There are a few topics as provocative and challenging in medicine as that of addiction. We are all well aware of the scourge of drug addiction and its attendant ability to destroy lives across all economic and social strata. As if the human tragedy were not sufficient, the political ramifications have become increasingly challenging, with drug money going to fund terrorist initiatives in different parts of the world. However, the most troublesome fact about addiction is that the most common and most devastating forms are perfectly legal and readily available.
Cigarette smoking is the single leading cause of preventable disease in the United States. You will never find this habit as the cause of death next to the physicians signature on a death certificate, but the toll of cardiovascular and cancer deaths that result from smoking is staggering. Cigarette smoking harms virtually every organ system in the human body, and yet has nearly no beneficial effects. The adverse health effects from cigarette smoking account for an estimated 438,000 deaths, or nearly 1 of every 5 deaths, each year in the United States. More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Despite huge legal settlements and massive campaigns to the contrary, approximately one quarter of the adult population continues to smoke, although the numbers are thankfully dropping. Aggressive efforts to reduce second hand smoke have recently been documented to correlate with diminished cardiorespiratory morbidity. Medication to aid cessation is improving, with one-year success rates jumping from the 10-15d% range to the 25% rangediscouraging, but improving. The social image of the smoker is an ephemeral phenomenon, but the once “cool” smoker is increasingly finding him/herself standing outside in the smoking area, somewhat of an outcast rather than the rugged individual of the “Marlboro man” years. We have “come a long way baby” (Virginia Slims ad touting the perverse concept that women succumbing to the addiction of cigarette smoking was somehow a manifestation of social progress), but we have a long way to go.
The other readily identifiable “social” addiction is alcoholism. The medical issue here is much less pristine. There is now more than credible evidence that one to two drinks per day are actually beneficial in cardiovascular disease protection. For obvious reasons, the medical community has been very reticent to discuss this fact, lest people misinterpret the findings and decide “if some is good, more must be better” and convince themselves that their doctors gave them permission to overindulge in alcohol.. However, one must never forget that the curve is “U”shaped; that is, even though one or two drinks per day may be good for your heart, more can be toxic. More importantly, aside from the well-known toxic impact that alcohol has on the liver, and the generally toxic impact on all body systems in high doses, the greater issue is one of the lethal nature of drunk driving (17,000 traffic deaths in 2006) and domestic violence. Unfortunately, this is a problem that is neither diminishing nor abating.
Perhaps it would not be inappropriate to consider adding one more behavior to this list. The epidemic of obesity is now threatening to overtake cigarette smoking as the leading cause of preventable illness in the western world. Although the problem is complex and multifactorial, there is ample evidence that despite genetic predisposition, problems of food additives and food production, and lack of physical activity to blame, much of the problem lies simply in our choice of foods. Calorie-dense, readily available and nutritionally dangerous foods in high quantity make up an increasing portion of the Western diet. And we are successfully exporting and marketing this lethal approach across the planet. A sober review of the data would lead one to conclude that the choice we make regarding food and exercise, combined with a modicum of medical vigilance and medication could well prevent the majority of what is now the leading killer of men and women in this countrycardiovascular disease.
It is our realization that the human factor is critical in understanding our addictions and their health consequences that has compelled the Florida Heart Research Institute to couple our leading edge scientific research with both professional and community outreach efforts at education and prevention. It is only through a combined approach can we continue to meet the enemy, who, painful as it may be to admit, is largely ourselves.
There are a few topics as provocative and challenging in medicine as that of addiction. We are all well aware of the scourge of drug addiction and its attendant ability to destroy lives across all economic and social strata. As if the human tragedy were not sufficient, the political ramifications have become increasingly challenging, with drug money going to fund terrorist initiatives in different parts of the world. However, the most troublesome fact about addiction is that the most common and most devastating forms are perfectly legal and readily available. 
