Health Sciences Report

Health Sciences Report UNIVERSITY OF UTAH SOCIAL DISEASES social disease n. 1: a disease which is directly related to social and economic factors 2: venereal disease. See also substance dependency, feminization of poverty, environmental health hazards. Spring 1989 THE NEW SOCIAL DISEASES These " diseases" are not really new. What is new is how we look at them. Like syphilis and gonorrhea, substance abuse has long been con-sidered a health problem. Only in recent years, however, has society recognized the economic and social consequences of substance dependen-cy: we all breathe air contaminated bv secondhand smoke. We all pay higher medical insurance rates as a consequence of the effects of others' substance abuse. We all depend upon the sober, safe conduct of workers, whether we're using public transporta-tion or relying upon nuclear energy to provide electricity. Society's view of the impact of these diseases has re-sulted in many substance abusers feeling socially ostracized - much like those who suffered from syphilis and gonorrhea years ago. The list of the new social diseases Joesn't end with substance depen-dency. Environmental health hazards; world hunger and the lack of medical care in Third World countries; the feminization of poverty; AIDS; lack of health care for the poor and the homeless - all are medical problems that also pose social and economic dilemmas. They offer greater resis-tance to research than many other diseases, but they still are the responsi-bility of the health- care community, especially when so much emphasis today is placed upon preventive health care. In this issue of Health Sciences Report, we examine how health- care professionals at the University of Utah Health Sciences Center are applying their expertise to help pre-vent and control some of these new-social diseases. Health Sciences Report University of Utah Vol. 13, No. 1, Spring 1989Published by the Office of Community Relations, University of Utah Health Sciences Center, 50 N. Medical Drive, Salt Lake City, Utah 84132. Telephone ( 801) 581- 7387. Health Sciences Report is mailed to faculty, staff, alumni, students and friends of the University of Utah School of Medicine; to the staffs of University Hospital and Spencer S. Eccles Health Sciences Library, and to the faculty, staff and alumni of the colleges of pharmacy, nursing and health. Articles may be reprinted without permission. Editor: Susan Sample Editorial Consultant: Anne Brillinger Photographers: Brad Nelson and Steve Leitch, Medical Illustration Service HEALTH SCIENCES REPORT Substance Dependency: The Habit Society Can't Kick Even if you don't smoke, drink or use drugs, you're not immune to the consequences of substance abuse, a leading cause of premature death. U Teen Mom Program Helps Break Cycle of Poverty Caring for the poorest of Americans - young single mothers - is the focus of the U Teen Mother and Child Program. Is ' Progress' Hazardous to Our Environmental Health? Many technologies enhance the quality of our lives, but they also may be creating serious health problems for society. 14 To Learn More... Books, journals and tapes on the new social diseases are available to the public at the Spencer S. Eccles Health Sciences Library. 20 Taking Risks: A Special Interview Dean Harold H. Wolf discusses the College of Pharmacy's beginnings and future directions. 22 A Guiding Principal of the U Health Sciences Center For nearly 30 years, Dr. Ken Castleton has played an integral role in the center's development. 26 Center of Excellence The Division of Respiratory, Critical Care and Occupational Medicine provides valuable research and clinical services to the Intermountain West. 35 Year in Review 32 Centerounds 56 SUBSTANCE DEPENDENCY: THE HABIT SOCIETY CANT KICK Imagine a standing ovation with no one clapping. It's a meaningless expression. Just as many people find it meaningless to relax without smoking a cigarette, celebrate without downing champagne, console them-selves without sneaking a box of chocolates, socialize without snorting cocaine. " We all have psychological habits, ways of dealing with stress and celebrating good news," said Michael A. Rigdon, Ph. D., assistant professor of family and preventive medicine in the University of Utah School of Medicine. " But smokers use cigarettes as universal tools for dealing with good as well as bad news. That be-comes a problem that we need to help people fix." These people don't just use to-bacco - or alcohol, food or drugs - to express themselves. They depend upon them. Even if they want to stop abusing these substances, they can't. They're addicted. Although substance dependency can't be brought into clear focus under the microscope as many infectious diseases can, it is a leading cause of premature death in America. Last year, 350,000 people died from health problems ( including lung cancer, heart attacks and emphysema) related to tobacco, while 125,000 died from conditions related to alcohol. Both tobacco and alcohol are controlled substances. In com-parison, about 4,000 died from opiates such as heroin and 2,000 from cocaine, according to U. S. Surgeon GeneralC. Everett Koop, M. D. The tragedy of substance dependency is not only in the loss of individual lives that could have been avoided, but in the damage to society. " Each alcoholic directly affects four other people, usually negatively," said Steve Hadden, adjunct associate instructor of health education in the U of U College of Health. And I don't know of a single person who isn't affected by alcohol, tobacco and drug problems either through increased taxes, crippled family relations or lost productivity in the workplace." " If you're paying for health insurance, you're paying the price" of substance abuse, added Dr. Rigdon. Addictive Society When Surgeon General Koop released his report " The Health Con-sequences of Smoking: Nicotine Addiction" last spring, responses at the U of U echoed those of national experts. " Big news. Nicotine is addictive. How many years have we known that?" said Glen R. Hanson, D. D. S., Ph. D., associate professor of pharma-cology and toxicology in the College of Pharmacy. Nonetheless, he does see value in the report. " Some people think you don't call it drug abuse until it's illegal," said Dr. Hanson, who is researching the neurochemical effects of designer drugs. " But if you talk in terms of a single drug killing people, tobacco is at the top, right there with alcohol." John H. Holbrook, M. D., profes-sor of internal medicine in the School of Medicine, felt that the 1988 report " codifies a generally accepted truism and backs it up with hard scientific data. " It's an important addition to the previous surgeon generals' reports on cigarette smoking," said Dr. Hol-brook, who has served as a consulting scientific editor for the reports since 1970. " In the last 10 years, scientists have concluded that cigarette smoking is an addictive behavior, but this hasn't been widely discussed by the general public." By emphasizing the pharma-cologic basis of the life- threatening behavior of cigarette smokers, the 1988 surgeon general's report " turns the notch up one level as to how society will deal with smoking as a problem," said Dr. Rigdon, who teaches smoking cessation classes at University of Utah Hospital. An ex- smoker, Dr. Rigdon said, " Often, you're told you're a bad person if you smoke, but you don't change because of that. And we can't pretend that raising the price of cigarettes and printing warnings on cigarette labels will force smokers to quit. As a society, we have to provide treatment and help support these people." Not only must we help meet their physiological needs, but we also must confront their psychological problems, for the substance abuser's disease is our disease. As Surgeon General Koop stated, I doubt people " want to be part of an addictive society" anymore than they " like to be known as addicts." A Dose of Stress Management Nicotine causes changes in a person's heart rate, blood pressure and brain waves; in the addicted individual, abstinence from nicotine causes a mood swing to dysphoria and 2 * - „ m y m Despite a wind chill factor that hovered near zero, office workers lingered outside last winter for a " smoke break." Even if many smokers want to quit, they can't: they're addicted to nicotine. a craving for the substance, according to Dr. Holbrook. " The central nervous system becomes tolerant of nicotine's effects. The more people use, the more the response is blunted, so they have to take more. When they quit the substance, they have physio-logical withdrawal," he explained. " To use a lay definition: Addic-tion is when people recognize they can't stop a harmful behavior." In the six years Dr. Rigdon has taught smoking cessation classes, he has found that " nine out of 10 smokers would like to quit... if it were that simple. It's what's going on in their lives that makes it so difficult." Mr. Hadden, an intervention specialist with the Utah State Depart-ment of Health who teaches " Alcohol and Drug Awareness" at the U, agreed. " In just a few weeks, we can delete the alcohol in people's systems and wean them from the physical dependency. But if that's all we do and those people return to their normal environment, they'll go right back to using alcohol again." Nicorette gum " helps take the edge off," temporarily relieving the physiological withdrawal for clients in Dr. Rigdon's smoking cessation class-es, although he prefers not to use the term " classes." " They're not like health edu-cation classes you might get for parenting," explained Dr. Rigdon. " We consider them counseling groups 3 NO SMOKING FOR THE HEALTH OF IT Because it's " in the business of promoting health, not disease," Uni-versity of Utah Hospital implemented a no- smoking policy last summer. As of June 1, 1988, smoking was prohibited throughout the hospital, except by patients who have the permission of their physician or primary care nurse. Smoking con-tinues to be permitted in a designated area of the cafeteria, except during peak lunch hours. " As a leading health- care institu-tion in the Intermountain region, we have the obligation to protect our patients, employees and visitors from the harmful effects of smoking and to discourage smoking whenever possible," saidGeorgeBelsey, Univer-sity Hospital executive director. " We are in the business of promoting health, not disease." The smoke- free policy is the result in part of an increasing number of complaints from patients and visitors, reflecting a national trend that shows public concern about the harmful effects of smoking, including secondhand smoke, continues to grow, according to Mr. Belsey. Hospital administration and staff committees researched the issue for two years before drafting the policy. They contacted other major hospitals nationwide to learn how they handled the smoking problem, and the com-mittees surveyed U hospital employees to determine their attitudes towards smoking. They found that a vast majority of patients and employees supported a smoke- free environment. " We are not telling our people that they can't smoke," said Mr. Belsey. " We are only telling them that, for the health, comfort and safety of those around them, they can't smoke in University Hospital." The hospital offered fre. e smoking cessation classes last summer to all employees who wanted to quit smoking, jp Carbon monoxide indicators enable clients in a smoking cessation class to visualize how healthy their lungs are becoming. The instru-ments measure the amount of carbon monoxide, a poisonous substance found in cigarette smoke, that remains in their respiratory systems. or therapy sessions for dealing with a difficult problem." The focus is on helping clients discover alternative tools for manag-ing stress. " Most people have never learned to relax in a systematic way," he said. When he asks clients how they relax, a common reply is, " I sit down with a beer and watch the news on TV." " But what else is happening to that person?" asked Dr. Rigdon. " The kids are playing nearby, a spouse is talking, the dishwasher is running There are 400 things going on at the same time. " We promote exercise as an alternative way of dealing with stress-ful situations. Instead of lighting up, walk around the block." But Dr. Rigdon is careful to note that " different people need different ways of relaxing." So clients are encouraged to choose and work at an activity that best fits their individual life- style. Opening oneself up to new oppor-tunities is critical to combating sub-stance dependency, agreed Mr. Hadden. He calls it " bumping." Investing time and energy in exploring new activities can help a person develop decision- making and coping skills, and, more importantly, self- esteem. " Low self- esteem comes up time and time again as a major cause of substance dependency," he said. " Everyone has the potential to be a drug abuser, but it's the person who looks in the mirror and says, ' I'm nothing,' who is more likely to be the next victim. " Self- esteem is one of the best innoculations against substance abuse, but where do you learn that? We probably spend more time balancing our checkbooks than we do working at developing self- esteem." Mr. Hadden recommends joining clubs and social organizations, or simply trying new activities. " This is where societal influence is so im-portant. As a friend, I can suggest that, instead of drinking and dragging State Street tonight, let's do x, yorz," he said. " Many of us fail to see how we can play positive roles in helping each other." " I'm very aware of the obligation society has in preventing and treating substance dependency problems, but I don't want abusers to use that as a copout," said Dr. Rigdon. " We don't spend any time in our groups talking about social problems that might have caused people to start, or not stop, smoking. Smokers need to make the changes. It's an individual's problem that only that person can solve - but, yes," he acknowledged, " it's a social disease, too." Glamor of Abuse Substance dependency is not just a social problem: it's a disease that infects everyone. We all breathe the same air, contaminated by second-hand cigarette smoke. We all are potential victims when an alcoholic attempts to drive home from a party. We all face the threat of radioactive contamination when a nuclear plant worker snorts cocaine. f> i mj • 01 But it's also our own fault: as a society, we've exposed ourselves by glamorizing unhealthy behaviors. " The problem in part is the result of the social policies we've developed," said Dr. Rigdon. " Being able to hold your liquor is considered macho. Smoking and drinking in this valley is an acceptable badge of honor among some non- Mormons." Our attitudes are only reinforced on television. " Look at ' Dallas,' and see how long it is before someone has a drink," said Dr. Rigdon. " We're saying that this is what people do. This is what life is like." The same message reverberates through the advertising world. The successful career woman holds a brief-case in one hand, a dainty cigar in the other. The virile logger puffs away on an unfiltered cigarette. " Tobacco companies bear a very large responsibility" for the smoking problem, maintained Dr. Holbrook. " They have attempted to discredit scientific findings linking smoking to death and disability. In fact, they deny that tobacco products cause harmful effects. " Now, they're using their finan-cial clout to portray themselves as benefactors of philanthropic causes around the world," he added. Interestingly, Dr. Holbrook said, the one warning label that the tobacco companies refused to accept, in discussions with the federal govern-ment, was that smoking is addicting. They did accept other labels that 5 HIGH ON HELPING OTHERS Russian therapists may pick up a tip or two on how to better deat with vodka lovers when they attend the 38th Annual Session of the University of Utah School on Alcoholism and Other Drug Dependencies this sum-mer. Over 1,100 students from around the world last year attended the week-long school, which is the largest and second oldest of its kind in the U. S., according to director Gary Q. Jorgen-sen, Ph. D., who also directs the Alcohol and Drug Abuse Clinic at U of U Hospital. The Soviet Union is planning to send a delegation to the school in June. Originally intended for the gen-eral public when it began in 1962, the U of U school now attracts mostly health- care professionals - such as physicians, nurses, pharmacists and dentists - and those involved in rehabilitation - including judges, lawyers, counselors and therapists. The public also is welcome. " When the school was estab-lished, information about alcohol and drug abuse typically wasn't taught at universities. It wasn't even talked about," said Dr. Jorgensen. " There was a stigma about it." However, the numerous drug-related deaths of celebrities and athletes in recent years, and the proliferation of psychiatric hospitals that advertise treatment programs for substance dependency, " have had a positive effect on the acceptance of the problem," said Dr. Jorgensen. In addition to an introductory section for those who have never attended an alcohol and drug abuse school, the U of U school offers 16 specialized training sessions. Some target drug problems in specific popu-lations, such as American Indians, women and youth, while others target substance abuse among particular professional communities, including dentists, nurses, physicians and pharmacists. The dentists' section was offered for the first time last summer due in part to a request from the American Dental Association, according to Dr. Jorgensen. The youth section also was a new offering that drew about 65 teenagers from across the nation who wanted to work as peer advocates or were having problems with substance abuse themselves. Other sections range from " Drugs: Treatment and Rehabilita-tion" to " Programs for Employees" to " Education and Prevention." For further information, contact the U of U School on Alcoholism and Other Drug Dependencies, P. O. Box 2604, Salt Lake City, UT 84110. ( g 6 bluntly state that cigarettes cause certain diseases such as lung cancer and heart attacks. But the reign of the tobacco companies' power may be waning, according to Dr. Holbrook. The 1988 surgeon general's report on nicotine finally publicized the addicting nature of cigarette use, and the U of U physi-cian predicts that the tobacco compa-nies will face more legal setbacks like the one last summer in which a federal jury found a cigarette company par-tially responsible for the death of a lifelong smoker who died of lung cancer. Yet, in the opinion of Dr. Rigdon, " advertising is not the main issue. The attitudes and beliefs we have as a society need to be changed. We need to promote life- styles in which people don't feel the need to rely upon these substances. " We tend to believe in quick fixes - alcohol, cigarettes and drugs," he said. " We're not willing to take a long time to solve problems." The U of U counseling psycholo-gist advocates " spending time to educate people in how to be effective and happy in developing a satisfying life." Mr. Hadden agreed. " We owe a responsibility to the well- being of society as a whole. We're looking at a future generation. We have to make sure these people have the oppor-tunity to be at peace, to develop their potential, to be happy." Rx: Education Education is undoubtedly one of the best ways to prevent substance dependency, according to the U of U experts. " If people can appreciate the liability, then maybe we can diminish the problem," said Dr. Hanson, who teaches a popular class on the use and ARE YOU CHEMICALLY DEPENDENT? misuse of over- the- counter medicines. " You don't try to scare people with photographs of cocaine addicts who have needle scars going up their arms. Be honest, hut let them know the risk and lack of predictability of drugs. Sometimes, the result is very pleasant, but sometimes, it's deadly." To learn about the dangers of drugs, Dr. Hanson suggests people turn to community pharmacists who, in recent years, have become drug information specialists. " It's a logical role for them to know about drug abuse." Dr. Holbrook, an internist, feels physicians should play a greater role in treating substance dependency. " There are courses available that teach doctors how to help their patients quit harmful behaviors," he said. Before health- care professionals can help, however, Dr. Rigdon said society must admit that substance abuse is a legitimate health concern. " Insurance companies don't pay for smoking cessation or weight loss classes," he noted. Yet, " it costs less to pay my salary than the hospitalization for the victim of an alcohol- related car accident." How can we innoculate ourselves so we don't become victims requiring expensive treatments? Focus on chil-dren, said the U of U experts. Help them develop problem- solving skills and raise their self- esteem, so their lives have meaning without resorting to abusive behaviors. " We have to see substance abuse as a continuum," said Dr. Rigdon. " Part of dealing with emphysema and heart disease is working with the third- graders who've skipped school a couple of times. It's all part of the same problem." Chemical dependency is recog-nized as the nation's most serious health problem and the fourth most common cause of death. Contrary to popular opinion that most chemically dependent people are on skid row, the average substance abuser is in his/ her twenties or thirties, holds a job, is married, has graduated from high school and, often, has attended college. The following quiz from the University of Utah Alcohol and Drug