“ Medical knowledge is a social process: The conversations that occur around artifactual data are always more important than the data themselves. ” - John Lester

This chapter aims to cover: What are the main forms of dependency?  Smoking, alcohol, other drugs, junk food, gambling, pornography.  How big a problem is dependency for health & wellbeing?  What are the effective treatments?  Identifying one’s own dependencies & working out a personal response.

Here are half a dozen studies on the long-term effects of various forms of abuse & deprivation.  Paras et al systematically reviewed the association between a history of sexual abuse and a lifetime diagnosis of a somatic disorder.  They found significant links with functional gastrointestinal disorders, nonspecific chronic pain, psychogenic seizures, and chronic pelvic pain.  When analysis was restricted to studies where sexual abuse was defined as rape, they also found an association with fibromyalgia.  Abstracts and links, for this research paper and the further papers described, can be found lower down this page.   

"Quis custodiet ipsos custodes?"    Juvenal

A recent article in the British Medical Journal (Kmietowicz 2009) reports that "The chief medical officer for England has called for a minimum price of 50 pence (0.54; $0.70) to be charged for a unit of alcohol to reduce excessive drinking and its associated harms.  Liam Donaldson said that antisocial drinking should be targeted in the same way as smoking in public places so that being drunk is no longer an aim or socially acceptable.  ‘England has a drink problem and the whole of society bears the burden,' said Professor Donaldson at the launch of his 2008 annual report. ‘The passive effects of heavy drinking on innocent parties are easily underestimated and frequently ignored. The concept of passive drinking and the devastating collateral effect that alcohol can have on others must be addressed on a national scale.'  He said that evidence shows that price and access are the two key factors that can help to change drinking habits, as they were for tobacco."  

Here are five papers on childhood, the effects childhood experience can have on adulthood, and the effects adults may then have on their own children.  The first paper by Brody et al. is the encouraging one.  It demonstrates how caring parenting can combat genetic vulnerability - "involved-supportive" mothering greatly reduced the link between vulnerable genes and subsequent youth substance abuse.  The Van Meurs et al study shows the reverse - how problem behaviours in one generation of children increases the likelihood that, when these children become parents themselves, their own children will develop similar problem behaviours.

An article in one of this month's editions of the Journal of the American Medical Association celebrates the publication of the CAGE alcohol screening questionnaire by Charles Ewing 25 years ago.  CAGE is a mnemonic to help remember the four simple questions.  "Have you ever ...

1.) felt the need to cut down your drinking?
2.) felt annoyed by criticism of your drinking?
3.) had guilty feelings about drinking?
4.) taken a morning eye opener?

An affirmative answer to 2 or 3 of these questions makes an alcohol problem likely, while a score of 4 suggests a diagnosis of alcoholism is almost certain. 

The questions can be used in most clinical settings to identify people who need to be checked out more fully.  In the United States, 30% of primary care physicians report  regularly screening for substance abuse.  Of these physicians 55% use the CAGE.  See too the January blog posting on The demon drink. 

Here are half a dozen recent research studies broadly on aspects of cognitive-behavioural therapy - computer delivery for addiction, a couple on therapist competence, CBT for compulsive shopping, a sy

“ We must all die. But that I can save (a person) from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even death himself. ” - Albert Schweitzer

Other anxiety disorders include Anxiety Disorders due to a General Medical Condition (where the anxiety is a direct physiological consequence of a general medical condition), Substance-Induced Anxiety Disorder (where the anxiety is directly caused by the physiological effects of a substance - drug of abuse or medication - including prescription use, poisoning, intoxication, or withdrawal), and Anxiety Disorder Not Otherwise Specified (where there is prominent clinically significant anxiety or phobic avoidance that doesn't meet the diagnostic criteria for any other anxiety or adjustment disorder).

Health anxiety disorder and hypochondriasis are typically classified under Somatoform disorders.

Teratology is the study of the effects that drugs, medications, chemicals and other exposures may have on the unborn child during pregnancy.  Particulary when a mother is taking a medication that is helping her stay well, it can be a difficult decision whether or not to stop taking the medication because of a possible risk to the fetus ... or because of a possible risk that could be transmitted through breastfeeding.  This decision is made harder because we know that if a pregnant woman becomes unwell, for example with depression, this too risks damaging the fetus, so it's not necessarily the case that stopping medication is going to be in the unborn baby's best interest.