Smoker’s Death Benefit Arguments

Do Governments Save Money by Watching Smokers Die Prematurely?

The argument is immoral, unjustifiable, and factually inaccurate (National Center for Tobacco-Free Kids, 2001), it would appear that 46 States in the United States are indirectly supporting this dreadful argument as only 5% of the tobacco-settlement funds (of the $206 billion settlement for tobacco-related 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?

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 Winston-Salem Journal reported Oct. 23, 2004. Observer, June 25, 2000.

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 non-recourse 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, 2006).

I was shocked to hear this death benefit argument for the first time, after making a presentation to a group of professionals ñ informing them that tobacco use is the chief avoidable cause of illness and premature death for over 430,000 Americans each year. They overdose and die, and then there is one less drug addict to worry about.

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).

Do Government Laws Prohibit Minors from Legally Smoking Cigarettes?

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 drivers license suspension (Honolulu Advertizer, March 12, 2006). Why has it taken the 50th State - 50-plus 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?Approximately 40% of teenagers who smoke eventually become addicted to nicotine.

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 cancer-related deaths in the United States.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 first-time use of tobacco occurs before high school graduation. Because the average age at first use is 14.5 years, smoking prevention must start early.

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? Less than 25% of smokers who try to quit succeed as long as a year (Stolerman, I.P. & Jarvis, M.J., 1995).

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.In 2001, a survey of the federal-state Medicaid coverage for tobacco-dependence in the United States was conducted, and only 1 State in 50 (Oregon) provided for all the tobacco-dependence counseling and pharmacotherapy treatments recommended by the 2000 Public Health Service (PHS) guideline. A lack of reimbursement for tobacco-cessation counseling services is also the most common complaint for private health insurance companies when inquiring about treatment for smokers.

Diagnosing Nicotine DependenceNicotine addiction is classified as a nicotine use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV  TR, 2000). The criteria for the diagnosis of 305.1 - Nicotine Dependence - include any 3 of the following within a 1-year time span. Tolerance to nicotine with decreased effect and increasing dose to obtain same effecto Withdrawal symptoms after cessation Smoking more than usual  Persistent desire to smoke despite efforts to decrease intake Extensive time spent smoking or purchasing tobacco Postponing work, social, or recreational events in order to smoke 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:

Do you smoke within 5 minutes of awakening?

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 6-minutes to light-up 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 BULL-SH #% ting yourself and go see a therapist.

Co-morbidity & Nicotine Dependence

Psychiatric disorders are more common among tobacco users than in the general population. More research and information is needed on the co-morbidity of nicotine dependence and behavioral addictions such as pathological gambling, eating disorders, and sexual addictions.

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. It specifically found that 56% of the respondents with a history of at least one disorder also had two or more additional disorders.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. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. 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 DiagnosisIn 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., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances - nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.

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 Poly-behavioral 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 obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex/ pornography, etc.). Behavioral addictions are just as damaging - psychologically and socially as alcohol and drug abuse.

New Proposed Theory

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 Relapse Prevention cognitive-behavioral approach (Marlatt, 1985) with the goal of identifying and preventing high-risk situations for relapse is also supported within the ARMS theory.

The Addictions Recovery Measurement Systemís (ARMS) theory is a nonlinear, dynamical, non-hierarchical 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. The process of relapse incorporates the interaction between background factors (e.g., family history, social support, years of possible dependence, and co-morbid psychopathology), physiological states (e.g., physical withdrawal), cognitive processes (e.g., self-efficacy, cravings, motivation, the abstinence violation effect, outcome expectancies), and coping skills (Brownell et al., 1986; Marlatt & Gordon, 1985).

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.). Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individuals 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 individuals life dimensions in addition to developing specific goals and objectives for each dimension.

Conclusions

The impact of nicotine dependence and poly-behavioral addictions is of course financially devastating. Considering that addictions involve unbalanced life-styles operating within semi-stable equilibrium force fields, the ARMS philosophy promotes positive treatment effectiveness and successful outcomes that are the result of a synergistic relationship with ìThe Higher Power, î 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 multi-task solution to Nicotine Dependence and Poly-behavioral 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 poly-behavioral addiction.

Poly-Behavioral Addiction and the Addictions Recovery Measurement System, By James Slobodzien, Psy.D., CSAC at: Washington, DC, American Psychiatric Association, 2000, p. 787 & p. 731. American Society of Addiction Medicineís (2003), Patient Placement Criteria for the Treatment of Substance-Related Disorders, 3rd Edition,. Nicotine Addiction, emedicine.com. Excessive appetites: A psychological view of addiction. Poly-behavioral Addiction and the Addictions Recovery Measurement System (ARMS), Booklocker.com, Inc., p. 5.

The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings.

The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings.​


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