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Preferences and offers at your disposalDiscounts: Interestingly,some of the best discount stores that sell baby outfits are some of the best on the net retailers. Each on the net retailer offers direct sales from their web site,and they have pretty almost everything you could need in terms of baby clothing,and offer it all at prices that won’t burn a hole through your pocket.Designer Infant Outfits: Designers are going on the net at last! From Chic Toddler clothing to punk and trendy wears,on the net shopping offers you much beyond your travel experiences to the outlets.Just Browse! With literally hundreds of websites offering baby outfits at all price ranges and designed to meet all specifications,just keep browsing– compare pricings,and just pick your option.Follow these principles while baby outfits on the net
Keep a tab on the kind of material and the quality the on the net retailer is offering.
Consider unisex outfits even if you are buying a little one cloth before the baby’s actual birth. This is the beat part of a little one’s cloth.
Make the most of on the net offers. On the net offers are much below the other offers made by physical retailers because on the net retailers need not maintain a shop to showcase their merchandise. Since they are not spending in maintaining a physical shop,they can offer you items much better value for money.
Consider the pros and cons of the baby cloth features. You might not end up disappointed upon delivery of the goods.
Follow these basic rules while shopping on the net for your baby outfitsThis guideline is not only for shopping your baby’s outfits,but for you to consider while shopping for any merchandize on the net: Use a secure server and browser with industry security standards before you enter credit card relevant information on the net; research the target site and verify the companies for authentication through contact relevant information such as business name,address and telephone numbers; avoid using debit cards and consider calling up to take in your orders instead; and print out relevant information on your order when you place it and keep the copies.
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Gambling identifies a certain act that’s conducted by 2 parties or in this case, two individuals who don’t own a legal contract with one another. Gambling is essentially taking part in a particular action or sport in which you risk a certain item or money in order to gain something else. Some examples of gaming are: Free lottery games, Lotto (6/49®), Instant lottery (3 chancellors) and other scratchcards. It’s likely to get a permit to bet if you fulfill certain requirements.
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London Tours is the best means to explore and enjoy all the beauty and charm that this beautiful and huge city has to offer. It is one of the most visited cities in the world. It is home to a large number of tourist attractions such as the Buckingham Palace, Big Ben, the Westminster Abbey, St. Paul’s Cathedral and much more. The tourist attractions are a great attraction for any tourists visiting London. There are many travel packages available for the tourists to make their tour a pleasant one. Most of the tour operators provide comfortable and cheap London tours so that every visitor gets to visit the places they have wanted to visit. Looking for cheap London tours? this website There are many options available for the tourists to select from to make their tour a pleasant one. For the first time visitors, they can choose to go for a London tour within the boundaries of the Capital. These tours cover sightseeing and shopping at some of the best markets in London. Some of the popular markets that are included in these tours are Stone Street, Piccadilly Circus, Oxford Street, Kensington High Street, Soho Square and so on. Another good option for the tourists to visit London is the tour across London in a train. This is the best option for the first time travelers as it allows them to see all the major sights in London with their own way. The tourists can travel from the North to South destinations like Hyde Park and Regent’s Park and can see all the beautiful buildings there. There are many train tours available for the tourists and you can select any one that suits your needs, like this: [visit our site] . Tourists also find it easier to travel with a tour operator as they help in all the necessary arrangements such as booking the tickets, picking up the guest, driving the tour and so on. The tourist also has an option to travel by a tram tour in London. These trams are operated by a company called London Trips. They take the visitors to all the important cities of London. At each destination the tram stops, allowing the tourist to have a drink from a bottle of chilled out orange juice. Other than the city tours, London has a number of other options for tourism. One can find tours of the Natural History Museum, Piccadilly Circus, Madame Tussauds Wax Museum, Westminster Abbey, Buckingham Palace and so on. Other attractions include the Kensington Garden, Hyde Park and Victoria and Albert Museum. For those who want to spend some quality time in London, there are numerous fine restaurants and shopping malls, which have made the tourists addicted to the city. If you want to enjoy London holidays to the fullest, it is recommended that you opt for London cheap tour packages. A good package from a tour operator will help you visit the city’s most famous landmarks and will also offer you plenty of experience. You can make use of various facilities offered under the tour package. The packages may also provide accommodation and car rental at affordable rates. Thus, a cheap London tour will make your trip hassle free and enjoyable. Enjoy London like this: read more here .
Introduction Since the publication of the first report of the Surgeon General’s Advisory Committee on Smoking and Health in 1964, more than 20 million deaths have occurred prematurely in the United States due to cigarette smoking.1 While efforts in the United States have led to a decline in cigarette smoking among adults from 42% in 1964 to 14% by 2019, more than 34 million adults still currently smoke.1,2 It is estimated that 50.6 million U.S. adults (20.8%) use some form of tobacco product.2
Cigarette smoking (including secondhand smoke exposure) is the leading cause of death and preventable disease in the United States, accounting for more than 480,000 deaths each year.1,2,3 If cigarette use continues at the current rate, 5.6 million U.S. children younger than 18 who are alive today will die prematurely as a result of smoking.3
Cigarette smoking has been causally linked to diseases of nearly all organs of the body, including an increased risk of heart disease, stroke, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and lung cancer.1 Lung cancer caused by smoking is the leading cause of lung cancer deaths.1,4 It also causes complications in pregnancy, harms the fetus, and leads to diminished overall health status.1 People who smoke are estimated to lose more than 10 years of life expectancy, but the risk of all-cause mortality for smokers who quit also dramatically decreases the sooner they quit.1 Quitting smoking by 40 years of age can eliminate more than 90% of excess mortality caused by continuing to smoke.1
Inhaling secondhand smoke is also detrimental to health. It consists of a mixture of gases and fine particles that includes smoke from a burning tobacco product, as well as exhaled smoke.5 This smoke contains thousands of chemicals, hundreds which are toxic, including 70 that can cause cancer.4
Some cancers, along with respiratory and cardiovascular diseases, may result from exposure to secondhand smoke, and it can also cause serious adverse effects during pregnancy and in infants and children.4 A number of risks associated with secondhand smoke exposure during pregnancy affect unborn babies and infants; these include premature delivery, low birth weight, stillbirth, sudden infant death syndrome (SIDS), lower respiratory infection, asthma, and middle ear infection.4
Nicotine is a highly addictive, naturally occurring chemical found in tobacco.1 Cigarette companies intentionally modify tobacco products to “create and sustain addiction.”6
While cigarette smoking is the predominant form of tobacco use in the United States, other tobacco products are often used by and marketed to certain racial, ethnic, and lower socioeconomic populations, as well as children and young adults.7 These include bidis, tobacco smoked with a hookah/waterpipe, snus, dissolvables, cigars, cigarillos, electronic nicotine delivery systems (ENDS), and electronic cigarettes (also called e-cigarettes).7
E-cigarettes and ENDS are battery-powered devices that contain nicotine-filled cartridges or reservoirs for adding nicotine-containing liquid or “juice.” They produce a vapor that is inhaled as a mist that contains flavorings and various levels of nicotine and other toxic substances.8 Manufacturers and marketers tout e-cigarettes as cheaper and safer alternatives to traditional cigarettes.9 These claims are being made despite a number of studies linking e-cigarette use to several harmful effects likely caused by increases in blood nicotine level,10 multiple physical symptoms,11 and negative effects on indoor air quality.12 A significant concern is the increased focus by manufacturers, marketers, and retailers on e-cigarette use as a smoking cessation tool.9 The American Academy of Family Physicians (AAFP) does not endorse ENDS as cessation devices in any population due to insufficient evidence of their efficacy.13 The AAFP does support the seven U.S. Food and Drug Administration (FDA)-approved tobacco cessation options, acknowledging that pharmacotherapy and counseling substantially improve cessation outcomes.14
Call to Action The AAFP urges all state, federal, and private sector institutions involved in tobacco prevention and cessation activities to increase and coordinate their efforts. Bold new initiatives are necessary to decrease the harm caused by tobacco and nicotine use. The AAFP supports the American Academy of Pediatrics, American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, and Legacy® in their call for action by all levels of government to achieve the following three bold goals15:
Reduce smoking rates to less than 10% by 2024 Protect all Americans from secondhand smoke Eliminate the death and disease caused by tobacco use There are opportunities for family physicians to become active in advocating for tobacco and nicotine control measures at the community, state, and national levels. Family physicians are trusted members of their communities and can serve as effective agents in facilitating and advocating for policy change, especially at the local level. To reach these bold goals, the AAFP calls for advocacy in the areas listed below.
Community and State Advocacy for: Evidence-based tobacco control policy changes, including increased tobacco excise taxes Comprehensive, evidence-based tobacco control programs supported by tax revenue Tobacco-free pharmacies and health care facilities, and elimination of all forms of tobacco sales in pharmacies Comprehensive clean indoor air policies that include the use of e-cigarettes and ENDS National Advocacy for: Insurance coverage with no co-payments or cost sharing, including Medicaid coverage, for evidence-based cessation counseling, prescriptions, and over-the-counter tobacco cessation medications Enhanced access to tobacco cessation services for all patients, regardless of health insurance Aggressive and timely regulation of all products containing nicotine by the FDA’s Center for Tobacco Products (CTP) Research on e-cigarettes to assess their safety, quality, and efficacy as a potential cessation device Restriction of access and marketing of e-cigarettes to children and youth Through these and other actions, the AAFP, its chapters, and its individual members can work in partnership to help eliminate the epidemic of tobacco-related death and disease.
Family Physicians’ Role Family physicians can make a significant impact on the tobacco use behavior of Americans. Approximately 70% of individuals who use tobacco products see a physician each year.16 Recent evidence reinforces the positive impact that primary care physicians can have by encouraging smoking cessation with their patients.17
Patients want to quit smoking. Nearly 70% of adults who smoke say they want to quit, and more than half report having made a quit attempt in the past year.18 However, fewer than one-third try to quit using evidence-based cessation methods.18 Quitting smoking can be difficult without assistance. One study found that only 3%-5% of adults who attempted to quit without cessation assistance maintained their smoking abstinence for 6-12 months.19
While most individuals try to quit on their own without participating in smoking cessation programs,18 research shows that evidence-based cessation programs can double successful quitting rates.16 If physicians would advise 90% of people who smoke to quit and offer them medication or other assistance, 42,000 lives could be saved each year.20
There are many opportunities for family physicians to address tobacco use and nicotine dependence in the practice setting. The following actions may help physicians take advantage of those opportunities16,21:
Counsel all patients on the harms of nicotine and tobacco products Promote medical education sessions for all care team staff that focus on effective cessation tools and ways to overcome barriers Implement or enhance office-based prevention programs and policies, including those that target high-risk populations Engage the health care team to provide tobacco cessation counseling and medical treatments Provide a clearly defined process for practices and clinicians to assess patient interest in quitting, encourage quitting for those not currently interested, encourage counseling and use of cessation medications, and provide follow-up Include a systematic way to provide patients with more information about and support for quitting, using appropriate members of the health care team besides physicians, when possible List tobacco use as a cause of death when appropriate Use tobacco use status as a vital sign Create a flowsheet in the patient’s record so the clinician can see a summary of past smoking discussions and quit attempts The AAFP encourages its members to use a variety of counseling techniques to address tobacco use and nicotine dependence, such as motivational interviewing, brief interventions, and group visits. Members should recognize and address barriers to successful intervention and treatment. Barriers exist at the patient and physician level, as well as at a systemic level.
Patient- and physician-level barriers include: Lack of motivation to quit22 Nonadherence to medications and counseling23 Use of non-evidence-based treatments18 Limited time with patients24 Systemic-level barriers include: Inconsistent follow-up to ensure that patients are adhering to cessation plans and appropriate referrals occurred25 Inadequate reimbursement and payment for cessation counseling and treatments26 Inconsistent follow-up with patients to remind them to utilize services20 Tobacco Cessation Tools for the Family Physician Ask and Act The U.S. Public Health Service (USPHS) encourages use of the five A’s (Ask, Advise, Assess, Assist, and Arrange) as a brief intervention for patients who smoke.16 The AAFP encourages its members and their practice teams to Ask all patients about tobacco use and then Act to help them quit. The AAFP’s Ask and Act tobacco cessation program uses an evidence-based strategy based on USPHS recommendations. This easy-to-remember approach provides the opportunity for every member of a practice team to intervene at every visit. The implementation of team-based care offers a significant opportunity to improve the rate of interventions for tobacco use and nicotine dependence. For more information about tobacco cessation tools and interventions, visit www.askandact.org.
Electronic Health Records Electronic health records (EHRs) allow for integration of evidence-based recommendations into the practice workflow. The AAFP encourages the use of EHRs that include the following:
A template that prompts clinicians or their practice teams to collect information about tobacco and nicotine use, secondhand smoke exposure, current cessation interest, and past quit attempts Clinical decision support that assists clinicians and/or staff in screening for use, encouraging quitting, connecting patients and families to appropriate cessation resources, and advising them about the benefits of smoke-free environments The AAFP encourages all members to track and assess tobacco and nicotine use at every visit or opportunity. Tobacco use assessments can be beneficial in meeting requirements of a variety of quality reporting programs.
Tobacco Cessation and Telehealth In addition to office-based tobacco cessation interventions, telehealth services can be an effective way to expand access and improve adherence to chronic care management, such as treating tobacco dependence, and provide physicians enhanced methods of delivering evidence-based treatment.27
Telehealth utilizes phone- or video-based clinical services through a patient’s primary care team and can be used to supplement services provided by state-led tobacco quitlines. Research shows that telehealth smoking cessation programs can be an effective tool in tobacco cessation treatment; for example, compared with in-person counseling, they result in similar abstinence rates from weeks 9 to 12, and lead to greater patient satisfaction and better adherence to pharmacotherapy treatment than quitline-style telephone counseling.28,29
Payment and Covered Benefits Repeated clinical tobacco cessation counseling is “one of the three most important and cost-effective preventive services that can be provided in a medical practice.”21 The AAFP strongly advocates for health plan coverage and appropriate payment for evidence-based physician services for screening and treatment of tobacco use consistent with the U.S. Preventive Services Task Force (USPSTF) recommendations.30
The AAFP recommends that all people who use tobacco in the United States be aware of the existence of and have access to all evidence-based, FDA-approved therapies and counseling. The Centers for Medicare & Medicaid Services (CMS) pays for physician services related to smoking cessation counseling provided to Medicare beneficiaries.31 The Patient Protection and Affordable Care Act (ACA) requires insurance plans to cover many clinical preventive services, including tobacco use screening and counseling.32 A guide to coding for tobacco cessation and screening is available on the AAFP’s website.
High-risk Populations Despite the overall decline in tobacco use, certain populations maintain high rates. Higher rates of tobacco and nicotine use in these populations increase their risk of harmful health effects. Populations more likely to use tobacco include the following:
Individuals in some racial and ethnic minority groups33 Lesbian, gay, bisexual, and transgender (LGBT) individuals34 Individuals with lower education levels and lower socioeconomic status34,35 Individuals living in rural areas36 Individuals with mental illness37 Individuals with substance abuse disorders38,39 Individuals with mental illness smoke at rates that are twice as high as the general population.37 Nearly half the cigarettes sold in the United States are smoked by individuals with mental illness.39 Smoking prevalence is particularly high among individuals diagnosed with schizophrenia, bipolar disorder, depression, post-traumatic stress disorder (PTSD), and alcohol/illicit drug use disorders.39 In addition, smoking prevalence increases as the number of mental disorders increases, with 61% smoking rates for individuals diagnosed with three or more mental disorders.39
Other populations with increased health threats from tobacco use include people who are pregnant; people with human immunodeficiency virus (HIV); and people with comorbid conditions such as diabetes, cancer, cardiovascular disease, COPD, diabetes, and asthma.
Tobacco Use in Adolescents In 2017, approximately 3.6 million middle and high school students were current tobacco users.40 Among high school students, 7.6% reported smoking in the past 30 days, with one in five reporting use of some form of tobacco.41 In addition to the well-known, long-term health effects of smoking, children may experience immediate effects on the brain, as well as the respiratory, cardiovascular, gastrointestinal, immune, and metabolic systems.42
While cigarette smoking by youth has been on the decline, the FDA reported a 77% increase in ENDS use among high school students within a 12-month timeframe in 2018.43 The Surgeon General’s Advisory on E-cigarette Use Among Youth, released in 2018, classified ENDS use among youth as an epidemic.44 The surgeon general called for immediate action to mitigate the rapid increase of ENDS use among youth, which subsequently leads to nicotine addiction. Nicotine exposure in adolescence can impact brain development, which affects learning, memory, and attention. Evidence also suggests ENDS use during adolescence may lead to traditional cigarette smoking later in life.44
There is clear evidence of a causal relationship between tobacco advertising and the influence, initiation, and progression of tobacco use among youth.7 Tobacco companies extensively market to youth, adolescents, and young adults.7 In a 1984 R.J. Reynolds report, the company expressed how essential those smokers are when they stated, “Younger adult smokers are the only source of replacement smokers If younger adults turn away from smoking, the industry must decline, just as a population which does not give birth will eventually dwindle.”45 The tobacco industry has worked hard and spent aggressively to keep these customers. In 2016, cigarette and smokeless tobacco companies spent a combined $9.5 billion on advertising and promotional expenses in the United States.46,47
Tobacco prevention programs are increasingly important to curb youth tobacco use initiation, particularly as the landscape of tobacco and nicotine products changes and adapts to appeal to new generations. Nearly all adults who smoke every day initiated smoking at 26 years or younger, with the majority (88%) beginning by 18 years of age.7 Despite some recent promising declines in overall youth ENDS use, middle and high school students continue to use ENDS at alarmingly high rates.48
Tar Wars The AAFP encourages its members to talk to children and adolescents about the risks of using tobacco and nicotine products, and to participate in community awareness and prevention activities. Tar Wars, the AAFP’s tobacco prevention program, helps keep youth from using tobacco and nicotine products. This program was developed by a family physician and health educator in 1988. It teaches children about the effects of tobacco use, the cost of using tobacco products, and advertising techniques used by the tobacco industry to market their products to children.
Research and Development The budgets in the public and private sectors for development of new technologies and approaches to tobacco use screening and treatment are not commensurate with the size and scope of the tobacco and nicotine use epidemic. The AAFP encourages increased funding for the pursuit of innovative approaches to identifying those at risk for tobacco and nicotine use and helping people quit. This includes providing medications, counseling, policy change, and improvements in primary care clinic systems.
Medical Education The AAFP strongly advocates for in-depth, effective education in the prevention and cessation of tobacco use in medical schools and residency programs. The AAFP also encourages family physicians to participate in continuing medical education (CME) activities and programs related to prevention and cessation of tobacco use, and strongly encourages organizations involved in the creation of CME to integrate tobacco and nicotine use screening, prevention, and treatment into their curricula. Organizations involved in the ongoing credentialing of primary care physicians, such as the American Board of Family Medicine (ABFM), should include questions about tobacco dependence treatment in examinations and test preparation materials.
Taxation and Subsidies The AAFP believes that increasing taxes on tobacco products provides a major disincentive to potential buyers. The AAFP encourages the development of health education and other tobacco control programs funded by the taxes collected on tobacco products. The AAFP supports its chapters’ efforts to ensure that funds from the Master Settlement Agreement (MSA) or excise taxes on tobacco products be used primarily for tobacco use prevention, cessation, education, and other elements of comprehensive tobacco control.
Secondhand Smoke The AAFP strongly supports prohibiting the use of all tobacco and nicotine products that emit smoke, vapor, or any form of inhalable substance in all public places. All tobacco or nicotine product smoke or inhalable vapor in indoor spaces must be eliminated to fully protect those who do not use such products. Mitigation efforts such as separating people who smoke or use any device containing nicotine that emits a vapor from those who do not within the same air space, cleaning the air, opening windows, or ventilating buildings do not effectively eliminate secondhand smoke exposure. Family physicians should advise their patients, especially those with children and those with cardiovascular diseases or other chronic conditions, to avoid establishments that permit smoking and to request that family members not smoke in their home or vehicle. To reduce children’s exposure to secondhand smoke, family physicians should encourage all household members who use tobacco to quit and to create a smoke-free home. The AAFP urges all employers to provide smoke-free work environments and incentives for employees who participate in cessation programs. Family physicians and AAFP chapters are encouraged to work with local governments and agencies to advocate for comprehensive clean indoor air ordinances and regulations.
Framework Convention on Tobacco Control Public Health Treaty The AAFP fully supports the World Health Organization’s (WHO’s) Framework Convention on Tobacco Control (FCTC) and urges its full ratification by the United States. The FCTC is the world’s first global public health treaty that requires nations to adopt a comprehensive range of measures designed to reduce the devastating health and economic impact of tobacco use. The FCTC calls for provisions that include price and tax measures to reduce the demand for tobacco products.49
The non-price measures to reduce the demand for tobacco products stated in the FCTC address the following50:
Protection from exposure to tobacco smoke Regulation of the contents of tobacco products Regulation of tobacco product disclosures Packaging and labeling of tobacco products Education, communication, training, and public awareness Tobacco advertising, promotion, and sponsorship Demand reduction measures concerning tobacco dependence and cessation The core supply reduction provisions stated in the FCTC address the following50:
Illicit trade in tobacco products Sales to and by minors Provision of support for economically viable alternative activities to tobacco farming and production The United States signed the treaty in 2004, but it has yet to be sent to the Senate for ratification.50 The AAFP supports the FCTC and urges the Senate to ratify the treaty.
Electronic Nicotine Delivery Systems (ENDS) Electronic nicotine delivery systems (also called electronic cigarettes, e-cigarettes, vaping devices, or vape pens) are battery-powered devices used to smoke or “vape” a flavored solution that usually contains nicotine.8 The AAFP recognizes the alarmingly high rates of ENDS use, especially among youth and young adults, as well as their use by those attempting to quit smoking tobacco.51,52
The AAFP calls for further research to assess ENDS’ safety, quality, and efficacy as potential cessation devices. The AAFP also recommends that the marketing and advertising of ENDS to children and youth cease immediately. The AAFP encourages members to screen for ENDS use starting with school-age children, to discuss the potential harms of ENDS, and to recommend cessation interventions to e-cigarette users. The AAFP encourages members to inform patients who use ENDS, especially children, that the majority of these products contain nicotine and are addictive.
Tobacco Advertising and Labeling The AAFP opposes all forms of advertisement of tobacco products, including all forms of ENDS, and direct or indirect marketing of tobacco products to children. The AAFP will endeavor to place advertising material in and develop relationships with publications that do not accept tobacco advertising. If placing advertising material in a publication that accepts tobacco advertising is unavoidable, the adjoining pages will not promote tobacco or alcohol. The AAFP urges removal of corporate tax deductions for the advertising of tobacco products. The AAFP supports state and community efforts to reduce or eliminate point-of-sale advertising.
The AAFP strongly supports prominently displayed labeling that warns potential users of health hazards of all tobacco products, including all forms of ENDS. The AAFP supports “plain pack” tobacco product packaging, removal of logos and colors associated with individual brands, and implementation of depictions of tobacco-related disease on packaging.
Federal Tobacco 21, Distribution, and Sales In December 2019, after years of state-level advocacy, the federal minimum age for sale of tobacco products was raised from 18 to 21 years of age for all retail establishments and individuals, with no exemptions.53 Although this federal Tobacco 21 legislation is a significant achievement for tobacco control advocates and public health, substantial deficiencies remain in the areas of implementation and enforcement.
Since the new federal law raises the minimum age for sale to 21, states are expected to enforce underage access laws to reduce the illegal sale of tobacco products to individuals under the age of 21.54 However, no federal support has been provided to states to help make this transition. Federal guidance gives states up to three years to be in compliance with the new age-at-sale requirements, even though the legislation itself requires states to be in compliance sooner.53,54 Additionally, the new law cuts the allowable penalty for states that are out of compliance from up to 40% of a state’s federal block grant funds to only up to 10% with no escalating penalty.54 This change significantly limits the federal government’s ability to incentivize states that are consistently out of compliance. The AAFP supports active enforcement of minimum legal age-of-sale verification at the time of sale with a burden of verification on tobacco retailers. The AAFP opposes state and local laws designed to penalize minors for possession, use, and purchase of tobacco products. The AAFP supports requiring that all tobacco products be placed behind sales counters in retail stores. The AAFP supports legislation to ban the sale of tobacco products via the internet and from vending machines and ban the promotional distribution of free tobacco products. The AAFP supports tobacco retailer licensing programs and zoning requirements reducing the density, type, and location of tobacco retailers.
The term “functioning alcoholic” is generally used to avoid labeling someone as a stereotypical alcoholic. Alcohol is one of the most commonly abused substances and often has specific stereotypes linked to abuse of it.
When picturing someone struggling with alcohol addiction, it is common to imagine a disheveled, homeless person, or someone who has lost their home, family and other possessions due to their alcohol abuse. These stereotypes are only the end result of a much longer process, and they can mislead functioning alcoholics because their lives have yet to fit these stereotypes.
Someone who uses the term “functioning alcoholic” to define themselves may be in denial about the extent of their problem. The reality is that a functioning alcoholic can still be controlled by their alcohol abuse.
Ready to make a change? Call to speak to a treatment specialist.
435-843-6594 Signs Of A Functioning Alcoholic If alcohol abuse is suspected, there are a few signs that can indicate there is a problem.
Possible signs of a functioning alcoholic may include:
if a person drinks alcohol to replace eating food. angry or defensive reactions when someone brings up the possibility of alcoholism. not being able to remember what happened while under the influence of alcohol. setting drinking limits and failing to stick to them. participating in “pre-drinking” before an evening out. attempting to hide drinking from others. drinking in the morning, throughout the day or while alone. joking about the possibility of being an alcoholic. Alcoholism is a disease that slowly develops over time, not all at once. While everyone may experience this progression differently, there are four common stages people go through when becoming a functional alcoholic.
Stage #1: Occasional Alcohol Abuse And Binge Drinking The first stage of alcoholism is a general experimentation with the substance. Individuals in this stage may not be familiar with different types of alcohol, so they are more likely to test their limits.
This stage of alcoholism is often defined by the goal of “drinking to get drunk.” People who abuse alcohol often use it to self-medicate and escape negative thoughts and feelings. This is how problem drinking starts.
Usually, people in the first stage of alcoholism are not drinking every day, and they are still able to perform daily activities. Although drinking may not consume their thoughts, they may need to drink more to reach the desired level of intoxication.
During this stage, someone may believe they are still functioning because they have a job and they are successfully maintaining relationships. In reality, this isn’t true, because after they consume their first alcoholic drink, they usually struggle to control their drinking.
Stage #2: Increased Drinking As A Coping Mechanism The second stage of alcoholism is defined by the mental obsession with the next drink. Many people consume alcohol in order to relax and unwind. But, those struggling with alcohol abuse may see drinking as the only way to relieve stress.
Over time, other coping skills will fade away and all negative thoughts and feelings will be addressed by drinking alcohol. At this point, people may not be physically addicted to alcohol, but they may be psychologically dependent on it.
During this stage, outward appearances don’t change much, but individuals may be routinely hungover. This is often justified by saying they just like to “cut loose and party.”
Stage #3: The Consequences Of Problem Drinking Start To Show The third stage of alcoholism is usually identified when others begin to show concern for someone’s drinking habits. For those struggling with alcohol abuse, stage three is all about managing the consequences of their drinking.
Individuals in this stage of alcoholism may try to set boundaries for themselves, but they will be unable to stick to them. Possible boundaries can include telling themselves, or someone else, they will only have a certain number of drinks and then stop, or they will drink only beer instead of hard liquor.
During this stage, individuals may feel like they are a “functioning alcoholic,” despite all the changes alcohol has caused them to make in their lives. These changes may include a new group of friends or frequently changing jobs.
At this point, an individual’s life is centered around managing the consequences of their alcohol abuse. People may continue to compare themselves to the stereotypical alcoholics who have lost it all and assure themselves that is not who they are.
Although the consequences of problem drinking will vary from person to person, some common issues can include:
isolation legal problems depression and anxiety Isolation Isolation happens when someone becomes uncomfortable drinking in front of concerned family and friends. People may feel embarrassed by being called out and choose to start drinking alone.
Legal Problems Another consequence of alcohol abuse is possible legal issues, such as being caught driving under the influence of alcohol (DUI). This may also cause people to stay home and drink alone, increasing their isolation.
Depression And Anxiety Prolonged alcohol abuse can also affect someone’s emotional state, causing them to feel depressed and anxious. When alcohol becomes the only way someone copes with stress or unhappiness, drinking to excess can amplify any negative emotions.
Spending more than you want on gambling? Struggling to find the money for bills? Taking out loans to cover gambling debts? A financial crisis is often what brings a person to address their gambling. It’s also not uncommon for partners, friends or family members to tell us that they did not realise their loved one had a gambling problem until there were serious financial consequences such as a court summons for non-payment of debt, or repossession action on their home.
Financial problems can really mount up, and more quickly than you realise. Bills don’t get paid, credit cards are maxed out, debts accumulate – pay day loans look like a solution, but high interest rates make the situation worse. Borrowing or stealing from loved ones, businesses or employers also happens when people feel increasingly desperate.
It may feel as though there is no chance of repaying your debts unless you carry on gambling – we hear from many people who feel completely trapped by their financial situation. Continuing to gamble will only make debts bigger – clearing debts gradually will take a while, but in reality it’s the only way to manage the problem.
Many problem gamblers have not let anyone know about how much they owe, and it can be daunting to take the step and tell people you trust, but it’s essential if you are ever going to take control and improve the situation.
Think about contacting a specialist not for profit debt advice agency. You can find links to other agencies at Links to other support agencies If you’re gambling, unless you get it under control, you’ll find it difficult to get out of debt and stay out of debt in future. So it will also be important to take steps to address your gambling, as well as your debt. Our Advisers can give you more information and advice to help you take the first step – talk to us now. Mental health
According to the Royal College of Psychiatrists, problem gamblers are more likely than others to suffer from low self-esteem, develop stress-related disorders, to become anxious, have poor sleep and appetite, to develop a substance misuse problem and to suffer from depression. In this section we explore some of the reasons for this, as well as giving you some advice if this concerns you.
Are you experiencing all or some or all of the following?
Extreme emotions or mood swings Feeling that gambling is the only thing you enjoy, to the exclusion of other things Using gambling as a way to deal with other problems or emotions in your life Difficulty sleeping Feeling depressed or anxious Having suicidal thoughts If you answered yes to any of these questions, gambling could be a problem. If you’re not sure how your gambling affecting you at this stage, our self assessment may help.
Although a lot of people gamble to escape feelings of depression or other mental health problems, gambling can actually make these conditions worse.
If you gamble a lot yourself, you may have found the ‘high’ of anticipating ‘the big win’ to be very mentally involving and extremely exciting, perhaps better than the feelings you experience taking part in any other activity. You may also have found the devastation of losing to be a massive low, leading to feelings of despair.
This is especially the case when large amounts of money are being staked, increasing the potential for a massive ‘high’, but also makes the ‘low’ feel worse when it comes. Feelings of loss and despair following a gambling spree can lead to greater desires to gamble straight away in order to try and get back on a ‘high’. However, by continuing to gamble, any negative feelings will only get worse.
The impact of these highs and lows on your mental health can be significant. Studies show that brain chemistry and cell structure can be changed by this type of exposure. The system of ‘rewards’ in the brain can be affected: where previously you might have found pleasure in other activities such as food or sex, you may now find that these don’t hold so much appeal.
The good news is that studies have shown that brain chemistry can be rebalanced, and everyday life can start to feel good again. Finding ways to change your relationship with gambling and getting the right support for yourself can begin this process.
Get help It is important to speak to professionals if you are worried about the impact of gambling on your mental health. Your GP may be the first person you talk to, and they may refer you to specialist services if they feel this will help. If you are not registered with a GP, you can find one local to you at www.cme2sel.com
If you are concerned about your gambling, GamCare has a range of help, advice and support services. To discuss this further, talk to our Advisers now.
Problem gambling and suicide Recent research has shown a strong link between gambling problems and thoughts of suicide – more than double the amount of people affected by gambling problems say that they have considered taking their own life compared to those who are not affected by gambling.
With other addictions, such as drugs or alcohol, there is a limit to how much a person’s body can take before they need medical intervention. Gambling is not like that, and often a downward spiral can continue unchecked for a long time. Especially if large amounts of debt are involved, it can seem as though there is no other option.
If you have self-harmed or had suicidal thoughts or feelings, it is really important to seek professional help as soon as possible. You can speak to your GP or find NHS support, or you may find the following links useful.
Relationships
Having a gambling problem can be very all-consuming, and as well as the effect on the gamblers themselves, it can have a devastating impact on their relationships with other people. Do you recognise any of the following?
Arguing more with your partner or family, especially about money Being preoccupied with gambling and finding it difficult to focus on other things Spending less time with people and more time gambling Lying to friends and family about losses Stealing money from friends or family to gamble with These are signs that gambling is becoming a problem. Your friends and family may feel like you don’t care about them any more, if all of your time and attention is taken up with gambling. The emotional distance and tension this creates can be devastating in the long term. Lying, breaking promises and constantly missing important events can mean your loved ones lose trust in your relationships, and this is very hard to repair. Your loved ones may also start to feel guilty about the situation, especially if they do not realise that you are gambling – they may think that they are doing something to drive you away.
Problem gambling in a family can also have an effect on children – the impact of stress within the family unit and potential loss of relationship with a parent can have lasting consequences.
Get help Once a problem gambler seeks help and enters recovery there can be an opportunity to re-establish relationships. Rebuilding trust can be a difficult task but relationships can heal once a problem gambler enters recovery. Breaking an addiction is a very difficult process. Recovery takes time, hard work and commitment.
If you are concerned about your gambling or that of a loved one, talk to us. We provide support for gamblers as well as friends and family who are affected, and we can help each person in their own right.
Isolation
Many gamblers report that they get a sense of ‘community’ from the environment they gamble in – for example the betting shop, or people they talk to online. Problem gamblers can lose interest in maintaining personal relationships, career or hobbies as they are preoccupied with gambling, and they can suffer from social isolation. Regular life sometimes doesn’t hold the same appeal as the gambling ‘high’.
Arguments, strained relationships, failure to meet responsibilities, alienation, separation, divorce, physical or mental abuse can all impact someone with a gambling problem. The gambler may isolate themselves due to guilt or shame, or perhaps because they have borrowed or stolen to fund their gambling. It can begin to feel like there is no way back.
