PS370 Unit 6 Tobacco and Substance Use Paper Example

Two Dependencies, One Recovery: A PS370 Unit 6 Tobacco and Substance Use Paper

[Student Name]

Purdue University Global

PS370: Health Psychology

Unit 6 Tobacco and Substance Use Paper

[Instructor Name]

[Date]

The captain, his history and his treatment are composite; the report, reviews and studies cited are real.

A Fishing Port and an Injury

Paul, now 51, has fished out of New Bedford, Massachusetts, since he left high school. His opioid use began the way it did for many people in his industry. In 2009 he herniated a disc in his lower back while working a dredge in rough weather. A doctor prescribed oxycodone, and for several years the pills let him keep fishing through pain. Commercial fishing has among the highest injury rates of any job, and crew members who do not fish are not paid.

Massachusetts later documented the pattern. A state analysis of opioid-related overdose deaths from 2011 to 2015 by industry and occupation found that construction and extraction workers had the highest death rate and farming, fishing and forestry workers the next highest, both far above the average for all workers (Massachusetts Department of Public Health, 2018). The report linked these rates to high injury rates and to jobs without paid sick leave or job security, which push people to work through pain.

By 2015 Paul's prescriptions had been cut back, and he was buying pills on the street. When those became too expensive, he spent about a year injecting heroin. A friend's overdose on the dock in 2017 led him to a treatment program, where he started buprenorphine. Seven years on, he has stayed off illicit opioids. Tobacco is the older dependency: about twenty cigarettes a day since age seventeen, and he still smokes at sea fourteen months after a heart attack.

Two Dependencies in the Brain

Volkow et al. (2016) summarized the brain disease model as a repeating loop with three phases. In binge and intoxication, a drug produces large surges of dopamine in reward circuits, and cues associated with the drug come to trigger dopamine release on their own. In withdrawal and negative affect, stress systems become more active and the reward system less responsive, so that the person uses partly to escape feeling bad. In preoccupation and anticipation, the prefrontal regions that normally put the brakes on impulses work less well, so cravings win more often. They argued that these changes explain why people keep using despite serious harm and why relapse risk lasts long after use stops.

Paul's opioid use and his smoking run through the same reward circuits, but only one of them was ever treated as a medical condition.

Nicotine follows a similar path. Benowitz (2010) described how nicotine acts on nicotinic receptors in the brain, releasing dopamine and other neurotransmitters, and how repeated exposure leads to tolerance and a withdrawal syndrome of irritability, poor concentration, anxiety and craving. He emphasized that smoking is maintained not only by the drug but by conditioned cues, the settings, times and moods in which a smoker has used thousands of times.

Paul's night watches are a powerful set of such cues. For thirty years he has lit a cigarette in the wheelhouse after the first tow, during the steam to the next bed and before dawn. On land those cues are absent, and his success at quitting there fits Benowitz's account. On the boat, every cue is in place, and the craving returns on the second night of every trip.

The brain disease model has critics. Some argue that it understates choice and social conditions and can make people feel powerless. Paul's case shows why both views matter: his opioid use began with an injury and a prescription, was shaped by an industry that does not pay sick days, and ended with a medical treatment that changed his brain's response to opioids.

What Treatment Research Shows

For opioid use disorder, the evidence for buprenorphine is strong. A Cochrane review found that people on buprenorphine maintenance stayed in treatment longer than those on placebo, and that medium and high doses reduced illicit opioid use; it performed similarly to methadone at adequate doses, though methadone retained slightly more people at flexible doses (Mattick et al., 2014). For Paul, buprenorphine had a practical advantage: he could take it daily on a boat, without traveling to a clinic, once his prescriber agreed to a supply for each trip.

For smoking, the evidence favors combining medication with behavioral support. A Cochrane review of 53 trials found that combined pharmacotherapy and behavioral support increased quit rates by roughly 70 to 100 percent compared with brief advice or usual care (Stead et al., 2016). Paul has never received either. His cardiologist told him to quit, and his recovery program, focused on opioids, did not address tobacco.

That gap is common, and Paul noticed it himself. His recovery counselor once asked about his drinking and his sleep at every visit but never about cigarettes, and when Paul raised it, the counselor said to focus on one thing at a time. Seven years later, the one thing has been handled, and the other has helped put a stent in his heart. Smoking rates among people in treatment for opioid use disorder are far higher than in the general population, and smoking contributes heavily to their deaths. Treating tobacco as a lesser problem in recovery reflects a belief that quitting smoking might threaten sobriety, but studies of smoking cessation in addiction treatment have generally not found that quitting increases relapse.

A Plan for the Remaining Dependency

Paul's opioid recovery provides a model for his tobacco treatment. It worked because he received a medication that addressed his brain's dependence, regular contact with a counselor and a plan for high-risk situations. His smoking at sea needs the same three elements.

First, medication: a nicotine patch combined with a short-acting form such as lozenges for the night watch, or varenicline, which his cardiologist would need to approve. Second, support between trips through a quitline or his rehabilitation program, using the same relapse-prevention skills he learned in opioid treatment. Third, a cue plan for the boat: no cigarettes on board, a different routine for the first tow and the steam, and a nonsmoking wheelhouse. His counselor could point out that he has already done this once, with a harder drug.

Conclusion

Paul's two dependencies share a biology and a history of being shaped by work. His opioid use was treated as a medical condition, with an effective medication and support, and he recovered. His smoking has been treated as a habit he should simply drop. The research supports treating both the same way, and his heart makes the second one urgent.

References

Benowitz, N. L. (2010). Nicotine addiction. New England Journal of Medicine, 362(24), 2295-2303. https://doi.org/10.1056/NEJMra0809890

Massachusetts Department of Public Health. (2018). Opioid-related overdose deaths in Massachusetts by industry and occupation, 2011-2015.

Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2014(2), Article CD002207. https://doi.org/10.1002/14651858.CD002207.pub4

Stead, L. F., Koilpillai, P., Fanshawe, T. R., & Lancaster, T. (2016). Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2016(3), Article CD008286. https://doi.org/10.1002/14651858.CD008286.pub3

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine, 374(4), 363-371. https://doi.org/10.1056/NEJMra1511480