Avoiding Tobacco, Alcohol, and Caffeine

In this article:

  • Quitting tobacco cuts risks
  • Drowning in alcohol, raising your blood pressure
  • Decreasing your blood pressure by curbing caffeine

Suppose we told you that even if you’re older than 45 years of age, you can do all the following:

  • Improve your work performance, your sex life, and, if you’re pregnant, the health of you and your baby
  • Increase your social activities and the possibility of living longer
  • Reduce the possibility of getting a driving ticket, contracting a sexually- transmitted disease, and committing suicide or homicide
  • Lower your blood pressure

Would you make a little sacrifice? Of course. All that you need to do is quit smoking (or chewing smokeless tobacco), drinking alcohol excessively, and drinking coffee. You’re probably thinking those are easy for us to say but much harder for you to do. Lucky for you, we give you every available tool to make this lifestyle improvement as easy as possible. Nothing you do for your health can make a greater difference than cutting out tobacco and significantly reducing your consumption of alcohol and caffeine.

In this article, we take up each one of these dangerous habits individually and discuss how they affect your blood pressure. We also discuss how eliminating these poisons from your life can help lower your blood pressure and make your mind and body healthier in the process.

Tobacco, alcohol, and caffeine most often go together. The person who smokes more often than not is the person who drinks too much alcohol and caffeine. Tobacco, alcohol, and caffeine represent a triple threat to your health. But within that triple threat may also be triple salvation. Reducing or eliminating one of these poisons often leads to a reduction or elimination of one or both of the others. The tendency to have that cigarette with your scotch or your coffee is eliminated if you don’t drink the scotch or the coffee.

Playing with Fire: Tobacco and High Blood Pressure

When you play with fire, you get burned. When you smoke, you run the risk of getting burned inside and out. Whether tobacco is smoked, chewed, or taken in by any other means, the nicotine (a colorless, poisonous chemical used to kill insects) in the tobacco raises the blood pressure. The more you smoke, the higher the nicotine level in your blood and the higher your blood pressure. To a large extent, this effect accounts for the great increase in strokes (brain attacks) (see article 7), heart attacks (see article 5), and pain in the legs due to poor circulation in smokers, sometimes leading to amputation.

Nicotine raises your blood pressure by constricting your blood vessels. The oxygen in your blood decreases as the nicotine directly stimulates the production of epinephrine (also known as adrenaline, a hormone that raises blood pressure) in the adrenal gland. After tobacco use raises blood pressure, you’re at risk for all the medical consequences of high blood pressure (Part II describes these), not to mention diseases such as mouth and lung cancer associated with smoking.

Numerous studies have shown that smoking and chewing tobacco raise blood pressure and that when you stop using tobacco products, your blood pressure falls. The latest such study in the Journal of Hypertension (March 2007) comes from China. For ten years, researchers followed 10,525 men and women who did not initially have high blood pressure. At the end of the study, key predictors of future high blood pressure included age, weight, excess alcohol, and cigarette smoking. Do you need more evidence than that?

The reason people have so much trouble giving up smoking is because they’re nicotine dependent. But along with the nicotine, cigarette companies generously provide more than 60 chemicals that are known to cause cancer and more than 4,000 other chemicals in each cigarette.

Cigarettes (and smokeless tobacco like chewing tobacco) deserve their own book, but in the following sections, I give you enough evidence of the dangers of tobacco and enough helpful advice to quit that you’d have to be a real dummy not to stop immediately, if not sooner. Consider this: Drugs that cause only a small fraction of the illness and death that tobacco can be blamed for have been taken off the market. So why are cigarettes still sold legally and advertised in prestigious magazines? The answer to that question lies squarely at the feet of government and the millions of dollars in cigarette sales that are turned around and used to influence that government. Some day you’ll look back on these times and ask yourself, “Could I really have been that stupid?”

You benefit from stopping smoking no matter your age or physical condition.

Examining the extent of the problem

Forty-six million Americans smoked in 2001. The problem is even greater in other countries. One-third of the population of the world older than age 15 smokes, a total of 1.4 billion people. In many other countries, more than half the adult population smokes.

The overall rate of smoking in America has declined from 25 percent in 1993 to 22.8 percent in 2001 according to the United States smoking statistics of the National Institutes of Health. The federal government has set a goal of 12 percent by 2010. However, this goal isn’t achievable at the current rate. The decline in other countries has been even less.

Regarding the age of smokers, about 18 percent of youths age 12 to 17 years smoke, 27 percent of young adults age 18 to 25 years smoke, 22 percent of people age 26 to 44 years of age smoke, and only 10 percent of adults aged 65 and older continue to smoke. Most tobacco users begin before the age of 18 despite the tobacco companies’ continued efforts to avoid attracting that age group.

At a rate of 33 percent, Native Americans lead among the various ethnic groups in percent of smokers. Caucasians and African Americans have the same rate of about 24 percent, and about 17 percent of Hispanics are smokers. Only 12 percent of Asians and Pacific Islanders are smokers. People can stop smoking. The evidence is 46 million former smokers in the United States in 2002.

The direct costs of smoking (like health insurance costs, use of medical care, and expenses due to medical care) amount to more than 60 billion dollars per year in the United States alone. The indirect costs (like loss of work due to smoking-related illness and loss in productivity from deaths due to smoking) add another 90 billion or so dollars. Many experts suggest that cigarettes should have a much higher tax to meet part of these costs. This added cost would not only help to pay for the self-inflicted diseases of smokers but also discourage the purchase of cigarettes in the first place. The current gradual decline in smoking among the population is the result of the last increase in cigarette taxes. 

Putting one foot in the grave

Blood pressure elevation is just one of smoking’s many consequences. Other smoking-related complications are as follows:

  • Lung cancer is 20 times more likely among smokers than nonsmokers.
  • Cancers of the mouth and throat as well as the bladder are more likely among smokers. The connection isn’t as clear, but smoking is also likely to increase the possibility of cancers of the liver, large intestine, pancreas, kidney, and cervix in women.
  • Coronary heart disease is much more common among smokers, whether they have increased blood pressure or not.
  • Strokes (see article 7) are more common among smokers — again, regardless of elevated blood pressure.
  • Bleeding from rupture of the large blood vessel (abdominal aortic aneurysm)in the abdomen is more common.
  • Chronic lung disease is most often the result of smoking.
  • Lung growth rate is reduced among adolescents who smoke.
  • Women who smoke have trouble conceiving a baby, and if they do, they’re more likely to miscarry. Women who smoke also tend to start menopause at a younger age.
  • Smoking reduces bone density and increases the risk of fractures, especially in older women.
  • Tobacco dries and wrinkles the skin while it yellows your teeth, fingers, and fingernails.
  • A correlation exists between smoking and depression.

Do you need more reasons to stop smoking? Just keep this in mind: If you smoke, you’re not utterly cool; you’re an utter fool.

Combating secondhand smoke

Secondhand smoke (also called environmental tobacco smoke or sidestream smoke) is mostly inhaled from the burning end of someone else’s cigarette. This smoke can be just as deadly as smoke from the other end (the main-stream smoke) and perhaps more so because it’s mostly unfiltered and contains more of the poisons, including nicotine (check back to earlier in this section for more on this). Each year in the United States alone, secondhand smoke causes 3,000 non-smoker deaths due to lung cancer and 55,000 non-smoker deaths due to heart and blood vessel disease. 

Don’t become a victim of secondhand smoke. Just follow these guidelines:

  • Allow no one to smoke in your home or car.
  • Never smoke with children around.
  • Improve ventilation if exposure to smoke can’t be avoided.
  • Insist that offices and bars be completely smoke-free.

Turning a cheek to smokeless tobacco

Smokeless tobacco is tobacco that you chew or put into your nostrils. Types of smokeless tobacco include:

  • Snuff, which people in the United States place between the cheek and the gum and which Europeans sniff into the nose
  • Chewing tobacco, a wad of tobacco placed inside the cheek and chewed on to extract the juices.

In the process of using either one, a great deal of saliva is produced, forcing the user to spit frequently. How handsome is that! Smokeless tobacco provides at least twice as much nicotine as a cigarette. Eight to ten chews a day is equivalent to the nicotine content of 40 cigarettes! So, smokeless tobacco damages the heart and blood vessels over the long term, and it has greater and longer effects on blood pressure than cigarettes. In addition, smokeless tobacco is filled with agents that cause cancer.

Smokeless tobacco can’t help you quit smoking. In fact, it:

  • Is just as addictive as cigarettes, if not more
  • Can’t get rid of your nicotine cravings
  • Discolors your teeth and sours your breath 
  • Creates cancer in your throat, voice box (larynx), and esophagus

Not exactly great advertising material!

Giving up tobacco: All wins, no losses

Why should you give up something you find pleasurable and that may help you keep those extra pounds off? As far as the pounds, plan to get rid of those with more exercise and fewer kilocalories (head to article 12 to find out more about exercise). As for the pleasure, the short- and long-term health consequences when you quit are as follows: 

  • The healing starts within 12 hours as the carbon monoxide levels in your body fall. Your heart and lungs begin to function more normally, lowering your blood pressure and heart rate.
  • Your taste buds and your sense of smell return in a few days.
  • Your face wrinkles far less as you age.
  • If you’re attempting to get pregnant, achieving pregnancy is easier; after you’re pregnant, the pregnancy proceeds in a healthier manner.
  • Your smoker’s cough diminishes after a few days, though it may last for a while as your rejuvenated lungs begin to mobilize and expel the gunk accumulated over years of smoking.
  • The stench of stale smoke and the mess of cigarette butts are gone, along with the expense of smoking and the time wasted buying ciga- rettes and finding a place to smoke.
  • Your risk of early death is the same as a nonsmoker’s after 10 to 15 years of no cigarettes, depending on how long you smoked before stopping.
  • After five years, the risk of cancer of the mouth and throat — along with bladder cancer and cancer of the cervix in women — significantly diminishes.
  • After ten years, you have half the chance of developing lung cancer than if you continued to smoke.

Obviously, the healthy consequences of quitting tobacco are reason enough for you to stop, but other reasons may sway you just as much:

  • A loved one may tell you that the cigarettes go or you go. After all, kissing a smoker is like licking an ashtray.
  • The money you save may provide a down payment for a new car, buy a new computer, or just allow you to keep eating. If you’re a two-pack-a-day smoker, cigarettes at the cheapest price in 2007 cost you a minimum of $1,600 a year.
  • You freeze while standing outside several times a day just to get your nicotine fix.
  • You can use the time you save by not going to the store or standing out-side to exercise or do some other healthy activity.
  • You’re getting as disgusted as I am with the cigarette butts that litter city streets.
  • The days that you add onto your life aren’t just a matter of time. They’re productive, healthy days — days that you may have spent gasping for breath, with an oxygen tube in your nose, and too short of breath to walk over to your grandchild and hug her.
  • Your children do as you do, not as you say. They probably won’t smoke if you don’t, which means your grandchildren won’t either. So if you stop, you may prolong the lives and improve the quality of life of generations to come.

Kicking the habit

The last few years have seen a smoking-cessation-treatment revolution. Psychotherapy started it, and it was followed by nicotine gum and then nicotine patches. Today’s drugs take away the craving for nicotine but don’t contain it. In this section, you can find a method that appeals to you. We know you want to quit smoking because more than 70 percent of adults have expressed a desire to stop. Now’s your chance!

No one way works for all people. Try each one. If it doesn’t work for you, try another technique. Something will click eventually.

Keys to quitting

You must take five steps to ensure that you quit and don’t relapse. If you do relapse, start with these same five steps next time:

1. Prepare yourself. Set a quit date and make it special. After all, your body is being reborn. Your birth date will do nicely — a day of celebration for the rest of your life.

In addition:

  • Make a list of reasons to quit.
  • Improve your fitness, which makes any significant change easier to manage.
  • Avoid drinks with caffeine to help you to sleep after you quit smoking (I show you how to curb your caffeine intake later in this chapter).
  • Satisfy your hunger with low-calorie beverages or snacks.
  • Relax yourself by exercising, taking a bath, or meditating.
  • Treat any cough with cough drops or hard candy.

2. Benefit from the support of friends and loved ones.

Let everyone know you’re quitting and ask for help, especially by not smoking in your presence. Even better, ask them to stop with you.

Use individual or group counseling to support you. This may mean talking to someone several times a day when you’re trying to quit. Check with your doctor or other healthcare provider for ideas that she may have to help you. 

3. Use new skills to handle problems that arise. Find enjoyable distractions (like exercise, reading a good book or watching a good movie) that substitute for the urge to smoke.

Stop activities that you combine with smoking (like an alcoholic drink or coffee, the morning break, or whatever you know to be a smoking trigger).

Change your routine to emphasize the lifestyle change. For example, go for a short walk first thing in the morning instead of lighting up.

Before you stop:

  • Switch to a brand that you don’t like that’s low nicotine.
  • Smoke only half the cigarette.
  • Limit yourself to an increasingly smaller fixed number of cigarettes daily.
  • After you get down to seven or less, set a quit date.
  • Drink plenty of noncaloric fluids such as water.

4. Make use of the medications that have proven to be effective in help- ing a person quit. Ask your doctor about nicotine replacement therapy and smoking cessation aids, which I discuss in more detail in the next section.

5. Prepare for relapses. Everyone who has successfully quit smoking has probably done it on the second, third, or fourth try. Giving yourself another chance to succeed if your plan has a glitch is essential. A relapse usually occurs within the first three months. Meanwhile, you can avoid the situations where relapse is most likely:

  • Try not to drink alcohol, which can lessen your control. (I discuss methods for avoiding alcohol later in this chapter.) 
  • Stay away from smokers. You don’t even want a whiff of smoke.
  • Don’t return to smoking just because you gain weight. You can lose it sooner or later.
  • Don’t treat your nervousness, depression, or anxiety with a cigarette.

If you relapse, begin the process of quitting again as soon as possible. The less you smoke before beginning again, the easier it will be to quit again. Try to recognize the situations that blocked your previous attempts and avoid them the next time around.

Effective methods of quitting

Two effective methods for quitting smoking are nicotine replacement therapy and smoking cessation aids. You can buy some methods over-the-counter, but others require a prescription from your doctor. These are the details of each method:

Nicotine-replacement therapy: The point of nicotine replacement therapy is to deliver small doses of nicotine to reduce the withdrawal symptoms. If you have high blood pressure associated with nicotine intake, plan to use this therapy as short a time as possible because nicotine in this form still raises your blood pressure. The therapy comes in five forms:

  1. Nicotine gum, available over-the-counter, comes in 2 mg and 4 mg strengths. As you chew, nicotine is released and absorbed by the membranes in the mouth. By reducing the number of pieces each day, you reach a day when you need none.
  2. Nicotine lozenge, a tablet that dissolves and delivers nicotine through the lining of your mouth, is also available in 2 and 4 mg doses.
  3. Nicotine patches, available both by prescription and over-the- counter, release nicotine gradually through the skin. They come in 15 mg strength or in varying doses that decline as withdrawal from tobacco continues. Note: People with allergies to adhesives have trouble with this method. Combining the gum or lozenges with the patches may work better than either alone, but be sure to get your doctor’s approval before using both treatments together.
  4. Nicotine nasal spray is available by prescription only. You inhale it whenever you have an urge to smoke. People with a sinus condition find it difficult to use.
  5. Nicotine inhalers, available by prescription, deliver nicotine in a vapor into the mouth, where the membranes absorb it. The inhalant may irritate the mouth and throat.

Smoking-cessation aids: These don’t contain nicotine but do decrease withdrawal symptoms. New preparations seem to appear almost daily. Some examples include the following:

  • Bupropion SR, trade name Zyban, is available by prescription and acts to disrupt the addictive power of nicotine. At a dose of 300 mg given as 150 mg twice daily, it effectiveness has been proven in large studies of smokers. A combination of bupropion and a nicotine-replacement aid (see the previous list) accomplished a much higher rate of quitting than either one did alone.
  • Varenicline, trade name Chantix or Champix, available by prescription, acts within the brain to diminish the high from smoking and decrease withdrawal symptoms. The dose is 1 mg twice a day.
  • Nicotine vaccine is a potential new treatment that prevents nicotine from getting to the brain. This may be available in the next year or two. A single vaccination is required. 

Tapping into resources

With the availability of the World Wide Web, you have many resources to help you quit smoking at the peck of a key on your computer keyboard. If you’re computer-challenged, you can access these resources by mail or telephone. Here are the best of the lot:

  • Agency for Healthcare Research and Quality has smoking cessation guidelines and other materials for both physicians and the public available at 301-427-1364 or on the Web at www.ahrq.gov.
  • American Cancer Society has many pamphlets and Web pages on quitting smoking as well as a bibliography of books and tapes on quitting available at 800-227-2345 or www.cancer.org.
  • American Lung Association has both information and clinics to help you stop smoking available at 800-586-4872 or www.lungusa.org.
  • American Heart Association provides information on smoking- cessation programs in schools, workplaces, and healthcare sites. To obtain, call 800-242-8721 or visit the Internet at www.americanheart.org
  • National Cancer Institute (NCI) is a division of the National Institutes of Health. The NCI researches quitting smoking, promotes programs to decrease the impact of smoking on health, and publishes materials on the Internet and in hard copy with tips on quitting and avoiding second- hand smoke. The NCI supports the Cancer Information Service from which these materials are available at 800-4-Cancer. The Web address is www.cancer.gov
  • National Institute on Drug Abuse (NIDA) is another part of the National Institutes of Health. It supports research on cigarettes and other sources of nicotine as an addictive drug. Fact sheets are available concerning drug abuse and addiction at 301-443-1124. The Web address is www.nida.nih.gov.
  • Centers for Disease Control Tobacco Information and Prevention Source has a database of smoking and health-related materials available at 800-232-4636 or on the Web at www.cdc.gov/tobacco.
  • Nicotine Anonymous is a 12-step program. To find out more, call 415- 750-0328 or visit the Internet at www.nicotine-anonymous.org.

Relating Alcohol to High Blood Pressure

This section tackles the second-most lethal substance you can put into your body: alcohol. Or maybe it’s the most lethal. We guess it depends on whether you’re looking at your lungs or your liver! In this section, we address men who drink more than two glasses of wine a day and more than ten glasses a week and women who drink more than a glass of wine a day and five a week.

Simply put, alcohol raises blood pressure. A comparison of the blood pressure of heavy drinkers (see the previous paragraph) with moderate and non-drinkers shows that alcohol does indeed raise blood pressure. When non-drinkers do drink alcohol, their blood pressure rises, and when heavy drinkers stop drinking, their blood pressure falls.

Abruptly stopping alcohol may cause a rise in blood pressure, so a doctor must carefully monitor this change.

Drinking large quantities of alcohol in one sitting (or standing, depending on the location!) also raises blood pressure, but it returns to normal if the drinking doesn’t continue. However, an individual who drinks excessively for extended periods of time has a persistent increase in blood pressure. The longer a person drinks, the higher the blood pressure; the more a person drinks, the higher the blood pressure. In this case, the double negative does not create a positive!

Eighty to ninety-five percent of alcoholics smoke cigarettes. We want to emphasize that eliminating the power of one habit goes a long way towards eliminating the power of the other. Cigarettes and alcohol may go together like Will and Grace, but smoking and drinking isn’t graceful or charming.

Surveying the symptoms of alcoholism

Alcoholism, the habitual or compulsive consumption of alcoholic liquor to excess, is an inherited physical abnormality, an inborn condition related to a certain type of body chemistry. Alcoholism is not a moral weakness.

A major medical consequence of alcoholism is a person’s much greater risk for strokes. A study in Annals of Internal Medicine (January 2006) showed that drinking more than two glasses of wine or the equivalent on a daily basis led to a considerable increase in strokes (brain attacks). (See article 7 for more information about strokes.)

If you’re taking medication for high blood pressure and drinking heavily, you need to determine whether you’re an alcoholic in order to clarify the role of your drinking in your blood pressure. You may be an alcoholic if you answer “Yes” to two or more of the following questions: Have you . . . 

  • Tried to reduce your drinking? 
  • Felt angry when someone talked to you about your drinking?
  • Felt guilty about drinking? 
  • Used alcohol in the morning to start the day and settle your nerves? 

The effects of drink

Endorphins, chemicals in the brain, are internal pleasure givers. The brain increases its release of endorphins when you drink alcohol. Habit-forming drugs like heroin also stimulate increased production of endorphins, creating a feeling of euphoria. Although alcoholics require more alcohol than a heroin addict requires heroin to get the same high, most people feel high at a blood level of 0.05 percent alcohol. The intoxication is severe at 0.2 percent blood level, and at 0.3 percent, the drinker may be in a coma. Death may occur when the level is 0.35 percent or higher.

Another way to determine whether you’re an alcoholic is to count the number of drinks that you consume in a week. (A drink is a 12-ounce bottle of beer, 5 ounces of wine, or 11⁄2 ounces of hard liquor.) Alcoholic men usually consume 15 or more drinks per week, and alcoholic women consume 12 or more. Those who consume more than five drinks in one sitting at least once a week are also considered alcoholics. Usually, alcoholics also . . .

  • Crave alcohol. They have a strong need to drink.
  • Lose control when they drink. They can’t stop after they start.
  • Have a physical dependence on alcohol. They have withdrawal symptoms (such as nervousness, shakiness, headache, and sweating) when they don’t drink.
  • Have a tolerance to alcohol. They need more alcohol than a non-alcoholic individual to achieve the same level of inebriation.

Looking at who’s drinking

According to the Journal of Studies on Alcohol (November 2001), alcohol use begins in high school even though it’s illegal to drink alcohol before the age of 18 in some states and 21 in the rest. In any given month, probably 70 percent of high school seniors have had alcohol to drink.

In the United States, the prevalence of alcoholism is 10 to 15 people per 100, which translates to more than 25 million alcoholics. An additional 10 million are problem drinkers who may become alcoholics, and the number of male alcoholics is only slightly greater than the number of females.

Alcohol abuse costs the United States 175 billion dollars every year due to lost productivity, early death, medical treatment, and legal fees for all the problems alcoholics get themselves into (such as auto accidents, fights, unprotected sex, and so forth).

Understanding alcohol’s medical consequences

Alcohol abuse can lead to two major, long-term medical problems:

  • Cirrhosis (tissue scarring) of the liver with gastrointestinal bleeding, liver failure, and death
  • Heart disease associated with high blood pressure

The following list of additional health consequences from excessive alcohol use is long. Unfortunately, you don’t get just one or another of these compli- cations, but all of them at the same time. The load is too heavy for anyone to bear, particularly for the elderly.

  • Depression of the central nervous system with loss of ability to perform complex tasks like driving; decreased attention span and short-term memory; impaired motor coordination
  • Degeneration of the brain with loss of coordination and emotional stability; nerve degeneration with severe pain 
  • Addiction to tranquilizers to treat the emotional instability
  • Physical damage in motor-vehicle crashes
  • Increased risk of suicide and homicide
  • Increased risk of unplanned pregnancy and sexually transmitted diseases
  • Giving birth to a baby with fetal-alcohol syndrome, stunted growth, mental retardation, and other abnormalities of the face and heart
  • Poor nutrition from an irritated liver and intestinal tract, which produces heartburn, nausea, and gas
  • Loss of sex drive
  • Neglect of food intake and physical appearance
  • Sleep loss
  • Severe inflammation of the pancreas (pancreatitis) with severe abdominal pain and nausea
  • Increased incidence of cancer

Cancers of the mouth, throat, and esophagus have a much greater occurrence rate among those who drink and smoke than among those who only drink or those who only smoke:

  • A drinker is six times more likely to get mouth and throat cancer as com- pared to a nondrinker. 
  • A smoker is seven times more likely to get mouth and throat cancer as compared to a nonsmoker.
  • The individual who drinks and smokes is 38 times more likely to have mouth and throat cancer than the individual who neither drinks nor smokes.

Undergoing treatment

All the medical consequences of alcoholism (except cirrhosis of the liver, which is irreversible) start to reverse after you give up alcohol, particularly (for the purposes of this article) the blood pressure. In addition, you may regain your job, your family, other loved ones, and your self-respect.

Through the years, the study of alcoholism and its treatment has proven useful in many ways. Most importantly, we now know that the more help the alcoholic gets and uses, the greater his chance for prolonged sobriety. Statistics that support this philosophy include the following:

  • Only 4 percent of alcoholics who try quitting on their own are sober after a year.
  • 50 percent of alcoholics who go through treatment are sober after a year.
  • 70 percent of alcoholics who go through treatment and regularly attend Alcoholics Anonymous (AA; see the later section “Alcoholics Anonymous”) are sober after a year.
  • 90 percent of alcoholics who go through treatment, attend AA meetings, and go to aftercare (self-help groups and individual therapy sessions) once a week are sober after one year.

Treatment and aftercare are undoubtedly valid and important. Treatment consists of three steps: a brief intervention during which the alcoholic is convinced to undergo therapy to stop drinking; a period of total abstinence from alcohol (detoxification); and finally, sessions that help the alcoholic develop techniques to keep her sober for the rest of her life. These techniques include drugs and AA.

The intervention

An intervention is recognized as the best way to help everyone affected by the person’s drinking. It has two goals: first, to help the person who drinks excessively to stop; second, to help his loved ones deal with the issues his drinking has created. Even if the drinker can’t be helped, the other people benefit greatly. These steps precede an intervention: 

  1. Take care of yourself. If you’re the partner, child, parent, or employer of an alcoholic, first help yourself by going to Al-Anon (a support program similar to AA for the loved ones of the alcoholic). Second, get the support of a counselor who will provide a clear vision of the challenge and help you understand what you have to do to help the alcoholic.
  2. Use outside help for the alcoholic. Find an addictions counselor to help you with the complicated process of getting your loved one or yourself off of alcohol. (For direction on finding a counselor, see the later section “Locating useful resources.”)
  3. Create an intervention team. This team consists of people who care about the alcoholic but whose lives have also been made miserable at times by the alcoholic’s actions. The addictions counselor is an important part of the team. Each person puts in writing how the alcoholic has made his or her life miserable. They also tell the alcoholic to go to a treatment center and clearly indicate that they will no longer protect the alcoholic from her bad behaviors. Finally, they clearly explain how they will separate themselves from the alcoholic if treatment is not sought. For example, the spouse will leave the marriage.

When the alcoholic is sober, the team carries out the intervention in a controlled environment where she has to listen. The intervention continues until the alcoholic agrees to treatment or until the professional feels that nothing further can be done.

Detoxification

Detoxification means complete abstinence from alcohol. During this stage, the alcoholic must stop all drinking. Alcohol withdrawal consists of sweating, a rapid heartbeat, agitation, confusion, nausea and vomiting, and sometimes tremors or seizures. The alcoholic often becomes depressed. The symptoms may last three to seven days, but the doctor can treat them with medications.

During detoxification, the alcoholic should be evaluated for his addiction’s medical consequences like liver disease and abnormalities of blood clotting. Alcoholics often show evidence of nutritional deficiencies and should be treated with vitamins, minerals, and a healthy, balanced diet.

Drug treatment

Total abstinence from alcohol is the goal of treatment. Absolutely no amount of alcohol, no matter how small, is acceptable for a recovering alcoholic. The alcoholic enters a rehabilitation program of counseling, education, medical care, and nursing. Many of the people who help the alcoholic are recovering alcoholics, so they’ve been there. 

Can moderate drinking benefit your health?

For years, people thought that a drink a day would keep the doctor away. And a number of studies have shown that people who drink moderately (no more than two drinks daily for men and one for women) have healthy improvements in their hearts and tend to live longer than people who don’t drink at all. But a more recent study of 5,500 men in Scotland published in the British Medical Journal (June 1999) showed that drinking two drinks daily led to a higher risk of dying from all causes as compared with drinking less alcohol. In another study from Harvard Medical School, researchers discovered a fat increase in the livers of men who ate well but who also had a daily dose of alcohol not large enough to cause inebriation. So a word to the wise: Don’t start drinking just to obtain the medical benefits of alcohol.

The medications help prevent the alcoholic from returning to drinking or they block the effects of alcohol. The principal medications in current use are:

Disulfiram (brand name Antabuse): When mixed with alcohol, Antabuse triggers a severe hangover — headache, nausea, vomiting, increased blood pressure, and a rapid heartbeat. Note these cautions about this medication:

  • The person must be vigilant because many prepared foods like sauces and vinegars contain alcohol, which can set off a reaction.
  • It may continue to work up to two weeks after the individual quits taking it, and it shouldn’t be used during pregnancy. 
  • It interacts with certain other medications, especially blood thinners and anticonvulsants, so the doctor must be aware of the patient’s other meds.
  • It can negatively affect mental illness and cause a severe allergic skin reaction.
  • It may reduce a person’s sex drive and cause drowsiness (people who experience this reaction shouldn’t use dangerous machinery or drive a car while on the drug).

The patient takes the medication until he is in control of his drinking. This period may last months or even years.

Naltrexone (brand name Revia): Naltrexone affects the pleasure chemicals that alcohol releases. The individual can no longer get high from alcohol, so there is little point in drinking. People don’t become dependent on naltrexone and don’t become euphoric when it’s taken. The following cautions apply:

  • Naltrexone has been known to cause dizziness, headache, and weight loss, and there are cases of naltrexone abuse.
  • Individuals with severe liver or kidney damage shouldn’t take naltrexone.
  • It doesn’t make a person sober nor does it prevent a person from enjoying other sources of pleasure.
  • Naltrexone blocks the effects of opiods such as morphine, so if the patient needs pain medication, it must be a non-narcotic.

Patients usually continue on naltrexone for three months if they successfully stop drinking.

Isradipine (brand name Dynacirc): Although this drug was originally used for the treatment of high blood pressure, it helped those people who were drinking heavily by taking away the pleasure associated with drinking. The craving for alcohol rapidly diminishes and continues to decline as treatment continues. Cautions include the following:

  • It may make a person feel light-headed and dizzy, so driving should be avoided until the patient’s reaction to it is determined.
  • It causes headaches and shouldn’t be taken during pregnancy.

Using two of the drugs together may be more effective than one alone. Your doctor will make this determination.

These drugs don’t work on a long-term basis without a treatment program such as AA.

Alcoholics Anonymous

A major step that an alcoholic can take is to join AA. Letting AA explain itself is probably best. I can tell you that more than 1 million recovered alcoholics are in AA in the United States and another million are in other countries. AA members meet in groups, large and small, to support one another. About 51,000 AA groups meet in the United States, and one is near you. Check online at www.alcoholics-anonymous.org or write to the main office to find a support group near you: Alcoholics Anonymous, Grand Central Station, P.O. Box 459, New York, NY 10163. You can also call 212-870-3400.

The support of AA is tremendously helpful for the alcoholic who utilizes it. A typical meeting consists of the group leader’s description of the AA program followed by the personal histories of several members. A collection for the cost of the facilities and snacks is taken up and then the members leave or meet informally. All opinions and interpretations are those of the speaker himself. No one speaks for the whole group.

Alcoholics Anonymous provides an abundance of helpful literature — some is free and some has a nominal fee. The success of AA is based on the power of one recovering alcoholic to help an uncontrolled drinker by passing along information about his experiences and sobriety. The process works through the famous Twelve Steps of Alcoholics Anonymous, which can be found in any of their publications. 

Locating useful resources

Numerous resources are available to the alcoholic who wishes to recover. The following list contains some of those resources. If you have access to the Internet, you can find tons of information. We have also added the phone number of each resource.

  • Al-Anon/Alateen provides help for the loved ones of the alcoholic. It uses the principles of AA to help these people regain control over their lives and see what action they can take to help the alcoholic. Information on meetings, resources, and plenty of other help is available at www.al-anon.alateen.org on the Web. You can also call 757-563-1600.
  • Alcoholics Anonymous has numerous sites on the Internet because so many of these groups dot the planet, but www.alcoholics-anonymous.org is the central Web site. Most of its publications are online along with directions to its groups worldwide. This is a key resource for anyone who lives with an alcoholic or is trying to quit alcohol. You can also call 212-870-3400. (See the previous section for more information about this group.) 
  • American Council on Alcoholism is a national non-profit organization dedicated to addressing alcoholism as a treatable disease through identification, education, intervention, and referral. It has useful links to sites concerning college drinking, drunk driving, general information on alcoholism, government resources, professional organizations that deal with alcoholism, treatment and recovery, and drugs that help. It also has a link to the Web sites of the alcohol industry. The council is on the Internet at www.aca-usa.org and answers any question about alcoholism. You can also call 800-527-5344.
  • Mothers Against Drunk Driving is another nationwide organization that provides information. It has over 600 chapters in this country and is dedicated to finding effective solutions to drunk driving and underage driving. Find it at www.madd.org or by phone at 800-438-6233.

Getting High on Caffeine

Caffeine is a chemical compound in the leaves, seeds, and fruits of more than 63 plant species, but it most commonly comes from coffee and cocoa beans, cola nuts, and tea leaves. But coffee isn’t the only source of caffeine — a can of cola contains 45 mg, green tea has 30 mg, an ounce of chocolate has 20 mg, and even Anacin comes in at 65 mg for two tablets.

Although the case against caffeine isn’t nearly as tidy as the ones against tobacco and alcohol, caffeine in any form has been shown to temporarily raise blood pressure. A cup or two of coffee doesn’t seem to be damaging over the long-term, but the tendency to drink multiple cups of high-octane (heavily caffeinated) coffee is a definite cause of persistently elevated blood pressure.

People who drink four to five cups of coffee daily have an increase in blood pressure of 5 mm Hg. (See article 2 for more on blood pressure measurement.) If they continue to drink that same amount, the blood pressure may fall if they don’t have high blood pressure already. However, if they do have high pressure, they may be more sensitive to the blood-pressure-raising effect of caffeine; this blood pressure rise is then sustained. The effect is particularly true of the elderly population.

A 5 mm Hg rise in blood pressure may sound trivial, but it results in a 21 percent rise in the incidence of heart disease (see article 5) and a 34 percent increase in the incidence of strokes (see article 7). In addition, when taken with alcohol or tobacco, which is so often the case, the combination greatly increases the blood-pressure-raising effect of those drugs.

Studies about the effect of caffeine on blood pressure continue to come in. In the November 2005 Journal of the American Medical Association, a study of more than 250,000 women found that those who drank the most caffeine-containing drinks (including coffee and sodas) tended to have the highest blood pressures.

Having a cup of coffee just before your blood pressure is measured is unwise. The acute elevation in blood pressure may convince your doctor that you have sustained high blood pressure.

Knowing how much is too much

The daily recommended maximum amount of caffeine is 300 mg, and an ordinary cup of coffee (5 ounces) has 100 mg of caffeine. 

  • A short (8-ounce) cup of coffee at a nice café or fancy coffee shop contains 250 mg, more than double the amount of that ordinary cup.
  • A tall (12-ounce) cup of coffee from the same shop is 375 mg, nearly four times that ordinary cup.
  • A coffee grande (16 ounces) packs 550 mg, more than five times the punch.

You can see where a few cups of coffee can quickly add up to much more than each day’s recommended maximum.

Considering caffeine’s health consequences

Caffeine is a mildly addictive drug. When a person stops drinking it, she has withdrawal symptoms such as:

  • Feelings of sleepiness 
  • Feelings of being overtired
  • A severe headache

But caffeine also has a number of potential medical consequences when a person consumes it in large doses (over 300 mg daily) over a period of years:

Osteoporosis (thinning of the bone) As a result of the urine-promoting effect of caffeine, the calcium that a body needs to build strong bones passes quickly into the urine. Women (and men) are encouraged to manage this problem by taking milk with the caffeine and getting extra calcium from other sources like dairy products or calcium pills.

  • Infertility, birth defects, and miscarriages
  • Heartburn and even ulcers due to increased stomach acid production
  • Increased risk of heart disease when coffee is unfiltered (more frequent before 1975)
  • Increased premenstrual pain and formation of breast lumps, but these are controversial findings
  • Poor sleep quality and difficulty falling asleep
  • Caffeine can keep you awake, but it does not improve your performance of complex tasks.

Recognizing the gains in giving up caffeine

When you give up caffeine, you eliminate the chance of developing any of the conditions in the preceding section, you eliminate an unnecessary drug from your body, and you help keep your blood pressure under control. As a woman, you may greatly enhance your chance of becoming pregnant and having a healthy pregnancy and delivery.

Note: The coffee bean isn’t a vegetable — no fair trying to get credit in the vegetable category of your DASH diet for consuming it.

Warning: You may become a coffee addict if you name your child Mocha and your dog Java!

Avoiding the beans, chocolate, and soda

If you consume no more than two cups of coffee daily, you should have no symptoms if you switch to decaffeinated drinks and avoid other sources of caffeine like chocolate. 

For the person who consumes much more caffeine daily, the process of quitting may be more difficult. Here are some practical suggestions:

  • Try to determine how much caffeine you’re taking in each day. Check all foods and medications to make sure you’re not missing an unexpected source.
  • Reduce your intake and see how you feel as you withdraw.
  • Gradually reduce your daily caffeine by 50 mg or so until you’re free of it.
  • Use exercise to give you the energy that you believe was coming from caffeine. (We discuss exercise in detail in article 12.)
  • Avoid the other habits such as smoking that go with drinking coffee.
  • Ask the people you live and eat with to help you by reducing their caffeine intake. The improvement they feel will make them grateful. 

Some pros and cons of caffeine

The final determination on all the effects of coffee, negative and positive, isn’t in. Some studies indicate that coffee may protect against cancer of the large intestine and rectum. Others suggest that it may have a protective effect against the damage that alcohol does to the liver. Very careful future studies can show whether these theories are valid. Most recently, in the February 2006 Diabetes Care, a study of more than 88,000 women reported that the occurrence of diabetes was reduced among those who drank caffeinated or decaffeinated coffee. But one proven, damaging consequence of caffeine is that it affects the woman who wants to become pregnant. Consuming more than three cups of caffeinated coffee each day reduces fertility. And the woman who is pregnant may deliver an underweight baby if she consumes more than three cups daily during her pregnancy. A few women who consumed enormous amounts of caffeine — 8 to 25 cups of coffee every day — delivered babies with birth defects.

Using resources

Article on enetmd.com about  caffeine

You can check a few Internet sites for the latest information on this controversial drug. These two are among the best: 

Center for Science in the Public Interest is a large Web source on a wide variety of topics, just as its title suggests. It also publishes the Nutrition Action Healthletter. Find any new information on the health effects of caffeine at www.cspinet.org or by phone at 202-332-9110. 

Columbia University’s Health Question & Answer Internet Service called “Go Ask Alice” is one of the best university hospital sites on the Web for information on caffeine. The address is www.goaskalice.columbia.edu  no phone number is available.