Smokers Death Benefit Arguments And Poly Behavioral Addiction

Smokers, Death Benefit Arguments, and​ ​ Polybehavioral Addiction
Do Governments Save Money by Watching Smokers Die Prematurely?
this​ was the conclusion​ of​ a​ report, commissioned by Philip Morris, who looked at ​ the cost of​ smoking in​ the Czech Republic in​ 1999. ​
They concluded that tobacco can save a​ government millions of​ dollars in​ health care and​ ​ pensions because many smokers die earlier. ​
They reported that the government had benefited from savings on​ health care, pensions and​ ​ housing for​ the elderly that totaled $30 million​ the indirect positive effects of​ early deaths Arthur D. ​
Little International, 2000.
I was shocked to hear this​ death benefit argument for​ the first time, after making a​ presentation​ to a​ group of​ professionals informing them that tobacco use is the chief avoidable cause of​ illness and​ ​ premature death for​ over 430,000 Americans each year. ​
it​ reminded me of​ the dialog in​ the movie, Traffic, when Michael Douglas playing a​ congressman/ ​Drug​ czar asked a​ Mexican general played by Tomas Milian, How do you​ treat your​ ​Drug​ addicts? and​ ​ the general responded by saying, We let our ​Drug​ addicts treat themselves. ​
They overdose and​ ​ die, and​ ​ then there is one less ​Drug​ addict to worry about.
Although the argument is immoral, unjustifiable, and​ ​ factually inaccurate National Center for​ TobaccoFree Kids, 2018, it​ would appear that 46 States in​ the United States are indirectly supporting this​ dreadful argument as​ only 5% of​ the tobaccosettlement funds of​ the $206 billion​ settlement for​ tobaccorelated health costs that went to 46 States according to a​ National Conference of​ State Legislators study, are being spent on​ tobacco prevention​ and​ ​ treatment programs.
Should the U.S. ​
Federal Government be in​ the Tobacco Business?
Federal taxpayers are directly paying more than $340 million​ to tobacco farmers to make up for​ lost income because of​ low prices and​ ​ tobacco litigation​ settlements. ​
These direct payments are in​ addition​ to subsidies in​ the form of​ tobacco crop insurance, administrative costs for​ price supports, and​ ​ nonrecourse loans. ​
this​ subsidy supports expanded tobacco production​ at ​ the same time that the federal government is spending millions actively discouraging the use of​ tobacco for​ public health and​ ​ safety reasons Green Scissors, 2018.
These subsidies also occur at ​ the same time that our political candidates accept millions of​ dollars in​ contributions from the tobacco industry. ​
Tobacco companies are heavily invested in​ politics, contributing $36.8 million​ to federal candidates and​ ​ political parties since 1989, the WinstonSalem Journal reported Oct.23, 2018.Observer, June 25, 2000.
Do Government Laws Prohibit Minors from Legally Smoking Cigarettes?
Federal law does not allow retailers to sell cigarettes, tobacco, or​ smokeless tobacco to anyone under the age of​ 18. ​
Laws regarding the possession​ of​ tobacco are left up to the individual states. ​
I ​ wonder why it​ is legal for​ minors to smoke cigarettes in​ most States, but illegal for​ minors to buy cigarettes when there are approximately 1.23 million​ new smokers under the age of​ 18 each year Gilpin, et al., 1999, and​ ​ more than 6,000 children and​ ​ adolescents try their first cigarette each day CDC, 1998.
• More than 90% of​ firsttime use of​ tobacco occurs before high school graduation. ​
Because the average age at ​ first use is 14.5 years, smoking prevention​ must start early.
• Approximately 40% of​ teenagers who smoke eventually become addicted to nicotine.
Hawaii presently has a​ bill before the Legislature that would prohibit the use of​ tobacco products by minors, with penalties including tobacco education, community service, fines and​ ​ driver’s license suspension​ Honolulu Advertizer, March 12, 2018. ​
Why has it​ taken the 50th State 50plus years to propose this​ bill? and​ ​ what are the other States doing with the other 95% of​ their settlement, if​ ​ their not attempting to educate and​ ​ treat smokers?
Children smoke 1.1 billion​ packs of​ cigarettes yearly. ​
this​ accounts for​ more than $200 billion​ in​ future health care costs. ​
The health consequences of​ this​ addiction​ are enormous. ​
Tobacco smoking is responsible for​ 1 of​ every 5 deaths and​ ​ is the most common​ cause of​ cancerrelated deaths in​ the United States.
Should Governments Promote Life and​ ​ Provide Treatment for​ Smokers?
Proponents of​ the death benefit argument would say that tobacco victims 46.5 million​ American smokers, CDC, 1997 deserve to die, because they have chosen to smoke and​ ​ risk the consequences. ​
Does this​ also include the 70% of​ smokers who want to quit Health Education​ Authority, 1995, but find themselves physiologically, psychologically, and​ ​ socially addicted to nicotine? in​ fact, less than 25% of​ smokers who try to quit succeed as​ long as​ a​ year Stolerman, I.P. ​
& Jarvis, M.J., 1995.
It does not appear that Governments are actively supporting treatment for​ smokers. ​
in​ 2018, a​ survey of​ the federalstate Medicaid coverage for​ tobaccodependence in​ the United States was conducted, and​ ​ only 1 State in​ 50 Oregon​ provided for​ all the tobaccodependence counseling and​ ​ pharmacotherapy treatments recommended by the 2000 Public Health Service PHS guideline. ​
Only 10 States in​ 2018, offered some form of​ tobaccocessation​ counseling services to the 11.5 million​ federalstate Medicaid program patients that smoke CDC, 2018. ​
a​ lack of​ reimbursement for​ tobaccocessation​ counseling services is also the most common​ complaint for​ private health insurance companies when inquiring about treatment for​ smokers.
if​ the death benefit argument was applied across the board to all areas, then these proponents would end all medical research directed at ​ preventing and​ ​ finding treatments for​ illnesses and​ ​ diseases, and​ ​ promote euthanasia for​ all unproductive people in​ society including the elderly, severely retarded, mentally ill, and​ ​ physically handicapped. ​
The answer is not in​ condemning victims of​ diseases, disorders, and​ ​ addictions, but in​ providing effective prevention, education, assessment/ diagnosis, treatment, and​ ​ aftercare programs for​ those in​ need.
Diagnosing Nicotine Dependence
Nicotine addiction​ is classified as​ a​ nicotine use disorder according to the Diagnostic and​ ​ Statistical Manual of​ Mental Disorders, Fourth Edition​ DSMIV TR, 2000. ​
The criteria for​ the diagnosis of​ 305.1 Nicotine Dependence include any 3 of​ the following within​ a​ 1year time span
o Tolerance to nicotine with decreased effect and​ ​ increasing dose to obtain​ same effect
o Withdrawal symptoms after cessation
o Smoking more than usual o Persistent desire to smoke despite efforts to decrease intake
o Extensive time spent smoking or​ purchasing tobacco
o Postponing work, social, or​ recreational events in​ order to smoke
o Continuing to smoke despite health hazards
Screening for​ Nicotine Dependence
Screening tools are available to assist counselors and​ ​ therapists with diagnosing this​ condition​ such as​ the Fagerstrom Tolerance Questionnaire FTQ. ​
Two items in​ the FTQ that are considered the key questions are as​ follows
1. ​
Do you​ smoke within​ 5 minutes of​ awakening? 2. ​
Do you​ smoke greater than 25 cigarettes per day?
Individuals that answer Yes to both questions are highly dependent on​ nicotine Prochazka, 2000.
Note if​ ​ after reading the above, you​ started rationalizing to yourself, Well it​ usually takes me 6minutes to lightup after I ​ get out of​ bed or​ I ​ never smoke more than 20 cigarettes per day, as​ my old graduate professor use to say STOP BULLSH#%ting yourself and​ ​ go see a​ therapist.
Comorbidity & Nicotine Dependence
Addictions such as​ nicotine dependence and​ ​ other addictions as​ a​ rule do not develop in​ isolation. ​
Individuals can shift from one addiction​ to another or​ sustain​ multiple addictions at ​ different times. ​
The National Comorbidity Survey NCS that sampled the entire U.S. ​
population​ in​ 1994, found that among noninstitutionalized American male and​ ​ female adolescents and​ ​ adults ages 1554, roughly 50% had a​ diagnosable Axis I ​ mental disorder at ​ some time in​ their lives. ​
this​ survey’s results indicated that 35% of​ males will at ​ some time in​ their lives have abused substances to the point of​ qualifying for​ a​ mental disorder diagnosis, and​ ​ nearly 25% of​ women will have qualified for​ a​ serious mood disorder mostly major depression. ​
a​ significant finding of​ note from the NCS study was the widespread occurrence of​ comorbidity among diagnosed disorders. ​
it​ specifically found that 56% of​ the respondents with a​ history of​ at ​ least one disorder also had two or​ more additional disorders. ​
These persons with a​ history of​ three or​ more comorbid disorders were estimated to be onesixth of​ the U.S. ​
population, or​ some 43 million​ people Kessler, 1994.
Psychiatric disorders are more common​ among tobacco users than in​ the general population. ​
Among patients seeking tobacco cessation​ services, as​ many as​ 30% of​ them may have a​ history of​ depression​ Anda, et al, 1990 and​ ​ 20% or​ more may have a​ history of​ dependence Brandon, 1994. ​
Most descriptive studies of​ ​alcohol​ abusers published in​ the past 20 years have reported tobacco use rates of​ at ​ least 90%. ​
Bobo, 2000. ​
More research and​ ​ information​ is needed on​ the comorbidity of​ nicotine dependence and​ ​ behavioral addictions such as​ pathological gambling, eating disorders, and​ ​ sexual addictions.
Poor Prognosis
We have come to realize today more than any other time in​ history that the treatment of​ lifestyle diseases and​ ​ addictions are often a​ difficult and​ ​ frustrating task for​ all concerned. ​
as​ already noted, less than 25% of​ smokers who try to quit succeed as​ long as​ a​ year Stolerman, I.P. ​
& Jarvis, M.J., 1995. ​
Repeated failures abound with all of​ the addictions, even with utilizing the most effective treatment strategies. ​
But why do 47% of​ patients treated in​ private treatment programs for​ example relapse within​ the first year following treatment Gorski,T., 2018? Have addiction​ specialists become conditioned to accept failure as​ the norm? There are many reasons for​ this​ poor prognosis. ​
Some would proclaim that addictions are psychosomatically induced and​ ​ maintained in​ a​ semibalanced force field of​ driving and​ ​ restraining multidimensional forces. ​
Others would say that failures are due simply to a​ lack of​ selfmotivation​ or​ will power. ​
Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it​ possibly be that patients with multiple addictions are being under diagnosed with a​ single dependence simply due to a​ lack of​ diagnostic tools and​ ​ resources that are incapable of​ resolving the complexity of​ assessing and​ ​ treating a​ patient with multiple addictions?
New Proposed Diagnosis
Since successful treatment outcomes are dependent on​ thorough assessments, accurate diagnoses, and​ ​ comprehensive individualized treatment planning, it​ is no wonder that repeated rehabilitation​ failures and​ ​ low success rates are the norm instead of​ the exception​ in​ the addictions field. ​
Treatment clinics need to have a​ treatment planning system and​ ​ referral network that is equipped to thoroughly assess multiple addictive and​ ​ mental health disorders and​ ​ related treatment needs and​ ​ comprehensively provide education/ awareness, prevention​ strategy groups, and/ or​ specific addictions treatment services for​ individuals diagnosed with multiple addictions. ​
Written treatment goals and​ ​ objectives should be specified for​ each separate addiction​ and​ ​ dimension​ of​ an individuals’ life, and​ ​ the desired performance outcome or​ completion​ criteria should be specifically stated, behaviorally based a​ visible activity, and​ ​ measurable.
To assist with resolving this​ problem a​ multidimensional diagnosis of​ Polybehavioral Addiction, is proposed for​ more accurate diagnosis leading to more effective treatment planning. ​
this​ diagnosis encompasses the broadest category of​ addictive disorders that would include an individual manifesting a​ combination​ of​ substance abuse addictions, and​ ​ other obsessivelycompulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or​ sex / ​porn​ography, etc.. ​
Behavioral addictions are just as​ damaging psychologically and​ ​ socially as​ ​alcohol​ and​ ​ ​Drug​ abuse. ​
They are comparative to other lifestyle diseases such as​ diabetes, hypertension, and​ ​ heart disease in​ their behavioral manifestations, their etiologies, and​ ​ their resistance to treatments. ​
They are progressive disorders that involve obsessive thinking and​ ​ compulsive behaviors. ​
They are also characterized by a​ preoccupation​ with a​ continuous or​ periodic loss of​ control, and​ ​ continuous irrational behavior in​ spite of​ adverse consequences.
Polybehavioral addiction​ would be described as​ a​ state of​ periodic or​ chronic physical, mental, emotional, cultural, sexual and/ or​ spiritual/ religious intoxication. ​
These various types of​ intoxication​ are produced by repeated obsessive thoughts and​ ​ compulsive practices involved in​ pathological relationships to any moodaltering substance, person, organization, belief system, and/ or​ activity. ​
The individual has an overpowering desire, need or​ compulsion​ with the presence of​ a​ tendency to intensify their adherence to these practices, and​ ​ evidence of​ phenomena of​ tolerance, abstinence and​ ​ withdrawal, in​ which there is always physical and/ or​ psychic dependence on​ the effects of​ this​ pathological relationship. ​
in​ addition, there is a​ 12 month period in​ which an individual is pathologically involved with three or​ more behavioral and/ or​ substance use addictions simultaneously, but the criteria are not met for​ dependence for​ any one addiction​ in​ particular Slobodzien, J., 2018. ​
in​ essence, Polybehavioral addiction​ is the synergistically integrated chronic dependence on​ multiple physiologically addictive substances and​ ​ behaviors e.g., using/ abusing substances nicotine, alcohol, & ​Drug​s, and/or acting impulsively or​ obsessively compulsive in​ regards to gambling, food binging, sex, and/ or​ religion, etc. ​
New Proposed Theory
The Addictions Recovery Measurement System’s ARMS theory is a​ nonlinear, dynamical, nonhierarchical model that focuses on​ interactions between multiple risk factors and​ ​ situational determinants similar to catastrophe and​ ​ chaos theories in​ predicting and​ ​ explaining addictive behaviors and​ ​ relapse. ​
Multiple influences trigger and​ ​ operate within​ highrisk situations and​ ​ influence the global multidimensional functioning of​ an individual. ​
The process of​ relapse incorporates the interaction​ between background factors e.g., family history, social support, years of​ possible dependence, and​ ​ comorbid psychopathology, physiological states e.g., physical withdrawal, cognitive processes e.g., selfefficacy, cravings, motivation, the abstinence violation​ effect, outcome expectancies, and​ ​ coping skills Brownell et al., 1986; Marlatt & Gordon, 1985. ​
To put it​ simply, small changes in​ an individual’s behavior can result in​ large qualitative changes at ​ the global level and​ ​ patterns at ​ the global level of​ a​ system emerge solely from numerous little interactions.
The ARMS hypothesis purports that there is a​ multidimensional synergistically negative resistance that individual’s develop to any one form of​ treatment to a​ single dimension​ of​ their lives, because the effects of​ an individual’s addiction​ have dynamically interacted multidimensionally. ​
Having the primary focus on​ one dimension​ is insufficient. ​
Traditionally, addiction​ treatment programs have failed to accommodate for​ the multidimensional synergistically negative effects of​ an individual having multiple addictions, e.g. ​
nicotine, alcohol, and​ ​ obesity, etc.. ​
Behavioral addictions interact negatively with each other and​ ​ with strategies to improve overall functioning. ​
They tend to encourage the use of​ tobacco, ​alcohol​ and​ ​ other ​Drug​s, help increase violence, decrease functional capacity, and​ ​ promote social isolation. ​
Most treatment theories today involve assessing other dimensions to identify dual diagnosis or​ comorbidity diagnoses, or​ to assess contributing factors that may play a​ role in​ the individual’s primary addiction. ​
The ARMS’ theory proclaims that a​ multidimensional treatment plan must be devised addressing the possible multiple addictions identified for​ each one of​ an individual’s life dimensions in​ addition​ to developing specific goals and​ ​ objectives for​ each dimension.
The ARMS acknowledges the complexity and​ ​ unpredictable nature of​ lifestyle addictions following the commitment of​ an individual to accept assistance with changing their lifestyles. ​
The Stages of​ Change model Prochaska & DiClemente, 1984 is supported as​ a​ model of​ motivation, incorporating five stages of​ readiness to change precontemplation, contemplation, preparation, action, and​ ​ maintenance. ​
The ARMS theory supports the constructs of​ selfefficacy and​ ​ social networking as​ outcome predictors of​ future behavior across a​ wide variety of​ lifestyle risk factors Bandura, 1977. ​
The Relapse Prevention​ cognitivebehavioral approach Marlatt, 1985 with the goal of​ identifying and​ ​ preventing highrisk situations for​ relapse is also supported within​ the ARMS theory.
The impact of​ nicotine dependence and​ ​ polybehavioral addictions is of​ course financially devastating. ​
The estimated smoking attributable cost for​ medical care in​ the US in​ 1998 was more than $75 billion​ and​ ​ the cost of​ lost productivity due to smokingrelated disability was estimated at ​ over 80 billion​ per year CDC, 2018. ​
But making life and​ ​ death decisions based on​ a​ cost analysis is putting a​ price on​ life itself, which I ​ believe no mortal man has the authority to do. ​
Considering that addictions involve unbalanced lifestyles operating within​ semistable equilibrium force fields, the ARMS philosophy promotes positive treatment effectiveness and​ ​ successful outcomes that are the result of​ a​ synergistic relationship with The Higher Power, that spiritually elevates and​ ​ connects an individuals’ multiple life functioning dimensions by reducing chaos and​ ​ increasing resilience to bring an individual harmony, wellness, and​ ​ productivity.
Partnerships and​ ​ coordination​ among all service providers, government departments, and​ ​ health insurance organizations in​ providing treatment programs are a​ necessity in​ addressing the multitask solution​ to Nicotine Dependence and​ ​ Polybehavioral addictions. ​
I ​ encourage you​ to support the addiction​ programs in​ America, and​ ​ hope that the ARMS resources can assist you​ to personally fight the War on​ nicotine dependence within​ polybehavioral addiction.
for​ more info see http//
PolyBehavioral Addiction​ and​ ​ the Addictions Recovery Measurement System, By James Slobodzien, Psy.D., CSAC at
James Slobodzien, Psy.D., CSAC, is a​ Hawaii licensed psychologist and​ ​ certified substance abuse counselor who earned his doctorate in​ Clinical Psychology. ​
The National Registry of​ Health Service Providers in​ Psychology credentials Dr. ​
Slobodzien. ​
He has over 20years of​ mental health experience primarily working in​ the fields of​ alcohol/ substance abuse and​ ​ behavioral addictions in​ medical, correctional, and​ ​ judicial settings. ​
He is an adjunct professor of​ Psychology and​ ​ also maintains a​ private practice as​ a​ mental health consultant.
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Polybehavioral Addiction​ and​ ​ the Addictions Recovery Measurement System ARMS,, Inc., p. ​
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James Slobodzien, Psy.D., CSAC, is a​ Hawaii licensed psychologist and​ ​ certified substance abuse counselor who earned his doctorate in​ Clinical Psychology. ​
The National Registry of​ Health Service Providers in​ Psychology credentials Dr. ​
Slobodzien. ​
He has over 20years of​ mental health experience primarily working in​ the fields of​ alcohol/ substance abuse and​ ​ behavioral addictions in​ medical, correctional, and​ ​ judicial settings. ​
He is an adjunct professor of​ Psychology and​ ​ also maintains a​ private practice as​ a​ mental health consultant.

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