Vincent Brogan 2015-10-06T12:41:11-04:00 Vincent Brogan Copyright 2008,, Inc. HuffingtonPost Blogger Feed for Vincent Brogan Good old fashioned elbow grease. Binge Drinking and a Minimum Price for Alcohol,2012:/theblog//3.2135150 2012-11-27T19:00:00-05:00 2013-01-27T05:12:01-05:00 Vincent Brogan
In a recent survey, published ahead of Alcohol Awareness Week, most 16-24 yr olds who were interviewed agreed that low cost encourages excessive drinking.

On a similar note Alcohol Health Alliance, in a letter to the Sunday Times, called on government to impose a minimum price of 50p per unit to curtail the damage cheap liquor is doing to many of these youngsters.

It should know. Its members are health professionals up and down the land and have first hand experience of dealing with the damage binge drinking does to youthful revellers every Friday and Saturday night.


Crack, speed, heroin, nicotine and alcohol all come from the same stable. They work differently but they are psychoactive drugs. They make us happy or 'euphoric' in small doses but in larger ones they are poisons and can kill, something they do with alarming regularity.

On a richter scale equivalent of deaths from drug use at any age nicotine is in a class of its own, accounting for over a 100,000 a year in the UK. Alcohol is some way behind at under 9000, with many more being indirectly attributable to its misuse.

Hard drugs like heroin, cocaine, methadone and amphetamines are further down the scale -less than 2000 deaths in England and Wales in 2011- but with no less tragic a circumstance behind each individual fatality.

Hardly registering at all is cannabis which, in its overall impact on society, could be regarded as a modest interloper compared to the rest.

But official figures tell only part of the story. Cannabis does kill - how many we do not know - and abusers are at increased risk of becoming psychotic or developing mental illnesses, heart attacks or lung diseases, lower IQs and cancers and of killing themselves or others if they drive while under its influence.

There are no safe recreational drugs and that includes alcohol.

Indeed, our skewed perception of which substances constitute the biggest threat to society can be compounded by the publicity given to high profile deaths from hard drug abuse, especially where a celebrity is tragically involved, while then ignoring the frequent but no less tragic deaths among ordinary youngsters when alcohol is the sole or important contributory cause.

Accidents, pranks that go wrong, fights, assaults, road traffic accidents, poisonings from binge drinking, drownings, fires, choking while unconscious and suicides are all personal disasters commonly associated with alcohol misuse and binge drinking amongst the young.

Incidents like these kill up to 5000 under 21-year-olds in the US each year. In the UK many hundreds of young people die in equally tragic circumstances. They are an important and largely avoidable cause of death at an age when deaths are fortunately rare. And all of this before the full health effects of excessive drinking, like liver cirrhosis, starts to notch up their inevitable toll.

Adolescents who binge drink are at greater risk of meeting such a fate, and downing more BOGOFs from supermarkets or promotional deals commonly offered by pubs and clubs than they need on stomachs full of beer certainly can't help.

The dangers of overdosing on high strength alcohol, with the obvious risks this entails, are commonly underestimated by naive young drinkers. The margins between the quantity of alcohol needed to give a buzz, stupify and kill is not as wide as many drinkers imagine. It is more likely to be breached when hard liquor is downed with gusto.

Cheap alcohol is a controllable factor which predisposes young drinkers to overdosing.

Educating young people (the vast majority are not addicted and will learn) about the immediate and long term health effects of excessive drinking, on what the different strengths mean and why downing strong liquor too quickly spoils an otherwise good evening, will each have an impact on sensible adolescents who want to have a good time.

In a study of 28 community focus groups published by BMC Public Health the majority felt that education, more than setting a minimum price for alcohol, would help alleviate the problems of binge drinking.

The evidence on minimum pricing and its effect on excessive drinking by young people in particular is considerable, however. It merits inclusion as a priority in any plan for tackling excess and binge drinking, both being risk factors for longer term dependence. Good intentions or voluntary codes on advertising, marketing and promotions, important as they are, do not obviate the need for sensible pricing strategies.

There is no one solution to fixing a culture of drinking that poses immediate and long term threats to the well being of a generation. But you have to start somewhere.

Those now calling for minimum prices might, in some revellers' eyes, be spoilsports. But they are just being pragmatic.

Alcohol is still a drug like any other and placing it beside the milk and water on supermarket shelves, and pricing it to match, won't change that.

Dr Brogan has trained and practices in addiction management, specialising in smoking cessation techniques.]]>
Quitting Smoking: Traps that Stop you Succeeding,2012:/theblog//3.2113830 2012-11-14T19:00:00-05:00 2013-01-14T05:12:01-05:00 Vincent Brogan lung cancer if he or she fails to quit. Why then does he keep it up?

Once you start, smoking is a difficult habit to break. Cigarettes are addictive and there are hurdles to be crossed if you want to stop.

Coping with the physical and psychological effects of nicotine withdrawal on your body after quitting is one.

Another, the smoking cue, is less tangible but no less important. It is part of the addiction package.

Smoking Cues
Smoking cues are prompts to smoke. They are everywhere, at parties, by the bar, on TV, inside your head, in a scent or lurking in the office waiting to explode. They are a type of conditioned response to prolonged smoking, and smoking behaviour.

They can provoke an intense craving for cigarettes which is not easy to resist. Time after time they dump the quitter back at the hard end of addiction, even when he feels in control. They act with nicotine, and long after it has left the ex-smoker's system.

You should be aware of triggers that prompt you to smoke. They don't go away when you quit.

Below are examples of social and not so social smoking cues:

1: Alcohol
Smoking and drinking at the same time is a habit many smokers enjoy and miss in the weeks and months after stopping. For the anxious quitter a pub without cigarettes is like one without beer. When he first stops smoking he finds it hard to relax with a drink, fidgeting and fumbling without a cigarette to appease him. Getting drunk doesn't help his chances of success.

The urge to smoke while drinking can be intense because of the strong social, physical and psychological link between tobacco and alcohol. This passes with time, sometimes quickly, and you acquire the taste for drinking again. Beat the alcohol cue and you have made major progress in your quit attempt.

2: Cigarettes
These are dangerous smoking triggers, especially at parties and in lively smoking company. The mere sight of someone lighting up, or the sniff of smoke, can blow a determined quitter's effort apart. Cigarettes play tricks with his mind, prodding and probing for 'weak moments'.

Smokers can underestimate the power of the simple cue which is a lighted cigarette, and overestimate their own willpower. It's a common mistake.

Paraphernalia like ashtrays, tobacco pouches and unopened boxes of cigarettes are also potent triggers to smoke.

3: Family and Friends
Being surrounded by friends, relatives or a partner who smokes is a real challenge to the addict, especially when smoke is wafting into his face and his desire to smoke is intense.

This situation is one you have to deal with in your own way. But if the temptation to smoke is unbearable consider moving until you are confident you can withstand the pressure.

Staying in an active smoking environment decreases your chances of quitting successfully. Hanging out with non smoking friends who avoid drugs, another smoking cue, improves them considerably.

4: Work
Work can be testing and awkward customers, fuming bosses, a good sale or late night deals are all familiar cues to remind you of situations where you'd like to smoke again, and which commonly catch the unwary smoker off guard.

Joining colleagues for cigarette breaks is a no-no after quitting. They may be friends but they are also smoking cues, at their most dangerous in the early weeks after you stop.

5: Individual cues
There are as many smoking cues, triggers or traps as there are smokers. The urge can hit if you

  • are bored

  • drive the car

  • watch TV

  • argue with your partner

  • play poker

  • see 007 light up

  • finish a meal

  • have coffee or tea

  • visit the newsagent

  • chill

  • stress

  • wake up

  • have sex

  • see an ad for cigarettes

  • chat on the phone with a friend

and in numerous other ways.

What they all have in common is an association with the individual smoker's behaviour. It is this, rather than nicotine withdrawal, which can be the trigger to smoke. It could also be both.
Some cues are inexplicable and unique to the smoker. Others, like a lighted cigarette, are universal.

Planning Ahead

Before you stop you need to take smoking triggers into account and avoid the more dangerous ones after quitting. Consider listing the times, places and situations where you enjoyed or felt the need to smoke in the past. Plan a diversion like taking up exercise. Above all, don't be fooled by innocuous but lethal smoking cues. Too may smokers are.

Dr Brogan is a stop smoking specialist and an ex smoker]]>
How to Quit Smoking: Start With the Facts,2012:/theblog//3.2017806 2012-10-29T19:00:00-04:00 2012-12-29T05:12:02-05:00 Vincent Brogan Million Women Study recently published in the prestigious medical journal, the Lancet. It will confirm their worst fears. They are likely to die a lot younger than non smokers. But it will also inspire them to redouble their efforts to quit smoking early.

The well documented benefits of doing so can be dramatic. Smokers who quit at 30 revert to a lifespan that almost matches that of non-smokers. Even for a 40-year-old the benefits are substantial. But if they continue to smoke they are much more likely to die from a smoking related illness and several years sooner than they normally would.

The results of the Lancet study confirm much of what we already know about the hazards of cigarettes.

Smoking is bad for your health and the sooner you stop the better.

Half , possibly more, of all smokers die from illnesses that are the direct result of their smoking. Cigarettes kill over a hundred thousand in the UK and nearly half a million in the US each year. These are preventable deaths and extraordinary statistics for a substance that is widely available, legal and easy to use.

Habitual smokers who smoke all their lives die somewhere between ten and fourteen years earlier than non smokers. This is the duration of a life sentence for murder in some countries. It is one the smoker has some control over if he succeeds in stopping.

Smokers also suffer poorer health than non smokers. They get heart attacks, cancers, bronchitis and emphysema, strokes and a myriad of other conditions which strike early on and reduce the quality of their lives considerably.

Their children are put at risk by the effects of secondhand smoke, as are the babies of women who continue to smoke during pregnancy.

The bulk of smoking related health problems are caused by the toxins, tars, gasses and additives in cigarettes.

But it is the nicotine in tobacco which keeps the smoker coming back for more despite having numerous reasons not to.

Nicotine is addictive. As a mood and behaviour changing agent it is considered by some experts to be just as addictive as heroin or cocaine.

When we inhale it in a cigarette it passes through the lungs into the bloodstream where it is quickly carried to the brain. There it binds to receptors on nerve cells that influence the release and levels of chemicals called neurotransmitters such as dopamine which produce a pleasurable sensation.

This encourages the smoker to repeat the process and tolerance develops. This is a capacity common to many drugs of abuse where repeated, fixed doses produce less of an effect. The user needs to increase his intake to get the same response as he did before. He smokes more.


Many smokers don't realise how potent nicotine really is, innocently putting their penchant for cigarettes on a par with their 'addiction' to coffee which is highly unlikely to kill them.

It also explains why cigarettes kill more people each year than all other recreational drugs, including alcohol, combined and why half hearted attempts to quit usually end in failure.

Smokers are aware, consciously or otherwise, that cigarettes are bad for their health. Most-nearly 70%-express a desire to stop at any one time. Less than half try and the vast majority fail at their first go.

This should not discourage them. Failure is more a testimony to the addictive power of nicotine than to any particular weakness in their own willpower. It should embolden them.

Many smokers have to try several times before succeeding and, having learned what to expect from previous failed attempts, eventually triumph. Estimates vary but it is thought about fifty percent of smokers stop over the longer term.

Anyone can quit, either on their own or with help from the several stop smoking organisations and aids that considerably increase their chances of stopping. As you may be dealing with a lengthy addiction to a potent substance, and the habit forming rituals that accompany it, you have to take quit attempts seriously if you want to stop.

Success depends on several factors, including motivation, the reasons you want to quit, your level of dependence on nicotine, previous quit attempts and whether you take advantage of smoking cessation aids like behaviour support or medications which can improve your chances of quitting.

Many smokers have done so and more people in the West now avoid taking up smoking than in the past. The number of smokers in the UK and US has been falling for years, from about 35% in 1980 to 20% today.

Being armed with the facts about the consequences of smoking-such as those in the recent study for example-is a key weapon in helping smokers make the decision to quit.
Being informed is a good start.

Dr Brogan is a certified NCSCT stop smoking practitioner.

Also on HuffPost:

American Health Care: Time for Voters to Decide,2012:/theblog//3.1926747 2012-10-01T17:17:27-04:00 2012-12-01T05:12:01-05:00 Vincent Brogan
With Republicans and Democrats fighting it out for the White House, health care reform is back on the agenda and both parties are sticking to their guns. It is time for voters to decide which way they want their medicine.

Terms like 'freedom to choose,' 'individual mandate,' 'Romneycare' or 'Obamacare' are touted to liven up the debate. But neither camp dare utter the SM phrase that describes health care systems many of us have happily lived with in other parts of the world for decades.

Socialized medicine is a term few like in the U.S. While American politicians endlessly debate the merits of private and not-so-private care almost everyone else, including their closest neighbor, gets on with the business of practicing cooperative rather than competitive medicine.

But forget images of endless queues, worn out faces and the Soviet collectives from the '50s when you contemplate European or Canadian health care models.

Their systems match that in the U.S. Some cost half as much to run and nearly everyone has access to affordable, quality health care.

Governments may control, even own, much of our medical hardware and tell insurers what to do but we are not socialists, even if our medicine gives the impression we are.

We believe access to health care is a right, not a privilege. Thousands of ordinary, working Americans queuing outside an LA sports arena, marveling at the miracle of 'free' health care being provided by a philanthropic organization, would probably agree.

We also believe the healthy should subsidize the ill, and the young the old while they can. We find it disturbing that someone who is dying could be denied care because they are not insured, or that their home could be taken from them because they cannot pay their medical bills.

America has talked socialized medicine for decades but that's as far as it went. It threatens the American principle of freedom of choice, a mantra the GOP likes to claim as its own but it is one few really disagree with.

Freedom to do has inspired the entrepreneurial spirit that has made the U.S. a world leader in so many fields.

But it makes for difficult health care planning when money is limited and freedom to choose is not.

After years of trying to make their largely private system work, with deeper pockets and an incessant flow of new treatments constantly driving the agenda, more and more ordinary Americans are beginning to see beyond the hype and realize it will not work for them.

They know because they are at the receiving end of its worst excesses -- deductibles they can't pay, jobs they can't leave, premiums they can't afford, co-payments which can be ruinous, pre-existing conditions that render you persona-non grata and illnesses that go untreated because you have no cover.

The cost of health care keeps on rising because money and profit, not need is setting the agenda. The pace is set by the private sector which drags costs in the public one as they are inextricably linked.

And yet well insured libertarians or politicians keep drumming the same message home: "Stick to your principles and don't touch socialized medicine. It sucks."

Whose freedom and interests are they really trying to protect? Is it the American family on a moderate wage and nice job that could disappear along with their health insurance and lifestyle in the morning? Is it the struggling one above the Medicaid threshold that is at the mercy of insurers happy to squeeze as much as they can? Or the stretched business that can ill afford employee insurance costs which keeps rocketing each year? Is it the uninsured, the uninsurable or the indebted insured for whom private insurance was never really meant in the first place?

The U.S. healthcare system fails many for whom it is supposed to work because it is designed around the needs of providers, not patients. This has been the case for decades.

The real winners in American health care are the insurers which rake in tens of billions in profits, medical device and drug companies which sell more and charge more for their products and for-profit organizations which make their own agenda.

There are marketing companies, administrators to check, agree or contest a claim, lawyers, lobbyists, advertisers, advisers and a plethora of hangers on whose reach extends to the corridors of power. There is little central control. Why change a health care system when there is nearly three trillion dollars to play with?

Obamacare goes some way towards remedying the situation and is a step in the right direction. It acknowledges flaws in the system and the strain it imposes on individuals and families. Romneycare, surprisingly given the Republican candidate's insightful approach to health care in Massachusetts, now sings from the more traditional hymn sheet and threatens to undo much of what has being done, leaving individuals at the mercy of insurers for years to come.

Neither unfortunately really addresses the elephant in the room -- the rising cost of medical care -- but that is for another day. What is important now is for America to decide which direction it want its health care system to go.

Socialized medicine does work -- most countries combine it with nonprofit insurance schemes and minimal for-profit input -- but it is not necessarily the answer to a particular American problem.

For most voters the choice is straightforward. Do you want the 'freedom' to choose a health care package you maybe can't afford? Or do you want a guaranteed one you can, even if your choice is limited?

'Freedom', like health care, comes at a price. The question is which can you do without.]]>
Private Healthcare and the 'New' NHS,2012:/theblog//3.1909057 2012-09-25T19:00:00-04:00 2012-11-25T05:12:01-05:00 Vincent Brogan



On which of these parameters has the NHS failed?





















Universal Credit and Disability Allowance Controversy,2012:/theblog//3.1869194 2012-09-12T19:00:00-04:00 2012-11-12T05:12:01-05:00 Vincent Brogan
At the heart of this controversy is something called the 'Work Capability Assessment' (WCA) which determines if you are entitled to Employment Support Allowance (ESA). This benefit is paid to those with limited capability to work because of ill health or disability.

To many who have been through the contentious 'medical assessment', part of the WCA carried out by ATOS Healthcare on the Department of Work and Pensions' (DWP) behalf, it is a blunt instrument which, they argue, makes a mockery of their illnesses and can be demeaning.




With the Universal Credit being rolled out in 2013 the distrust generated by the ongoing controversy over ESA won't help endear sceptics to another package that could, in spite of concerns about readiness, make life easier for many welfare recipients. Sorting out the Employment Support Allowance mess first might help.


But a common grievance with the scheme is that it is work, not 'condition' oriented. It emphasises what you can, rather than what you can't do and makes a virtue of looking beyond your limitations, concentrating, unrealistically some feel, on your capabilities.

Claimants undergoing WCA fill a questionnaire some find confusing, even duplicitous. Such is the unfortunate level of mistrust trust surrounding the whole thing that support groups frequently tell their clients to consider how they respond to even informal, friendly queries like "did you come by car?"or "did you walk from the bus stop?" as these reveal snippets about the physical capabilities of the informant.






If we are to challenge a decades-long 'culture of dependence' then we need to tread carefully, know its extent and not confuse 'dependence' with 'disability'.


It is the silent minority you don't see or hear complaining on social media, but who accept 'judgements' that they are 'fit to work' when clearly many are not and have little prospect of ever finding it, who are the hidden victims of a policy being implemented with the finesse and speed of a runaway freight-train.

An equitable system would help those who need assistance and challenge those - there are many - who don't. It will work if there is trust but won't if there is not. Certifying dubious cases - and this lies at the heart of the present debate - is nearly always a matter of clinical judgement. But it can be done fairly, effectively, authoritatively and with consensus.

Russell Brand's Insight Into Addiction Helps Drug Debate,2012:/theblog//3.1809422 2012-08-20T05:35:27-04:00 2012-10-20T05:12:04-04:00 Vincent Brogan



















