How do I quit smoking?

What is tobacco addiction?

In its many forms, tobacco is one of the most commonly-used addictive substances in India. While cigarettes are the leading form of nicotine tobacco across the world, in India it is consumed in several forms including cigarettes, bidis, snuff, hookah and chewing tobacco.

Tobacco is a highly addictive substance and often users are unable to quit using it even when they want to. It also has high toxicity: an estimated five million deaths are caused globally due to tobacco addiction every year. In India, tobacco kills more than one million people every year.

What is tobacco?

Tobacco is a substance created using extracts from the tobacco plant, nicotiana tobaccum. The leaves of this plant are dried and mixed with some other ingredients to create bidis, cigarettes, snuff, hookah, kaddipudi, zarda and other forms of tobacco for consumption. Tobacco is consumed in several ways: by chewing supari, by inhaling (snuff) and by smoking (cigarettes, bidis).

The stimulant nicotine is a chemical found in the leaves of the tobacco plant. Smoking or chewing tobacco releases nicotine and nearly 4000 other chemicals, including carbon monoxide and tar.

How does tobacco addiction occur?

Consuming tobacco triggers a release of dopamine in the brain. Dopamine is a neurotransmitter that is associated with feelings of pleasure. The brain perceives this as a pleasurable activity, and this makes the person want to use tobacco again. Gradually, the transmitters become less sensitive, and the brain requires more of the substance in order to feel the pleasurable effect.

When a person consumes nicotine, the chemicals reach the human brain through the skin, the mouth, the mucal lining in the nose, and through the lungs. Smoking nicotine can give you an immediate buzz and a surge in your energy. In a few minutes, the buzz wears off and you may feel tired or low on energy. This effect, which is one of the withdrawal symptoms associated with smoking, makes you want your next dose.

Research suggests that children and teens may be more vulnerable to getting addicted to tobacco products. The earlier a person starts using tobacco, the more possibility that they will get addicted to it.

The nature of changes caused by tobacco addiction to the brain is similar to that caused by cocaine and heroin. After long-term use, the person may have certain situations or cues that make him want to smoke (or use tobacco products). Some specific times of the day, for instance when they normally wake up , or during coffee or lunch breaks at work, may make them want to use tobacco. The person may also feel strong urges to smoke while indulging in other activities such as driving, drinking or doing some stressful work.

What is the impact of tobacco addiction?

The consumption of tobacco or nicotine affects every organ of the body. Using the substance triggers the release of adrenaline, which increases the body’s temperature, heart rate and blood pressure.

People who smoke tobacco are at a high risk of developing cancers of the lung, mouth, breast, uterus, pancreas, kidney or stomach. People who consume smokeless tobacco may develop cancers of the mouth, esophagus, larynx, stomach and pancreas.

Long-term use of tobacco can also lead to several other health problems, including premature aging of skin and teeth, cataract, high or low blood pressure, cholesterol, respiratory problems, increased risk of heart disease and strokes, damage to the fetus (if a pregnant woman smokes), impotence or infertility. Using tobacco also increases the risk of developing diabetes, rheumatoid arthritis and osteoporosis.

It is estimated that a smoker’s life expectancy is approximately 15 years less than that of a non-smoker.

Second-hand smoke, also known as passive smoking, from tobacco can also have serious health effects and can prove fatal. Prolonged exposure to second-hand smoke can lead to lung, breast and liver cancers. It can also cause strokes and heart attacks. Contrary to popular belief, there is no ‘safe’ level of exposure to second-hand smoke, and any exposure to smoke can be hazardous.

Who is at risk of developing a tobacco addiction?

Any person who uses tobacco products for a long duration can be at the risk of developing an addiction. Having close relatives who have been addicted to tobacco, having begun using tobacco products during childhood or adolescence, having a history of addiction to other substances (alcohol and/or drugs) and having a history of mental illness: each of these factors increases a person’s vulnerability to addiction.

How can you identify a tobacco addiction?

If you are in the habit of smoking a few cigarettes or chewing tobacco every day, you are likely to get addicted or develop an addiction. Some of the symptoms of nicotine dependence/addiction among cigarette smokers are:

• You know that smoking is bad for you and you have made unsuccessful attempts to quit.

• You smoke more cigarettes per day now than you did when you began.

• You now need more cigarettes to get the ‘high’ than you did some months ago.

• When you finish the day, you discover that you have smoked more cigarettes than you intended to.

• You feel stressed when you run out of cigarettes.

• When you try to stop smoking, you experience withdrawal symptoms that make it difficult for you to carry on with your daily life.

• When you do not smoke for a certain period of time, your thoughts are mostly focused on how and where you can get your next cigarette.

• You plan your schedule around places and activities that can support your smoking habit (going only to restaurants that permit smoking, or to places where you can buy your cigarettes).

• You find it difficult to stay away from cigarettes in places where smoking is not allowed.

• You smoke even when you are ill and cannot function normally.

If you think you have experienced some of the symptoms listed above, then it is likely that you need help to quit smoking cigarettes.

*If you think you are addicted to snuff, chew tobacco, or use other tobacco substances, you can check if you display the signs of addiction by using the same guidelines. Replace “smoking” or “cigarettes” with the name of the substance you use.

Withdrawal symptoms for tobacco use include tremors, shivering, anxiety, depressed mood, lack of sleep, feeling lightheaded, slowing down in heart rate, increased appetite and irritation.

Diagnosis and treatment

Amar (name changed) had gotten into the habit of smoking several cigarettes a day. As he was a busy professional, Amar would look for moments in which he could take a cigarette break. As he got more addicted to the cigarettes, he began to observe that he could not focus on work and other activities for more than an hour. He would hide cigarettes in his pockets, leave meetings early to smoke, and avoid flights because smoking was prohibited.

After he received support from a team of mental health professionals, Amar noticed that his overall productivity and the quality of his life improved. He reported to his doctor that he no longer feels compelled to smoke a cigarette every now and then, and was leading a stress-free life. 

This fictional narrative has been constructed to aid the understanding of this condition by placing it in a real life situation.

Several people are able to quit cold turkey (though this method is not recommended by psychiatrists) and get rid of their nicotine addiction by themselves. Others require the assistance of a medical professional. If you have tried to quit smoking but haven’t been successful, don’t lose heart. It’s possible that some support can help you overcome your addiction. You can approach a psychiatrist for help.

It is estimated that only about 3 percent of smokers can quit by themselves. Most others may need professional help. Tobacco addiction is not an easy habit to break, and there is nothing wrong in seeking support to overcome it.

In many cases, a person with an addiction is referred to the doctor or psychiatrist by a family member or friend. The doctor or counselor will ask you questions that will help them determine the severity of your addiction. Assessments such as the Fagerstrom test, combined with evaluations of an interview with you and your friends and family, will be used to determine the best course of treatment.

Unlike drug and alcohol addictions, the treatment for nicotine addiction can be done on an outpatient basis. The aim of treatment is to help the person to be motivated about quitting. This is done by helping the person create an image of themselves as a non-smoker, as it can help them cope with any challenges or temptations they may face.

With tobacco use, the patient is usually asked to pick a “quit date”. They are then provided with nicotine patches that help them ease into the quitting process. They may also be prescribed some medication which can help them handle the withdrawal symptoms.

It is also recommended that the patient join a support group to help them manage withdrawal symptoms and develop the ability to cope. Along with this, material on nicotine use and coping skills is also given to the patient. The support of friends and family, as well as members of the support group go a long way in helping the patient overcome the addiction and stay tobacco-free.