Substance abuse is a major problem and is linked to many negative health effects. Substance abuse takes many forms including the abuse of alcohol, illegal drugs and tobacco. It is responsible for many preventable health problems including diseases such as cirrhosis, heart disease and multiple cancers as well as accidents such as motor vehicle accidents.

Smoking is one of the worst things you can do for your health. Smoking is associated with many diseases including heart disease, stroke, emphysema and multiple types of cancer. Quitting smoking is one of the most important steps you can take to improve quality and quantity of life.

Health experts report alcohol in moderation can have beneficial effects on health. Excessive alcohol can have multiple negative effects including liver damage, stomach problems, and problems with balance, which leads to falls and fractures. Moderate alcohol consumption, which is defined as one drink per day for women and two drinks per day for men, may protect the heart and raise HDL or good cholesterol.

Excessive use of alcohol also leads to accidents often times due to poor decision making or impaired coordination. In 1998, 5.3 deaths per a 100,000 population were an alcohol-related motor vehicle accident.

Certain groups are at greater risk for alcoholism than others. This includes:

• American Indians
• Alaskan Natives
• High school students are having an increased prevalence of alcohol use

If we could reduce the amount of alcohol and drugs used by those before the age of 20, there would be less alcohol and drug abuse in society.

Being aware of high-risk times can reduce the impact of alcohol use among adolescents. Boredom is a major reason for alcohol or drug use. Encouraging kids to remain active with multiple activities reduces the use of drugs and alcohol.

Another high risk time is when a family moves. Moving to a new community typically brings new friends. Parents should closely monitor their children’s new friends. Talking to them about the drugs and alcohol during these high-risk time is critical.

Binge-drinking – heavy utilization of alcohol over a short period of time - is a major cause of death and health problems. In 2006, 25% of high school seniors binge drank in the past two weeks while in that same period of time 40% of college students binge drank.

In the primary care setting all patients should be screened and offered behavioral counseling. Even in those patients who are not dependent on alcohol, the primary care setting is the ideal place to screen patients, provide counseling and follow up to reduce the amount of alcohol consumption.

Curbing alcohol use is critical. Alcohol can cause many problems including

• Personal problems such as problems with relationships
• Health problems: liver disease, increased risk of breast, stomach, head or neck cancer
• Social problems
• Legal problems such as drunk driving arrests
• Mental health problems such as depression

Tobacco use is a major cause of chronic disease, disability and even death. It is associated with multiple lung diseases (COPD, asthma and lung cancer), cardiovascular disease, certain cancers (lung, oral, esophagus, larynx, throat, bladder, pancreas, kidney, cervix and stomach) and many types of infections (respiratory infections and ear infections).

If no one smoked, there would be better overall health, more money for health care and more money in the pocket of smokers.

Second-hand smoke is another factor that affects the health of those afflicted. About 20% of individuals under 6 years old were exposed to second-hand smoke in the late 1990’s but with improved awareness and improved public smoking laws this number was reduced to 8% in 2004.

In 1998, 24% of those over age 18 smoked. In 2006, the number dropped to 21%. In 1998, forty percent of high-school students used tobacco – with cigarettes being the most commonly used form of tobacco; but this number decreased to 28% in 2005 .

Smokeless tobacco – only used by 2.5% of adults in 1998 – is associated with multiple negative side effects such as oral cancer, pancreatic cancer, problems with the teeth and gums and bad breath.

Smoking cessation is a critical aspect in the prevention of many health related diseases.