A study published in March 2008 in The New England Journal of Medicine showed that a mere 2% of Indians quit smoking, and only after falling ill.
Says Dr Sameer Parikh, head of department, psychiatry, Max Healthcare, New Delhi, “Nicotine increases the level of dopamine (a pleasure-enhancing hormone) in the brain, because of which the more an individual smokes, the harder it becomes for him to give it up.” He adds, “If you google nicotine dependency on the Internet, it will be classified as an illness, and therefore should be treated as an illness rather than a habit.”
These days there are many techniques to help people quit smoking. Here, we put four smokers through a week-long test using some of these methods.
The social smoker
Sambhav Mohapatra, 35, private banker-turned-entrepreneur, New Delhi
Been smoking for: Six years; Daily consumption: 10-15 cigarettes; Reasons to give up: Just wants to try it; Smoke cycle: Tries to avoid smoking on Sundays; Triggers: Boredom; enjoys smoking with a drink; Method: Herbal cigarettes (Honeyrose)
“I haven’t had a drink for almost a month and I’m sent these cigarettes that will serve as substitutes for the real thing. They feel stronger than tobacco, cut my throat a lot worse and each flavour tastes absolutely disgusting.
“When I lit up one of these at a party, people around me thought something was burning. While these cigarettes have done nothing to satisfy my cravings, my smoking has come down a lot only because I’m put off by the whole act. I have seen a change in my appetite—I’m enjoying my meals and craving for spicy food. When I broke my alcohol ban I did smoke a few normal cigarettes but much lesser than I would have smoked otherwise.”
Some of the additives in a cigarette include:
Dr Prakash Gupta, director, Healis-Sekhsaria Institute for Public Health, Mumbai, says: “One must remember that all cigarettes are harmful since they all have tar and a huge number of chemicals. Since Sambhav is usually bored when he lights up, he can take up other activities. For example if he feels bored when he is being driven in a car, he should take up activities such as solving a Sudoku puzzle, reading a book, or even playing with a portable PlayStation to keep his hands busy. At work, he can chat with a colleague or call a friend instead of smoking during a break.”
Dr Shital Raval, researcher, Cancer Patients Aid Association, Mumbai, says: “Whilst we know the consumption of cigarettes and alcohol together can increase your risk for getting cancer, attempting to quit both simultaneously can be difficult for many people and must have an adequate support system in place. I don’t know if this product has scientific evidence to suggest its efficacy. There (are) many such products available, which are not approved by the government. However, they seem to act like a repulsive/repellent alternative by leaving a bitter taste in the mouth and also help keep the hands busy, which is crucial in kicking the habit.”
The stressed smoker
Kabir Singh, 28, account manager, New Delhi
Been smoking for: Seven-eight years; Daily consumption: 15 cigarettes; Reasons to give up: Conscious that it’s bad for health; Smoke cycle: Smokes mostly at work; Triggers: Just lights up without thinking, it’s a habit, a reflex action; Method: Nicotine patches
“On the first day I felt extreme anxiety and restlessness when I just wanted to tire myself out so I could sleep. In complete contrast, the next day I felt totally dead.
“Even when I needed to put my point across in the office, I just couldn’t be bothered. Despite these emotions, the patch has kept my cravings under control.
“However, mid-week I had an argument in the office, which made me crave for a cigarette. I smoked three drags of a cigarette with my patch on. Immediately, my head began spinning so hard that I had to sit down. At nights I’m sleeping fitfully and there has been a huge surge in appetite. One of the days my lunch was a burger, extra large fries, nuggets, half a dosa and an extra large shake. When I went out with friends over the weekend, I was tempted to smoke and took my patch off to sneak in a cigarette. I didn’t carry my own and had to bum from other people, which made me smoke much lesser than I would have.”
Dr Gupta: “He must stop carrying cigarettes to work. He must also explain to his colleagues and friends that he plans to stop smoking. Saying it aloud will also strengthen his resolve to quit. When he’s tempted or stressed, deep breathing, going out for a walk or even some normal chewing gum will help.”
Dr Raval: “It is natural to feel slightly depressed, irritable, tired, restless, edgy and lethargic as the body deals with the withdrawal of the nicotine. If these physiological symptoms persist for long, consult a physician. The patch is a nicotine replacement therapy (NRT) product only to be used after consulting a cessation expert. Smoking with a patch on is harmful as it runs a risk of nicotine overdose. Most people think that smoking relieves stress but nicotine is a stimulant that temporarily causes a feeling of relaxation but on withdrawal causes anxiety, restlessness and irritability.”
The relapse smoker
Dev Bhatia, 26, music promoter and band manager, New Delhi
Been smoking for: Nine years; Daily consumption: Usually 10 cigarettes, up to a pack during a gig; Reasons to give up: A recurring throat infection; Smoke cycle: Has a pattern of quitting for months and then coming back; Triggers: Work overload, firefighting, coordinating too many things at a time; Method: Cold turkey
“I usually don’t have a morning smoke so I don’t miss that at all. I kind of know how to distract myself by avoiding the usual smoking areas and only concentrating on work. I have been working round the clock, therefore haven’t even thought of smoking.
“But I miss cigarettes in the afternoon and I replaced them with a glass of cola. On Day 4, I smoked only because I forgot that I had quit. Over the weekend there was a gig for the band but since I had left the cigarette pack at home I didn’t have much of a problem sticking to the ban. Later in the week I stopped replacing cigarettes with cola but broke the ban on the last day after getting a piece of good news. Overall I feel fresher in the mornings without that smoky residue in my throat, which also helps me sleep better at night.”
Dr Gupta: “Most people relapse thinking they will smoke just that one cigarette but it rarely happens. With Dev it’s obvious that his body isn’t nicotine dependent—since he has quit for months in between—but is more of an environmental or situational issue. He needs to identify the triggers that make him start smoking again and be conscious about these.”
Dr Raval: “He needs to consult a doctor who may advise investigative tests to diagnose the throat ailment. Cigarette smoke contains about 4,000 chemicals, of which 80 are carcinogenic (cancer causing). These chemicals may also cause irritation to the lining of the oesophagus and induce inflammation. Like most quitters, he is substituting his craving with food, snacks and beverages. Cola contains caffeine, which would act by replacing the stimulant in his body. Cola is acidic and has high sugar content. I would advice drinking water instead—take a sip every 20 minutes to quell the urge to smoke.”
The habitual smoker
Anuj Tikku, 36, actor, Mumbai
Been smoking for: 20 years; Daily consumption: 10-15 cigarettes; Reasons to give up: A pretty girl at his shoot told him he had smokers’ breath; Smoke cycle: Never given up; Triggers: Helps me think, enjoy a movie; works in the morning; Method: Nicotine gum*
“I started my week with a smoke since I am a morning smoker and was also woken up rudely with a last-minute dubbing call. When I tried the gum I noticed that the taste was very tobacco-like and (the) texture crunchy. In the beginning the gum made me feel slightly sweaty and my attention span wavered, but these symptoms were gone by the end of the week.
“Once I got the hang of the chewing gum, I didn’t feel any craving for a cigarette. Even when I watched a movie on my laptop I didn’t feel the need to light up. My father came to visit me and he was exceedingly happy that I have stopped smoking.
“Surprisingly, I have even stopped my morning smoke, but I am chewing about six pieces of gum on a daily basis. While I have smoked in between, the total number of cigarettes in the week would not be more than four or five. I feel fresher not smoking, there’s no cigarette smell on my fingers and I’m also not coughing that much.”
Dr Gupta: “Since nicotine dependency can be judged by how soon a smoker needs his cigarette, Anuj seems to be more dependent than others. For this purpose he must start by simply postponing his smoke. Take a walk, drink a glass of water, eat something—anything to postpone it for about an hour. By doing so he will cut down the number of cigarettes, reducing the overall need that will eventually make it easier for him to quit.”
Dr Raval: “This is another NRT product that releases nicotine directly into the gums and mouth to help (the) cravings of a quitter. Early morning smoke is a physiological effect due to the long-term consequence of nicotine. For a healthy digestive system, increase fluid and fibre intake with regular physical activity. Smoking doesn’t help concentrate. This is a common myth which has no medical evidence and an excuse commonly used by smokers.”
*To be used under expert supervision
From 13 types of cancer to abdominal obesity and age-related blindness, smoking can be the cause of many diseases
Tobacco is responsible for 13 different kinds of cancers, including cancer of the bladder, kidney, pancreas, cervix, pharynx, larynx and mouth.
Macular degeneration is the degeneration of the optical nerve caused by smoking that makes smokers more prone to cataract and age-related blindness.
Psychological effects include anxiety, sleep impairment, nervousness and, in the long run, loss of concentration and reduced attention span.
An April study conducted by an international team, including scientists from Nottingham University in the UK, published in the ‘Obesity Journal’, shows that children born to mothers who smoked during pregnancy are more prone to abdominal obesity later in life. Another study published in the ‘Archives of General Psychiatry’ in November, conducted by the same team of scientists, found that children exposed to smoke in the womb were more likely to experiment with drugs.
Doctors can identify smokers by just the pattern of wrinkles on their faces. A highlight of a 2006 National Health Service anti- smoking campaign in the UK was visuals of the ‘cat’s bum mouth’ wrinkle pattern that is characteristic of smokers.
Third-hand smoke is a term coined by doctors from the Massachusetts General Hospital in Boston, US, to describe the chemicals and toxins that are embedded in the upholstery, carpets and even hair after a smoker leaves the room. These chemicals are particularly hazardous to crawling infants who are in the habit of putting things in their mouths.
An article in ‘The New England Journal of Medicine says that not only does smoking cause death 10 years earlier, even smoking one to seven cigarettes increases the risk of cancer by one-third and doubles it, respectively.
Experts: Dr Prakash Gupta, Dr Shital Raval, Dr Sameer Parikh; to get help to quit smoking, call the Cancer Patients Aid Association at 022-24924000.