40 percent of smokers begin between the ages of 15-19. According to researchers, the intensity of spiritual-psychological and social problems between the ages of 13 and 19 puts youths under a higher risk of starting smoking. Smoking as an adolescent can be related to low self-esteem and academic problems. It is an established fact that teenage smoking is the most influential risk factor for adult smoking. A young person looking for a role model can be influenced by one’s parents, teachers, and friends. Family structure and social environments are influential regarding smoking and other addictive behaviors. Keeping away from smokers reduces the likelihood of smoking.

It is reported that light depression increases smoking, and that regular smokers’ have higher incidences of depression and suicide when compared to non-smokers. Smoking rates are higher with those who do manual labor, who have smokers among family members or close friends, who live in urban centers, who have a high income, who work under difficult conditions, who have a history of social problems, and who are male. It is also reported that 94% of people who smoke more than three cigarettes a day at the beginning become addicted in the long run.

Why do people insist on continuing a behavior they know to be harmful or that they cannot give up easily even if they wish to? There are various reasons for this. First of all, human beings do not only make decisions and act within the control of reason, logic, willpower, and conscience. Cigarettes contain addictive chemicals that stimulate the brain’s pleasure center. Developing an addiction weakens willpower. When individuals realize how dangerous this addiction is, it is mostly too late to give up, since it takes significant willpower. We act not only based on logical information, but on intense feelings, too. Thus, a person continues to smoke in spite of knowing the dangers. A person’s degree of psychological and spiritual “hunger,” the strength of their feelings, and a failure to meet other healthy goals can be contributing factors to an addiction.

The World Health Organization defines dependence syndrome as “a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value.” Considering cigarette dependence, the person may find it really hard to break free from a vicious cycle beginning with thought, gaining velocity with feelings, and ending with the execution of a certain act.

In terms of the human brain and neurotransmitters, smoking causes nicotine to react with nicotine receptors. As a result of long-term nicotine intake, a neuro-adaptation increases the number of nicotine receptors in the brain. The brain develops tolerance to certain effects of nicotine. After a person has become neuro-physiological dependent, they begin to crave nicotine.

The effects of nicotine on the human body depend on the dose and have two aspects. The reduction of nicotine in blood causes symptoms of depravation, and its increase causes symptoms of poisoning. If a person smokes more cigarettes, and has free access to them, the amount required to achieve stimulation grows; their tolerance gets higher. Because nicotine is a psychological and spiritual stimulant, it often gives a feeling of temporary relief, which helps the smoker to forget their problems. This causes the smoker to draw a connection between smoking and a lack of worries, thus further affecting their reasoning and will power. Researches have shown that as the daily number of cigarettes increases, the habit shifts from the critical phase to the supercritical, and that psychological dependence turns into neuro-psychological dependence. 75-80 percent of smokers wish to give up smoking, and one third of dependent smokers attempted to give up smoking at least three times.

Phases of treatment

The purpose in treatment is making the smoker give up the habit in the long run. The first goal is to get the behavior under control by reducing the amount of cigarettes, and then, finally, cutting them out completely. A set of psychological thresholds smokers need to overcome are defined. Each of them is passed by overcoming different psychological and social obstacles.

1. Not being aware of the damage and not taking any steps for change: At this phase, the smoker does not calculate the possible harm of smoking and thus does not wish to give it up. When the subject is mentioned, it is dismissed by means of certain defense mechanisms. Those who wish to help the smoker must know this situation, and they should never engage in a dispute about smoking; by using soft spoken words, they should patiently try to make that person feel the grim realities of smoking.

2. Beginning to think about giving up smoking: At this phase, the person states that he or she will give up smoking whenever the subject is mentioned. The person also expresses being aware of the dangers and being in need of help to give up. However, taking action can sometimes take months, or even years. At this phase, the person should make a self-evaluation for the sake of putting one’s knowledge to real life practice, and to help them face their conscience. Those who wish to give up smoking had better prepare a list of the advantages to not smoking. Sincerity and empathy shown by the person to help the smoker are the most influential help; a single look or word might have an adverse effect and cause a relapse.

3. The preparation: The person is ready to give up smoking. At this phase, it will be useful to prepare a practical plan by benefiting from the tips of those who gave up smoking successfully. The date to give up should be set, preferably a meaningful day for the person, such as a birthday or anniversary. For spiritual support, it can be useful to previously announce the day to give up smoking to the person’s friends and family.

4. Action: The person has quit smoking. Having a small ceremony can be beneficial, as it creates a sense of psychological and social obligation; in the interest of these obligations, it’s important the person receive social support throughout the process. The person should keep away from people and places that make them feel like smoking. Exercise is a good way to combat any urges. When the person feels an urge to smoke, one must take a deep breath, and then release it slowly after holding it for some time. They should know that an intense urge to smoke only lasts for two or three minutes and soon subsides.

5. Continuing the newly acquired good behavior: At this phase, the person must be resolved not to relapse. At this point, the issue depends on the person’s freewill. It will be useful to reward ones’ self for not having started again. One of the most important components of treatment is helping the smoker develop proper interests and hobbies so that they are not tempted to start smoking again. Others around the person can provide positive psychological support. It is narrated that one drunken man came to visit Rumi, but his disciples tried to get rid of him with harsh treatment. On seeing this, Rumi remarked: “He drank the toxicant, but you have become intoxicated.” In the same way, we must also act with magnanimity, tolerance, and a feeling of responsibility to save our friends from such a dangerous habit.

Smoking is a habit that can be given up and treated

Is it a wise strategy to give up smoking all of a sudden? Is it possible? Is it advised to give it up gradually? Answers to these questions differ from patient to patient. First and foremost, giving up smoking depends on the person’s own wish, resolution, and willpower. It is possible to give up this habit. According to the WHO, treating smokers are among a doctor’s duties. It is known that as a consequence of anti-smoking campaigns and activities, millions of people gave up smoking. As the average rate of success remains under 10% for those who receive no help, we need to provide as much support as possible and encourage people to be healthy.

None of the methods for giving up smoking are 100% successful on their own. The best results are obtained when medical treatment supports the psychological, mental, and spiritual processes. Medical treatment include symptomatic treatments that target the feeling of deprivation that arise after giving up smoking and using other drugs to lessen the wish to smoke.

References

• Heatherton, Todd F. et al. 1991. “The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire.” British Journal of Addiction 86:1119-1127.
• JC Norcross, Krebs PM, Proschaska JO. 2011. “Stages of Change.” J. Clin. Psychol. Feb. 67 (2):143-54.
• World Health Organization http://www.who.int/mediacentre/factsheets/fs310/en/index.html. Accessed March 9, 2013.

The extent of the problem

In the last two decades, there has been a tremendous increase in alcohol consumption in the world, an all-time high (WHO, 1980, pp7-13). The way to estimate the marked increase is probably to look at total or per capita consumption in different countries over a certain period of time (see Graphs 1, 2).

The WHO committee on alcohol-induced problems found that per capita consumption of alcoholic beverages has been increasing throughout most of the world in the last 20 years. Between 1960 and 1972, for example recorded world-wide production increased by 19% for wines, 68% for beer, and 61% for distilled spirits. Both industrialised and developing countries in various regions of the world showed that the annual consumption of alcoholic beverages, in terms of 100% ethanol (ethyl alcohol), was above 8 litres per capita in only two countries in 1950, but by 1976 this level was found in 22 countries (ibid.). A 1982 WHO report showed that by 1982 beer production had increased by 124% world-wide. In some countries in Asia, the increase was a horrifying 500%; in some African countries beer consumption increased by as much as 400%. Even remote villages, in many third world countries, were consuming alcoholic beverages while they lacked clean water and sewage disposal and other primary health amenities (Medicine Digest, 1982, p.S7).

In the UK, the per capita spending on alcohol increased by 76% over 1960-70. The adult population of the UK drank about twice as much alcohol in 1984 as it did in 1950. Spirit consumption increased by 135% while wine consumption increased by 250% (RCGP, l986).

The negative consequences of alcohol consumption are so great that it is impossible to list them. In 1979, members of the Executive Board at its 63rd session and delegates of numerous countries at the 32nd World Health Assembly confirmed that alcohol problems now rank among the world’s major public health concerns (resolution WHO 32.40; WHO, 1980); that in many parts of the world, they constitute a serious obstacle to socio-economic development and threaten to overwhelm the health services. A summary of the major losses due to alcohol consumption will be given here.

Socio-economic losses

Although the alcohol industry seems to benefit a few big international companies and provide jobs for many workers and even seems to increase state revenue from levying taxes on alcoholic beverages, the total socio-economic loss is so tremendous that these benefits become trivial. The deleterious effect on health, welfare and social consequences of alcohol consumption will more than tilt the balance towards the benefits of proscribing or at least limiting alcohol consumption.

The cost of alcohol abuse to a society is difficult to measure. In the USA, it was estimated that 30,000 million dollars were lost due to alcohol consumption in 1971 (Brunt, 1978). Table 3 gives some details. By 1979 these estimated costs were put at $43 billion dollars (WHO, 1980); and by 1986 at a staggering $120 billion dollars (Al-Sharq al-Awsat, 1986, Nov.11).

The UK spent 3 billion on alcohol in 1971; the figure increased to 11.4 billion in 1984 (RCGP, 1986), while France, in 1971, was spending annually an equivalent of $7 billion (Al-Sharq al-Awsat, 1980. July 1). West Germany in 1971 was spending 27.5 million DM on alcohol compared with 12.75 for smoking.

Alcohol features prominently in traffic accidents. WHO statistics suggest that it is involved in about 50% of all traffic accidents. Even in countries where alcohol and addictive drugs are prohibited, like Saudi Arabia, the Director of the Department of Alcohol and Drug Control claims that about 50% of long road accidents are due to alcohol and drug abuse (reported in personal conversation). In the USA, 25,000 deaths occur annually due to accidents caused by alcohol consumption. Another 15,000 deaths occur due to diseases caused by alcohol and another 15.000 deaths occur due to murder crimes and suicide committed under the influence of alcohol (Harris, 1971, pp.138-42).

The risk of accidents rises exponentially above 50 mg of alcohol percent, and at 200 mgs, the risk is a hundred times above that of the non-drinker (Brunt, 1978). It is estimated that 250,000 USA citizens die annually due to tobacco and alcohol consumption.

In crimes of violence, alcohol plays a prominent role. Nearly 70% of murders are committed under the influence of alcohol (ibid. ). WHO, after studying violent crimes in thirty countries including the USA and the UK, concluded that 86% of murders and 50% of rapes and other crimes of violence were committed under the influence of alcohol-reported in the Daily Mai l, June 26, 1980, which also quoted Lord Harris whose commission on the prison population in the UK reported that the majority of criminals were suffering from alcohol related problems.

Industrial losses are tremendous. In Scotland alone losses reached 100 million annually (SCA, 1977). In the USSR alcohol abuse is the most important cause of absenteeism and loss of production. (Gulf Times, 1983, Jan.12).

WHO (1980) cites the following consequences of alcohol abuse: absenteeism, illness, decreased production and quality of work, difficulties in work relationships, accidents and loss of trained personnel. Many countries, especially in the Third World, soffer badly from loss of management and trained staff due to alcohol abuse.

A lot of other social problems arise due to alcohol abuse. 74% of wife and child batterers are heavy drinkers. Incest, rape and other sexual crimes are usually committed under the influence of alcohol.

Divorce and separation are the ultimate result of indulgence in alcohol.

The price paid in human misery, poverty, broken homes and social degradation is beyond calculation.

Incidence of alcohol dependence

The term ‘alcohol dependence’ has replaced ‘alcoholism’ which is a denigratory unspecified term. Alcohol dependence is manifested by overt drinking behaviour, a continuation of drinking in a way not approved by one’s culture and in changed behavioural state. The dependent person’s control over his drinking becomes impaired, his craving for drink becomes relentless, and planning for drinking takes precedence over all other activities. Altered psychosomatic changes occur whereby the dependent person experiences the psychological and/or somatic signs of withdrawal during periods of abstinence. There is also increased tolerance whereby the effective dose of the intoxicant has to be increased in order to get the save pharmacological effect and satisfaction from the drug abused (Edwards et al.,1977, p.3; WHO, 1977, p.198).

It is estimated that at least one in ten of those who drink alcohol even occasionally will become alcohol dependent. In the USA the majority of the adult population drink. Some 100 million Americans drink alcoholic beverages at least occasionally (Miles, S., 1974, pp.10-14). The statistics show that practically every 17- or 18-year old will have experimented with at least one drink. As many as 50 to 85 percent of high school students drink at least occasionally. The average age at which youths begin to experiment is 13 to 14 (ibid.). In Scotland, 92% of boys and 85% of girls have experienced alcohol by age 14 (Jahoda & Crammond, 1972). In the age group 17-30 no less than 87% of men and 60% of women are regular drinkers (Dight, 1976).

Youngsters are more prone to heavy drinking when they are exposed to alcohol. In Scotland, 70% of boys and 61% of girls admitted to heavy drinking occasionally, while 40% of boys and 32% of girls (15-16 years) are regular heavy drinkers (Plant et al, 1980). 60% of Glasgow’s six-year-olds had tried alcohol (Jahoda & Crammond, 1972).

Increasing numbers of women are exposed to drinking. Heavy drinkers among women rose from 4% in 1972 to 11% in 1978 (Show, 1980). In the USA 93% of teenagers (12-17) have experienced alcohol; 1.2 million drink regularly (Strasburger, 1985).

In the USSR, the problem seems even worse. 90% of all cases of acute alcoholic intoxication being treated for the first time are under 15; one-third of them are under 10 (Al-Madina, 1984, Dec.13, quoting the Russian magazine Nash Supermenik ). 15% of the adult population are at present being treated for alcohol dependence.

There are hundreds of millions who suffer from alcohol abuse annually in the whole world. In the USA, it is estimated that 10 million are suffering from the deleterious effects of alcohol abuse (problem drinkers and alcohol dependents), with lens of millions being involved with alcohol dependent persons (Miles, 1974). In France and West Germany, there are 2.5 million alcohol dependents in the UK the figure is lower at 0.5 to 1 million, while those classed as ‘heavy’ drinkers (consuming more than 5I units weekly for males or 35 units for females), amounted to 3 million in England and Wales in 1981 (RCGP, 1986). In the USSR, its staggering figure of 25 million puts it at the top of the world as the first alcohol dependent country. In France, one-third of the electorate get some or all its income from the production and sale of alcoholic beverages (Badri, 1976, p.4l).

It is estimated that 40,000 deaths occur annually in the UK due to alcohol consumption. Though this figure is staggering, it is less than half those killed by smoking cigarettes (100,000). Heavy drinkers have a mortality rate over twice the normal population (RCGP, 1986).

WHO Technical Report on Alcohol, 1980, claims that in many countries the heavy drinkers and alcohol-dependents constitute 4-10 % of the whole population. The WHO Expert Committee on Drug Dependence concluded that in many parts of the world, problems associated with the use of alcohol far exceed those associated with non-medical use of less socially accepted dependence producing drugs such as those of amphetamine, cannabis and morphine types (WHO, 1980). The reason for this widespread alcohol dependence emerges from the fact that many cultures look upon alcohol drinking, at least in moderation, as normal behaviour. ‘Alcohol is such a permissible and trusted poison, so easy of access for those who wish to escape from their troubles that it is resorted to in excess by the maladjusted person,’ as Sir Aubrey Lewis said in Price’s Textbook of Medicine (Lewis, 1966, pp.1172-4).

Alcohol is completely forbidden by Islam. However, even in Muslim countries, alcohol dependence is becoming a problem that has to be tackled. In Khartoum province (Sudan), Dr. Al-Bager (1976) studied the incidence of alcohol consumption and alcohol dependence in 1975-76. He found the following important facts that: 1) females rarely drink alcohol; 2) most of those who drink alcohol started at the age of 16 or over; 3) the majority of alcohol drinkers do not drink at home as there is still strong refusal by the family; 4) the male adult population in Khartoum province in 1975 was 417,820-47% of them had tried intoxicating liquor at least once; 87% of those who drink are social drinkers while the remaining 13% are regular, daily drinkers who are starting to experience problems from their drink in habits; 5) divorce was high in those who drink compared with non-drinkers of alcohol, 20% and 4% respectively. 6) 22% of those who drink do so because of psychological problems while 9% do so because of problems at home; 7) 52% of all traffic accidents in 1975-76 were committed under the influence of alcohol; 8) the amount spent on alcoholic beverages (10 million Sudanese) was double the amount allocated to the Ministry of Health in 1975. In Bahrain, a small Gulf country, the consumption of alcohol is very high indeed. As much as 9 million kg of alcoholic beverages were consumed in 1981. The total annual cost was estimated at 3,195 million (Towajiri, 1985; Musaiger, 1985).

Medicine Digest (1982) summarised the 1982 WHO report on alcohol and its problems. Most Islamic countries had minor problems related to alcohol consumption:

Saudi Arabia, Iran, Kuwait, Qatar, Libya and North Yemen were all prohibiting alcohol in 1982. By 1984, Pakistan and Sudan followed suit while Egypt and Bahrain allowed alcohol in tourist places, both for indigenous persons and foreigners.

,Unfortunately, many Muslim governments have sought to spread alcohol consumption against the will of the majority of their people. In Egypt, Turkey, Tunisia, South Yemen, Indonesia, Iraq, Syria and many others, the governments not only encourage private enterprise of the brewing industry, but the governments themselves own outright or share ownership in the breweries and alcohol factories. They help spread alcohol consumption in their nations on the assumption that they will get more income and provide more jobs for the unemployed. The ill effects that ensue from this policy are well manifested by the staggering debt hills to the international banking system.

Though the vast majority of the people in Muslim countries abstain from alcohol despite incitement by governments, the elite, unfortunately, are entangled in all the problems of alcohol consumption. This is owed to the contradictory effects of Westernization of the elites who remain hypnotized by Western civilisation and try to promulgate its values to their own, different culture.

REFERENCES

• AL-BAGER, O.S. (1979) Zahirat Taati al-Khamr, Military Press, Khartoum, pp.34-8.
• BADRI, M. (1976) Islam and Alcoholism, American Trust Publications, Muslim Student’s Association of USA and Canada.
• BRUNT, P. (1978) ‘Alcoholism as a medico social problem’ in Vere, D.W. (ed) 1978, pp.124-35.
• DIGHT, S. (1976) Scottish Drinking Habits, OPCS, HMSO, London.
• EDWARDS G. (1977) ‘alcohol-related disabilities’ WHO, WHO Offset Pub.32.
• HARRIS, I. (1971) ‘Alcohol problem and alcoholism’ in Beeson, P.B .& McDermott, W. (eds) Cecil Loeb Textbook of Medicine, Saunders, Philadelphia, pp.138-42.
• JAHODA, G. & CRAMMOND, J. (1972) Children and Alcohol, OPCS, HMSO, London.
• LEWIS, A. (1966) ‘Psychological Medicine’ in Scott, R.B. (ed) (1966) Price’s Textbook of Medicine, 10 th edn, Oxford University Press.
• Medicine Digest (1982) 8 (12).
• MILES, S. (1974) Learning About Alcohol, American Assoc, for Health, Physical Education and Recreation, Washington D.C.
• MUSAIGER, A. (1985) Youngsters and Drugs in Arab Gulf Countries (in Arabic), Al Rabian, Kuwait.
• PLANT, M.A. et.al. (1980) ‘Self Reporting drinking habits and alcohol related consequences among cohort Scottish teenagers’, British Journal of Addiction, 77, pp.75-90.
• RCGB (1986a) ‘Alcohol: a balanced view’, Journal of the Royal College of General Practitioners, 24 pp.1-3.
• RCGB (1986b) ‘Alcohol: a balanced view’, Journal of the Royal College of General Practitioners, 24 pp.5-53.
• SHOW, S. (1980) ‘Causes of increasing drink problems amongst women’ in Women and Alcohol, Camberwell Council on Alcoholism, London, pp. 1-40.
• STRASBURGER, V. (1985) ‘Sex, drugs and rock ‘n roll: understanding teenager behaviour ‘, PaediatricA, 76 (4,2), pp. 659-63.
• TUWAIJIRI, A.M. (1985) ‘Ghadan sawfa yuqtaloon (Tomorrow they will be killed)’, Risalat al-Khalij , 16(5), pp. 9-29.
• VERE, D. W. (ed) (1978) Topics in Therapeutics, Royal College of Physicians, Pittman Medical, London.
• WHO (1977) Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death, vol.1, Genev a.
• WHO (1980) Problems Related to Alcohol, WHO Technical Report Series No: 650, Geneva, pp. 7-13.