Humza Khizer

Discover the detrimental effects of smoking and tobacco use on your health. Explore the dangers of smoking, including increased risks of cancer, heart disease, respiratory problems, and more. Learn why smoking is dangerous and harmful to your well-being in this informative essay.

Every Cig You Light, Is A Fight Against Life

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

The Truth Behind Vaping

Overview

A quick google search will tell you about the abundance of vaping lounges and cafes all across the country. There are tons of resources from where you can buy vaping salts, oils, cartridges etc. An e-cigarette here, a juul pod there can be easily located at most social gatherings. This makes one wonder what this new craze is about. Is it just a novel trend or is there more behind this phenomenon? 
&nbsp;

Truth Behind Vaping

The process of consuming a regular cigarette is called smoking since you&rsquo;re inhaling smoke. In that vein, the term vaping is based on the inhalation of vapor. Where does this vapor come from?&nbsp;

The answer lies in the intricate mechanics of an e-cigarette. It has a tank which you fill with a liquid solution (e-liquid/vape-oil/vape juice, etc.) and a rechargeable battery that powers the atomizer. The atomizer heats the liquid and turns it into vapor. This vapor delivers nicotine (and so much more!) into your system.&nbsp;

In most countries, especially the third world, the manufacture of e-cigarettes is not regulated. This means almost any substance can be added to the vape oil. Nicotine and humectants such as propylene glycol and glycerin are usually the main components. Scents, flavours, psychoactive substances, such as THC, and sometimes even trace amounts of alcohol may be present.&nbsp; 
&nbsp;

We all know smoking is a vice. The widespread scorn for smoking is rightfully backed by a ton of peer-reviewed medical literature. But there was a time when it was actually cool to have a cigarette dangling from your lips. The downfall of smoking came once several major medical reports found a strong association of smoking with <a href="https://merisehat.pk/disease/lung-cancer-67" target="_blank">lung cancer</a>.&nbsp;

Ever since then, people who want to quit smoking have been looking for alternate ways to satiate their nicotine cravings. Nicotine patches, gums or medicines (Bupropion, Veranicline, Wellbutrin) are commonly used for this purpose. One of the most exciting prospects on this front was the introduction of e-cigarettes back in 2002. Slowly gaining popularity, we saw a sudden surge in e-cigarette users between 2011 and 2021 when number of users went from a mere seven million to a whopping 68 million. Most of these users were women and young adults.&nbsp;

Several studies have demonstrated that vaping can not only be helpful for kicking the smoking habit, but also people who used this method to quit also showed fewer withdrawal symptoms. 
&nbsp;

There is widespread consensus in the medical community that vaping still fares better than smoking when it comes to its side-effects profile. This is mostly because of it being a newer phenomenon. We haven&rsquo;t been able to collect enough data to fairly make this judgment.&nbsp;

What we do know so far already makes it sound like something you should either stay far away from or at least employ some discretion with. In 2019, many American officials were already calling it a national health crisis when several teens were rushed to the hospital for life-threatening conditions linked to vaping.&nbsp;

The market leader for e-cigarettes, Juul, was banned by the FDA when they failed to back up their claims that their products lead to smoking cessation. They were also charged with encouraging teenagers, and some of their vape pods were found to have a whole pack worth of nicotine in them.&nbsp;

Now, some of the major side-effects of vaping are:&nbsp; 
&nbsp;

Acute Lung Injury: With the rise of its popularity, vaping has managed to increase hospital admission due to a disease called EVALI (e-cigarette or vaping-product use associated lung injury). These patients usually present with pneumonia and leave doctors baffled at the lack of association with the usual causes of pneumonia.&nbsp;

Symptoms like fever, chills, cough, where some blood might also come up, are usually noted. A little digging usually leads to a history of vaping. Upon further investigations, the damage was linked to a thickening substance used in THC vaping products called Vitamin C acetate. Our lung cells are not designed to process this thick oily substance, so an inflammatory reaction is the next best thing they can do.&nbsp;

This is the current working hypothesis we have. Researchers are still looking into more reasons for why this might be happening. Outbreaks of EVALI have mostly been limited to the North American region. Isolated cases in countries like Canada, Japan, UK and Mexico failed to establish a correlation between disease presentation and vaping while some also predated the outbreak.&nbsp; 
&nbsp;

Nicotine Addictions: Increased blood pressure and heart rate, spikes in adrenaline, narrowing of blood vessels are all effects of nicotine that add to the likelihood of a heart attack. However, not all e-cigarettes contain nicotine. 
&nbsp;

Harmful Chemicals: Diacetyl is a compound used to formulate flavors for vape oils. It has been linked to popcorn lung (bronchiolitis obliterans) in factory workers. Now imagine putting that directly into your lungs! Heavy metals such as nickel, tin, lead and ultra-fine particles also cause irritation.&nbsp; 
&nbsp;

Detrimental For Brain Development: Nicotine is not just addictive, but hinders normal brain development. The part of our brain known for processing learning, memory, and attention and impulse control suffers as a result. This eventually leads to a long-term sequela of disordered cognition. 
&nbsp;

It&rsquo;s Not Just The Lungs: Owing to how the human body is designed and functions, inhaling anything means delivering it to each and every cell and organ. It causes nausea, vomiting, diarrhea and stomach aches. Sore throats, bad breath, ulcers, dry mouth, bleeding gums are also common. 
&nbsp;

Bottom Line

Traditional cigarettes have cadmium, arsenic and hydrogen cyanide with the potential to kill half the people who smoke them. E-cigarettes have roughly the same number of toxic substances. Research has shown that 90% of smokers couldn&rsquo;t quit smoking by replacing it with vaping, and a meta-analysis published in The Lancet established that adults who vape were 28% less likely to stop.&nbsp; 
 
Although branded as an alternative to cigarette smoking, most people, especially teens, are stumbling upon vaping at the start of their smoking journey. Much of the marketing around vaping is similar to what tobacco companies were telling the general public back in the day.&nbsp; 
 
The crackdown by American authorities on vaping and related products also means that promotional efforts have been doubled in developing nations such as Asia and Africa. If you are an adult trying to quit smoking,&nbsp;then this might be a good option for you but there are far healthier ones as well. Be vigilant about THC vaping products, buy from legitimate resources, avoid exposing yourself to products there&rsquo;s not much evidence for or against and in the best-case&nbsp;scenario just don&rsquo;t do it.

Dr. Safia Mehmood

Online Consultation

Iqra Mazhar

Alcohol Addiction Treatment And Recovery

Introduction

Alcohol addiction is considered as a chronic mental health disorder of a relapsing nature. It is regarded as the third largest factor globally that contributes to loss of health and premature mortality (death)<a href="#accordion">[1]</a>. 
&nbsp;

Alcohol addiction, more commonly known as alcohol use disorder, is a pattern of consuming alcohol to such great lengths that a person finds it difficult to quit despite facing problems associated with uncontrolled drinking.&nbsp; 
&nbsp;

In alcohol use disorder, individuals consume more alcohol to get the desired effect because their body develops tolerance to the previous dose<a href="#accordion">[2]</a>. 
&nbsp;

Alcohol addiction not only causes psychological issues, but it is also associated with emotional, social, financial, and physical challenges<a href="#accordion">[3]</a>. 
&nbsp;

Many individuals do not realize the gravity of the situation and consider that alcohol addiction can be dealt through willpower. However, this is far from the truth because alcohol addiction is a brain disorder. Alcohol is a psychoactive substance and it alters the chemical environment in the brain, making it a real challenge for individuals who plan to quit without any assistance or guidance from a healthcare professional.&nbsp; 
&nbsp;

Alcohol use disorder is a state of psychological and physical dependence on alcohol and to such a great extent that individuals find it hard to function without it. These individuals experience withdrawal symptoms when they stop drinking alcohol<a href="#accordion">[4]</a>. 
&nbsp;

Individuals who are dealing with alcohol addiction often have coexisting mental health issues. Their personal relationships crumble and suffer the most damage due to their addiction. Moreover, they struggle with financial problems. 
&nbsp;

Understanding Alcohol Addiction and Recovery

Alcohol use disorder can be classified into mild, moderate or severe based on how many of the following symptoms of alcohol addiction the individual experiences<a href="#accordion">[2][3]</a>:&nbsp; 
&nbsp;

<ul>
	<li>Not being able to control or limit the amount of alcohol they consume despite trying&nbsp;</li>
	<li>Trying to cut down on the amount of alcohol yet being unsuccessful with each attempt&nbsp;</li>
	<li>Continuing to drink despite dealing with the negative consequences associated with alcohol addiction&nbsp;</li>
	<li>Feeling irritable, restless, or cranky when supply of alcohol is ceased or when they are not drinking&nbsp;&nbsp;</li>
	<li>Experiencing withdrawal effects when they try to attempt quitting&nbsp;</li>
	<li>Frequently craving for alcohol</li>
	<li>Always being preoccupied with drinking, and recovering from alcohol</li>
	<li>Isolating themselves from friends and family for drinking&nbsp;</li>
	<li>Giving up on activities that earlier used to excite them&nbsp;</li>
	<li>Increase in absent days at work or school which drastically impacts the financial and academic spheres of their life&nbsp;</li>
	<li>Breaking relationships and social ties because of drinking&nbsp;&nbsp; 
	&nbsp;</li>
</ul>

Alcohol use disorder not only affects the individual who is involved in the addiction, it also takes a significant toll on the loved ones.&nbsp; 
&nbsp;

Anyone who has these symptoms is suffering from alcohol use disorder. However, the good news is that recovery is possible through different treatment options. A healthcare provider can provide a tailored treatment plan that consists of detoxification, medication, and training to prevent relapse.&nbsp; 
&nbsp;

Alcohol addiction is quite a frequent problem in the West. Globally, 1.4% of the population is estimated to have an alcohol use disorder<a href="#accordion">[5]</a>. 
&nbsp;

However, a recent trend depicts a rise in alcohol consumption in Asia. In 2014, Asia had 30% of global alcohol sales making it one of the most rapidly growing alcohol markets. Moreover, there was an overall increase of 176% in alcohol sales from the year 2000 to 2019, highlighting the surge in alcohol consumption in this region<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

In Pakistan, the numbers are on the rise, too, and alcohol use disorder is becoming a growing problem. According to a study, there has been a 10% increase in alcohol-related diseases in the past 5 years. Another matter of concern is that the growing number of individuals admitted in the rehabilitation centers for treatment of alcohol addiction are as young as 14 years of age while previously individuals in rehabilitation were mostly in their 20s<a href="#accordion">[1]</a>. 
&nbsp;

The only way to achieve recovery from alcohol addiction is to seek professional help for the alcohol use disorder. There is no denying that the road to recovery is not a smooth journey and it requires determination from the individual&rsquo;s end. With persistence and support from the healthcare provider, the individual will be able to achieve an addiction-free life.&nbsp; 
&nbsp;

Alcohol addiction treatment consist of brief intervention, counseling either in groups or separately, an outpatient program that can be started at home through outpatient clinics or an inpatient program at a rehabilitation center that involves a residential stay at an inpatient clinic receiving round-the-clock care while being under the supervision of a healthcare team.&nbsp;&nbsp; 
&nbsp;

So, the alcohol addiction treatment comprises of the following: 
&nbsp;

<ul>
	<li>
	<h5>Brief Intervention&nbsp;</h5>
	</li>
</ul>

It is a short counseling session of 5-10 minutes that aims to discuss the individual&rsquo;s pattern of drinking. Individuals are briefed about the risks that are associated with their pattern of drinking and are given guidance on how to reduce alcohol intake to prevent complications from developing. Moreover, it addresses the emotional challenges that are linked with excessive alcohol intake. It also updates them about the support groups that they can become a part of, establishing a social network that further encourages quitting alcohol<a href="#accordion">[7]</a>.&nbsp; 
&nbsp;

Another useful tip is to maintain a &#39;drinking diary&#39; in which they can record their daily alcohol intake. This will help the individuals stay mindful about their drinking routine and will also track their progress<a href="#accordion">[7]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Detoxification&nbsp;</h5>
	</li>
</ul>

This is the process of body cleansing by completely eliminating alcohol from the individual&rsquo;s system. It is achieved through complete cessation of alcohol and withdrawal symptoms are then medically managed. The duration of detoxification usually takes 2-7 days on average. Sedative medications are often given to prevent episodes of withdrawal. As mentioned earlier, it can either be done in an outpatient or inpatient setting<a href="#accordion">[8]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Medications</h5>
	</li>
</ul>

Oral medications are given as part of the treatment plan to manage the cravings of alcohol. There would definitely be a strong urge to drink during the withdrawal phase.&nbsp; 
&nbsp;

Disulfiram is given to prevent individuals from drinking alcohol by mounting a physical reaction upon alcohol administration and this includes headaches, flushing, nausea, and vomiting.&nbsp; 
&nbsp;

Naltrexone is another drug that blocks the receptors in the body on which alcohol acts. Consequently, individuals do not experience the good feeling that is associated with drinking alcohol which decreases their alcohol intake. 
&nbsp;

Acomprosate is also an oral medication that suppresses or manages the alcohol cravings once the individual has quit drinking. 
&nbsp;

Vivitrol, similar to naltrexone, is an injectable medication that is administered once in a month. It is considered to be an effective option since people find it easier and treatment can be consistent because it doesn&#39;t require daily dosing<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Aftercare Programs&nbsp;</h5>
	</li>
</ul>

Continued support is part of alcohol addiction treatment. It involves keeping in touch with patients after the treatment is over and helping them in managing relapses, if any, or challenges that they might be facing. It encourages patients to join support groups and practice lifestyle changes. Moreover, it also offers medical and psychological care whenever a patient needs it<a href="#accordion">[8]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Psychological Treatment&nbsp;</h5>
	</li>
</ul>

Many individuals dealing with alcohol addiction have profound mental health disorders, such as depression and anxiety. These individuals find it very difficult to address their concerns and struggles. Through talk therapy or cognitive behavioral therapy (CBT) these individuals express the problems they are struggling with and oftentimes it helps in reaching the root cause of alcohol use disorder. Through psychological, behavioral, and talk therapies, these individuals learn strategies to cope with their stressors and help them to have an improved perspective of life. Additionally, it also treats the coexisting mental health disorders in these individuals<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Support Groups</h5>
	</li>
</ul>

Individuals who are dealing with alcohol addiction greatly benefit from attending self-help groups, such as Alcohol Anonymous (AA). It helps them to connect with other people who share a similar journey. Moreover, it helps individuals to learn strategies to cope with challenges that follow alcohol addiction treatment plans.&nbsp; 
&nbsp;

Support groups help individuals to achieve long-term abstinence from alcohol and assists in recovery from alcohol use disorder<a href="#accordion">[7]</a>. 
&nbsp;

Rehab is the process whereby an individual changes from being addicted and alcohol dependent to recovering and living a healthy and drug-free life. As painful and challenging as it might be, rehabilitation and treatment for alcohol addiction is the only way that can help one break free from the vicious cycle of addiction. 
&nbsp;

Since alcohol and other drug use disorders are on the rise in Pakistan, rehabilitation and addiction treatment centers are needed for the population affected with drug misuse disorders.&nbsp; 
&nbsp;

Some of rehabilitation centers available in Pakistan are<a href="#accordion">[9][10]</a>: 
&nbsp;

<ul>
	<li>Anti Narcotics Force (ANF) Hospitals - located in Islamabad, Karachi, Hyderabad, and Sukkur&nbsp;</li>
	<li>Nishan Foundation - located in Islamabad 
	&nbsp;</li>
</ul>

Conclusion

Alcohol addiction is quite a common drug misuse disorder. It makes the individuals enter a vicious cycle of drug abuse and many find it hard to break free from it. While many feel like there's no way out of their alcohol addiction, the truth is that recovery is possible through treatment and rehabilitation.&nbsp;

Key Points

<ul><li>Alcohol addiction is a drug misuse disorder in which individuals start consuming alcohol in excess despite dealing with the negative consequences that ensue with alcohol abuse.</li><li>Alcohol use disorder not only causes psychological and physical dependence, but also negatively affects all the spheres of an individual's life.</li><li>Alcohol addiction presents with a myriad of signs and symptoms that can help identify if someone is dealing with alcohol use disorder.</li><li>Treatment and rehabilitation are the cornerstone to recovery. It includes medications, detox, psychotherapy, and support groups.&nbsp;</li></ul>

[1] Ghazal P. The Growing Problem of Alcoholism in Pakistan:An overview of Current Situation and Treatment Options. INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH (IJEHSR). 2015;3(3):15. doi:10.29052/ijehsr.v3.i3.2015.15-21

[2] Alcohol use disorder - Symptoms and causes. Mayo Clinic.

[3] Alcohol Use Disorder: What It Is, Risks & Treatment. Cleveland Clinic.

[4] Tyler M. Alcohol Addiction: Signs, Complications, and Recovery. Healthline.

[5] Ritchie H, Roser M. Alcohol Consumption. Our World in Data.

[6] Jiang H, Xiang X, Hao W, Room R, Zhang X, Wang X. Measuring and preventing alcohol use and related harm among young people in Asian countries: a thematic review. Glob Health Res Policy. 2018;3(1). doi:10.1186/s41256-018-0070-2

[7] Alcohol misuse - Treatment. nhs.uk.

[8] Alcohol use disorder - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org.

[9] ANF :: MATRC. Anf.gov.pk.

[10] Best Rehab Centers in Pakistan of 2022 (with Pricing). Luxuryrehabs.com. Accessed September 16, 2022. https://luxuryrehabs.com/pakistan/. Published 2022.

Nawal Adnan

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

This article or video has been viewed by many visitors, and is popular.

The Dark Side Of Social Media

Disclaimer: This article mentions self-harm, suicide, eating disorders, and harassment.

Social media&#39;s rise and unprecedented popularity are perceived as a reflection of futuristic forms of social interactions and virtual connections.

Social media has constructed a trailblazing path for the digital world. Most of the studies center around the promising results of social media and, therefore, encouraging the development of such technological advancement. Social media&#39;s rise and unprecedented popularity are perceived as a reflection of futuristic forms of social interactions and virtual connections.&nbsp; 
&nbsp;

However, it is gradually becoming clear that social media endangers the sheer fabric of society by influencing people, networks, firms, and all social institutions. What was alluded to as the inception of a new era has manifolded opportunities for sinister purposes and counterintuitive activities, such as cyberbullying, social media addiction, harassment, the spread of misinformation, a lack of privacy, and the exchange of illicit substances<a href="#accordion">[1]</a>. 
&nbsp;

This article discusses the multidimensionality of what is termed the dark side of social media and depict the various unfortunate results of its rampant consumption by society.&nbsp;

&nbsp;

Understanding The Dangers of Social Media

Research has suggested that people feel compelled to participate and leave a digital footprint in the virtual world. The addiction to social media apps is not an exaggerated notion. It is rather the realistic and enthralling effect of two chemicals abundantly released when an individual interacts on social media platforms. These two chemicals are: 
&nbsp;

<h5>a) Dopamine</h5>

For a long time, scientists were under the impression that <a href="https://merisehat.pk/article/dopamine-detox-how-to-fix-your-screen-addiction">dopamine</a> exclusively functioned to encourage pleasure and feelings of delight in the brain. However, recent research delves further into the complex and multifaceted biomechanism of the chemical.&nbsp; 
&nbsp;

Dopamine boosts individuals to not settle for monotony, and continuously search and seek for what they truly desire. The chemical is invigorated by capriciousness, elusive and vague information, and remuneration signals. Essentially, these are all the specific states of social media that create mystery and curiosity<a href="#accordion">[2]</a>. 
&nbsp;

The previously cryptic chemical has such a magnetic pull and irresistible charm that it is comparable to alcohol and drugs. Studies aiming to gauge the effect of dopamine have revealed that tweeting appears to have a stronger and more enthusiastic effect on individuals, making it more difficult to quit than cigarettes or liquor<a href="#accordion">[2]</a>. 
&nbsp;

<h5>b) Oxytocin&nbsp;</h5>

Another chemical that influences social media use is oxytocin, a chemical commonly linked to expressions of love. But what is more peculiar is how the same chemical has an increased flow when a person tweets or posts or shares virtual content on social media. Just 10 minutes of social media use can cause a 13% rise in oxytocin levels, a spike that was normally seen in individuals on their wedding day<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Moreover, the benefits of oxytocin such as trust, feelings of affection, decreased stress, and generosity are all also associated with web-based entertainment. Subsequently, social media users have demonstrated to be more trusting than the typical internet client. The average Facebook user is 43% more probable than other internet clients to feel that the vast majority can be relied upon<a href="#accordion">[2]</a>. 
&nbsp;

Along with the unprecedented surplus of mood boosters such as dopamine and oxytocin, social networking and the facade of an internet presence promote feelings of elation. They also disrupt a person&#39;s restraint to avoid such content daily.

&nbsp;

Addiction, regardless of the guilty substance, always has a negative connotation; an excess of anything has never done anyone any good. Similarly, the addictive nature of social media has inculcated pseudo values, norms, and ethics that are validated through social media. This can be aptly visualized through the skewed reward system. 
&nbsp;

Social media platforms have presented a myriad of functions and features through which the wider public can share their opinions and thoughts. Whenever an individual posts a photo or shares an article that aligns with their political stance, they continuously glance over their phones to revel in the stream of notifications. The increasing number of interactions - likes, reactions, comments - reverberating with the sound of the notifications creates the same sentiment a gambler experiences when successful at the slot machine, or a chain smoker when they puff their cigarette. They are relieved and exhilarated to know that the majority of their followers (mostly close friends and family members) endorse their thoughts and opinions, praise their pictures, or commend their eloquence and activism on a social issue.&nbsp;

&nbsp;

Even though social media is championed for creating innovative ways to battle dejection, promote social interactions, and decrease solitude, studies indicate that the opposite may actually be true. By normalizing the counterproductive culture of comparison, research suggests that the exponential endemic of social media platforms after 2010 has resulted in more cases of mental health disorders and internalized problems<a href="#accordion">[4]</a>.

&nbsp;

<h4>"Is social media adding to your anxiety? Try out the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and check your stress level today!" </h4>

Researchers often refer to people who were born after 1995 as iGen due to their heavy dependence on social media. As a result of the increased time spent on new media screen activities, iGen adolescents have a higher incidence of panic attacks, prolonged depressive episodes, irregular meal patterns due to underlying eating disorders, and lingering and intrusive thoughts of self-harm and suicide<a href="#accordion">[4]</a>.&nbsp;

&nbsp;

Whenever people stumble on perfectly curated photos of celebrities, social media influencers, and people surrounded by fame, they are more likely to question their satisfaction with life and compare their average lives with sponsored ones. Breathtaking vacation posts can further affect a person&rsquo;s self-esteem as people begin comparing their corporate cubicles to hotel rooms, cafeteria lunches to massive spreads in restaurants, and crowded modes of commute to private jets. When users are repeatedly supplied with such extravagant and unrealistic life expectations, they become more conscious. This can result in corresponding coping mechanisms. They might start mimicking the celebrities in the way they talk, dress, and even eat. As per studies, many people end up splurging their paychecks at the same clothing boutiques as their favorite celebrities<a href="#accordion">[5]</a>. Repetitive comparisons tend to cause more drastic decisions.&nbsp;

&nbsp;

Photoshopped images on social media platforms have stemmed self-image and bodily insecurities in countless individuals, especially younger girls and women. Disappointment with body weight or shape is essentially the predominant factor that encourages modified eating behaviors among teenagers and young adults. There is substantial proof featuring a directly proportional relationship between excessive social media use and the recurrence of dietary problems<a href="#accordion">[6]</a>. Moreover, individuals end up subscribing to fad diets and unhealthy weight loss programs to achieve the unrealistic beauty standards set by computed filters, photoshop editors, and social media applications.

&nbsp;

There exists another class of social media users - those who do not compare their lives with that portrayed on the internet; rather, they choose to spew hate online. In the last decade, there has been a surge of targeted crimes and hate-motivated attacks on sectarian groups, ethnic minorities, the trans community, and anybody that is not categorized as &lsquo;normal&rsquo;. Thus, raising concerns about the association between hate speech online and targeted attacks, as well as the role of companies and governments in policing the online discourse<a href="#accordion">[7]</a>. According to research analysts, the patterns in hate crimes across the world point to a shift in the political environment, and social media can further amplify this friction<a href="#accordion">[7]</a>.&nbsp; 
&nbsp;

Moreover, hateful exchanges online have given rise to cyberbullying, racism, sexism, and at the most extreme, physical acts of violence.&nbsp; The accessibility of social media has allowed us to catalyze hate and dissent, spread vitriol, and galvanize people toward common objectives. People or keyboard netizens from the comfort of their homes, can insult, abuse, and even threaten foes and rivals, and remain masked. Social media has further perpetuated predatory behaviors such as stalking and hacking<a href="#accordion">[8]</a>. Moreover, social media has, in effect, achieved what it hoped to - it allows people to lead a solitary life and yet be &#39;social&#39; with other virtual users. However, it has done so at the cost of compassion and human decency.&nbsp;

&nbsp;

The herd mentality has grouped individuals and aggravated situations where people would be hesitant if they were alone. Trends are quickly adopted because of the lingering fear of missing out (FOMO). Furthermore, people are quick to form an opinion as they are afraid to be ostracized for choosing the wrong side<a href="#accordion">[8].</a> This is perhaps why it is necessary to evaluate the existing guidelines, censorship, and rules of conduct of most social media applications.&nbsp; 
&nbsp;

Engineers and software developers work tediously with a product team to build and invent a forum, platform, or application.&nbsp;These social media apps are created to grasp a user's attention and provide them with enough incentive to stay hooked on their web application.&nbsp;This strategy works, and assists companies to seal deals, monetize through advertisements, and bring money in as many versatile ways as they can.&nbsp;However, similar to a gambling problem, or substance addiction, consumption of social media can cause mental health concerns and influence psychological desires.

[1] Baccarella, C., Wagner, T. F., Kietzmann, J., & McCarthy, I. P. (2018). Social media? It's serious! Understanding the dark side of social media. European Management Journal, 36(4), 431-438.

[2] Seiter, C. (2016, August 10). The Psychology of Social Media: Why We Like, Comment, and Share Online. Retrieved from Buffer:

[3] Penenberg, A. L. (2010, July 1). Social Networking Affects Brains Like Falling in Love. Retrieved from Fast Company:

[4] Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time. Clinical Psychological Science, 6(1), 3-17.

[5] Newbert, J. (2020). Celebrity Impact on Fashion Brand Choice Using Social Media. University of South Carolina, Scholar Commons, 66.

[6] Dutta, S. S. (2022, March 28). Eating Disorders and Social Media. Retrieved from News Medical:

[7] Laub, Z. (2019, June 7). Hate Speech on Social Media: Global Comparisons. Retrieved from Council on Foreign Relations:

[8] Dalomba, F. (2022, March 1). Pros and Cons of Social Media. Retrieved from Lifespan

Zarlish Kazmi

Digital Detox: Should You Quit Or Lower Your Dose?

Be it your fav celebrity&rsquo;s marriage, divorce or just a random blogger&rsquo;s gossip on Instagram, admit it, we are all hooked and the juiciest content is often the most toxic too. Most of us can scroll on social media endlessly. Raccoon memes and sad boi reels have become my entire personality. However, a little self-reflection has also made me wonder if I am shaping myself according to the content I am seeing. We are very used to negative humor and our need to relate to it.

All of us are in a <a href="https://merisehat.pk/article/signs-that-you-are-toxic-and-how-to-fix-it">toxic </a>relationship with the digital world. The constant bursts of dopamine has left us feeling empty or numb when we do not have our devices in hand. 
&nbsp;

social media addiction

In today&#39;s era, the blend of digital and real has become so seamless that it&#39;s hard to decipher where one ends and the other begins. As our reliance on digital platforms burgeons, the question that looms large is: Do we need a digital detox? Let&rsquo;s navigate through the maze of digital consumption and understand its implications on our psyche. 
&nbsp;

The Pervasiveness Of Digital Consumption: The reach and depth of digital media in our lives is staggering. According to a Common Sense Media report from 2019, US teenagers are glued to screens for more than 7 hours daily, barring academic activities. The figure is similar for adults, who clock around 6 hours. 
&nbsp;

The Neurological Web: Why We Can&#39;t Let Go: The allure of digital platforms is deeply rooted in neuroscience. Notifications, messages, and social media interactions induce dopamine release, a neurotransmitter driving pleasure sensations. In a 2016 study published in the Journal of Applied Psychology,&nbsp; it was found that this cycle of dopamine release fosters addictive patterns, causing an incessant need for digital engagement. 
&nbsp;

<h5>Consequences Of Digital Excess: Recognizing The Signs</h5>

<ul>
	<li>Attention Fragmentation: Persistent digital interruptions create an environment where maintaining focus becomes arduous.</li>
	<li>Cognitive Overload &amp; Fatigue: Prolonged screen time leads to not only eye strain but cognitive weariness, diminishing our processing capabilities.</li>
	<li>Sleep Disturbances: Prolonged screen exposures, especially before bedtime, interfere with melatonin secretion, disrupting sleep cycles.</li>
	<li>Erosion Of Social Fabric: A paradoxical outcome of digital immersion is social disconnection, leading to elevated feelings of isolation. 
	&nbsp;</li>
</ul>

<h5>Digital Detox: The Great Debate - Quit Or Reduce?</h5>

<ul>
	<li>The Cold Turkey Approach: Completely cutting off can work wonders for a few but can be jarring for many. Disconnection can induce symptoms akin to withdrawal in several individuals, as delineated in a study by University of Maryland.</li>
	<li>Gradual Reduction: A more feasible approach for a majority, this involves steadily decreasing screen time. It aids in recalibrating the brain&rsquo;s reward mechanisms without triggering distress. 
	&nbsp;</li>
</ul>

<h5>Strategies Rooted In Research</h5>

<ol>
	<li>Periodic Disengagement: According to a 2011 study published in Opthalmic and Physiological Optics the 20-20-20 rule is effective in mitigating eye strain: every 20 minutes, focus on something 20 feet away for 20 seconds. 
	 
	Here&rsquo;s how you can master it:</li>
</ol>

<ul>
	<li>Identify Your Work Cycles: Start by identifying your periods of focused work. These should ideally last around 20 minutes. Use a timer or a dedicated app to track time.</li>
	<li>Set Up Reminders: Create periodic reminders on your computer or phone to alert you every 20 minutes. You can use apps like &quot;Time Out&quot; for Mac or &quot;Eye Care 20 20 20&quot; for Windows.</li>
	<li>Choose A&nbsp;Distant Object: Identify an object or point at least 20 feet away from you that you can focus on when your timer goes off. Make sure it&#39;s something that won&#39;t strain your eyes further.</li>
	<li>Engage In The 20-20-20 Rule: Once the timer or reminder alerts you, shift your focus from your screen to the object you selected. Focus on this object for 20 seconds.</li>
	<li>Blink And Breathe: While focusing on the distant object, make a conscious effort to blink. This can help refresh the eye&rsquo;s tear film. Take deep breaths to help relax your overall body and return your focus to work.</li>
	<li>Return To Work: After completing your 20-second break, you can return your focus to your screen and resume your tasks. Reset your timer for another 20 minutes.</li>
	<li>Make It A&nbsp;Habit: Consistency is key for the 20-20-20 rule to be effective. Make it a regular practice to integrate these steps into your daily routine.</li>
	<li>Monitor Results And Adjust: Take note of how your eyes feel after implementing this rule for several days. If you find relief from eye strain, continue with the practice. Otherwise, consider consulting an eye care professional for personalized advice. 
	&nbsp;</li>
</ul>

<ol start="2">
	<li>Embrace Night Mode: Modern gadgets offer &ldquo;night mode&rdquo; options, curbing blue light emission during evenings, a prime contributor to disrupted sleep. Here&rsquo;s how you can activate it:</li>
</ol>

<ul>
	<li>Identify the screens you use in the evening (phone, tablet, computer).</li>
	<li>Go to display settings on each device.</li>
	<li>Turn on &quot;Night Mode&quot; or a similar option that reduces blue light.</li>
	<li>Automate the feature to activate during your typical evening hours.</li>
	<li>Use your device in the evening and adjust settings if needed for comfort.</li>
	<li>Track any improvements in sleep quality over a week.</li>
	<li>Consistently use &quot;Night Mode&quot; to help improve sleep quality. 
	&nbsp;</li>
</ul>

<ol start="3">
	<li>Demarcate Tech-Free Sanctuaries: Areas like bedrooms or dining spaces can be earmarked as zones free from digital interference. Achieve it successfully by following these steps:</li>
</ol>

<ul>
	<li>Choose areas like bedrooms or dining spaces for tech-free sanctuaries.</li>
	<li>Remove gadgets from these spaces</li>
	<li>Inform family members about the tech-free zones.</li>
	<li>Place books or board games as alternative entertainment.</li>
	<li>Stick to the no-tech rule, especially during mealtimes or bedtime.</li>
	<li>Tweak the sanctuary boundaries or rules based on observations. 
	&nbsp;</li>
</ul>

<ol start="4">
	<li>Intentional Digital Consumption: Prioritize meaningful digital interactions. It&#39;s crucial to differentiate between mindless scrolling and purposeful usage. Here&rsquo;s how you can do it:</li>
</ol>

<ul>
	<li>Identify your essential digital activities, such as work emails, research, or connecting with family.</li>
	<li>Implement time restrictions on non-essential apps or websites.</li>
	<li>Use prompts to remind you of your time limits or purpose when using devices.</li>
	<li>Place essential apps on your home screen for easy access and non-essential ones in folders.</li>
	<li>Turn off notifications for non-essential apps to minimize distractions.</li>
	<li>Have a purpose each time you unlock your device; be it learning, communication, or productivity.</li>
	<li>End your day by reviewing digital activities to ensure alignment with your priorities.</li>
	<li>Based on the review, adjust your settings or self-imposed rules to better meet your goals for intentional digital consumption. 
	&nbsp;</li>
</ul>

A blanket cessation of digital devices is perhaps impractical for the majority. However, an informed, measured approach towards digital consumption can be the key to harnessing its benefits while safeguarding our mental well-being.

Umna Salah

Demystifying Sex Addiction: Understanding The Compulsion

Sex addiction, also known as compulsive sexual behavior disorder, is a condition that has gained recognition in recent years. Yet, it remains shrouded in misconceptions. In this article, we will delve into what sex addiction truly entails, exploring its definition, characteristics, and the avenues for seeking help and support. 
&nbsp;

Demystifying Sex Addiction

<ul>
	<li>A Pattern Of Compulsive Behavior: Sex addiction is characterized by a persistent pattern of engaging in sexual activities despite negative consequences. Individuals with this condition often find it challenging to control their sexual impulses, leading to a sense of powerlessness. 
	&nbsp;</li>
	<li>Escalation And Preoccupation: Those with sex addiction may experience an escalation in their sexual behaviors and preoccupation with sexual thoughts. This can disrupt daily life and lead to distress. 
	&nbsp;</li>
	<li>Impact On Relationships: Sex addiction often takes a toll on personal relationships, as individuals may prioritize their sexual behaviors over their loved ones&#39; well-being, causing conflict and emotional turmoil. 
	&nbsp;</li>
</ul>

<ul>
	<li>Excessive Pornography Consumption: Frequent and compulsive consumption of <a href="https://merisehat.pk/article/how-pornography-impacts-sexual-wellness">pornography</a> can be a sign of sex addiction. Individuals may spend significant time viewing explicit material, even to the detriment of their work or personal life. 
	&nbsp;</li>
	<li>Multiple Sexual Partners: Engaging in sexual activities with multiple partners, often without regard for their own safety or the safety of others, is a common manifestation of sex addiction. 
	&nbsp;</li>
	<li>Unsafe Sexual Practices: Sex addicts may engage in unsafe sexual practices, such as unprotected sex or risky sexual encounters, increasing the risk of sexually transmitted infections (STIs). 
	&nbsp;</li>
	<li>Loss Of Control: An inability to control sexual behaviors despite a sincere desire to stop or cut back is a hallmark of sex addiction. This lack of control can lead to feelings of shame and guilt. 
	&nbsp;</li>
</ul>

<ul>
	<li>Biological Factors: Some research suggests that brain chemistry and genetics may play a role in the development of sex addiction. Differences in neurotransmitter levels and reward pathways could contribute to compulsive behavior. 
	&nbsp;</li>
	<li>Psychological Factors: Underlying psychological issues, such as trauma, depression, anxiety, or low self-esteem, can contribute to the development of sex addiction as individuals use sex as a coping mechanism. 
	&nbsp;</li>
	<li>Environmental Factors: Early exposure to explicit material or experiencing a permissive attitude toward sexual behavior within the family or peer group can influence the development of sex addiction. 
	&nbsp;</li>
</ul>

<ul>
	<li>Therapy And Counseling: Individual and group therapy, as well as cognitive-behavioral therapy (CBT), can be effective in helping individuals understand and manage their compulsive sexual behavior. 
	&nbsp;</li>
	<li>Support Groups: Joining support groups like Sex Addicts Anonymous (SAA) or seeking the help of a sponsor can provide valuable peer support and accountability. 
	&nbsp;</li>
	<li>Medication: In some cases, medication may be prescribed to address underlying issues such as depression or anxiety that contribute to sex addiction. 
	&nbsp;</li>
	<li>Lifestyle Changes: Learning healthy coping mechanisms, managing stress, and adopting a balanced lifestyle can also aid in recovery from sex addiction. 
	&nbsp;</li>
</ul>

Sex addiction is a complex condition that can have a profound impact on an individual&#39;s life and relationships. Understanding its signs and causes is the first step toward seeking help and embarking on a journey of healing and recovery. With the right support and treatment, individuals can regain control over their lives and build healthier, more fulfilling relationships.

Rukhsana Rizwan

Breaking Free: How To Recover From Porn Addiction

<a href="https://merisehat.pk/article/how-porn-addiction-affects-your-social-interactions-relationships-and-libido">Porn addiction</a>, like any other addiction, can be a challenging and isolating struggle. However, it&#39;s important to know that recovery is possible, and there are effective strategies and support systems available to help individuals break free from the grip of addiction. In this article, we will outline a step-by-step approach to recovering from porn addiction. 
&nbsp;

Recovery Tips from Porn Addiction

1. Acknowledging The Problem: The first and most crucial step in overcoming porn addiction is acknowledging that there is a problem. This self-awareness is the foundation upon which the recovery process is built. 
&nbsp;

2. Seek Professional Help: Recovery from porn addiction often requires professional guidance. A therapist or counselor with expertise in addiction can provide valuable insights, support, and tools to help individuals on their journey to recovery. 
&nbsp;

3. Develop A Support System: Building a strong support system is essential. Share your struggle with trusted friends or family members who can offer emotional support and hold you accountable. 
&nbsp;

4. Identify Triggers: Understanding the triggers that lead to pornography use is crucial. These triggers can be stress, boredom, loneliness, or specific emotional states. Identifying them allows you to develop healthier coping mechanisms. 
&nbsp;

5. Create A Recovery Plan: Work with a therapist or counselor to create a personalized recovery plan. This plan may include setting boundaries, tracking progress, and establishing a routine that promotes positive habits. 
&nbsp;

6. Establish Healthy Habits: Replacing addictive behaviors with healthy ones is key to recovery. Engage in physical activity, pursue hobbies, and focus on self-improvement to fill the void left by pornography. 
&nbsp;

7. Mindfulness And Meditation: Practicing mindfulness and meditation techniques can help individuals become more aware of their thoughts and feelings, enabling them to manage cravings and stay committed to recovery. 
&nbsp;

8. Use Technology Wisely: In the digital age, managing technology usage is vital. Employ content filters, website blockers, and accountability software to create a safer online environment. 
&nbsp;

9. Join Support Groups: Participating in support groups, either in person or online, can provide a sense of community and shared experience. It can also be a source of encouragement during challenging times. 
&nbsp;

10. Celebrate Milestones: Recovery is a journey, and it&#39;s important to celebrate milestones and successes along the way. Recognize your progress and use it as motivation to stay committed to your recovery goals. 
&nbsp;

11. Be Patient And Persistent: Recovering from porn addiction is not linear. There may be setbacks and relapses, but these should be viewed as opportunities to learn and grow. Be patient with yourself and remain persistent in your efforts. 
&nbsp;

12. Seek Professional Accountability: Consider working with a therapist or counselor who specializes in addiction to hold you accountable and provide ongoing support throughout your recovery journey. 
&nbsp;

Recovering from porn addiction is a challenging but entirely achievable goal. By acknowledging the problem, seeking professional help, and building a strong support system, individuals can break free from the chains of addiction and embark on a journey towards a healthier, more fulfilling life. Remember that recovery is a process, and with commitment and determination, you can reclaim your life and build a brighter future.

Dopamine Detox: How To Fix Your Screen Addiction

With our modern, tech-dependent lifestyles, we cannot escape our screens &mdash; whether on our smartphones, computers or televisions. And as a result of this massive overexposure to that bright blinking light that connects us to the world, our eyes and our overall health suffer the most.&nbsp;

Spending <a href="https://merisehat.pk/article/the-effects-of-prolonged-screen-exposure" target="_blank">excessive hours in front of a screen can have several negative effects</a> on your eyes. These effects may be short-term or may even present themselves in long-term issues. Some of the most common effects of prolonged screen time include:

&nbsp;

effects of prolonged screen time

<ul>
	<li>
	<h5>Fatigue</h5>
	</li>
</ul>

Staring at screens for an extended time causes your eyes to get tired. It may even give you a double vision and lead to troubles in concentrating. This discomfort of the eyes accompanied with blurred, dimmed vision and a headache is often termed as Asthenopia. 
&nbsp;

<ul>
	<li>
	<h5>Dryness And Irritation</h5>
	</li>
</ul>

When your eyes are open for longer durations without blinking, they tend to get irritated and dry. This in many cases not only leads to discomfort, but is also known to blur your vision. 
&nbsp;

<ul>
	<li>
	<h5>Retinal Damage</h5>
	</li>
</ul>

Fatigue and dryness may not seem that serious, but there are several other long-term issues that you may not experience right now. The blue light in our devices penetrate retina of your eyes. Prolonged exposure of the retina to the blue light may cause the photosensitive cells to overwork and cause early age-related macular degeneration. This can not only cause weak eyesight but also lead to complete loss of sight in severe cases. 
&nbsp;

Like the old times, no one can just shy away or completely restrict their screen exposure, but what we can do is be smart about it. If screens cannot be turned off, then you can take the right measures to reduce blue-light emission to your eyes.

Steps for betterment

You can take the following steps to improve your eye health:

<ul>
	<li>Break Your Focus</li>
</ul>

An ideal duration to break your concentration is after 30 minutes. Walk around. Look at other things, let your eyes relax.

<ul>
	<li>Longer Hours, Bigger Screen</li>
</ul>

Your eyes are put at a lot more strain when the screen that you are using is small. If you are someone who spends longer hours on their phones, switch to tablet. Similarly, for work try to switch to a bigger monitor for a better view without having to squint your eyes.

<ul>
	<li>Blue Light Filter</li>
</ul>

An ideal approach to this would not only include turning on the eye-comfort shield on your screens, but also to make use of blue-light specs. These specs inhibit the penetration of blue light into your eyes.

<ul>
	<li>Switch To Grayscale</li>
</ul>

iOS and Android phones offer you the option of turning your phone&rsquo;s display grey. This is perfect for nighttime; by taking away the visual appeal of the phones, you are bound to put your phone down eventually.

<ul>
	<li>Exercise</li>
</ul>

<div>This may seem a little farfetched, but increased screen time comes at an expense of lower physical activity. Working out ensures that your body is functioning the way it is supposed to, giving your brain necessary endorphins, and most importantly, giving your eyes rest.</div>

<div>&nbsp;</div>

At the end of the day, hard choices are to be made for the betterment of your body. Screens are not bad for us, prolonged use of anything can have a bad impact on our body. Balance is the key to living a healthy, long life.

&nbsp;

Meth: What Is It And How Does It Affect You?

We are seeing an increasing number of young people getting hooked on meth in Pakistan. Most of these young adults get their first exposure at their educational institutions, regardless of gender and belong to well off socioeconomic backgrounds. Several meth-related deaths have been noted in major cities of Pakistan. According to the Anti-Narcotics Force (ANF), around 27 million Pakistanis were using meth back in 2018. 
&nbsp;

Meth and its effects

Methamphetamine is a psychostimulant drug used commonly for recreational purposes. It is chemically similar to amphetamine (a drug used to treat hyperactivity disorder and narcolepsy). It is illegally produced from pseudoephedrine (yes, that stuff in most cold medicines). The powder form is called meth or speed and the bluish-white crystal form is called crystal meth, ice or glass which is also its most potent form. It&rsquo;s consumed by either swallowing, smoking, snorting or injecting. Sharing needles puts people at risk of <a href="https://merisehat.pk/disease/hiv-61">contracting HIV</a> as well.&nbsp; 
&nbsp;

It works by increasing dopamine in the brain that is the key factor in our brain&rsquo;s reward system. The brain&rsquo;s reward centre is located in the limbic system which controls our ability to feel pleasure and gives us motivation. It was originally designed to make us feel better after performing functions that are essential for survival, such as feeding when hungry. Engaging in activities you enjoy releases dopamine from your neurons, this gives us the feelings of pleasure and is then promptly cleared away once it serves its function so as not to overstimulate the brain.&nbsp; 
 
Meth blocks this reuptake of dopamine while also causing the neurons to release more of it. The sheer amount of dopamine now present in your brain gives you that intense feeling of overstimulation leading to prolonged euphoria that is felt while on meth. 
&nbsp;

At a low dose, it can increase heart rate, breathing rate, elevates mood, concentration and alertness, reduces appetite and increases weight loss. The person feels on edge, overly excited and might start experiencing paranoia and/or anger. The feelings of euphoria and extreme arousal that accompany all this is what eventually gets the users hooked onto the drug. Some other things that can be seen are flushed skin, tremors, numbness, dizziness, pale appearance, blurred vision irritability, wakefulness, insomnia, extreme confidence and a phenomenon called &lsquo;punding&rsquo; where the individual repetitively performs a task without a purpose or an end goal. 
Long-term addicts suffer from effects like extreme weight loss given the poor diet, there is poor hygiene in general and leads to tooth decay, dental damage (dry mouth and teeth grinding lead to what is called &lsquo;meth mouth&rsquo; &mdash; common in those who inject it), sleeping disorders, anxiety, seizures, bleeding in the brain, skeletal muscle damage, skin sores and violent behaviours.&nbsp; 
&nbsp;

It may also lead to raised temperature which causes one to pass out, severe itching, hair loss, loss of skin elasticity and Parkinson&rsquo;s disease down the line are some other adverse effects. Long-term use has been shown to be severely neurotoxic leading to neurodegeneration, neuro-plastic change, hypertrophy of white matter, shrinkage of grey matter and disturbance in normal metabolic pathways.&nbsp;

Chronic use leads to severe mood swings, paranoia, delirium, hallucinations, delusions, increased propensity for violence and risky sexual behaviour, anxiety and depression leading to suicide.

Overdose causes psychosis, heart attacks, seizures, strokes, organ failure and even death.&nbsp;

Infants born to mothers who have used meth undergo a neonatal withdrawal syndrome characterized by poor feeding, abnormal sleep, tremors, increased muscle tone and might develop ADHD down the line. 
&nbsp;

When it comes to meth addiction, treating physical withdrawal is not that hard if the addict is young and a fairly new user. With enough sleep and adequate nutrition the body recovers rapidly. What&rsquo;s tough to deal with is the psychological withdrawal and usually requires in-patient treatment. 
There are no approved pharmacological treatments for it but sometimes antidepressants, antipsychotics and anticonvulsants are used. When studied for their positive impact, they were shown to have little to no benefit.&nbsp; 
 
 
Cognitive Behavioural Therapy (CBT), motivational interviewing, 12-step therapy, group therapy, psychodynamic therapy and combination therapy (contingency management and community reinforcement approach) along with physical exercise has been found to be effective as well.&nbsp;&nbsp; 
Treatment for overdose is activated charcoal and haemodialysis to clear away the substance from the body, beta blockers to bring the blood pressure down, benzodiazepine for calming down and antipsychotics for the behavioural symptoms. All this work to calm the mind and the body and bring functions back to baseline.&nbsp; 
&nbsp;

This is a highly addictive central nervous system stimulant and a party drug. The younger generation of students in Pakistan are increasingly turning towards this illicit substance and we don&rsquo;t have any regulatory bodies taking the issue seriously. It&rsquo;s important to start a conversation where users can openly come clean about their addictions and get the much needed help. A strong crackdown by ANF and social and psychological support for the younger generation will also go a long way in dealing with this issue.&nbsp;

A Lowdown On Medical Marijuana And Its Effectiveness In Pain Management

Marijuana (Cannabis) is a psychoactive substance we obtain from the cannabis plant. The psychoactive component in marijuana is THC (Tetrahydrocannabinol). Apart from this there are above 400 active compounds in cannabis, more than 70 of which are cannabinoids. It&rsquo;s popular for its recreational and spiritual purposes but has also been a part of traditional medicine for a long time.&nbsp; 
 
The use of marijuana for medicinal purposes has been a topic of debate and has elicited strong reactions from the medical community. The much-publicised positive effects of marijuana are scoffed at, outright dismissed or at the very least taken with a grain of salt. The fact remains that many patients use it and find it effective.

However, medical science hasn&rsquo;t gotten around to conclusively proving this yet. Due to limited production capacity, the vast number of chemicals in cannabis and government restrictions, this hasn&rsquo;t been very rigorously tested through clinical research. Marijuana is now legal in 37 states in the United States including Washington DC. It&rsquo;s also legal in Australia, Canada, Chile, Colombia, Germany, Greece, Israel, Italy, the Netherlands, Peru, Poland, Portugal, and Uruguay. 
&nbsp;

medical marijuana

Doctors have been known to prescribe cannabis or cannabinoids in order to deal with certain ailments. Mostly patients use it on their own to manage symptoms of their illness and reported positively about its therapeutic effects. It&rsquo;s mostly used for pain management.&nbsp; 
&nbsp;

But doesn&rsquo;t it get you high? That is where the distinction comes in. The marijuana used for medicinal purposes tends to have more CBD (cannabidiol) than THC in it. These cannabinoids interact with the cannabinoid receptors located in the brain (CB1) and all over the body (CB2). CB1 receptors are responsible for the psychoactive effects and CB2 receptors control process such as mood, memory, inflammation, appetite and pain. Patients taking CBD dominant marijuana do not suffer any altered consciousness or get a high. 
&nbsp;

So far, we have seen that evidence for the usefulness of medical marijuana is insufficient, inconclusive and heavily anecdotal or biased. Although, based on that alone, we have found it to be effective for the following reasons:

 
For Pain Management: Chronic pain plagues millions of people especially as they age, medical marijuana or cannabinoids are increasingly being utilised to manage this. It has been found to be safer than opioids in palliative care since the potential for abusing opioids is well documented. Another option for pain management is NSAIDs but they don&rsquo;t have a very alluring side effect profile either. What does one do in such cases then? Medical marijuana can help us manage this kind of pain. For example, nerve pain in multiple sclerosis is managed via Pregablin/Gabapentin both of which causes drowsiness and other adverse effects. You can eradicate that completely by employing medical marijuana instead. 
&nbsp;

Some other diseases where pain management is paramount have also shown improvement with medical marijuana, these are;&nbsp;&nbsp;

<ul>
	<li>Endometriosis</li>
	<li>Fibromyalgia</li>
	<li>Interstitial cystitis</li>
	<li>Rheumatoid arthritis&nbsp;</li>
</ul>

A systemic review published by BMJ (a peer-reviewed medical journal published by the trade union the British Medical Association) in 2021 assessed 32 trials and found that there is increased likelihood that medical marijuana is effective in pain management, better sleep, and physical functioning while it does have the usual side effects associated with marijuana. We need more randomised control trials before we dive into systemic reviews to pass the final verdict regarding its effectivity in pain management.&nbsp; 
&nbsp;

Some other uses of medical marijuana have been documented for the following ailments:

1.&nbsp;<a href="https://merisehat.pk/disease/epilepsy" target="_blank">Epilepsy</a>: There are a few conditions FDA has approved Epidiolex (Cannabidiol) for

<ul>
	<li>Lennox-Gastaut Syndrome: it&rsquo;s used as adjunct therapy for seizures.&nbsp;</li>
	<li>Dravet Syndrome: Charlotte&rsquo;s Web, a CBD dominant strain, has shown dramatic improvement in children with this severe form of childhood epilepsy.&nbsp;</li>
	<li>Tuberous Sclerosis Complex.</li>
</ul>

2. Nausea/Vomiting: It&rsquo;s associated with chemotherapy, Dronabinol and Nabinol are FDA approved synthetic formulations of cannabinoid medicine. Some studies have also found cannabis to be more effective than regular anti-emetic medications (promethazine, metoclopramide).

3. Weight loss, appetite loss, anorexia, pain and wasting syndrome associated with HIV/AIDs.&nbsp;

4. Insomnia

5.&nbsp;<a href="https://merisehat.pk/disease/anxiety" target="_blank">Anxiety</a>

6.Glaucoma

7.&nbsp;<a href="https://merisehat.pk/disease/migraines-73">Migraines&nbsp;</a>

8. Tourette syndrome &mdash; aids in improving tics

9.&nbsp;<a href="https://merisehat.pk/disease/schizophrenia" target="_blank">Schizophrenia</a>

10.&nbsp;<a href="https://merisehat.pk/disease/alzheimers-disease" target="_blank">Alzheimer&rsquo;s disease&nbsp;</a>

11. PTSD in veterans

12. Irritable bowel syndrome&nbsp;

13. Chron&rsquo;s disease&nbsp;

14. Spasticity &mdash; tight or stiff muscles

15. Tremors &mdash; In Parkinson&rsquo;s. 
&nbsp;

Any substance that modulates the normal functioning of our brain comes with its own specific side effect profile, some of the side effects associated with medical marijuana are:&nbsp;

<ul>
	<li>Dizziness</li>
	<li>Fatigue</li>
	<li>Tachycardia</li>
	<li>Hallucinations</li>
	<li>Low BP</li>
	<li>Dry mouth/Cotton mouth</li>
	<li>Orthostatic hypotension</li>
	<li>Pruritus</li>
	<li>Bloodshot eyes</li>
	<li>Impaired coordination</li>
	<li>Impaired judgment</li>
	<li>Cognitive and memory issues</li>
	<li>Adversely impacts mental development (if used by teenagers, it&rsquo;s contraindicated in pregnancy since it effects brain development in utero as well)</li>
	<li>Increased risk of bronchitis and lung damage if smoked</li>
	<li>Cannabinoid Hyperemesis Syndrome &mdash; long term use leads to nausea and vomiting</li>
	<li>Dependency</li>
	<li>Paranoia</li>
	<li>Psychosis</li>
	<li>Diarrhea</li>
	<li>It&rsquo;s considered a &lsquo;gateway drug&rsquo; into stronger addictions 
	&nbsp;</li>
</ul>

<ol>
	<li>Smoking or inhaling a vapor has an effect is felt faster via this method.</li>
	<li>Edibles (cookies, brownies, lollipops etc) take up to 1-2 hours to work.</li>
	<li>Topical application via lotion, cream, oil or sprays, dermal patches.&nbsp;</li>
	<li>Tinctures or sublingual drops.</li>
	<li>Capsules</li>
	<li>Lozenges&nbsp;</li>
	<li>Oromucosal spray (nabiximols) 
	&nbsp;</li>
</ol>

US Drug Enforcement Administration (DEA) classifies marijuana as a Schedule I drug which means that it&rsquo;s in the same league as heroin, ecstasy and LSD. However, big strides have been made in order to reclassify it as Schedule II drug instead to make it easier to study its effects. Further research will help us understand the real impact of this substance and help determine the actual efficacy of it. Doctors being forthcoming and easier to approach regarding this will also help bridge the gap we see in clinical practice and patient practices.&nbsp;

King James I of England is quoted to have said that, &ldquo;Smoking is a custom loathsome to the eye, hateful to the nose, harmful to the brain, <a href="https://merisehat.pk/disease/lung-cancer-67" target="_blank">dangerous to the lungs</a>, and in the black, stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless.&rdquo;

&nbsp;

He didn&rsquo;t even need to be a healthcare practitioner to deduce the obvious horrific effects of smoking, yet generations later on have - and still are - under the impression that smoking is the best remedy to fix their problems regarding their social standing and issues in general.&nbsp;

&nbsp;

Rather than seek professional help with the burning paper and carcinogens (any agent causing cancer), Generation Z are invested in popular alternatives to &ldquo;quit smoking&rdquo; e.g. <a href="https://merisehat.pk/article/the-truth-behind-vaping">vaping and electronic cigarettes</a>; however, what needs to be understood is that it is still the same concept only with a delayed expiration date than the stereotypical cigarette.

&nbsp;

Smoking is the best example of the saying &ldquo;curiosity killed the cat&rdquo;. According to research, curiosity among the youth for cigarettes was 28.8% while it was 19.5% for cigars. Meanwhile, 9.7% of the young generation was curious about smokeless tobacco<a href="#accordion">[1]</a>.

<div>&nbsp;</div>

Understanding the Harmful Health Effects of Smoking

&quot;Smoking kills&rdquo; &ndash; a disclaimer we are accustomed to seeing with every ad, every drama, and every film we see; it&rsquo;s there even on a pack of cigarettes that we pick up.

&nbsp;

Smoking takes 7 million lives annually around the globe. A recent hypothesis suggests that if something is not done about the smoking habits that currently exist, this number will jump to 8 million a year by the year 2030<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

In the United States alone, cigarette smoking accounts for more than 480,000 deaths each year. This figure also includes approximately 41,000 deaths because of passive smoking (inhaling smoke because there&rsquo;s a smoker in your vicinity). This can be translated as 1 in 5 deaths per year. Statistics even show that a smoker&rsquo;s life duration is cut down by 10 years when compared to a non-smoker<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

According to the Canadian Community Health Survey (CCHS), female smokers are usually between 50 and 64&thinsp;years of age. In 2012, a survey showed that the total expenditure associated with tobacco use in Canada was estimated at $16 billion CDN<a href="#accordion">[3]</a>. The amount was a sum of the money used to cover the expenses of hospital visits as well as the financial loss associated with premature death and disability.&nbsp;

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In 2018, cigarette smoking cost the United States more than $600 billion, which included a total of $240 billion in hospital visits and $180 billion due to the lost productivity from smoking-related premature deaths<a href="#accordion">[2]</a>.

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However, people are now becoming aware about the vicious reality of smoking. Studies have been dedicated to the warriors who tried to quit their habit and succeeded to some extent. The results might not sound that great, but anything done in this regard should be considered an achievement.&nbsp;

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In a cross-sectional study carried out in lower- to middle-income countries, it was found that almost 19.1% of the Pakistani adult population are tobacco users, most of them being smokers.&nbsp;

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When the study focused on the factors that helped them quit, it was found that among 330 former smokers who were a part of the study, 50.3% were successful in quitting on their first attempt; 62.1% of those people, in fact, quit smoking &ldquo;cold turkey&rdquo;. Cold turkey essentially means sudden cessation.&nbsp;

&nbsp;

Moreover, 10.9% of the population was seen to use a cessation aid, out of which 8.2% went for a nicotine replacement therapy.&nbsp;

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The factors which motivated them to quit consisted of concerns for their own health (74.5%), family pressure (43%), and concern for family&rsquo;s health (14.8%). Other factors included social pressures such as peer-pressure (31.2%) and the phenomenon of social avoidance by non-smokers (22.7%). Interestingly, marriage was seen as a consistent smoking cessation factor<a href="#accordion">[3]</a>.&nbsp;&nbsp;

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Several effective management plans that can be employed to combat this irresistible habit are listed below<a href="#accordion">[4]</a>:

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<h5>Behavioral Counseling Interventions</h5>

It is an interaction-based management plan to counsel the patient about smoking and its hazards. This counseling can be delivered by a physician, a nurse, cessation specialist. It can be a one-on-one session or the session can be conducted in a group setting. Moreover, in this digital age, counseling can be offered over the phone as well. However, it is necessary to seek help from a licensed healthcare practitioner only.

&nbsp;

<h5>Pharmacotherapy</h5>

The Food and Drug Administration (FDA) has currently allowed 3 pharmacological approaches to help you quit smoking:

<ul>
	<li>Nicotine Replacement Therapy (NRT)</li>
	<li>Bupropion Hydrochloride Sustained-Release (SR)</li>
	<li>Varenicline</li>
</ul>

&nbsp;

NRT is available in the market as short-acting and long-acting preparations, and studies show that using them in a combination is a better approach than using them singularly. While a transdermal nicotine patch is considered to be long-acting, nicotine gums and nasal sprays are short-acting.&nbsp;

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Furthermore, studies show that varenicline is more effective than NRT and Bupropion Hydrochloride SR.&nbsp; &nbsp;&nbsp;

&nbsp;

<h5>Combined Behavioral Counseling And Pharmacotherapy</h5>

This has, by far, been the best intervention to aid people in their battle. Research proves that using behavioral therapy along with pharmacological intervention yields the best results. More than 4 sessions capping up to 90 minutes helped a lot in enabling the attendees to move a step closer to the finish line.&nbsp; &nbsp;&nbsp;

<div>&nbsp;</div>

<h4>"Quitting smoking is highly beneficial for your respiratory system. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and check your respiratory rate today!"</h4>

Because smoking has now become a big issue, not only for the person actively doing it, but also for those exposed to the smoke in their vicinity (essentially called passive smoking), a number of organizations have cropped up to help.&nbsp;

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There&rsquo;s at least one organization in every country around the world. The best part is a majority of these organizations are free so financial issues should not be a hindrance for smokers to seek help. For example, there is Quit for Life, Lung Helpline and Tobacco QuitLine and Smokefree.gov.&nbsp;

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You can also join support groups if that is what you are looking for. This includes Truth Initiative: Become an Ex and Nicotine Anonymous<a href="#accordion">[5]</a>.

&nbsp;

In Pakistan, a project called PANTHR (Pakistan Alliance for Nicotine and Tobacco Harm Reduction) works day and night to promote solutions for smoking cessation in Pakistan. PANTHR is a project of Alternative Research Initiative (ARI) and consists of 13 organizations actively working in the country<a href="#accordion">[6]</a>.

&nbsp;

According to the data presented by the National Health and Nutrition Examination Survey (NHANES), 35.4% of 3&ndash;17-year-olds were exposed to tobacco smoke in the US during 2013-2016. To combat this an intervention called Clinical Effort Against Secondhand Smoke Exposure (CEASE) was introduced with the sole purpose of preparing pediatric healthcare clinicians and staff members to equip them with the knowledge, skills, and resources that are needed to ask family members about their tobacco use and habits. Moreover, CEASE also provided brief counseling and medication assistance along with referring parents and caregivers to free cessation services.&nbsp;

<div>&nbsp;</div>

It won&rsquo;t be easy to quit. You will be restless, agitated, and will crave it. But so did Icarus. He was unable to find a balance and flew too close to the sun and lost his life. Similarly, every time you light a cigarette, you take one step closer to a fatally proven disease, including cancers and irreversible lung damage. If puffing out smoke was either cool or the solution to the hard stuff, silencers in a car would have been better than humans. It&rsquo;s time you decided who you want to be; a silencer or a human? 
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<ul><li>According to research, curiosity leads 28.8% of the youth to light their first cigarette while the same can be said for 19.5% of them going picking a cigar for the first time. Meanwhile, 9.7% of the young generation was curious about smokeless tobacco.&nbsp; </li><li>Smoking takes 7 million lives annually.</li><li>In the United States alone, cigarette smoking is said to cause more than 480,000 deaths annually.</li><li>Statistics even show that a smoker’s life duration is cut down by 10 years when compared to a non-smoker.</li><li>In 2012, a survey proved that the total expenditure associated with tobacco use in Canada was estimated at $16 billion CDN.</li><li>In 2018, cigarette smoking cost the United States more than $600 billion.</li><li>19.1% of the Pakistani adult population are tobacco users, with most of them being smokers.</li><li>50.3% were successful in quitting on their first attempt with 62.1% of those people quitting “cold turkey”</li><li>10.9% of the population was seen to use a cessation aid, 8.2% of which went for a nicotine replacement therapy.</li><li>The factors which motivated them to quit consisted of concerns for their own health (74.5%), family pressure (43%), and concern for family’s health (14.8%).</li><li>Being married has been shown to be a consistent smoking cessation factor.</li><li>FDA-approved methods to help people quit smoking include Behavioral Therapy, Pharmacotherapy and a combination of Behavioral and Pharmacotherapy.</li><li>Pharmacotherapy includes NRT, Varenicline and Bupropion Hydrochloride SR.</li><li>There are organizations to help, including Quit for Life, Tobacco Quit Line and Nicotine Anonymous.</li><li>In Pakistan, a project called PANTHR (Pakistan Alliance for Nicotine and Tobacco Harm Reduction) works day and night to promote solutions for smoking cessation in Pakistan. </li></ul>

[1] Portnoy, David & Wu, Charles & Tworek, Cindy & Chen, Jiping & Borek, Nicolette. (2014). Youth Curiosity About Cigarettes, Smokeless Tobacco, and Cigars. American Journal of Preventive Medicine. 47. S76–S86. 10.1016/j.amepre.2014.04.012.

[2] Fast facts and fact sheets. Smoking and Cigarettes. Centers for Disease Control and Prevention.

[3] Hersi, M., Traversy, G., Thombs, B.D. et al. Effectiveness of stop smoking interventions among adults: protocol for an overview of systematic reviews and an updated systematic review. Syst Rev 8, 28 (2019).

[4] US Preventive Services Task Force. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(3):265–279. doi:10.1001/jama.2020.25019