That smoke isn’t funny any more: Nicotine addiction and the ‘Stoptober’ campaign

Although most of my academic research is on behavioural addiction, I do publish the odd paper here and there are on more traditional addictions such as alcohol and nicotine addiction (particularly in relation to the relationship to behaviours like gambling). Over the last few months (on a personal rather than level) I have thought a lot about nicotine addiction as I have had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died last Saturday (September 8th, 2012 aged 66 years) and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease (aged 54 years).

Last week, the British government’s Department of Health (DoH) launched the ‘Stoptober’ campaign urging as many nicotine smokers as possible to give up smoking for 28 days from October 1st. This is the first time ever that such an innovative campaign has been launched on a national basis, and the DoH website claims that “people who stop smoking for 28 days are five times more likely to stay smoke free” compared to those that don’t give up for such a long period (I’m not sure on what empirical evidence that is based but it sounds reasonable). Those that decide to try and stop for the month will be given a lot of encouragement during the four-week period including access to the Smokefree Facebook page, and a downloadable Stoptober app. Those signing up to stop will also be sent daily emails providing additional encouragement. At present in the UK, smoking accounts for approximately one in four cancer deaths (and as I said, it’s something I’ve witnessed first hand).

I’m sure most people reading this are aware of the addictive nature of nicotine (it was one of the main reasons why my parents were never able to stop). As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within 10 seconds (and stimulates the release of the neurotransmitter dopamine). The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects. Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette.

For those of you out there with an addiction to nicotine, I thought I would provide my 10 golden tips that may help you in taking steps towards giving up for good. The tips are not foolproof and I failed with my own parents. However, that doesn’t mean you shouldn’t give it a go.

• Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
• Get all the emotional support you can get: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
• Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. Gradually cutting down the number of cigarettes smoked per day is a good starting strategy.
• Use nicotine replacements: Cutting out nicotine completely is hard, so consider using some kind of nicotine replacement. Nicotine patches, chewing gums, and lozenges will help inhibit the cravings and will help you stabilize your behaviour.
• Use non-nicotine shaped cigarette substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
• Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
• Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
• Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
• Know the triggers for your smoking: Knowing the situations that you tend to smoke can help in overcoming the urges to smoke. Lighting up a cigarette can sometimes be the result of a classically conditioned response (e.g., having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
• Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g., chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g., alcohol) or activities (e.g., gambling).

Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, you can find the incentives you need to help you give up permanently.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

BBC News (2012). ‘Stoptober’ stop-smoking campaign launched in England. BBC Health News, September 8. Located at: http://www.bbc.co.uk/news/health-19506327

Department of Health (2012). Stoptober campaign will encourage smokers to quit for 28 days. September 8. Located at: http://www.dh.gov.uk/health/2012/09/stoptober/

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

Griffiths, M.D. (1994). Co-existent fruit machine addiction and solvent abuse in adolescence: A cause for concern? Journal of Adolescence, 17, 491-498.

Griffiths, M.D.  (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.

Norse power: A brief look at Berserker rage

Ever since I was a young kid, I have used the word ‘beserk’ (to describe someone going into a mad, wild, uncontrolled and violent rage) in my day-to-day language. However, it wasn’t until I was in my teens when I bought the Gary Numan albums The Fury and Beserker that I came to realize the origin of the word.

Beserker rage is a culture-bound condition historically affecting Norsemen. The condition manifested itself among males only as an intense fury and rage (berserkergang, i.e., “going beserk”) and mostly occurred in battle situations (but could also occur when they were engaged in labour-intensive work). Dating back as far as the ninth century, the berserker Norse Warriors were alleged to be able to perform almost seemingly impossible super-human feats of strength. Nowadays, the word ‘berserker’ refers to anyone that fearlessly fights with a disregard to their own lives. Similar conditions have been noted in other cultures. For instance, the Irishman Cúchulainn (“Culann’s Hound”) was recorded as displaying ‘battle frenzy’ and ‘foaming at the mouth’ akin to berserkers in texts such as The Tain. The Malay phenomenon of ‘running amok’ (i.e., running mad with rage) also appears to bear a close resemblance to berserkers.

Those displaying beserker behaviour were also said to experience a specific set of symptoms prior to the rage (i.e., beginning with shivering and chattering of their teeth, followed by a swelling and changing of colour in the face as they literally became ‘hot-headed’. The final stage was full-blown rage and fury accompanied by noisy grunts and howls. They would then just indiscriminately injure, maim and kill anything in their path. This would be followed by one or two days of feebleness, along with a dulling of the mind. The condition of berserkergang was described in the thirteenth century by Icelandic poet Snorri Sturluson:

“[Odin’s] men rushed forwards without armour, were as mad as dogs or wolves, bit their shields, and were strong as bears or wild oxen, and killed people at a blow, but neither fire nor iron told upon them. This was called Berserkergang”.

The ravenous self-induced rage before battle commenced enabled the Norsemen to indiscriminately ‘loot, plunder and kill’. 
A recent book about the Vikings claimed that some battle chiefs held their berserkers “in reserve” during a battle. The berserkers were only sent into fight if one section began to weaken. An article on berserkers in the Journal of World History by Dr. M. Speidel noted that Norse berserkers were very effective killers, but could not stop killing at will. Apparently, their berserker state was only turned off once all members of the opposition were dead. László Kürti, in a 2004 encyclopedia entry on shamanism claimed that berserker is a regional form of present-day shamanism that utilizes archaic Nordic techniques – particularly the ability to go into a trance-like state.

Various theories about the causes of the condition have been speculated. Some have alleged that psychoactive drugs (such as hallucinogenic agaric mushrooms or copious alcohol drinking) were used. Some botanists claim that berserker behavior can be caused by the ingestion of the plant bog myrtle, one of the main spices in Scandinavian alcoholic beverages. Other theories speculate either pre-existing genetic and/or medical conditions or pre-existing psychological disorders (e.g., mental illness, manic depression [i.e., bipolar disorder], epilepsy). Some have even speculated that the fury may just be a consequence of post-traumatic stress. For instance, clinical psychiatrist Dr. Jonathan Shay wrote in his 1994 book Achilles in Vietnam:

“If a soldier survives the berserk state, it imparts emotional deadness and vulnerability to explosive rage to his psychology and permanent hyperarousal to his physiology –  hallmarks of post-traumatic stress disorder in combat veterans. My clinical experience with Vietnam combat veterans prompts me to place the berserk state at the heart of their most severe psychological and psychophysiological injuries”

Professor Jesse L. Byock claimed in a 1995 issue of Scientific American, that berserker rage could perhaps have been a symptom of Paget’s Disease (i.e., uncontrolled skull bone growth that often causes painful pressure in the head). However, there doesn’t seem to be any conclusive evidence of this.

Other more esoteric theories surround spiritual and/or supernatural beliefs. For instance, some scholars have claimed that the Vikings believed in spirit possession and that berserkers were possessed by the animal spirits of wolves and/or bears. According to some theorists, berserkers learned to cultivate the ability to allow animal spirits to take over their body during a fight (an example of animal totemism) that also involved drinking the blood of the animal that they wished to be possessed by.

Back in 1987, Dr. Armando Simon published a paper in the journal Psychological Reports and argued that berserker rage (or as he termed it ‘Blind Rage Syndrome’) should be incorporated into the Diagnostic and Statistical Manual of Mental Disorders. Dr. Simon characterized the condition as (i) violent overreaction to physical, verbal, or visual insult, (ii) amnesia during the actual period of violence, (iii) abnormally great strength, and (iv) specifically target oriented violence. Some case studies are presented and a parallel is made with the Viking Berserkers of the Middle Ages. Dr. Simon also claimed that the condition had typically been diagnosed as part of other violent disorders (such as intermittent explosive disorder). However, it looks unlikely that berserkers will be making a separate entry into the DSM anytime soon.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Armando, S. (1987) the berserker/blind rage syndrome as a potentially new diagnostic category for the DSM-III. Psychological Reports, 60, 131-135.

Kürti, L. (2004). Shamanism – Neo (Eastern Europe). Located at: http://publikacio.uni-miskolc.hu/data/ME-PUB-31198/Kurti_Neo_shamanism_2004.pdf.

Nationmaster (2012). Berserker. Located at: http://www.statemaster.com/encyclopedia/Berserker

Shay, J. (1994). Achilles in Vietnam. New York: Scribner.

Simon, A. (1987). The berserker/blind rage syndrome as a potentially new diagnostic category for the DSM-III. Psychological Reports, 60, 131-135.

Speidel, M. (2002). Berserks: A history of Indo-European ‘mad warriors’. Journal of World History 13, 253-290.

Wikipedia (2012). Berserker. Located at: http://en.wikipedia.org/wiki/Berserker

High interest: Is jenkem hokum?

While I was researching a previous blog on “cremainlining” (i.e., people who allegedly snort the ashes of dead people), I came across a number of press stories (all from the end of 2007) that American teenagers were allegedly using ‘jenkem’ and that it was becoming an epidemic in terms of its usage. Since the 2007 reports surfaced in the US, many further press reports and stories have questioned whether there is any evidence of jenkem use at all.

For those who have no idea what I am talking about, jenkum is a street drug (allegedly an auditory and visual hallucinatory inhalant) that is made from fermented human faeces and urine and according to users is more potent than cannabis and (according to news reports) gives “a powerful high” and has dissociation properties. The effects are alleged to last for about an hour, and it is sometimes known by the name ‘butthash’. Emma Guest describes jenkem as:

“Fermented human sewage, scraped from pipes and stored in plastic bags for a week or so, until it gives off numbing, intoxicating fumes” (from her 2003 book Children of AIDS: Africa’s Orphan Crisis)

Reports of its use first surfaced during the 1990s when news stories (including one by the BBC) started appearing about its use by Zambian children and teenagers living in Lusaka because it cost next to nothing to make. The correspondent who covered the story for the BBC (Ishbel Matheson) witnessed the practice first-hand:

“At the Lusaka sewage ponds, two teenage boys plunge their hands into the dark brown sludge, gathering up fistfuls and stuffing it into small plastic bottles. They tap the bottles on the ground, taking care to leave enough room for methane to form at the top. A sour smell rises in the hot sun, but the boys seem oblivious to the stench and the foul nature of their task. They are manufacturing ‘Jenkem’, a disgusting, noxious mixture made from fermented sewage. It is cheap, potent and very popular among the thousands of street-children in Lusaka. When they cannot afford glue or are too scared to steal petrol, these youngsters turn to Jenkem as a way of getting high… Nobody knows exactly where the idea for making Jenkem came from, but it has been used by street-children in Lusaka for at least two years. Nason Banda of the Drug Enforcement Agency is not proud when he says that it is unique to Zambia. He shudders when he sees the boys at the sewage ponds, scavenging for faecal matter to make Jenkem”.

Jenkem derives its name from an African brand of glue named ‘Genkum’ which became the generic name for all types of glue used by African teenage glue sniffers. According to an interview conducted by Jamie Pietras in Salon magazine, Fumito Ichinose (an American expert on anesthesia was quoted as saying that “the inhalation of gases like those produced from jenkem could result in hypoxia, a lack of oxygen flow to the body that could be alternately euphoric and physically dangerous”. Pietras also reported that:

“Psychedelic researchers are unconvinced that huffing fecal fumes ever caught on in the U.S. ‘It is potentially believable to me that a handful of extremely experimental people have tried this, but it is also quite easy for me to believe that no one in the U.S. has actually produced and inhaled sewage gas of their own,’ says Earth Erowid, co-creator of Erowid.com, a repository of documented narcotic experiences, in an e-mail. The communications director for the Multidisciplinary Association for Psychedelic Studies, Jag Davies, is equally skeptical. Davies says no one at MAPS, which supports research into the medical use of hallucinogens, has heard of jenkem use and certainly not jenkem research in the United States”.

An article on jenkum in Wikipedia reported that:

“In 2002, Project Concern International Zambia and Fountain of Hope released a report entitled ‘Rapid Assessment of Street Children In Lusaka’ where jenkem is listed as the third most popular drug among Lusaka’s street children, following Dagga (cannabis) and “glue and Dagga” but ahead of ‘Ballan’ (uncured tobacco) and petrol”.

It wasn’t until September 2007 that alleged use of jenkem by American adolescents first emerged following a bulletin about jenkem use issued by Corporal Disarro at Collier County’s Sheriff’s Department in Florida. The bulletin was instigated following an email to Disarro from a concerned parent regarding “a new drug called Jenkem”. The parent told Disarro that her child had learned about Jenkem through various conversations with several students at Palmetto Ridge High school. Disarro then researched the existence of the drug including a report on the TOTSE website.

However, the bulletin distributed across many US states was based on information from the dubious TOTSE website, and later admitted as a hoax by the person who posted the original article. (The TOTSE – Temple of the Screaming Electron – website was based in San Francisco and published on controversial and/or unusual subjects). However, the story spread and was reported by many major US news outlets including the Washington Post newspaper and the Fox News television channel. The story eventually spread to other countries including national television coverage in Australia.

From all my own reading on the topic it would appear that some American teenagers have tried jenkem (most likely as a result of hearing about it on the news) and even video recorded the experience. There are certainly videos on YouTube of jenkem being made and used. However, there doesn’t appear to be any evidence for widespread jenkem use except perhaps in Lusaka where the story originated.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK 

Further reading

Guest, E. (2003). Children of AIDS: Africa’s Orphan Crisis. London: Pluto Press.

Matheson, I. (1999). Children high on sewage. BBC News, July 30. Located at: http://news.bbc.co.uk/1/hi/world/africa/406067.stm

Mikkelson, B. & Mikkelson, D. (2011). Jenkum. Snopes.com, July 28. Located at: http://www.snopes.com/crime/warnings/jenkem.asp

Morgan, S. (2007). Drug Scare: Kids in Florida are Getting High by Sniffing Feces. Stop The Drug War, November 5. Located at: http://stopthedrugwar.org/speakeasy/2007/nov/05/drug_scare_kids_florida_are_gett

Pietras, J. (2007). Smoke this! Salon, November 9. Located at: http://www.salon.com/2007/11/09/jenkem/

Wikipedia (2012). Jenkem. Located at: http://en.wikipedia.org/wiki/Jenkem