty from family practice to addiction medicine. “Brighton used to have an inpatient adolescent treatment center, but it closed almost 10 years ago. The funding dried up.” (Diane Montes responded to her son’s death in part by forming a foundation in his name that raises money for adolescent treatment. They’ve been able to send 10 through programs.)

An increasingly popular treatment option is the so-called three-quarter house, a group home for addicts trying to learn a new way to live. Mark Burchell owns and runs Doorway to Recovery, a network of 13 houses for men and women across the metro area, where addicts pay $420 a month rent and, in the process, break old habits. Burchell got into the business after using the model to break his own addiction. But it didn’t happen in 28 days, or four days, or even four months. “I stayed in mine for 18 months,” he says. “I recommend at least a year. It takes that long for people to readjust.”

Doorway to Recovery residents go to Tigers games, have picnics, make their own beds, and show up for jobs, all while undergoing random drug tests, until they’ve learned how to do all of those things sober. In the process, ideally, they give up their standard defenses. Burchell ticks off his own: “I don’t give a s—, I do things when I want the way I want, I’m lazy and kiss my ass.”

He’s looking out at his clients when he says this, a crowd of mostly men, assembled for a weekly meeting. They’re lectured about leaving doors open in air-conditioned houses, about not gathering on front porches, about the sorts of issues that come up when non-related adults share housing. The room smells of cigarettes, the men with that rode-hard look addicts get. Burchell scans the room with knowing eyes, and stops on one.

“Get out of here,” he says, jerking a thumb toward the door. “Don’t come here to nod. Dirty on benzos, you are.” A red-eyed client rises and leaves the room to drop urine for a test, which comes back dirty. The ripples spread a little farther.

Derringer is a Grosse Pointe Woods-based freelancer. Email: editorial@hourdetroit.com.


 

Addiction: Alcohol

By: Richard Bak

Alcoholic? Yes. Anonymous? Hardly.

Ted Everingham is a familiar face in Grosse Pointe circles, the consequence of his many community and professional involvements, most of which revolve around his twin passions of the law and boating. A past commodore of the Bayview and Detroit yacht clubs, he hosts Great Lakes Log on local cable television and covers the Bayview Mackinac Race for WJR.

When it comes to describing his struggles with addiction, he is an open book, though after all those years of “doing my share to keep the scotch industry in good shape,” some of the passages resemble the blacked-out redactions of an FBI file. “I can remember more than once being terrified that I was driving and not knowing where I was supposed to be going,” he says. “But the most frightening and sad thing was going to a birthday party or some other family gathering and only remembering part of it.”

At 72, he is trim, tan, and with a full head of silver hair. Born in Buchanan, Mich., and raised in Jackson, he is a graduate of the University of Michigan Law School and a former partner at Dykema Gossett. He has been in private practice since 1998, specializing in joint ventures, mergers, acquisitions, and other complex transactions. On this Friday morning he’s wearing the uniform of a corporate attorney: a snow-white shirt, tastefully colored tie, and blue pinstripe suit pants with a crease so sharp it could carve a holiday turkey. His tasseled shoes shine like black marble. His office on Kercheval has the requisite Grosse Pointe touches: understated traditional furniture, maritime prints.

Although Everingham has been sober for 34 years, he is apologetic about his story. He knows how much more colorful the telling would be if he had become a punch line at work known to snickering secretaries and offended clients as “Stinky Ted,” how much more theatrical it would be if he had been reduced to living out of some cardboard box near the train station, a bothersome panhandler dubbed the “Mayor of Roosevelt Park” as he accosted folks up and down Michigan Avenue for “bus fare.” In fact, he admits that sometimes for the sake of drama he fudges the date of his intervention, changing it to happening on his birthday instead of the day after. “You know, the idea of re-birth,” he says. “It makes for a better story.”

Revisionism isn’t necessary. Ted Everingham is Ted Everyman, which means the banality of his experience actually has greater resonance with his white-collar contemporaries. The narrative of the typical middle-class professional who slips into alcoholism follows an unremarkable but sadly familiar arc: years of abuse and denial, interrupted by a personal epiphany or intervention, followed by treatment, and, if they’re lucky, recovery and redemption, not relapse and recycle. Everingham is one of the lucky ones.

“I did look somewhat bad for my age,” he remembers. “I was a little puffy-faced. I wasn’t eating right. But I wasn’t falling-down drunk. I wasn’t showing up at work needing a shave or wearing four-day-old shirts. I wasn’t pulling a bottle out of my desk drawer in the middle of the morning. Your tolerance increases and you’re not really aware of it. I suppose by the end I was getting in a little late, leaving a little early. I felt I was still functioning as well as I should.”

According to Lloyd Semple, he wasn’t. Semple attended law school with Everingham, then joined him at Dykema Gossett. Today he is dean of the law school at the University of Detroit Mercy. “Ted is a very good lawyer,” he says. “He’s very good in terms of doing the real nitty-gritty detail work, the kind of work that many lawyers don’t like to do.” Semple remembers Everingham going to lunch with a fellow attorney who had an incredible capacity for alcohol. “Ted would try to keep up. But while this other amazing creature could go right back to work as if he hadn’t had a drop, Ted would be wiped out. We started getting feedback from clients.”

On Sunday, May 22, 1977, Everingham celebrated his 38th birthday with what turned out to be the last drops of alcohol he would ever have. The following day at work, the firm’s executive partner invited him into his big corner office. Everingham was told that, effective immediately, he was on a paid leave of absence while he concentrated on the more important challenge of drying out and turning his career — and his life — around. “He was told, ‘You know, Ted, if you don’t get this under control, you’re going to lose your job, and then you’re going to lose your family,’ ” Semple says.

Ted’s reaction? “I felt relieved, like I was having a burden lifted,” he says. “I was really good at stopping because I had tried it so many times before on my own.” Now he was getting expert help. By the end of the week, Everingham was checked into Brighton Hospital. “We didn’t call it an intervention then,” he says. “There just wasn’t the kind of awareness about addiction that there is today.”

Brighton Hospital was the first treatment center for alcoholism and addiction in Michigan, growing out of a program started at the Bloomfield Hills Sanitarium during World War II. The current hospital campus in Livingston County was acquired in 1950. Bill Wilson, co-founder of Alcoholics Anonymous, helped develop Brighton’s month-long inpatient program. Early on, Brighton partnered with the State Bar of Michigan, establishing an assistance program open to attorneys, judges, and law-school students.

Brighton was a humbling experience, Everingham admits. “It didn’t matter if you were a graduate of one of the finest law schools in the country or a high-school dropout. We were all wrestling with the same demon.” There were about 60 people in recovery, and one, an optometrist from the west side of the state, became a quick friend. “In the evening, after dinner and the last meeting of the day, we’d sit in the lounge and talk, talk, talk. We’d talk about our fears, our hopes, our goals. It was really good because it allowed us to examine ourselves.”

Everingham’s self-scrutiny revealed a rewarding life that was in danger of being lost because of the bottle. At the time he was living in a 3,000-square-foot Tudor in Detroit’s University District with his wife of 16 years, Marcia, and their three school-age children. He had a sedan, a station wagon, and a sailboat. He didn’t want to lose any of that. At the same time, he was looking to regain his self-respect.

Reflecting on his life, Everingham saw that his addiction had come on gradually, quietly. “I didn’t drink as a kid,” he says. “My father liked to drink. In hindsight, I can see that he was an alcoholic.” Going to college in Albion, Everingham joined fellow frat-house members in regularly getting drunk — a pastime, not an affliction, he reasoned. After graduating from U-of-M law school in 1964, he fulfilled his longtime dream of practicing law in the big city by moving to Detroit. The era’s uninhibited drinking, perhaps best depicted today on AMC’s acclaimed Mad Men, a show about Madison Avenue ad men of the 1960s, was in full force as Everingham coped with the pressures of a new career and a growing family. Soon, Everingham was drinking a fifth of scotch every other day, in addition to the usual beers and martinis that crossed his path in the course of conducting business or pursuing a good time.

“As you may know, alcoholism is not uncommon in the legal profession,” Semple says. “Lawyers are under pressure 24 hours a day: heavy case loads, trying to make partner, generating new business. I know experts argue the causes of alcoholism, how much is genetic, how much is environmental, how much can be attributed to education or social standing. It is what it is. It’s very hard to determine how someone will react to alcohol. Some people can handle drinking, but for others, alcohol gets the best of you.”

Brighton’s program consisted of detoxification, education, and group discussion. Withdrawal was not as agonizing an experience as Everingham had imagined. “I didn’t have any tremors, cold sweats, or the DT’s,” he says. “I was given some medications to help ease the symptoms. In a few days, I was feeling better. I was off the alcohol and eating good meals again. You know, most alcoholics are malnourished because alcohol has been our ‘nourishment.’ It was a 28-day program, and I remember being proud at the time that I was allowed to leave two or three days early.”

Everingham anxiously returned to work. Those who knew the nature of his absence were very supportive, he recalls: a pat on the back, a quiet word of encouragement, an invitation to lunch, sans the usual martinis or scotch. For his part, Everingham was worried about meeting a client at Joe Muer’s. “That scared me some. What would they think? And more importantly, how would I react?” This was the 1970s, and ordering a soft drink at a restaurant, club, or some other masculine enclave “still raised eyebrows,” he says. Everingham’s sobriety “required tremendous self-discipline,” says Semple, whose own mother struggled with alcohol dependency.

For alcoholics, the support of family, co-workers, and similarly afflicted strangers is particularly crucial in the early stages of recovery. Everingham remembers his first Alcoholics Anonymous meeting one summer evening inside a windowless room in the Blue Cross Blue Shield Building on East Lafayette. “Talk about your smoke-filled room. Everybody was smoking cigarettes and drinking bad coffee. But it was good. I said aloud what I’d been saying to myself for years: ‘I’m Ted and I’m an alcoholic.’ ”

As his recovery continued over the coming years, Everingham battled temptation. “The hardest time was just going to an Italian restaurant,” he says. “We would go to Roma’s and I would really want a nice robust red wine to go with all that good Italian food.” He also puzzled over the unraveling of certain friendships. “Some were uncomfortable with my recovery. They quit coming around. I thought they were friends, but I eventually decided that to them I was just a reminder of their own problems.” Conversely, others “who were good friends became closer friends. If alcohol is the glue that holds a friendship together, then you’re really not friends in the first place.”

Today, Everingham professes to be proud that he went through what he did. “I tell everybody I’m glad I’m an alcoholic,” he says. “I’m a better person for it. I have more empathy for people. And I believe it has served a purpose. It allows me to help others. I think, well, I came out of this particular closet; why’d I do it? I’ll talk about it in front of community groups, on television. It’s worthwhile if someone can look at me and say, ‘This works.’ ” Everingham keeps liquor inside his home, though he’s “happy with an iced tea,” he says. His wife still drinks a glass or two of chardonnay at dinner, and it’s no longer uncomfortable for friends at a cocktail party to ask if he’d prefer a Coke or ginger ale. He doesn’t go to AA meetings nearly as frequently as he once did, having found that “in a way, the entire community is my support group.” Talking about it as openly and regularly as he does, in as many venues as possible, “fortifies my recovery,” he says.

“I have tremendous respect for Ted,” Semple says. “He realized he was headed for the scrap heap. He pulled himself together and has had a complete and lifelong recovery. He didn’t have to be recycled. It’s never easy, but Ted has shown that someone can become sober — and, more important, stay that way.”

Bak is a Dearborn-based freelancer. Email: editorial@hourdetroit.com.


 

Are you an alcoholic?

Dr. Mark Menestrina, addiction medicine specialist most recently of Brighton Hospital, uses the word “CAGE” as a memory device when assessing patients for alcoholism.

1. Have you ever tried to Cut down on your drinking?

2. Do people Annoy you with comments about your drinking?

3. Do you ever feel Guilty about your drinking?

4. Have you ever had an Eye-opener to calm your nerves in the morning?

“If the answer is yes to two out of four, I ask more questions,” Menestrina says.

“Three out of four, or four out of four, and you’ve got a live one.”

— Ilene Wolff


 

Addiction: Alchohol’s Effect

By: Ilene Wolf

Every one of us has a laboratory inside our body that’s more sophisticated than any lab in the world: the liver.

The lab assistants in our liver are always busy processing nutrients, filtering toxins, generating enzymes, and doing other tasks that help keep us alive and healthy. Research has shown that a small amount of daily alcohol is good for us. But, when we drink too much alcohol, our lab workers can’t follow instructions or go on break, and can’t keep up with their workload.

“The liver can adjust to increasing amounts of alcohol, but it takes a toll,” says Dr. L.J. Dragovic, Oakland County’s chief medical examiner.

As alcohol kills cells in the liver, it leaves behind scarring known as cirrhosis. To compensate, the organ regrows itself and can become twice its normal size, Dragovic says. It chugs along, trying but failing to do its job. After enough time passes, most of the lab assistants resign. If there’s no one to take their place — with a liver transplant — the laboratory starts to shut down. This typically happens sooner in women in men, possibly due to their female hormones. The liver gets hard as a rock, the body wastes away, skin and eyes turn yellow, and the belly fills with fluid. Before long, the body takes a cue from the lab assistants and it resigns, too.

But before that, alcohol affects just about everything else in the body, especially the heart and brain. It raises blood pressure, increases triglycerides (which correlates to higher cholesterol), decreases the clotting ability of platelets in the blood, enlarges the heart, or makes it beat irregularly. It even makes small blood vessels burst, producing the alcoholic’s telltale red nose.

What happens in the brain tells another tale.

Your Brain on Booze

One task on the liver’s to-do list is filtering out substances that are toxic to the brain, such as ammonia, a byproduct of digesting protein. But when the liver starts to malfunction from repeated assaults by alcohol, the brain is bathed in ammonia and other poisons. This leads to confusion, forgetfulness, and an inability to concentrate.

Because alcoholics often eat poorly, they become vitamin deficient. A chronic lack of vitamin B-1 destroys some of our gray matter, leading to a condition called “wet brain.” If you look at a CT scan of a wet brain, it resembles Swiss cheese, says addiction specialist Dr. Mark Menestrina, a staff doctor at Brighton Hospital for 12 years who recently left to become a medical adviser in private industry. “And you lose cognitive function,” he says. At first, an alcoholic with wet brain can’t walk without staggering, has trouble swallowing and talking, and is confused. With continued drinking, he can’t make new memories or recall the past.

Cancer in a Bottle

Alcoholics also make poor use of vitamins B-12 and A, which work against cancer. This, along with the carcinogenic effects of alcohol breaking down in the body, may let damaged cells divide with drunken abandon until a tumor forms, says oncology researcher Dr. Jennifer Beebe-Dimmer, of Wayne State University and the Karmanos Cancer Institute.

Beebe-Dimmer adds that because so many alcoholics smoke, their alcohol and cigarettes conspire to help cancer along. Alcohol is the delivery truck that gets tobacco’s carcinogens to a body’s tissues, and then rams through the door to the tissue’s cells to let the cancer causers in. Cancers associated with alcohol include those of the breast in women, head and neck in men, and liver, colon, and rectum in both sexes.

In people who light up along with their drink, those cancer risks add up exponentially, Beebe-Dimmer and addiction expert Menestrina agree.

For example, a person who smokes two packs of cigarettes a day has a three-times greater risk of oral cancer versus a non-smoker. Similarly, someone who drinks 32 ounces of beer, 13 ounces of wine, or four shots of liquor daily has twice the risk of a non-drinker. But a two-pack-a-day smoker who guzzles four shots a day has a risk ranging from 16-to-30 times that of a non-smoking teetotaler.

Rehab

Even more stunning than the severe effects of combining alcohol and cigarettes are the dangers of withdrawal. When British singer Amy Winehouse died in July, her family and others speculated that it may have been from her cold-turkey approach to stopping drinking after years of abuse.

Menestrina explains that alcohol depresses the central nervous system. To stop suddenly after longtime use causes a rebound effect: the pulse races, the body trembles and sweats, and sleep is impossible. The most dangerous result is a condition known as delirium tremens (DTs), known for its agitation, confusion, hallucinations, fever, and seizures. Just as when all the liver’s lab assistants quit, the DTs may help the body decide to call it quits too.


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