Effects of Smoking While Pregnant
In the U.S., there are an estimated 42 million people (nearly 18% of the total population) who currently smoke 1. Tobacco use is the leading cause of preventable disease, disability and death in the U.S. In fact, smoking accounts for nearly 1 in every 5 deaths each year 2.
Effects of Smoking on a Baby
Cigarette smoke contains thousands of harmful chemicals. When a woman smokes during pregnancy, these toxic chemicals enter her bloodstream and increase the risk of fetal injury. The nicotine and carbon monoxide in cigarettes are especially harmful because they can damage a baby’s developing brain and make it difficult for a baby to get enough oxygen. Nicotine narrows the blood vessels in the umbilical cord, which can result in inadequate levels of oxygen exchange for the developing baby.
Smoking increases the risks of prenatal issues, complicated birth, and a number of peripartum and newborn health issues. Risks include 3,4,5 :
- Roughly 1 in 10 women report that they smoked during the last 3 months of their pregnancy6.
- Approximately 50-60% of women who quit during pregnancy will start again within 1 year after the birth of their child7.
- Low-birth weight.
- Premature birth.
- Ectopic pregnancy.
- Spontaneous abortion.
- Placenta previa.
- Placental abruption.
- Sudden infant death syndrome (SIDS).
When babies are born too early, they are deprived of the safe environment and regular developmental duration they would have otherwise experienced in the womb. The earlier a baby is born, the greater the chance that they will experience health issues. In some cases, premature birth can result in infant death.
Premature babies may experience 8,9:
- Problems with feeding.
- Respiratory distress.
- Cerebral palsy.
- Delays in development.
- Problems with hearing or eyesight.
If a baby is born prematurely, they will often need to be hospitalized for days or even months so that doctors and nurses can safely monitor their progress.
The harmful effects of prenatal exposure to smoking are not limited to childhood. Negative effects can last throughout a child’s lifetime. Studies have found that children who are exposed to tobacco in utero have significantly higher odds of having a learning disability later on 10. Children born to mothers who smoked a pack or more a day during pregnancy are also significantly more likely to be smokers themselves when they grow up 11.
Electronic cigarettes (also referred to as e-cigarettes) are hand-held battery-operated devices that people use to smoke a liquid that is made of nicotine, flavoring, and other chemicals. The battery in the device heats the liquid nicotine to create an aerosol that the smoker then inhales 12.
The use of e-cigarettes has become increasingly popular. According to Forbes, e-cigarette sales generate over $1 billion every year.
People often think that they are safer than tobacco cigarettes, which may lead them to smoke more freely during pregnancy 13. For pregnant women, the chemicals in e-cigarettes can cause adverse effects to their baby.
E-cigarettes contain nicotine—a potent teratogen or, in other words, an agent that can be profoundly harmful to prenatal development 13. Nicotine crosses the placental barrier and studies have found that it can cause a significant amount of damage to the development and well-being of a fetus.
In animal studies, nicotine has been found to cause 14,15:
- Respiratory problems, including impaired lung function and decreased lung size. (This may affect both first- and second-generation offspring.)
- Reduced fertility for female offspring.
Some people turn to e-cigarettes to help them stop smoking tobacco. However, there is no evidence that e-cigarettes are a safe alternative to cigarettes. In fact, to date, no e-cigarette is approved by the FDA for smoking cessation purposes 16. This is due in part to the fact that e-cigarettes are currently unregulated and contain nicotine at varying levels.
If you are pregnant and currently smoking e-cigarettes, talk to your doctor about the risks and benefits of exposing your baby to nicotine during pregnancy.
Dangers of Secondhand Smoke
Secondhand smoke (SHS) refers to the potentially inhaled smoke resulting from another person’s doing it. Just like immediately inhaled cigarette smoke, SHS is a human carcinogen – which means it contains chemicals that cause cancer 17. SHS can cause a number of negative health problems in children and adults.
Exposure to SHS during pregnancy is associated with an increased risk of 18,19:
- Low birth weight.
- Preterm delivery.
Babies who are exposed to SHS after they are born are more likely to die from SIDS compared to babies who are not exposed to cigarette smoke 19.
Babies exposed to SHS also have weaker lungs than other babies, which can increase their risk for other chronic health problems such as asthma, ear infections, bronchitis, and pneumonia 19.
Credit: American Medical Association
Did You Know?
Below are some interesting facts and statistics about smoking during pregnancy:
- Smoking reduces a woman’s chances of getting pregnant 20,21,22. Approximately 15% of couples have trouble getting pregnant. One of the causes for this is female infertility. Smoking and secondhand inhalation are risk factors for decreased female fertility 23. In a study on infertile couples, males who smoked had significantly lower sperm quality. Cigarette smoking was associated with reduced sperm density and sperm count 24.
- Smoking during pregnancy can increase the risk of tissue damage in an unborn baby: Studies show that maternal smoking can cause tissue damage in the baby’s lungs, brain, and increase the risk of the baby having a cleft lip 25,26.
- Nicotine passes freely into breast milk: The amount of nicotine transferred through breast milk is more than double the amount transferred through placenta 27. However, breastfeeding is beneficial to a baby’s health and even if a woman smokes, she will be encouraged to breastfeed vs. use formula, as evidence shows the milk itself still provides protection against respiratory illness 27.
Quitting Smoking While Pregnant
Quitting smoking during pregnancy is one of the most important steps a woman can take to improve her health. It will help you feel better and provide a healthier environment for your baby.
Keep in mind that many people try to quit multiple times before they are successful. It is difficult to quit smoking, and you are not a failure if you “slip.” The important thing is to keep trying.
Benefits of Quitting for Mothers
Mothers who quit smoking will get numerous health benefits. If you quit smoking, you’re likely to experience 17:
- Reduced likelihood of developing heart disease, stroke, lung cancer, chronic lung disease, and other smoke-related diseases.
- Increased levels energy.
- Increased ease of breathing.
- Better financial prospects, as money previously put toward cigarettes will be available for other expenses.
- A sense of peace about the choices you made for yourself and your baby.
If you are in the process of quitting smoking, below are some useful strategies to help you handle cravings and avoid triggers 28.
- Engage in physical activity, such as walking, jogging, running, swimming, or dancing.
- Practice deep breathing at least once a day. Take long, slow breaths to center yourself.
- Talk to friends and loved ones.
- Write down your thoughts and feelings in a journal or blog.
- Remind yourself that you are not a smoker—identity is powerful, and identifying yourself as a nonsmoker can help you quit and stay tobacco-free.
- Spend time with people who don’t smoke.
- Ask others not to do it in front of you.
- Establish a “smoke-free” zone in the car or house.
- Identify triggers, such as people or stressful situations that cause you to want to smoke. Avoiding these triggers can help you stay drug-free.
- Redirect your focus and attention when a trigger makes you want to smoke: immediately go for a walk, listen to music, call a friend, or brush your teeth.
- Reduce stress in your life, such as work stress or personal stress.
- Eat a healthy diet, drink plenty of water, and get at least 8 hours of sleep each night.
Some women may feel guilty or ashamed about their smoking. But every mother wants the best for her child. Try not to let fear stand in the way of getting help. There are numerous resources available for individuals looking to quit. For example, this virtual clinic is free for those looking for help to stop smoking. You can also call 1-800-44U-QUIT, a national quitline for pregnant women seeking to end their tobacco use.
If you are abusing any other substances like alcohol that may also cause potential harm during your pregnancy, reach out to us today at 1-800-980-3927Who Answers?. You and your baby deserve to be healthy.
Are Nicotine Replacement Therapies Safe During Pregnancy?
While nicotine replacement therapy (NRT) is shown to be highly effective in non-pregnant individuals, there is not evidence to determine whether or not NRT is safe and effective for use among pregnant smokers 29. More data is needed to determine whether or not NRT is safe to use during pregnancy given that there is conflicting and inconclusive evidence in the research community regarding its use 30.
Gynecologists may recommend nicotine replacement therapy only after a woman has tried behavioral therapy interventions and they have failed 31. A doctor should first discuss the risks and benefits of nicotine replacement therapy before prescribing it to a pregnant patient.
Below are a few facts about these medications 30,31:
- Varenicline acts on the brain’s nicotine receptors.
- Bupropion is an antidepressant.
- Both of these medications are transferred through breast milk.
- The U.S. Food and Drug Administration recently added warnings on these products because they increase the risk of psychiatric symptoms and suicide.
There is currently not enough evidence to conclude whether any of these medications are safe to use during pregnancy.
Mothers can breastfeed while being on nicotine replacement therapy as long as the dose is less than the number of cigarettes usually smoked. Women should first consult their doctor before breastfeeding and using nicotine replacement therapy, since a baby can be exposed to nicotine through a mother’s breast milk. Additionally, the FDA discourages lactating women from using other smoking cessation pharmacotherapies such as bupropion or varenicline 32.
Handling Nicotine Withdrawal
An addiction to tobacco can have both physiologic and psychological components, potentially compounding the difficulty in quitting.
In order to quit smoking, a physician may recommend any of the following cessation techniques 33:
- Alternative or nontraditional treatments and therapies like hypnosis, meditation, and acupuncture.
- Pharmacologic therapy.
The acute nicotine withdrawal syndrome has a number of unpleasant associated symptoms. These are normal and will last a few days to a few weeks.
Symptoms of withdrawal may include 10:
- Negative moods.
- Urges to smoke.
- Difficulty concentrating.
Women who smoke during pregnancy are encouraged to stop smoking and seek help. Although physicians recommend quitting smoking before 15 weeks of gestation for the greatest benefits to the baby and the mother, quitting at any point is beneficial 34.
Additional Resources to Help You Quit
If you are addicted to smoking and looking for ways to quit, below are a few resources designed to help you.
Additionally, extra cessation therapy is offered to pregnant women under the Affordable Care Act, or ObamaCare.35. This includes free counseling and medication – as approved by a doctor 36.
Quitting smoking can be challenging. But there are more resources than ever to help you quit.
If you’re struggling with substance addiction, don’t wait to get help. Our treatment placement specialists at 1-800-980-3927Who Answers? can help you find the care you need to quit today and become as healthy as possible for yourself and your child.
1 Jamal, A., Agaku, I. T., O’Connor, E., King, B. A., Kenemer, J. B., & Neff, L. (2014). Current cigarette smoking among adults—United States, 2005–2013. MMWR Morb Mortal Wkly Rep, 63(47), 1108-1112.
2 Centers for Disease Control and Prevention. (2016). Current Cigarette Smoking Among Adults in the United States.
3 Pineles, B. L., Park, E., & Samet, J. M. (2014). Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. American journal of epidemiology, 179(7), 807-823.
4 Centers for Disease and Control. (2015). Highlights: Impact on Unborn Babies, Infants, Children, and Adolescents.
5 Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes.Nicotine & Tobacco Research, 6(Suppl 2), S125-S140.
6 Centers for Disease Control and Prevention (2016). How Does Smoking During Pregnancy Harm My Health and My Baby?
7 American College of Obstetricians and Gynecologists. (2015). Smoking Cessation During Pregnancy: Committee Opinion.
8 Centers for Disease Control and Prevention. (2015). Preterm Birth.
9 Been JV, Lugtenberg MJ, Smets E, van Schayck CP, Kramer BW, Mommers M, Sheikh A. (2014). Preterm Birth and Childhood Wheezing Disorders: A Systematic Review and Meta-Analysis. PLOS Medicine.
10 Anderko, L., Braun, J., & Auinger, P. (2010). Contribution of tobacco smoke exposure to learning disabilities. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 39(1), 111-117.
11 Buka, S. L., Shenassa, E. D., & Niaura, R. (2003). Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. American Journal of Psychiatry, 160(11), 1978-1984.
12 Centers for Disease Control and Prevention (2016). E-Cigarettes and Pregnancy.
13 Baeza-Loya, S., Viswanath, H., Carter, A., Molfese, D. L., Velasquez, K. M., Baldwin, P. R., … & De La Garza, R. (2014). Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bulletin of the Menninger Clinic, 78(3), 243.
14 England, L. J., Bunnell, R. E., Pechacek, T. F., Tong, V. T., & McAfee, T. A. (2015). Nicotine and the developing human: a neglected element in the electronic cigarette debate. American journal of preventive medicine, 49(2), 286-293.
15 Petrik, J. J., Gerstein, H. C., Cesta, C. E., Kellenberger, L. D., Alfaidy, N., & Holloway, A. C. (2009). Effects of rosiglitazone on ovarian function and fertility in animals with reduced fertility following fetal and neonatal exposure to nicotine. Endocrine, 36(2), 281-290.
16 Siu, A. L. (2015). Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: US Preventive Services Task Force Recommendation Statement. Annals of internal medicine, 163(8), 622-634.
17 World Health Organization, & International Agency for Research on Cancer. (2004). Tobacco smoke and involuntary smoking(Vol. 83). Iarc.
18 Khader, Y. S., Al-Akour, N., AlZubi, I. M., & Lataifeh, I. (2011). The association between second hand smoke and low birth weight and preterm delivery. Maternal and child health journal, 15(4), 453-459.
19 Centers for Disease Control and Prevention. (2016). Health Effects of Secondhand Smoke.
20 US Department of Health and Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 709.
21 U.S. Department of Health and Human Services. (2010). A Report of the Surgeon General: Highlights: Overview of Finding Regarding Reproductive Health.
22 Meeker, J. D., & Benedict, M. D. (2013). Infertility, pregnancy loss and adverse birth outcomes in relation to maternal secondhand tobacco smoke exposure. Current women’s health reviews, 9(1), 41-49.
23 Hyland, A., Piazza, K., Hovey, K. M., Tindle, H. A., Manson, J. E., Messina, C., … & Wactawski-Wende, J. (2015). Associations between lifetime tobacco exposure with infertility and age at natural menopause: the Women’s Health Initiative Observational Study. Tobacco control, tobaccocontrol-2015.
24 Künzle, R., Mueller, M. D., Hänggi, W., Birkhäuser, M. H., Drescher, H., & Bersinger, N. A. (2003). Semen quality of male smokers and nonsmokers in infertile couples. Fertility and sterility, 79(2), 287-291.
25 Leslie, E. J., & Marazita, M. L. (2013). Genetics of cleft lip and cleft palate. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 163, No. 4, pp. 246-258).
26 Centers for Disease Control and Prevention. (2016). Smoking During Pregnancy.
27 Massachusetts General Hospital. (2007). Smoking While Breastfeeding: What Are the Risks.
28 American College of Obstetricians and Gynecologists. (2011). Smoking Cessation During Pregnancy.
29 Pollak, K. I., Oncken, C. A., Lipkus, I. M., Lyna, P., Swamy, G. K., Pletsch, P. K., … & Myers, E. R. (2007). Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. American journal of preventive medicine,33(4), 297-305.
30 Pfizer Labs. (2010). Chantix® (varenicline) tablets: highlights of prescribing information.
31 American College of Obstetricians and Gynecologists. (2008). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol,111(4), 1001-1020.
32 Sachs, H. C., Frattarelli, D. A., Galinkin, J. L., Green, T. P., Johnson, T., Neville, K., … & Van den Anker, J. (2013). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics,132(3), e796-e809.
33 American College of Obstetricians and Gynecologists. (2015). Smoking Cessation During Pregnancy: Committee Opinion.
34 England, L. J., Kendrick, J. S., Wilson, H. G., Merritt, R. K., Gargiullo, P. M., & Zahniser, S. C. (2001). Effects of smoking reduction during pregnancy on the birth weight of term infants. American Journal of Epidemiology, 154(8), 694-701.
35 ObamaCare. (n.d.). ObamaCare and Smokers.
36 Substance Abuse and Mental Health Services Administration. (n.d.). How the Affordable Care Act Affects Tobacco Use and Control.
Kratom Abuse, Treatment and Withdrawal
Kratom is a mind-altering substance that comes from the Mitragyna speciosa tree, which is indigenous to Southeast Asia.
The leaves and stems are dried and either chewed or brewed into tea for stimulant effects at low doses and opioid-like effects at higher doses, the European Monitoring Centre for Drugs and Drug Addiction(EMCDDA) reports. Kratom is particularly popular in Thailand where it is sometimes mixed with iced-down caffeinated soda or codeine-containing cough syrup into a drink called 4×100 for its alcohol-like effects.
Kratom can cause euphoria, or a “high,” within 5-10 minutes of ingestion, the DEAreports, and that high may last for 2-5 hours. The active ingredient in kratom, mitragynine, increases energy and alertness at low doses and has sedative and pain-blocking effects when more of the substance is taken.
In the United States, kratom is not a controlled substance by the Drug Enforcement Administration (DEA), although it is listed as a “drug of concern.” Bars in Florida are selling kratom for recreational use in the form of a drinkable tea. The drug may also be purchased in bars or stores in New York, Colorado, and North Carolina, although it is likely more commonly obtained online, Business Insider reports. Recent trends in America, which may indicate a rise in kratom abuse, have caused four states – Wyoming, Indiana, Tennessee, and Vermont – to ban kratom, USA Today publishes.
Some people claim that kratom is useful in helping to kick a heroin addiction; however, this claim is greatly disputed by experts. In addition to potential negative side effects like suppressed respiration, nausea, vomiting, itching, constipation, and loss of appetite, kratom may also lead to dependence and addiction much like opioid drugs themselves do, Fox News states.
Kratom may be marketed and sold as a dietary supplement. In 2014, the U.S. Food and Drug Administration (FDA) issued an import alert on the substance. In January 2016, the FDA placed a ban on imports of products containing kratom, detaining one marketed as RelaKzpro. The FDA decided that kratom does not have any legitimate use as a dietary supplement and banned products claiming otherwise from being imported into the United States. In addition, the FDA placed businesses selling known kratom-containing products onto a RED LIST, allowing blanket seizure of any form of kratom, including capsules, resins, leaves, and liquids containing the leaves.
Understanding Kratom Abuse
Kratom may be abused as a “legal” way of getting high and may therefore appeal to individuals who deem it safer than illicit drugs, such as younger adults and teens. Bars may sell kratom in powdered form or mixed into a drink. Kratom is also known by slang names, such as Thom, Ketum, Biak, Kakuam, and Thang. Kratom may not be detectable on drug tests either, even though it may behave much like other narcotics. Its abuse has been banned in Thailand for years, The New York Times reports.
Since this drug is relatively new on the recreational drug scene in the United States, its full mechanism may not be completely understood yet, although the general consensus is that it does have psychoactive effects and can lead to dependence and addiction.
When Abuse Becomes Addiction
Dependence and addiction are closely linked, but they are not actually the same thing. A dependence on a drug is when physical changes are made to brain chemistry due to regular drug use or abuse. Since kratom is thought to act like opioid drugs, this means that some neurotransmitters, which are the brain’s chemical messengers that signal pleasure, may be impacted. Since kratom may interfere with the natural production of “happy cells” like serotonin, when the drug leaves the bloodstream, the brain may have lower than normal levels of these neurotransmitters. As a result, withdrawal symptoms can occur that may include depression, fatigue, drug cravings, and trouble feeling pleasure.
The DEA reports that long-term kratom abuse may lead to weight loss or anorexia, a frequent need to urinate, constipation, dry mouth, skin discoloration on the face, and insomnia. Withdrawal side effects may also include hostility, uncontrollable jerky movements, muscle and bone aches, aggression, and runny nose. In some cases, psychotic episodes including hallucinations, confusion, and delusions may occur.The National Institute on Drug Abuse (NIDA) published a study that reported on psychiatric illness and significant withdrawal symptoms in Thai individuals who abused kratom for a long period of time, citing muscle aches, insomnia, and irritability as the most common symptoms. In addition, hallucinations, paranoia, trouble feeling pleasure, and decreased cognition were also reported.
Addiction is considered a brain disease. Drug dependence is one of the signs and potential side effects of the disease. However, NIDA reports that in order to be diagnosed with addiction, according to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must exhibit compulsive and drug-seeking behaviors and continue to use drugs with no regard to the negative consequences that may result. Compulsive means that drug use is no longer in the person’s direct control and much of the person’s time is spent trying to get the drug, using it, and coming down from the drug’s effects. Drug abuse may even constitute an obsession, and other interests may go by the wayside.
Some of the behavioral, emotional, social, and physical changes to look for when trying to pinpoint addiction include the following:
- Change in physical appearance: weight loss and decreased interest in personal hygiene
- Irregular sleep patterns: sleeping at odd times, or sleeping more frequently
- Mood swings: from excitability and euphoria when taking kratom, to depression, aggression, irritability, and even potentially suicidal thoughts when withdrawing from kratom
- Increased risk-taking behaviors: lowered inhibitions when on kratom, encouraging users to potentially do things that may be out of character
- Irresponsibility: unfilled obligations and decline in grades or work performance
- Interpersonal relationship conflict: a shift in personality as well as increased secrecy and social withdrawal that lead to relationship problems
- Financial strain: working less, job loss, or spending significant funds on kratom
- Legal troubles: increased risky or even dangerous behaviors, leading to run-ins with law enforcement
Getting Help for Kratom Abuse and Addiction
In general, treatment for drug abuse and addiction typically follows three phases: physical stabilization, therapeutic treatment, and recovery. Safely removing the drug from the body through detox is often part of the physical stabilization. Medications and medical monitoring are provided in a medical detox facility in order to accomplish this.Therapy and counseling are part of the therapeutic treatment model and may be offered in a residential or outpatient setting. Residential treatment means that a person will stay onsite in a specialized treatment center to receive continual care in a safe and secure environment in order to heal and recover. Days are scheduled with meetings, sessions, educational opportunities, set meal and sleep times, and potentially holistic or complementary medicine offerings like yoga or massage.
Outpatient programs generally fall into two main categories. Intensive outpatient treatment generally follows a similar schedule to a residential program. General outpatient programs may be more flexible and tailored around a person’s specific schedule requirements.
One of the most popular therapeutic methods in addiction treatment is Cognitive Behavioral Therapy (CBT), which helps people struggling with substance abuse or addiction to find the root causes, or potential triggers, behind the abuse. CBT helps people to modify behaviors that may be self-destructive by addressing negative thought patterns and low self-esteem.
Stress may be effectively managed with new coping strategies taught during group and individual CBT sessions.
Counseling may include family sessions, as well as individual ones, where communication skills can be explored and improved. Support groups and 12-Step programs may be part of continuing, or aftercare support services, and may be beneficial during recovery as they can provide healthy connections to peers in similar circumstances. Relapse is considered a normal facet of addiction, and support groups can help to minimize the duration and severity of relapse in recovery.
Detox and Withdrawal
DUE TO ITS SIMILARITY TO OPIOID DRUGS, KRATOM DETOX IS BEST HANDLED WITH MEDICAL DETOX IN ORDER TO ENSURE AN INDIVIDUAL’S SAFETY AND COMFORT.
Since withdrawal side effects may be significant and potentially dangerous, kratom may be slowly weaned, or tapered off, in order to minimize the symptoms. Medical detox usually lasts between 5-7 days, and medical professionals are available 24 hours a day to monitor vital signs, smooth out withdrawal symptoms, and ensure clients’ safety.As in opioid withdrawal, medications may be useful during medical detox from kratom as well. EMCDDA reports that antidepressants, anxiolytic drugs, anti-inflammatory medications, and other pharmacological agents may be useful to treat kratom dependence.
The duration and type of detox, as well as the intensity of withdrawal, may be influenced by specific factors related to a person’s dependency on kratom. The amount of drug taken each dose as well as the length of time abusing kratom can increase dependence, for example. Abusing drugs at a young age may increase the risk that the person will suffer from a substance use disorder later in life, NIDA publishes, since drugs like kratom may damage regions of the brain responsible for regulating emotions, making decisions, and controlling impulses before they are fully formed in adulthood. Abusing other drugs or alcohol in conjunction with kratom can increase the potential side effects and risks for a negative interaction between the substances, and may also influence detox and withdrawal timelines. Underlying medical or mental health conditions as well as environmental factors, such as chronic stress, childhood trauma, and other outside influences, may also contribute to a person’s level of dependency.
Mostly Legal but Not without Risks
In conclusion, plant-based kratom may appear harmless as a “dietary supplement” or herbal drug that is technically legal in the United States; however, this perception is false. Purchased over the counter at head shops, gas stations, and music stores, as well as over the Internet, kratom leaves may be chewed or ground up and dissolved in drinks such as tea for stimulating effects.
When taken in higher doses, kratom may have sedative and euphoric effects similar to opioid drugs, and when taken regularly, individuals may become dependent on it. This dependence may lead to addiction, as control over its use may become difficult or even not possible without professional help.
Treatment for kratom abuse, dependency, and addiction may include a combination of pharmacological and therapeutic methods in a comprehensive substance abuse treatment program. Detox may be the initial step in kratom addiction treatment to help individuals reach healthy physical balance, and medical detox may be useful for managing withdrawal side effects and drug cravings. Detox should be followed with a more complete drug abuse treatment program that may be done in an outpatient or residential setting, depending on the needs of the individual.Addiction is not the same for everyone. What works for one person may not be as helpful for someone else, which is why substance abuse treatment professionals should work directly with a person to determine what treatment model may work best. With proper care, individuals can leave kratom abuse in the past and move toward a healthy future.
- Particular alcohol risks in women
- Women—and girls—are drinking more
- Alcohol affects women in unique ways
- Drinking during pregnancy–Never a good idea
- Overcoming barriers to treatment and recovery
- Back to top
The Hidden Risks of Drinking
- Women are more vulnerable than men to alcohol’s effects, even after drinking smaller amounts.
- Heavy drinking can lead to increased risk of health problems such as liver disease, brain damage, and breast cancer.
- Women are as likely as men to recover from alcohol dependence, but women may have more difficulty gaining access to treatment.
Women in many different cultures enjoy drinking alcohol for a variety of reasons—to celebrate a special occasion, help them feel more sociable, or simply to unwind with family and friends. While many are able to drink responsibly, alcohol use does pose unique risks to all women. While men are more likely to drink alcohol than women, and to develop problems because of their drinking, women are much more vulnerable to alcohol’s harmful effects.
Women tend to develop alcohol-related diseases and other consequences of drinking sooner than men, and after drinking smaller cumulative amounts of alcohol. Women are also more likely to abuse alcohol and other substances in order to self-medicate problems such as depression, anxiety, and stress, or to cope with emotional difficulties.
Women who drink more than light to moderate amounts of alcohol (more than about 7 drinks a week) are at increased risk of car accidents and other traumatic injuries, cancer, hypertension, stroke, and suicide. In addition, drinking at an elevated rate increases the likelihood that a woman will go on to abuse or become dependent on alcohol.
The health consequences of alcohol abuse in women
Women who abuse or are dependent on alcohol are more vulnerable than men to:
- Liver disease. Women are more likely to contract alcoholic liver disease, such as hepatitis (an inflammation of the liver), and are more likely to die from liver cirrhosis (a chronic disease that progressively destroys the liver’s ability to aid in digestion and detoxification).
- Brain damage. Women are more likely than men to suffer alcohol-induced brain damage, such as loss of mental function and reduced brain size.
Compared with women who don’t drink or who drink in moderation, women who drink heavily also have an increased risk of:
- Osteoporosis (a thinning of the bones)
- Falls and hip fractures
- Premature menopause
- Infertility and miscarriages
- High blood pressure and heart disease
Alcohol and breast cancer
Alcohol may also raise a woman’s chance of developing breast cancer. Each additional 10 grams of alcohol (the amount in about one 4-oz glass of wine) per day raises the relative risk of developing breast cancer over a lifetime by about 10%.
To put this in perspective: A woman’s overall lifetime risk of breast cancer is almost 9 in 100 if she drinks no alcohol. Two drinks per day increases the risk to just over 10 in 100, while six drinks a day ups her risk to about 13 in 100.
According to a 2009 survey, approximately 47% of women ages 12 and over in the United States reported being current drinkers, defined as having had a drink in the past 30 days.
Trends suggest that white, employed women are drinking greater amounts of alcohol and with greater frequency. Some of this increase may reflect a greater comfort on the part of women to discuss their drinking.
Social stigmas are starting to fade
Historically, women have tended to feel a greater sense of shame about drinking and getting drunk than men, but it appears that among younger women, this stigma may be fading. While men are still more likely to drink—and to binge—women are drinking more, and more often, than they did in the past.
According to data from a survey of almost 18,000 college students across the U.S., about one in three female students engages in binge drinking (consuming four or more drinks in a row, often in quick succession).
- The rate of binge drinking in all-female colleges more than doubled between 1993 and 2001.
- While more college men are dependent on alcohol, women constitute more than half of alcohol abusers among college students.
These trends are disturbing, given that binge drinking not only carries health risks for both men and women but also increases the chance of unwanted and unplanned sexual activity. Women risk becoming pregnant, and both men and women risk contracting a sexually transmitted disease.
It’s easy to cross the line into risky drinking
A standard drink is:
- One 12-ounce bottle of beer or wine cooler
- One 5-ounce glass of wine
- 1.5 ounces of 80-proof distilled spirits
Remember: alcohol content of different beers, wines, and distilled spirits can vary and a single mixed drink may actually contain nearly two standard drinks.
For women in particular, there is a very fine line between healthful and harmful drinking—one that is easy to cross. While moderate drinking is defined as no more than seven drinks a week and no more than three on any given day, those levels aren’t set in stone.
The amount a woman can safely drink depends on:
- Her weight and health
- Personal genetic makeup and family history
- The time since eating
- Her age
Some experts believe that women who drink even one alcoholic drink per day may be putting themselves at increased risk for health problems. For pregnant women, no amount of alcohol is deemed safe.
Because women become addicted to alcohol more easily than men, drinking even moderately can be a slippery slope. This is especially true for older women. In fact, about half of all cases of alcoholism in women begin after age 59.
Certainly, no one should feel obliged to start drinking for the health benefits. There are plenty of other ways to safeguard your health, such as regular exercise, a nutritious diet, keeping your weight under control, and not smoking. But for women who enjoy alcoholic beverages, it’s important to know where to draw the line, and to be prepared to redraw it as you get older.
A woman’s body processes alcohol more slowly than a man’s. One drink for a woman has about twice the effect of one for a man. Plus, women have a “telescoping,” or accelerated, course of alcohol dependence, meaning that they generally advance from their first drink to their first alcohol-related problem to the need for treatment more quickly than men.
Why are women more sensitive to the effects of alcohol?
Several biological factors make women more vulnerable to the effects of alcohol than men.
- Body fat. Women tend to weigh less than men, and—pound for pound—a woman’s body contains less water and more fatty tissue than a man’s. Because fat retains alcohol while water dilutes it, alcohol remains at higher concentrations for longer periods of time in a woman’s body, exposing her brain and other organs to more alcohol.
- Enzymes. Women have lower levels of two enzymes—alcohol dehydrogenase and aldehyde dehydrogenase—that metabolize (break down) alcohol in the stomach and liver. As a result, women absorb more alcohol into their bloodstreams than men.
- Hormones. Changes in hormone levels during the menstrual cycle may also affect how a woman metabolizes alcohol.
These biological factors explain why women become intoxicated after drinking less and are more likely to suffer adverse consequences after drinking smaller quantities and for fewer years than men.
Sexual and physical abuse increases risk
Evidence suggests that sexual or physical abuse during childhood may predispose both men and women to alcohol and drug problems in adulthood. Since women are more likely to have been victims of childhood sexual abuse, they are disproportionately affected. Research shows that:
- Women who have been physically or sexually abused as children are far more likely to drink, have alcohol-related problems, or become dependent on alcohol.
- Physical abuse during adulthood, which is suffered more by women than men, seems to raise a woman’s risk of using and abusing alcohol.
- Alcohol is a major factor in violence against women, playing a role in as many as three of every four rapes and nearly the same percentage of domestic violence incidents.
- Women with a family history of alcohol abuse are more likely than men with the same background to abuse alcohol.
Drinking alcohol during pregnancy can cause an array of physical and mental birth defects, and is the leading preventable cause of mental retardation in the United States. When a pregnant woman drinks, alcohol passes through the placenta to her fetus. In the fetus’s developing digestive system, alcohol breaks down much more slowly than it does in an adult body, meaning that the fetus’s blood alcohol level can remain high for longer periods.
Any kind of alcohol in any amount can harm a developing fetus, especially during the first and second trimester. Physicians and public health officials recommend that women avoid drinking any alcohol during pregnancy.
Risks to offspring
Each year in the U.S. alone, about 40,000 babies—or one in every 100—are born with fetal alcohol spectrum disorders (a term that encompasses fetal alcohol syndrome and several related disorders).
Babies with these problems usually:
- Have a low birth weight
- Have facial abnormalities, including smaller eye openings, flattened cheek bones, and an underdeveloped groove between the nose and the upper lip
- Have problems eating and sleeping
- Develop learning disabilities
- Develop behavioral problems
- Need special education
- Need special medical care through much of their lives
Not only are women less able to tolerate the effects of alcohol than men, they are also less likely to seek specific help to overcome any drinking problems they develop. Men who abuse alcohol are more likely to enter alcohol-treatment programs, whereas women are more inclined to seek help from primary care practitioners and mental health counselors.
Women with drinking problems:
- Are particularly reluctant to be labeled alcoholics
- Are more likely to ascribe their problems to depression, anxiety, or family trouble
- May tend to shy away from treatment programs specifically designed to deal with alcohol problems because of the social stigma about women drinking
As a result, women may seek treatment in general medical or mental health settings. Even brief counseling in this type of setting, though, has been shown to lower a woman’s use of alcohol by nearly one-third.
Women and men are equally capable of recovery
For a long time, professionals believed that women with substance abuse problems were less likely than men to recover from them. Yet limited evidence on the matter was available, because many studies on the outcome of substance abuse treatment conducted before the 1990s enrolled only men. The few studies that enrolled both men and women did not examine the impact of gender differences.
The situation changed in the early 1990s after the FDA and the National Institutes of Health issued guidelines aimed at increasing the representation of women and minorities in research studies. A review in Drug and Alcohol Dependence found that women are equally able to recover as men. Still, women face some unique challenges.
Women may have difficulty gaining access to treatment
A number of studies conclude that women are less likely than men to enter treatment programs for substance abuse problems, including those involving alcohol. Although it remains unclear why this is so, particular barriers to treatment seem to affect women more often than men. These include:
- Access to childcare. Women with young children need access to appropriate childcare services before they can undergo treatment. They may be concerned about losing custody of their children if they reveal that they have an alcohol problem.
- Economic challenges. Women are more likely to face economic challenges such as lower-paying jobs with little flexibility in scheduling or paid time off.
- Mental health disorders. Women are more likely than men to suffer from mood, anxiety, and eating disorders that may benefit from being treated at the same time as the substance abuse disorder. However, few substance abuse treatment programs provide adequate treatment of psychiatric disorders.
- Need for women-only treatment programs. These may be more helpful than mixed-gender programs for some women, such as those who have suffered sexual or physical abuse.
There is hope
Even if women remain reluctant to enter traditional alcohol-treatment programs, it’s important to seek medical and emotional support from other sources. Psychotherapy, self-help groups, and medications are all available to help women stop or reduce their drinking.
Anyone who has struggled to overcome alcohol dependence or an alcohol abuse problem knows how difficult a process recovery can be. But the evidence suggests that women are just as likely to recover as men once they begin treatment—a glimmer of hope that may make the journey to recovery worth trying.
Adapted with permission from Alcohol Use and Abuse, a special health report published by Havard Health Publications.
- What are dietary supplements?
- Who can benefit?
- Dietary supplement safety
- Buying dietary supplements
- More help
- Resources and references
The Smart and Safe Use of Vitamins and Supplements
We’re always hearing how a certain vitamin or herbal supplement will cure a chronic condition or drastically improve the quality of our lives. However, information about dietary supplements is often confusing or unclear. It’s hard to know which offer genuine health benefits and which are merely giving false promises, or worse, running the risk of actually damaging your health. By learning all you can about vitamins and supplements, you can make better choices about those that are right for you.
What are dietary supplements?
The Dietary Supplement Health and Education Act (DSHEA) defines a dietary supplement as a product that:
- supplements the food you eat;
- contains one or more dietary ingredient (including vitamins; minerals; herbs or other botanicals; amino acids, and other substances);
- comes in pill, capsule, tablet, or liquid form; and
- is labeled as a dietary supplement.
There are different types of dietary, or nutritional, supplements. Vitamin and mineral supplements are types of dietary supplements containing micronutrients meant to help a healthy body function smoothly. Herbal (or botanical) supplements are dietary supplements that have a medicinal purpose. Herbal supplements generally support a specific area of the body’s health, such as the liver, bones or skin.
Health benefits of vitamin and mineral supplements
Vitamins and minerals are micronutrients that serve a specific purpose and benefit the body in a unique way. For example, vitamin A supports vision and bone growth, whereas vitamin E strengthens the immune system and helps repair DNA. Vitamin and mineral deficiency can impair the body’s ability to heal and protect itself.
Taking vitamins does not make up for an unhealthy diet, and vitamins are an insufficient substitute for nutrients from fresh fruits, vegetables, and whole grains. However, a general multivitamin and mineral supplement can be a good safeguard against periodic vitamin shortfalls in your diet.
Herbal supplements are different from vitamin and mineral supplements in that they are considered to have medicinal value. Herbs, also known as botanicals, are one of humanity’s oldest health care tools, and the basis of many modern medicines. Primitive and ancient civilizations relied on herbs for healing, as do many contemporary cultures throughout the world. In fact, the World Health Organization has estimated that 80% of the world’s population continues to use traditional therapies, a major part of which are derived from plants.
If you are taking other medications, refrain from taking herbal supplements without first checking with your doctor. Herbal supplements and over-the-counter medications or prescription drugs can combine to cause adverse side effects. Just because an herbal supplement is extracted from a “natural” source does not render it any less potent than any other chemicals you may ingest.
Who can benefit from vitamin and mineral supplements?
In general, children and adults might benefit from taking one multivitamin per day. A multivitamin helps provide a consistent source of the necessary vitamins and micronutrients. According to the Havard School of Public Health, “a daily multivitamin, and maybe an extra vitamin D supplement, is a great way to make sure you’re getting all the nutrients you need to be healthy.”
However, the very first consideration is to eat a healthy diet. Even the best supplement is no substitute for good nutrition. In many Western countries, people tend to consume foods that are high in calories, but lack nutrients that are vital for good health.
Some groups of people, because of distinct nutritional needs, benefit most from taking a vitamin and mineral supplement:
- Women of childbearing age (need extra calcium and iron)
- Pregnant or lactating women
- Children and teenagers with irregular eating habits
- Vegetarians or vegans (may be deficient in key nutrients)
- Dieters or people avoiding certain food groups (may be deficient in key nutrients)
- People with eating disorders or medical conditions (deficiency diseases, absorption problems, lactose intolerance, etc.)
- People who often eat processed and fast food
Ensuring smart supplementation
The word “supplement” means something added. In this case, you’re “adding” to a basic healthy diet and lifestyle, or to a prescription medication or therapy to treat a medical condition. An herbal supplement or vitamin regimen on its own will not necessarily cure or treat your condition or heath problem. It’s also important to remember that not all supplements are beneficial, especially when taken in toxic doses or combined with other medications.
The media loves exciting headlines, so the moment an herb or vitamin is tentatively shown to be beneficial in some way, it is touted as the next miracle cure. Advertising can be misleading as well, promising us “totally safe”, “natural”, and “quick and effective” solutions to many health problems. You can keep yourself from falling prey to false promises by researching any product you are considering taking. Make sure there is good scientific research that supports the claims of the supplement’s marketers.
Before you decide to take a dietary supplement, ask yourself:
- Do I need this supplement?
- Do I know that this supplement is safe?
- Does this supplement interact with any drug or food I am consuming?
- Do I know that this supplement works?
- Can I afford this supplement?
- Do I know enough about this supplement?
Dietary supplement safety
Homeopathic vs. Herbal Supplements: What’s in a name?
Homeopathy uses natural substances derived from botanical, animal, or mineral sources in micro doses to assist the body’s natural mechanisms for protecting and healing itself. In the U.S., homeopathic medicines are regulated by the Food and Drug Administration (FDA), but in different ways than other drugs. Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA and their products are exempt from good manufacturing practice requirements. However, homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer, the active ingredient, and dosage strength, and indicates that the drug is homeopathic.
Herbal remedies are made from parts of whole plants. Herbal supplements are not regulated as medicines by the FDA and thus can make unsubstantiated health claims.
Dietary supplements may not be risk-free under certain circumstances. Be sure to consult your health practitioner before purchasing or taking any supplement if you are pregnant, nursing a baby, or have a chronic medical condition such as diabetes, hypertension, or heart disease. Also, while vitamin and mineral supplements are generally considered safe for children, you may wish to check with your doctor before giving these or any other dietary supplements to your child.
In many cases dietary supplements and homeopathic remedies can be marketed without providing evidence of safety or efficacy. In order for a product to get removed from the shelves in the United States, for example, the FDA must prove that it is dangerous – and that is often to the detriment of the consumer.
Supplement manufacturers are allowed to make claims regarding health, nutritional content, and structure/function, subject only to limited restrictions. Health claims describe a relationship between a dietary supplement ingredient and reducing the risk of a disease or health-related condition. For example, the label on a bottle of Evening Primrose Oil capsules might claim that the product, “Provides relief from symptoms associated with PMS and menopause such as cramps, hot flashes, breast tenderness, and moodiness.”
Nutrient content claims refer to the percentage of DV (daily value) of the nutrient the supplement provides. A structure/function claim is a statement describing how a product may affect the organs or systems of the body. It can’t mention a specific disease. For example: “COQ10 supports heart function as a component of the electron transport system, and as an antioxidant protects mitochondrial membranes and cholesterol from oxidation.”
When selecting a nutritional, dietary, or herbal supplement, keep in mind the following:
- Nutritional, dietary, and herbal supplement manufactures are not are required to run studies to determine product safety or efficacy.
- In the U.S., the FDA does not analyze the contents of dietary supplements.
- Dietary supplement manufacturers in the U.S. must meet the FDA’s Good Manufacturing Practices (GMP) for food, but some companies also follow the GMP for drugs on a voluntary basis.
- Specific health claims on dietary supplement labels in the U.S. are not approved by the FDA and must also include a disclaimer that states the nutritional supplement is not intended to “diagnose, treat, cure, or prevent any disease.”
- Daily Value (DV) describes the recommended daily intake of a particular nutritional supplement, if one is established.
In addition, keep in mind the following safety concerns when taking vitamin or mineral supplements:
Don’t substitute dietary supplements for medication
If you’re considering using a dietary supplement in place of drugs, consult your health care provider first. And remember, just because it is “natural” doesn’t mean it’s gentler or more beneficial to your body. Many supplements contain active ingredients that have strong biological effects and their safety is not assured.
Caution: Interactions with other medications
Some dietary supplements may interact with other supplements or prescription and over-the-counter medicines. Taking a combination of supplements or using the products with medications (whether prescription or OTC drugs) can cause dangerous interactions which could be life-threatening.
Some common negative interactions:
- Calcium can interact with heart medicine, certain diuretics, and aluminum and magnesium-containing antacids.
- Magnesium can interact with certain diuretics, some cancer drugs, and magnesium-containing antacids.
- Vitamin K can interact with blood thinners like Coumadin.
- St. John’s Wort is known to adversely affect selective serotonin reuptake inhibitor (SSRI) drugs (i.e., anti-depressant drugs), blood pressure medication, and birth control pills.
- Coenzyme Q-10 can interact with anticoagulants, blood pressure medication, and chemotherapy drugs.
- Ginkgo biloba and vitamin E can increase the risk for internal bleeding when taken with aspirin or anitcoagulants such as warfarin.
- Ginseng can also increase the risk for internal bleeding when taken with anticoagulants or NSAIDs, and may cause side effects when taken with MAOI antidepressants.
- Echinacea can change how the body breaks down certain medications in the liver.
- Saw palmetto can interact with anticoagulants and NSAID pain relievers.
Some dietary supplements can have unwanted effects during surgery
You may be asked to stop taking certain products 2 to 4 weeks ahead of time to avoid potentially dangerous supplement/drug interactions, such as changes in heart rate, blood pressure, and increased bleeding. Talk with your doctor about everything you are taking before the surgery—vitamins, minerals, and herbal supplements, as well as medications.
Some dietary supplements are known to be dangerous
Just because a product is on the market does not mean it is definitely safe. There are some known toxic herbs that are still available to the consumer, such as: aristolochia (linked to kidney failure and cancer in the U.S., China, Europe, and Japan); yohimbe (a sexual stimulant linked to heart and respiratory problems); bitter orange (has effects similar to those of the banned stimulant ephedra); and chaparral (linked to liver damage).
Some supplements combine different vitamins or herbs, or include hidden ingredients, often labeling them as simply “energy boosters,” “fat-burning products,” or weight-loss supplements.” The combination of some of these ingredients can cause significant liver damage. Aside from a daily multi-vitamin, it’s much safer to choose supplements that contain just the single ingredient your body needs.
More isn’t always better
Even if your body can benefit from a certain supplement, in excessive doses it may still cause health problems. For example, drinking green tea may provide fat-burning and antioxidant benefits, but taking high-concentration green tea supplements can be toxic to the liver.
- Taking too much selenium and vitamin E may increase the risk for prostate cancer.
- Beta-carotene beyond the amount included in a daily multi-vitamin may increase the risk of lung cancer in smokers.
Do “energy boosters” work?
There are a multitude of herbs and other supplements that claim to boost energy. However, many have side effects and long-term consequences that haven’t been fully studied. Here’s a look at some commonly touted as “energy boosters”:
- Creatine – a widely sold supplement, creatine can build muscle mass and improve athletic performance when using the recommended dosage. However, there are very few adequate studies into the lack of adverse effects.
- DHEA – this naturally occurring hormone is said to boost energy as well as prevent cancer, heart disease, and infectious disease. DHEA has no proven benefits, and likely causes liver damage and increases the risk for breast and prostate cancers.
- Ephedra – banned by the FDA because of major safety concerns, including increased risk of heart attack and stroke, there is no safe amount of ephedra you can consume. A cup of coffee or another caffeinated beverage will work just as well.
- Ginkgo biloba – used for centuries in Chinese medicine and now common in Western countries, its effects on cognition, mood, alertness, and memory have been the subject of many studies. Some weaker studies suggest ginkgo biloba may improve some aspects of mood, including alertness and calmness, in healthy subjects. By making you more alert and calm, it may increase your sense of energy.
- Ginseng – a relatively safe and popular herb said to reduce fatigue and enhance stamina and endurance. Studies are sparse and conflicting, and some report that ginseng improves mood, energy, and physical and intellectual performance. Other research concludes ginseng doesn’t improve oxygen use or aerobic performance, or influence how quickly you bounce back after exercising.
- Vitamin B12 – Injections of vitamin B12 are given by some doctors as “energy boosters.” But unless they are given to correct anemia which results from a true deficiency of the vitamin, there is little evidence that vitamin B12 treatments boost energy.
Bottom line: Some of these supplements may boost your energy, but like caffeine, the effects normally wear off within hours.
Adapted with permission from Boosting Your Energy, a special health report published by Havard Health Publications.
Researching and buying vitamin, mineral and herbal supplements
The safest way to purchase supplements is from a reputable vitamin or health food store, or from a health practitioner. However, not all of us have access to these types of resources. As an Internet-savvy consumer, your computer can be your best friend when it comes to choosing the right supplement for you.
The amount of information available on the Web can be overwhelming, but by using the following simple steps, you can be sure you’re getting reliable information about herbal or vitamin supplements.
How to research dietary supplements
- Safety and Efficacy: Before you embark on a supplement regiment, be sure that what you’re going to take is safe and effective. The National Institute of Health Office of Dietary Supplements offers fact sheets on most herbal dietary supplements, including safety aspects. See Resources and References section below for the link.
- Dosage: The Mayo Clinic offers a searchable database of supplements, also in the Resources and References section below. It rates the efficacy of a supplement for various health conditions, explains safety concerns, and details recommended dosage information for adults and children.
- Quality: Look for “standardized” products from manufacturers participating in the US Pharmacopeia’s Dietary Supplement Verified Program or those carrying the NSF International mark of safety.
A seal from one of these organizations indicates a dietary supplement has met certain manufacturing standards, such as uniformity, cleanliness, and freedom from environmental contaminants, including lead, mercury, and drugs. Each group has different standards and processes, but the goal of each is to certify that herbal supplements meet certain safety and purity criteria.
There are a lot of different companies marketing supplemental products. Quality does matter, so it’s good to read the ingredients and warnings on the bottle, and learn about the manufacturers. It’s up to you as the consumer to protect your own health – so practice caveat emptor (“let the buyer beware”), and consult your health care professional before taking any type of dietary supplements.
More help for nutrition
Healthy Eating Help Center: Explore these articles to help you make the right healthy eating choices for you and your loved ones.
- Healthy Eating: Easy Tips for Planning a Healthy Diet and Sticking to It
- High-Fiber Foods: Benefits, Sources, and Getting More Fiber in Your Diet
- The Mediterranean Diet: Myths, Facts, and Health Benefits of a Mediterranean Diet
- Are Organic Foods Right for You? Understanding Organic Food Labels, Benefits, and Claims
- Choosing Healthy Fats: Good Fats, Bad Fats, and the Power of Omega-3s
- Vitamins and Minerals: Are You Getting What You Need?
Resources and references
General information about dietary supplements
Using Dietary Supplements Wisely – General information on supplements. (National Center for Complementary and Alternative Medicine)
Making Decisions – Explore a wealth of dietary supplement resources, including supplement fact sheets, consumer health alerts, an app, and safety tips. (National Institutes of Health, Office of Dietary Supplements)
Who can benefit from a vitamin or mineral supplement
Vitamins: Nutrition Source – Overview of key vitamins and why judicious supplementation is essential for good health. (Havard School of Public Health)
Dietary Supplements (PDF) – Special concerns relating to senior health and use of vitamin and mineral supplements. (National Institute on Aging)
Herbal supplements: What to know before you buy – Primer on what to know before taking herbal supplements, including precautions and tips for purchasing. (Mayo Clinic)
Herbal Health Products: What you should know – Describes some common side effects of popular supplements, and what to avoid if you suffer from certain conditions. (American Family Physician)
Dietary Supplements Factsheets – Offers fact sheets on most herbal dietary supplements, including safety aspects. (National Institute of Health Office of Dietary Supplements)
Choosing a vitamin, mineral or herbal supplement
Supplements Database – Allows you to look up a supplement by name, and find out background, dosing information, and pertinent research. (Mayo Clinic)
Tips for the Savvy Supplement User – Overview containing tips for evaluating information (labels, books, internet resources) and guidelines for making informed decisions about whether or not to take supplements and how to purchase wisely. (U.S. Food and Drug Administration)
- What you need to know
- Stimulant medications
- Stimulant safety concerns
- Non-stimulant medications
- ADD/ADHD medication and your child
- Medication alone is not enough
- Side effects
- More help
- Resources and references
ADD / ADHD Medications
Are ADHD Drugs Right for You or Your Child?
Medication can help reduce symptoms of hyperactivity, inattentiveness, and impulsivity in children and adults with ADD/ADHD. However, medications come with side effects and risks—and are not the only treatment option. Whether you’re the parent or the patient, it’s important to learn the facts about ADD/ADHD medication so you can make an informed decision about what’s best for you or your child.
Medication for ADD / ADHD: What you need to know
Making ADD/ADHD medication decisions can be difficult, but doing your homework helps. The first thing to understand is exactly what the medications for ADD and ADHD can and can’t do. ADHD medication may help improve the ability to concentrate, control impulses, plan ahead, and follow through with tasks. However, it isn’t a magic pill that will fix all of your or your child’s problems. Even when the medication is working, a child with ADD/ADHD might still struggle with forgetfulness, emotional problems, and social awkwardness, or an adult with disorganization, distractibility, and relationship difficulties. That’s why it’s so important to also make lifestyle changes that include regular exercise, a healthy diet, and sufficient sleep.
Medication doesn’t cure ADD/ADHD. It can relieve symptoms while it’s being taken, but once medication stops, those symptoms come back. Also, ADD/ADHD medication works better for some than for others. Some people experience dramatic improvement while others experience only modest gains. Because each person responds differently and unpredictably to medication for ADHD, its use should always be personalized to the individual and closely monitored by a doctor. When medication for ADD/ADHD is not carefully monitored, it is less effective and more risky.
Generic vs. Brand-Name Drugs
Generic drugs have the same use, dosage, side effects, risks, safety profile, and potency as the original brand-name drug. The main reason why generic drugs are cheaper than brand-name drugs is that the generic drug manufacturer does not need to recoup huge expenses for developing and marketing a drug. Once the patent for the original drug has expired, other manufacturers can produce the same drug with the same ingredients at a markedly lower cost.
Occasionally, brand-name drugs have different coatings or color dyes to change their appearance. In rare cases, these extra ingredients will make the generic form of the drug less tolerable, so if your condition worsens after switching from a brand-name to a generic drug, consult your doctor. In most cases, however, generic drugs are just as safe and effective as brand-name drugs.
Stimulant medications for ADD / ADHD
Stimulants are the most common type of medication prescribed for attention deficit disorder. They have the longest track record for treating ADD/ADHD and the most research to back up their effectiveness. The stimulant class of medication includes widely used drugs such as Ritalin, Adderall, and Dexedrine.
Stimulants are believed to work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement. For many people with ADD or ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.
Short-acting vs. long-acting stimulants for ADD / ADHD
Stimulants for ADD/ADHD come in both short- and long-acting dosages. Short-acting stimulants peak after several hours, and must be taken 2-3 times a day. Long-acting or extended-release stimulants last 8-12 hours, and are usually taken just once a day.
The long-acting versions of ADD/ADHD medication are often preferred, since people with ADHD often have trouble remembering to take their pills. Taking just one dose a day is much easier and more convenient.
Common side effects of stimulants for ADD / ADHD:
Stimulant medications may also cause personality changes. Some people become withdrawn, listless, rigid, or less spontaneous and talkative. Others develop obsessive-compulsive symptoms. Since stimulants raise blood pressure and heart rate, many experts worry about the dangers of taking these ADD/ADHD drugs for extended periods.
ADD / ADHD Stimulant safety concerns
Stimulant Medication Red Flags
Call your doctor right away if you or your child experience any of the following symptoms while taking stimulant medication for ADD or ADHD:
- chest pain
- shortness of breath
- seeing or hearing things that aren’t real
- suspicion or paranoia
Beyond the potential side effects, there are a number of safety concerns associated with the stimulant medications for ADD/ADHD.
- Effect on the developing brain — The long-term impact of ADD/ADHD medication on the youthful, developing brain is not yet known. Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.
- Heart-related problems — ADD/ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. An electrocardiogram is recommended if the person has a history of heart problems.
- Psychiatric problems — Stimulants for ADD/ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.
- Potential for abuse — Stimulant abuse is a growing problem, particularly among teens and young adults. College students take them for a boost when cramming for exams or pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them.
ADD / ADHD stimulants are not recommended for those with:
Non-stimulant medications for ADD / ADHD
In addition to the traditional stimulant drugs, there are several other medications used to treat ADD/ADHD, including Strattera, atypical antidepressants, and certain blood pressure medications. In most cases, non-stimulant medications are considered when stimulants haven’t worked or have caused intolerable side effects.
Strattera Suicide Risk in Children
Strattera may cause an increase in suicidal thoughts and actions in some children and teenagers, especially if your child has bipolar disorder or depression in addition to ADD/ADHD.
Call the doctor immediately if your child shows agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior.
Strattera, also known by its generic name atomoxetine, is the only non-stimulant medication approved by the FDA for ADD/ADHD treatment. Unlike stimulants, which affect dopamine, Strattera boosts the levels of norepinephrine, a different brain chemical.
Strattera is longer-acting than the stimulant drugs. Its effects last over 24 hours—making it a good option for those who have trouble getting going in the morning. Since it has some antidepressant properties, it’s also a top choice for those with co-existing anxiety or depression. Another plus is that it doesn’t exacerbate tics or Tourette’s Syndrome.
On the other hand, Strattera doesn’t appear to be as effective as the stimulant medications for treating symptoms of hyperactivity.
Common side effects of Strattera include:
Straterra can also cause insomnia and appetite suppression, but these side effects are more common in stimulants.
Other ADD / ADHD medication options
The following medications are sometimes used “off-label” in the treatment of attention deficit disorder, although they are not FDA approved for this purpose. They should only be considered when stimulants or Strattera aren’t viable options.
- High blood pressure medication for ADD/ADHD – Certain blood pressure medications can be used to treat ADD/ADHD. Options include clonidine (Catapres) and guanfacine (Tenex). But while these medications can be effective for hyperactivity, impulsivity, and aggression, they are less helpful when it comes to attention problems.
- Antidepressants for ADD/ADHD – For people suffering from both ADHD and depression, certain antidepressants, which target multiple neurotransmitters in the brain, may be prescribed. Wellbutrin, also known by the generic name bupropion, is most widely used. Wellbutrin targets both norepinephrine and dopamine. Another option is the use of tricyclic antidepressants.
ADD / ADHD medications and your child
Even when armed with all the facts, deciding whether or not to let your child take ADD/ADHD medication isn’t always easy. If you’re unsure, don’t rush the decision. Sometimes other medical conditions–or even normal childhood behavior–can be mistaken for ADD/ADHD symptoms, so be sure to eliminate all other possible causes before considering medication for your child. Take your time to weigh the options and get your child’s input in the decision-making process.
Most importantly, trust your instincts and do what feels right to you. Don’t let anyone–be it your physician or the principal at your child’s school–pressure your child into medication if you’re not comfortable with it. Remember: medication isn’t the only treatment option. For young children especially, medication should be viewed as a last resort, not the first course of treatment to try.
Questions to ask an ADD / ADHD specialist
Consulting with an ADD/ADHD specialist or an experienced psychiatrist can help you understand the pros and cons of medication. Here are some questions to ask:
- What ADD/ADHD treatments do you recommend?
- Can my child’s symptoms be managed without medication?
- What medications do you recommend and what are the side effects?
- How effective is medication for my child’s ADD/ADHD?
- How long will my child have to take medication?
- How will the decision be made to stop medication?
For Parents: Helpful questions about ADD / ADHD medication and your child
When deciding whether or not to put your child on medication, Jerome Schultz, Ph.D., ADHD expert, says to first consider the following questions:
- Has my child been helped by non-medication approaches? Self-calming techniques, deep breathing, and yoga often can help children with ADHD.
- Has the school tried to teach my child to be more attentive and less active?
- Is the decision to put my child on medication the result of behavioral observations over time and in different settings, such as in school and at home?
- When is my child at his or her best? Fishing with his uncle or playing video games? Help the physician understand how pervasive or selective the problem is.
- Does my child have other conditions that can be mistaken for hyperactivity? Children exposed to toxic chemicals or who have undiagnosed learning disabilities and low-level anxiety disorder may produce similar behaviors.
Source: Family Education Network
Talking to your child about ADD / ADHD medication
Many kids and teens with ADD/ADHD don’t take their medication correctly—or stop taking it without talking to their parents or doctor—so if your child is on ADD meds, make sure that he or she understands how to take the medication correctly and why following prescription guidelines are important.
Encourage your child to come to you with any medication-related concerns so you can work together to solve the problem or find another treatment option. It’s also important to remember that ADD/ADHD medication should never have a numbing effect on a child’s energy, curiosity or enthusiasm. A child still needs to behave like a child.
Monitoring Medication’s Effects on Your Child
Here is a list of questions you should ask when your child begins medication therapy, changes dosage, or starts taking a different medication.
- Is the medication having a positive impact on your child’s mood and/or behavior?
- Do you think the dosage or medication is working?
- Does your child think the dosage or medication is working?
- Does the dose need to be increased or decreased?
- What was the change in a specific behavior or set of behaviors that caused you to conclude that the medication needed to be evaluated?
- Is your child experiencing any side effects, such as headaches, stomachaches, fatigue or sleeplessness, (or suicidal thoughts if taking Strattera)?
- What is the likelihood those side effects will last? (Ask your doctor)
- Do any lasting side effects (if any) outweigh the medication’s benefits?
- Do you or your child think a medication or dosage level has stopped working?
Source: From Chaos to Calm: Effective Parenting of Challenging Children with ADHD and Other Behavioral Problems, by Janet E. Heininger and Sharon K. Weiss.
Medication alone is not enough
Treatment for attention deficit disorder isn’t just about seeing doctors or taking medication. There is a lot you can do to help yourself or your child tackle the challenges of ADD/ADHD and lead a calmer, more productive life. With the right tips and tools, you can manage many of the symptoms of your ADD/ADHD on your own. Even if you choose to take medication, healthy lifestyle habits and other self-help strategies may enable you to take a lower dose.
- Exercise regularly. Exercising is one of the most effective ways to reduce the symptoms of ADD/ADHD. Physical activity boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. Try walking, skateboarding, hiking, dancing or playing a favorite sport. Encourage your child to put down the video games and play outside.
- Eat a healthy diet. While diet doesn’t cause ADD/ADHD, it does have an effect on mood, energy levels, and symptoms. Set regular snack and meal times. Add more omega-3 fatty acids to your diet and make sure you’re getting enough zinc, iron and magnesium.
- Get plenty of sleep. Regular quality sleep can lead to vast improvement in the symptoms of ADD/ADHD. Simple changes to daytime habits go a long way toward resting well at night. Have a set bedtime and stick to it. Avoid caffeine later in the day.
- Try therapy. ADD/ADHD professionals can help you or your child learn new skills to cope with symptoms and change habits that are causing problems. Some therapies focus on managing stress and anger or controlling impulsive behaviors, while others teach you how to manage time, improve organizational skills, and persist toward goals.
- Maintain a positive attitude. A positive attitude and common sense are your best assets for treating ADD/ADHD. When you are in a good frame of mind, you are more likely to be able to connect with your own needs or your child’s.
Guidelines for taking ADD / ADHD medication
If you decide to take medication for ADD/ADHD, it’s important to take the drug as directed. Following your doctor and pharmacist’s instructions will help you maximize the effectiveness of medication for ADD/ADHD and minimize the side effects and risks. Here are some guidelines for safe use:
- Learn about the prescribed medication. Find out everything you can about the ADD/ADHD medication you or your child is taking, including potential side effects, how often to take it, special warnings, and other substances that should be avoided, such as over-the-counter cold medication.
- Be patient. Finding the right medication and dose is a trial-and-error process. It will take some experimenting, as well as open, honest communication with your doctor.
- Start small. It’s always best to start with a low dose and work up from there. The goal is to find the lowest possible dose that relieves you or your child’s symptoms.
- Monitor the drug’s effects. Pay close attention to the effect the medication is having on your or your child’s emotions and behavior. Keep track of any side effects and monitor how well the medication is working to reduce symptoms.
- Taper off slowly. If you or your child wants to stop taking medication, call the doctor for guidance on gradually decreasing the dose. Abruptly stopping medication can lead to unpleasant withdrawal symptoms such as irritability, fatigue, depression, and headache.
Dealing with the side effects of ADD / ADHD medication
Most children and adults taking medication for ADD/ADHD will experience at least a few side effects. Sometimes, side effects go away after the first few weeks on the medication. You may also be able to eliminate or reduce unpleasant side effects with a few simple strategies.
Tips for minimizing side effects
- Loss of appetite – To deal with reduced appetite, eat healthy snacks throughout the day and push dinner to a later time when the medication has worn off.
- Insomnia – If getting to sleep is a problem, try taking the stimulant earlier in the day. If you or your child is taking an extended-release stimulant, you can also try switching to the short-acting form. Also avoid caffeinated beverages, especially in the afternoon or evening.
- Stomach upset or headaches – Don’t take the medication on an empty stomach, which can cause nausea, stomach pain, and headaches. Headaches can also be triggered by medication that’s wearing off, so switching to a long-acting drug may help.
- Dizziness – First, have you or your child’s blood pressure checked. If it’s normal, you may want to reduce your dose or switch to a long-acting stimulant. Also make sure you’re drinking enough fluids.
- Mood changes – If medication is causing irritability, depression, agitation, or other emotional side effects, try lowering the dose. Moodiness may also be caused by the rebound effect, in which case it may help to overlap the doses or switch to an extended-release medication.
If troublesome side effects persist despite your best efforts to manage them, talk to your doctor about adjusting the dose or trying a different drug. Many people respond better to the long-acting or extended release formulations of ADHD medication, which build gradually in the bloodstream and then wear off slowly. This minimizes the ups and downs caused by fluctuating medication levels and causes less of a rebound effect, where symptoms return, often worse than before, as the drug wears off.
More help for ADD/ADHD in children
ADD/ADHD Help Center: Find ways to stay focused, turn chaos into calm, and manage the symptoms of distraction, hyperactivity, and impulsivity.
- ADD / ADHD Treatment in Children: Signs and Symptoms of Attention Deficit Disorder in Kids
- Treatment for Adult ADD / ADHD: A Guide to Finding Treatments That Work
- Adult ADD / ADHD: Signs, Symptoms, Effects, and Treatment
- ADD / ADHD Tests and Diagnosis: Diagnosing Attention Deficit Disorder in Children and Adults
- Help for Adult ADD / ADHD: Tips for Managing Symptoms & Getting Focused
Help for ADD / ADHD at home
Help for ADD / ADHD at school
- ADD / ADHD in Children: Signs and Symptoms of Attention Deficit Disorder in Kids
- ADD / ADHD and School: Helping Children with ADHD Succeed at School
- ADD / ADHD Parenting Tips: Helping Children with Attention Deficit Disorder
Resources and references
General information about ADD / ADHD medications
Attention-Deficit Hyperactivity Disorder: Medications – Covers common ADD/ADHD medications for children and adults, including side effects, long-term complications, and concerns for abuse. (University of Maryland Medical Center)
ADHD Treatment: Your Guide to Common ADD Drugs – Find answers to parents’ top 10 questions about common ADD/ADHD medications. (ADDitude)
Stimulant Medication and ADHD – In-depth article on stimulants for ADD/ADHD, including side effects, treatment guidelines, and effectiveness. (Northern County Psychiatric Associates)
ADHD Medications – Article written for kids about ADD/ADHD medications and their safety. (Nemours Foundation)
ADHD: Making Medication Decisions – Questions to consider when deciding whether or not to put your child on medication. (Family Education Network)
Side Effects and Safety Concerns of ADD / ADHD Medication
FDA Asks Attention-Deficit Hyperactivity Disorder (ADHD) Drug Manufacturers to Develop Patient Medication Guides – Overview of the FDA’s requirement for ADD/ADHD drug labels, with links to each specific medication. (U.S. Food and Drug Administration)
ADD / ADHD Medication Guidelines
ADD Drugs 101: Stimulant Strategies – Guidelines for taking ADD/ADHD stimulant medications safely and effectively. (ADDitude)
ADD Drugs: Say No to Side Effects – Guide to finding the right ADD/ADHD medication for you or you child and minimizing side effects. (ADDitude)
What If Einstein Had Taken Ritalin? – Examines the effects of Ritalin and other ADD/ADHD drugs on active kids and questions what effects these drugs might have had if some famous people had taken them. (Overmatter.com – reprint of Wall Street Journal article)