As cosmetic procedures surge worldwide and beauty content increasingly dominates social media platforms, a new study from the Hebrew University of Jerusalem, suggests that for some women, cosmetic treatments may begin to resemble compulsive or addiction-like behaviour. The study, led by Dr Vera Skvirsky alongside Dr Uri Lifshin, Dr Dvora Shmulewitz, and Prof Mario Mikulincer from the Department of Psychology at Hebrew University of Jerusalem and the Israel Center for Addiction and Mental Health (ICAMH), examined what the researchers describe as “addictive cosmetic procedures use,” or ACPU, among women.
Published in the Journal of Health Psychology, the study surveyed 1614 women between the ages of 25 and 71, making it one of the larger investigations to date into the psychological patterns associated with repeated cosmetic treatments. The findings point to a phenomenon that researchers say deserves greater attention from both clinicians and the public. Among women who had undergone cosmetic procedures, 20% met the threshold for moderate to severe risk of addictive cosmetic procedure use during their lifetime.
More than 15% reported symptoms that were active within the past year.
Across the full sample, nearly 9% of women showed moderate to severe signs of problematic cosmetic procedure use. The researchers adapted an assessment tool originally based on the Diagnostic and Statistical Manual of Mental Disorders criteria for substance-related disorders. Participants were asked questions typically associated with addiction, including whether they had unsuccessfully tried to stop undergoing cosmetic procedures, felt compelled to continue despite negative consequences, or experienced cravings related to treatments.
While previous research has linked cosmetic procedures to body image concerns and body dysmorphic disorder, this study goes further by examining whether repeated cosmetic treatments can, in some cases, resemble a behavioural addiction. Unlike earlier studies, which often focused on patients at cosmetic clinics, this research surveyed more than 1600 women from the general population and found that addiction-like patterns were most strongly associated with the combination of low body esteem and problematic social media use.
While cosmetic procedures are often associated with confidence and self-expression, the researchers found that repeated engagement may also intersect with vulnerabilities tied to body image and digital behaviour. Women with lower body esteem were significantly more likely to report addictive patterns of cosmetic procedure use, particularly when paired with high levels of problematic social media use. Participants who reported problematic or excessive social media behaviour were especially vulnerable if they also struggled with dissatisfaction about their appearance.
The researchers also observed smaller associations between addictive cosmetic procedure use and lower feminist attitudes, lower attachment security, and more negative attitudes toward aging, though those relationships were less consistent once multiple factors were analysed together.
The findings arrive amid a sharp global increase in cosmetic procedures. According to international estimates cited in the paper, cosmetic interventions worldwide rose by roughly 40% between 2019 and 2023.
The researchers stressed that the study does not argue cosmetic procedures are inherently harmful. Rather, they say the results suggest that in some cases, repeated engagement may take on characteristics similar to behavioral addictions already recognized in mental health research.
“Cosmetic procedures have become deeply normalised in many societies, and for many people they may be a positive experience,” said the researchers. “But our findings suggest that for a meaningful minority, the behaviour may begin to resemble other compulsive patterns we see in addiction research, especially when low body esteem and problematic social media use are involved.”
The researchers cautioned that the study was cross-sectional, meaning it cannot determine cause and effect. It remains unclear whether problematic social media use contributes to addictive cosmetic behaviour, whether cosmetic procedures themselves influence body image and online engagement, or whether other psychological factors drive both.
Dr Hermann Reuter founded SAHARA, a non-profit organisation in George that provides support groups and free medication for people affected by harmful substance use. (Photo: Nasief Manie/Spotlight)
By Sue Segar for Spotlight
Dr Hermann Reuter did pioneering work treating HIV in the early 2000s in Cape Town and in the rural Eastern Cape. Today, his focus is substance abuse, which he believes is the country’s biggest health issue after HIV. Spotlight spent time with him to learn about his work in the Garden Route city of George.
On a Tuesday afternoon, just before 14:00, Jodie Fonseca, walks into a small consulting room inside the Central Clinic in the Garden Route town of George.
The 37-year-old, who says she has been addicted to heroin for 20 years, is here to fetch her supply of medication used to treat her substance use disorder. The slight, weary looking woman is welcomed warmly by two men as she takes her seat.
“How’s it going?” says Dr Hermann Reuter, a bespectacled man with a strong German accent. He’s wearing a T-shirt with the words Substance Survivor on the front. He looks at her file and dispenses tablets into a bottle.
Brian Faul, a volunteer behavioural change counsellor, chats and jokes with Fonseca. He describes himself to us as a recovering alcoholic, sober for 26 years.
Outside the consulting room, a line of about 30 people, needing help with substance use, have gathered in the narrow corridor in this typical inner-city government clinic. They range from gaunt older women in trackpants to young men in frayed hoodies. Some are seated and others stand patiently waiting.
Reuter hands Fonseca a bottle of pills. “See you next month for your medication,” he tells her.
“Remember, we’re always here if you have issues. We’re an open door, hey.”
Faul urges Fonseca to return to the clinic on Friday, when he runs group and individual counselling sessions for people with addiction.
Fonseca is here to attend a weekly outpatient service, run by the NGO Smoking and Alcohol Harms Alleviation and Rehabilitation Association (SAHARA). Founded in George by Reuter five years ago, the NGO offers free medical-assisted outpatient rehabilitation, and counselling in the form of support groups to people with substance addiction.
Currently, these services are not offered in the public healthcare system in George, but thanks to a relationship with the Western Cape health department, SAHARA uses a consulting room in Central Clinic for a few hours to run the Tuesday methadone programme and the Friday counselling services. On Wednesdays, through a similar arrangement, the NGO runs a programme in Thembalethu clinic.
An addict since 17
Desperate to “get away from the heroin”, Fonseca, a mother of three, tells Spotlight she moved to George from Johannesburg a few months ago.
“Johannesburg was just a battle. I ended up on the streets and lost everything,” she says. “The lifestyle and the familiarity just kept my boyfriend and I in the cycle. Heroin is so easily accessible up there. I’d just had enough. I wanted to get on the methadone programme.”
Fonseca says while it was a struggle for her to get onto a programme in Johannesburg, it was smooth sailing in George with Reuter helping her on her first visit to the clinic. “I was amazed and grateful, actually speechless,” she says. “I walked in and said to him, ‘I can’t carry on in this lifestyle. I feel the next time I pick up I’ll … make sure it’s a deadly dose’.”
Fonseca says the counselling sessions have been helpful too. “Brian downloaded a breathing app to help with my anxiety. It calms me and helps me sleep,” she says.
She dreams of a normal life, back with her children and to spend time with her mother, “my rock”, who she says is in poor health.
Fonseca is by no means alone in having become addicted to heroin. As previously reported by Spotlight, rates of heroin use in South Africa have been on the up. It is estimated that a few hundred thousand people in the country take the drug every day.
A stream of people with substance-use disorders
Next to enter the consulting room are a father and his teenage son. One can sense the love between them, but there’s tension. It’s their first visit, and they’re here because the son wants to quit his marijuana habit. The concerned father asks Reuter to test his son’s urine to check whether his son is using other drugs, like crystal meth, on top of marijuana. The son insists he only uses marijuana.
Intervening gently, Reuter says there’s no need for a urine test. “The treatment for cannabis (marijuana) and crystal meth is the same; there will be no benefit from additional information,” he says. The dad nods. Both agree to return to the clinic for more counselling.
Next to see Reuter are Peter-John Truter and his twin brother, Kenneth, both 36, and addicted to heroin. They tell Spotlight their mother died of breast cancer when they were three-months old and they were lovingly raised by a relative in Mitchells Plain, Cape Town. Initially hard-working and sporty children, they started using “weed, alcohol, ecstasy and tik” as teenagers, before discovering heroin in their 20s.
“Drugs took over the Cape Flats. Wherever you went, people were drinking, smoking tik or whatever. It’s the weekend thing. Our area became infected with heroin. We moved from smoking to mainlining (injecting),” says Peter-John.
The brothers tried rehab several times. Their heartbroken adoptive mother sent them to George, thinking there were no drugs there. They found dealers immediately. Both are now on the methadone programme and sometimes attend counselling.
Next in the small consulting room is a young man who’s addicted to the medication Tramadol.
“I started taking it for toothache and got up to 20 tablets a day. It made me feel good, like I was on drugs, but I started passing out in the street,” he says.
Reuter explains that the treatment for Tramadol addiction is the same as for heroin addiction. Both drugs are opioids.
“No cold turkey with methadone”
Reuter explains that heroin addiction is treated with methadone Opioid Substitution Treatment (OST). Methadone is a synthetic opioid that is typically taken once a day.
“It sits on the same receptor as heroin, so people don’t suffer withdrawal. There’s no cold turkey or cramping. They can go back to normal life quite quickly if they stick to this,” he says.
The first six months of the treatment is usually “a bit up and down”, Reuter says, but the programme has seen most addicts moving back into their homes and into jobs.
“Most people on the programme stop the methadone at some stage, so you won’t see them here anymore. The people you see here today are those who are still on the street and struggling – or who started recently,” he says.
It’s clinic closing time but a few people still need support. Reuter, undaunted, carries his box of medication and continues outside. A small group of users join him.
There we meet Sarah Lessing who says she has been clean from heroin for four years since joining Reuter’s programme. She’s brought two youngsters who live in the mountains outside George.
“In George, there’s unfortunately nowhere for people without a support system to go,” says Lessing. She recalls how she decided to give up heroin, after her partner who also used heroin died. “I had to literally walk past my dealer to get to the taxi to go to Dr Reuter’s clinic.” Fully recovered, she feels part of his “lifesaving” mission to work with other people struggling with addiction.
Thembalethu’s Wednesday clinic
The next morning, Reuter is working in George’s Thembalethu clinic. The service here is offered every Wednesday for people struggling mainly with alcohol and nicotine use.
The first hour is spent with community health workers. SAHARA has been sub-contracted to manage about 65 health workers from five clinics in the district trained in substance use, as well as mental healthcare. Reuter says that, with substance use and mental health issues at crisis levels, it is essential health workers have this capacity added to their skillset.
As part of a Western Cape government youth wellness and substance prevention programme called Planet Youth, the community health workers will be working with schools in their areas to link health and education; and to teach people about the dangers of alcohol and cigarettes.
“Now that we are entrusted with community health workers, we want to expand their scope of practise, so they support the schools, including the relationship between the schools and parents,” says Reuter.
Soon after 09:00, a stream of service users has entered the consulting room. There’s an old man with a walking stick, a few middle-aged women, and some very young people.
Switching from English to Afrikaans to isiXhosa, Reuter greets every person. “You are taking a big step today … we can help you with these tablets, and with our support group,” he says.
A 29-year-old woman tells Spotlight she’s been smoking cigarettes since she was 17. She’s lost count of how many cigarettes she smokes daily and says she feels sick all the time. “It doesn’t even help my stress,” she says.
A man who works as a painter says he hopes to give up alcohol and smoking. “I’ve been smoking since 1984. At weekends, I drink and smoke till I’m dizzy. I don’t even have tastebuds till Wednesday or Thursday,” he says.
More and more people arrive. Reuter listens to each one, and packs medicines for each. For nicotine, he’s got bupropion, and when funds are sufficient, varenicline. “Bupropion helps quit smoking by reducing cravings and withdrawal symptoms. Varenicline is a nicotine receptor blocker. It reduces withdrawal symptoms and reduces enjoyment of smoking,” he explains. He says it’s safe to use these with other medications and during pregnancy but people who have epilepsy must be properly consulted.
For those wanting to reduce alcohol use, he prescribes diazepam and naltrexone. “Diazepam reduces withdrawal symptoms by working on the GABA (gamma-aminobutyrid acid) system, which is the main inhibitory neurotransmitter in the central nervous system… Naltexone blocks the euphoria caused by alcohol-induced endorphins,” he explains.
David Nongogo says he joined Reuter’s programme about five years back and is now a regular at the clinic to encourage others. “It took me only three weeks to get off smoking and drinking,” he says.
“I won’t ever go back there. There’s a drink they make in the township, called ‘iginja’ made from a powder you brew into alcohol. If you drink it, you don’t even know when you need to urinate. You just urinate. I found myself there. If it wasn’t for the programme, I wouldn’t be here,” he says.
Reuter’s public health journey
Well-known for his groundbreaking work in HIV treatment and activism, Reuter graduated in medicine from Stellenbosch University in the early nineties. Politically involved from an early age, he worked for the Treatment Action Campaign (TAC) in the Western Cape in the late nineties. He then ran HIV treatment programmes in Khayelitsha, Cape Town and Lusikisiki in the rural Eastern Cape for Medecins Sans Frontieres (MSF). He also ran HIV services for the health department in KwaZulu-Natal. In 2004, Reuter received the Rural Doctor of the Year Award from the Rural Doctors Association of Southern Africa (RuDASA) for his efforts in providing HIV medicines in remote areas of the country. In 2020, Reuter published this moving article looking back at the role of some key people in the struggle for antiretrovirals in South Africa.
Reuter moved to George in 2015 where, besides running SAHARA, he works as Community-Based Education Coordinator in the Garden Route, for the Division of Primary Health Care in the Department of Family, Community and Emergency Care of the Faculty of Health Sciences at the University of Cape Town.
Reuter’s passion these days is what he calls the “neglected problem” of substance abuse which, he says, is the country’s second biggest health issue after HIV. He says the health system carries the high costs of the harm and illness caused by substance misuse. He argues that it is more cost-effective to treat addiction before it takes hold. This, he feels, should be done at primary care level, as opposed to dealing with the fallout in public hospitals.
He says government should carry the cost of substance abuse medications and points out that the public health system does not currently provide methadone or other medications for treating substance abuse as they are not on the essential medicines list, and clinics are not authorised to keep them on site.
The public health system does not currently provide methadone, a synthetic opioid typically taken once daily, or other medications used to treat substance use disorders. (Photo: Nasief Manie/Spotlight)
“So, I arrive with my stock, hand it out, and monitor people to ensure they are safe on the medication,” says Reuter. “I am registered as a dispensing doctor so can buy the medication wholesale and distribute it.” His funding comes from a charity in Canada called Child.
George, he says, is no different from any other town in South Africa.
“Over weekends, the hospital is overwhelmed with trauma cases … clearly linked to alcohol abuse. Like other hospitals, we see numerous people with complications arising from smoking, like cardiovascular issues, lung disease, and cancer.”
He continues: “I see families in tears every week, saying ‘our child is stealing and doing drugs, and is not our child anymore’.”
Treat the substance use, not the repercussions
Reuter says he became disillusioned with medicine when he realised he was just working at the tail end of people’s misery. “I knew that the social context in which people lived needed to change. Rather than putting a plaster on much bigger problems, issues should be dealt with much earlier,” he says.
He is disappointed that more doctors are not advocating for medications for treating substance abuse to be made available in government facilities.
“It reminds me of the early days of HIV. We knew there were medicines that worked and not many doctors were prepared to stand up and advocate for it,” he says.
Reuter says that the government’s approach to tackling substance use is not ideal. He explains that the Department of Social Development is tasked with issues relating to substance abuse.
“But substance use is a medical problem. There are many social causes and social problems caused by it. The Department of Health should be dealing with it because the complications down the line are so expensive, and [they do end up] paying for all of them. We should be medically treating substance users to save the health department from these costs,” he says.
A few positives
On the plus side, SAHARA’s integration of its services into the local clinics is yielding results. Community health worker at Thembalethu clinic, Gcobisa Kraai, says she is learning so much about the treatment of substance abuse. “I can see the community really wants this service. Substances are killing our communities,” she says.
Reuter says last year his NGO treated 2 400 people for smoking, 1 400 for alcohol use, with more than 50 people on methadone. “Our budget cannot treat more people, so we restrict clinics where we work so that we have medication for the whole year,” he says. “If we had more funding, we could be at more clinics.”
Lyra Southern Africa’s latest behavioural health data reveals a steady year‑on‑year rise in addictive behaviours among South African employees, reflecting how prolonged stress is reshaping the ways people cope, escape and self‑manage emotional pressure.
Drawn from a five‑year analysis of Employee Wellness Programme trends, the data shows total addictive behaviour cases increasing from 1.79 percent of all cases in 2021 to 2.85 percent in 2025. While this may appear modest when viewed only as a percentage point shift, it in fact represents close to 60 percent growth over the period. Clinicians caution that this scale of increase reflects a material change in coping patterns, unfolding alongside heightened financial, social and psychological strain.
“This is not about sudden spikes or isolated events,” says Dubekile Mugumbate, Business Intelligence and Consulting Manager at Lyra Southern Africa. “It’s about stress that has become part of everyday life, and the coping strategies people reach for when that stress doesn’t let up.”
Lyra’s clinicians note that addictive behaviours rarely appear in isolation. They are often intertwined with anxiety, burnout, relationship strain and overwhelming life pressure. In the current climate, marked by economic uncertainty, rising living costs and ongoing instability at both household and societal levels, more people are turning to behaviours that offer short‑term relief or distraction.
Alcohol remains the most prevalent addictive behaviour across all five years, showing consistent year‑on‑year growth. Alcohol‑related cases have nearly doubled over the period, rising from just over 1 percent of all cases in 2021 to slightly above 2 percent in 2025. Clinicians describe this as a familiar pattern in high‑stress environments, where alcohol becomes an accessible and socially acceptable form of escape from relentless pressure. “When pressure is constant, people reach for what’s available and what works quickly to ‘numb the pain’,” Mugumbate explains.
Drug‑related cases present a different picture. While still significant, drug use and misuse shows a gradual decline as a proportion of addictive behaviour cases over the same period. This does not signal reduced risk, but rather changing access and preference as people gravitate toward behaviours that feel easier to hide or justify in daily life.
Gambling shows one of the sharpest increases. Though starting from a low base, gambling‑related cases more than quadrupled in the data set between 2021 and 2025. Clinicians link this rise to the normalisation of online betting platforms, instant gratification mechanics and the false sense of control gambling can offer to people feeling powerless in other areas of their lives.
Pornography use and sex‑related addictions remain smaller categories overall, but they continue to surface consistently year after year. These behaviours are often framed by employees not as addiction at first, but as stress relief, boredom management or emotional escape. Over time, however, they frequently intersect with shame, relationship breakdown and emotional withdrawal.
Internet and social media addiction, while still representing a smaller proportion of cases, shows renewed growth in 2025 after earlier fluctuations. Lyra clinicians note that constant digital engagement offers immediate distraction, connection and numbing, particularly during periods of uncertainty, loneliness or emotional overload.
Generational insights reveal important differences in how addictive behaviours manifest. Gen Y continues to represent the largest share of cases across all five years. This group consistently accounts for around a third of addictive behaviour presentations, reflecting the compounded pressures of mid‑career responsibility, financial obligation, dependants and expectation overload. For many, escapist behaviours become a way to briefly step away from relentless demand.
“For many Gen Y employees, the load never really comes off,” says Mugumbate. “Escapist behaviours can become the only space where the system pauses, even briefly.”
Gen Z follows closely behind, with a notable dip and resurgence over the period. Clinicians working with younger employees describe a generation navigating early career insecurity, limited disposable income and high exposure to digital environments that reward compulsive engagement.
Gen X shows steady growth year on year, particularly in the later years of the data. Here, addictive behaviours often emerge alongside cumulative burnout, long‑term stress and emotional fatigue rather than risk‑taking alone.
Gen Alpha presentations remain small but concerning. Drug use and pornography are more pronounced within this group than might be expected, highlighting early exposure, digital accessibility and the role of unmonitored online spaces. Clinicians stress the importance of early intervention as these patterns form at younger ages.
Baby Boomers make up a small proportion of cases but tend to present later and with more entrenched patterns. When addictive behaviours do surface in this group, they often intersect with grief, retirement‑related identity loss, health challenges or financial anxiety.
Across all generations, the common thread is escapism. Each behaviour offers momentary relief from stress, whether through numbing, distraction, stimulation or perceived control. In a high‑stress environment, those short breaks can become coping habits, and habits can harden into dependency.
“The rise we’re seeing in addictive behaviours is closely linked to the sustained pressure South Africans have been living under for several years now,” says Mugumbate. “When stress becomes chronic, people don’t always look for long‑term solutions. They look for immediate relief, and that’s where these behaviours come in.”
She adds that organisations often underestimate how closely stress, mental health and addictive behaviours are connected in the workplace.
“Addictive behaviour is rarely about the behaviour alone it’s a signal that something deeper is going unmet. In the current environment, many employees feel overwhelmed, financially stretched and emotionally depleted. Employers who want to protect productivity and wellbeing need to understand that prevention, early support and open conversation are far more effective than waiting until patterns become entrenched.”
As economic pressure, uncertainty and emotional fatigue continue to define daily life for many South Africans, the data suggests that addictive behaviours will remain a growing risk where people are left to cope alone. Organisations that recognise these patterns and invest in accessible, stigma‑free support play a critical role in helping employees find healthier ways to manage the weight they are carrying.
The psychedelic effects recreational users often seek from taking ketamine do not predict the therapeutic benefits for people being treated for alcohol use disorder, according to new research from King’s College London and University of Exeter.
The popular theory, which says that ketamine may have its therapeutic benefits because it produces strong psychedelic effects, has been called into question by the new study, published in Addiction. The findings suggest the treatment response may be down to other effects of the drug.
The research, led by the Institute of Psychiatry, Psychology & Neuroscience at King’s, is the largest randomised controlled trial to date examining the use of intravenous ketamine-assisted psychotherapy for individuals with moderate to severe alcohol use disorder. It uses data from the Ketamine for reduction of Alcoholic Relapse (KARE) clinical trial at the University of Exeter and University College London.
For the first time, we thoroughly investigated the acute psychoactive effects of repeated ketamine infusions in people with alcohol use disorder. The effects didn’t predict ketamine’s therapeutic benefit, which leaves open other psychological or neural mechanisms that need to be investigated.
Dr Will Lawn, Senior Lecturer at King’s College London and study lead
Researchers carried out a secondary analysis of the KARE clinical trial which was conducted at two clinical research facilities in England involving 96 adult participants and sought to clarify the role of ketamine’s psychoactive effects in supporting abstinence from alcohol.
Participants receiving three weekly infusions of intravenous ketamine reported marked psychoactive experiences, including altered reality, out-of-body sensations, and perceptual distortions, compared to those receiving placebo. These effects were consistently strong across all three dosing sessions. This suggests little to no development of tolerance to ketamine’s subjective effects over the short dosing schedule.
But despite the pronounced psychoactive effects, the study found no significant evidence that these experiences mediated ketamine’s therapeutic benefit in reducing alcohol consumption. The percentage of days abstinent from alcohol over six months was not predicted by the intensity of subjective drug effects.
A larger trial will explore ketamine’s effects in brain connection and function changes, as well as dosing.
New research finds that UK teens who vape are 33% more likely to smoke cigarettes
Photo by Nery Zarate on Unsplash
Teens who regularly use e-cigarettes are equally as likely as their peers from the 1970s to take up cigarette smoking, despite a substantial reduction in the prevalence of teenage cigarette use over the last 50 years, according to a study co-led by the University of Michigan.
U-M researchers, in collaboration with Penn State University and Purdue University, concluded that teenagers who had never used e-cigarettes had an approximately less than 1 in 50 chance of weekly cigarette use, whereas those who had previously used e-cigarettes had more than a 1 in 10 chance. More importantly, teenagers who reported consistent e-cigarette use had nearly a 1 in 3 chance of also reporting current conventional cigarette use.
The study illustrates shifts in the likelihood of youth cigarette use over time and the impacts of e-cigarettes on this trend. The results were derived from three longitudinal studies collected by the Centre for Longitudinal Studies at the University College of London, following teens from three different U.K. birth cohorts.
The research was published in the journal Tobacco Controland was supported by the National Cancer Institute, part of the National Institutes of Health, and a seed grant from the Criminal Justice Research Center at Penn State University, while data collection by the Centre for Longitudinal Studies was supported by funding from the Economic and Social Research Council.
“The use of e-cigarettes and the proliferation of e-cigarettes have really disrupted those awesome trends and improvements. For kids who have never used e-cigarettes, we do see those historic declines in risk,” said Jessica Mongilio, a research fellow at the U-M School of Nursing and one of the lead researchers on the study. “But for kids who do use e-cigarettes, it’s almost as if all of those policies and all of those perceptions have done nothing, and they’ve got a really high risk of smoking cigarettes.”
Over the past few decades, cigarette smoking has evolved from a once glamorous status symbol to an unhealthy and socially discouraged practice, according to the researchers. This evolution was, in large part, driven by aggressive campaigning that labeled cigarette smoking as a public health risk.
By the late 1990s and into the early 2000s, cigarette smoking was structurally and socially stigmatized, embedded in national federal regulations and health policy. In recent years, cigarette smoking in youths dropped to an all-time low, according to research from the Centers for Disease Control.
E-cigarettes, colloquially known as vapes, often sold in bright colorways and in fruity flavors, have quickly emerged as a perceived “safer” alternative to the conventional cigarette. They stand to threaten decades of advocacy, health policy and cultural aversion toward smoking in both the U.K. and United States, the researchers say.
The Millennium Cohort Study, or MCS, tracked teens born in England, Scotland, Wales and Northern Ireland in 2000 and 2001 and who were children when e-cigarettes were first commercialised. The British Cohort Study tracked individuals born in 1970, who were teenagers during the 1980s when cigarette use was fairly common and in their 40s when e-cigarettes were commercially available. Finally, the National Child Development Study tracked individuals born in 1958, who were young children when cigarette use was at its cultural peak.
“We took data from different cohorts, essentially different generations of people who live in the U.K., and looked at their probability of smoking cigarettes at least once a week, based on some well-known risk and protective factors,” Mongilio said. “For the most recent cohort, we also examined how use of e-cigarettes changed those probabilities.”
According to Mongilio and her collaborators, it’s not entirely clear whether e-cigarette use directly caused cigarette use, but it’s clear their incidences are strongly related. Still, the MCS cohort will be continuously surveyed over time to further understand how the use of e-cigarettes during the critical developmental teen years will affect their health in the long term.
Ultimately, with the findings of this study, the researchers hope to demonstrate the profound impact of e-cigarettes on today’s youth in an attempt to exact meaningful legislative, social and economic change.
“The more you can build evidence – the bigger the pile of support – the harder you can make it to ignore. This will lead toward policy changes and toward increased regulations for e-cigarettes and for producers of e-cigarettes,” Mongilio said. “I think we’re in a place where change is possible and to have increased regulations and enforcement of those regulations for companies that are producing e-cigarettes.”
Study analysed data from the US National Youth Tobacco Survey on more than 60 000 middle and high school students.
Photo by Nery Zarate on Unsplash
Adolescents who use either e-cigarettes or conventional tobacco products (CTP) – like cigarettes, cigars, hookah and pipes – are significantly more likely to report symptoms of depression and anxiety than teens who don’t use tobacco products at all, according to a study published this week in the open-access journal PLOS Mental Health by Noor Abdulhay of West Virginia University, USA, and colleagues.
Tobacco use and mental health challenges are known to have a complex, bidirectional relationship. Understanding the interplay between adolescent tobacco use and mental health is particularly important, since adolescence is a critical developmental period during which many health-related risk-taking behaviors begin. Moreover, there are increasing rates of anxiety, depression, and suicide among adolescents in the U.S. as well as shifting patterns of tobacco use.
In the new study, researchers used data on tobacco use, depression and anxiety symptoms, among different demographics, from the 2021-2023 National Youth Tobacco Survey. Among the 60,072 middle and high school students who had completed all questionnaires in full, 21.37% had used tobacco products, with 9.94% using only e-cigarettes, 3.61% using only CTPs, and 7.80% using both.
Overall, 25.21% of respondents reported symptoms associated with depression and 29.55% reported anxiety symptoms. Compared to adolescents who had not used any tobacco products, users of e-cigarettes or CTPs displayed a potentially heightened risk of depression and anxiety, whilst those who used both CTPs and e-cigarettes had the highest odds of reporting mental health struggles
The authors conclude that “while causality cannot be determined, the results from this study showed that all forms of tobacco use were significantly associated with mental health issues. There is a need to continue promoting mental health support and implementing tailored interventions to combat all forms of tobacco use among adolescents”.
“Unhealthy commodities” such as tobacco, alcohol, ultra-processed foods, social media, and fossil fuels, as well as impacts of fossil fuel consumption such as climate change and air pollution are associated with depression, suicide, and self-harm, according to a study published August 28 by Kate Dun-Campbell from the London School of Hygiene & Tropical Medicine, and colleagues.
Globally, around one out of every eight people currently live with a mental health disorder. These disorders – including depression, suicide, anxiety, and other diseases and disorders – can have many underlying causes. Some of those causes could be related to commercial determinants of health – the ways in which commercial activities and commodities impact health and equity. Commercial determinants of health can be specifically unhealthy, such as alcohol or tobacco consumption, unhealthy food, and the use of fossil fuels. To further understand how these unhealthy commodities might impact mental health, the authors of this study performed an umbrella synthesis of 65 review studies examining connections between six specific commodities – tobacco, alcohol, ultra-processed foods, gambling, social media, and fossil fuels. The author also included studies looking at mental health impacts of fossil fuel use such as climate change and air pollution.
The umbrella review found evidence for links between depression and alcohol, tobacco, gambling, social media, ultra-processed foods and air pollution. Alcohol, tobacco, gambling, social media, climate change and air pollution were associated with suicide, and social media was also associated with self-harm. Climate change and air pollution were also linked to anxiety. The review brought together many different methodologies and measurements, and could not establish the underlying cause of the negative mental health outcomes. But the results indicate that unhealthy commodities should be considered when researchers attempt to understand and improve mental ill health.
The authors add: “Our review highlights that there is already compelling evidence of the negative impact of unhealthy products on mental health, despite key gaps in understanding the impact of broader commercial practices.”
A team of researchers led by the University of California, Irvine has discovered that an antioxidant found in rosemary extract can reduce volitional intakes of cocaine by moderating the brain’s reward response, offering a new therapeutic target for treating addiction.
The study, recently published online in the journal Neuron, describes team members’ focus on a region of the brain called the globus pallidus externus, which acts as a gatekeeper that regulates how we react to cocaine. They discovered that within the GPe, parvalbumin-positive neurons are crucial in controlling the response to cocaine by changing the activity neurons releasing the pleasure molecule dopamine.
“There are currently no effective therapeutics for dependence on psychostimulants such as cocaine, which, along with opioids, represent a substantial health burden,” said corresponding author Kevin Beier, UC Irvine associate professor of physiology and biophysics. “Our study deepens our understanding of the basic brain mechanisms that increase vulnerability to substance use disorder-related outcomes and provides a foundation for the development of new interventions.”
Findings in mice revealed that globus pallidus externus parvalbumin-positive cells, which indirectly influence the release of dopamine, become more excitable after being exposed to cocaine. This caused a drop in the expression of certain proteins that encode membrane channels that usually help keep the globus pallidus cell activity in check. Researchers found that carnosic acid, an isolate of rosemary extract, selectively binds to the affected channels, providing an avenue to reduce response to the drug in a relatively specific fashion.
“Only a subset of individuals are vulnerable to developing a substance use disorder, but we cannot yet identify who they are. If globus pallidus cell activity can effectively predict response to cocaine, it could be used to measure likely responses and thus serve as a biomarker for the most vulnerable,” Beier said. “Furthermore, it’s possible that carnosic acid could be given to those at high risk to reduce the response to cocaine.”
The next steps in this research include thoroughly assessing negative side effects of carnosic acid and determining the ideal dosage and timing. The team is also interested in testing its efficacy in reducing the desire for other drugs and in developing more potent and targeted variants.
Researchers share insights from US reduction of cigarette, sugar, and opioid consumption
Photo by Sara Kurfess on Unsplash
A case definition of market-driven epidemics (MDEs) could help address critical barriers to timely, effective prevention and mitigation, according to a study published this week in the open-access journal PLOS Global Public Health by Jonathan Quick from Duke University School of Medicine, US, and colleagues.
The misuse and overconsumption of certain consumer products have become major global risk factors for premature deaths at all ages, with their total costs in trillions of dollars. Progress in reducing such deaths has been difficult, slow, and too often unsuccessful. To address this challenge, Jonathan Quick and colleagues introduced a case definition of MDEs, which arise when companies aggressively market products with proven harms, deny these harms, and actively oppose mitigation efforts. To demonstrate the application of this concept, the researchers selected three MDE products: cigarettes, sugar, and prescription opioids. Based on the histories of these three epidemics, the researchers described five MDE phases: market expansion, evidence of harm, corporate resistance, mitigation, and market adaptation.
From the peak of consumption to the most recent available data, US cigarette sales fell by 82%, sugar consumption by 15%, and prescription opioid prescriptions by 62%. In each case, the consumption tipping point occurred when compelling evidence of harm, professional alarm, and an authoritative public health voice or public mobilisation overcame the impact of corporate marketing and resistance efforts. Among the three epidemics, the gap between suspicion of harm and the consumption tipping point ranged from one to five decades – much of which was attributable to the time required to generate sufficient evidence of harm. Market adaptation to the reduced consumption of target products had both negative impacts (eg, geographical shift of corporate marketing efforts) and positive impacts (eg, consumer shift away from sugar-sweetened beverages).
According to the authors, this is the first comparative analysis of three successful efforts to change the product consumption patterns of millions of people – and, over time, some of the associated adverse health impacts of these products. The MDE epidemiological approach of shortening the latent time between phases provides the global health community with a new method to address existing and emerging potentially harmful products and their health, social, and economic impacts.
While the specific product and circumstances are unique to each MDE, understanding the epidemiology of consumption and health impacts, and epidemic milestones, should help public health leaders combat current MDEs and more swiftly recognise future MDEs. Given the similar patterns among different MDEs, public health leaders, researchers, civil society and others can apply the mitigation strategies presented in the review article to save lives and lessen the impact of continuing and emerging MDEs.
The authors add: “The use of cigarettes and other unhealthy products costs the world millions of lives and trillions of dollars each year. An analysis of U.S. progress against three such market-driven epidemics demonstrates that we can save lives through earlier, more decisive action by public health leaders, researchers, and public mobilization,” concluding: “The use of cigarettes and other unhealthy products often follow patterns similar to infectious disease epidemics, causing widespread harm before any public health response. We can save lives by recognizing these market-driven epidemics earlier and acting more decisively to control them.”
Dr Siya Mjwara, founder of the AskDrSiya Psychotherapy and Wellness Coaching Practice, has just launched the first online recovery school in South Africa. The Recovery School will support individuals in identifying and confronting their challenges and businesses in developing and implementing wellness solutions in order to reduce absenteeism and improve productivity, as well as overall workplace culture. Dr Mjwara will provide a supportive and transformative environment where healing and growth are possible for all.
She says, “We create a virtual sanctuary where individuals can find healing, empowerment and community support. We strive to cultivate a space where you can reclaim your life and thrive, no matter what you’ve been through.
“After 17 years of working with individuals, couples and families, I can say, without a doubt, that we South Africans are a traumatised nation. Unfortunately, many of us are completely unaware of how our traumas are negatively impacting our lives, as well as the decisions we take on a daily basis. Recently, I’ve been hearing people say, “avoid dating anyone who has never been to therapy”. This is an indication that more of us are recognising how unresolved trauma can negatively impact our relationships.
“Besides our personal experiences, such as childhood trauma, relationship, family and workplace traumas, many of us are still dealing with the effects of intergenerational trauma.
This is part of the background that informs the vision for The Recovery School. My wish is for individuals to not only cope with trauma, but also to be able to thrive and become the best version of themselves. It takes courage to face your fears and begin living authentically, and you don’t need to walk the journey alone.
The school’s programmes are primarily designed to enable individuals to
Rediscover themselves
Break free from limiting beliefs
Cultivate resilience
Forge meaningful connections
Live fully in the present
Achieve their goals
Dr Mjwara BSW Hons (UWC), MA FCS (UWC), Dphil (UNIZULU) can be contacted on Ask@DrSiya.co.za or 079 772 1950.
