Say NO to smoking!

Today is "No Smoking Day". If you'd like to quit, here's why and how you can do it as it has destructive effects on the human body

person refusing a cigarette"Ask anyone about their first experience of smoking and you will be regaled by animated recollections of coughing, retching, acute respiratory distress and general embarrassment. If smoking could be considered as simply an act of inhaling smoke into the lungs, it would be reasonable to ask why anyone would voluntarily seek to repeat such an unpleasant experience." Being a non-smoker, I still find it hard to understand why smoking can be so pleasurable. All I see is a dirty, smelly, unhealthy and expensive habit, which not only affects the smokers, but also makes life uncomfortable for non-smokers. Most smokers would agree with me on this, but still continue to smoke."

If smoking was only an act of inhaling smoke into the lungs, doing little or no harm to the human body, then probably we would have justified the smoke through our logical interpretations. Being a Tobacco Cessation Specialist, I interact with all types of tobacco victims, on a daily basis. Everyday I see people suffering from terminal illnesses, such as cancers, heart diseases and respiratory diseases. I cannot, even in my wildest dreams, think of justifying this act of inhaling poison into your lungs, and crippling your body, making your mind so weak and paralysed that it accepts the tyranny of a cigarette for life.

Appetite for nicotine

A cigarette 'hits' you very quickly, more quickly than any other drug taken via mouth or inhaled through smoke, for that matter. It acts more quickly than marijuana, which usually takes as long as alcohol—15 to 20 minutes. The smoker knows the hit comes within five seconds of the first puff. "Within seven seconds, nicotine reaches the brain and stimulates the release of neuro-chemicals [dopamine and noradrenalin] leading to a pleasurable feeling and enhanced energy and alertness". The appetite of smoking increases with every cigarette smoked; and one becomes an established smoker in the nurturance of these dopamine surges.

A burning cigarette is like a chemical factory. Cigarettes contain cancer causing, tumour initiator and toxic agents such as tar, arsenic, ammonia, carbon monoxide, hydrogen cyanide, formaldehyde, asbestos, PO210, cyanide, lead, DDT and acetaldehyde. The combination of an addictive substance [nicotine] with Polonium 210 and other mutagens has made tobacco the foremost human poison of the 20th century. "Within seconds after tobacco smoke is inhaled, some 4,400 chemical [many hundreds of which are toxic] by products are absorbed into the bloodstream and transported to every cell of the smoker's body". The chronic inhalation of tobacco smoke exposes the entire body, every tissue and cell, to powerful mutagens and carcinogens, thus hastening the malignant cellular evolutionary process and resulting in the accelerated occurrence of the broad spectrum of cancers, degenerative diseases, and other diseases constituting tobaccosis.

Tobaccosis, described as a 20th century catastrophe, denotes collectively, all those diseases resulting from the smoking, chewing and snuffing of tobacco and the breathing of tobacco smoke. These include nicotine addiction; cancers of the mouth, nasopharynx, larynx, trachea, bronchi, lungs, oesophagus, stomach, liver, pancreas, kidney, bladder, prostrate, cervix and brain; colorectal cancer; leukaemia; atherosclerosis of the cardiovascular system, including coronary heart disease [with ischemia and infarction], cardiomyopathy, aortic and other aneurysms, cerebrovascular haemorrhages and blockages, renal failure and peripheral vascular disease; emphysema; chronic obstructive pulmonary disease; pneumonia; childhood asthma; peptic ulcer disease and regional ileitis; cirrhosis of the liver; immunological deficiencies and failures of endocrine and metabolic functions; cataract; osteoporosis; optic neuropathy; infertility; foetal and neonatal deaths, child disabilities; and much more.

"Four million unnecessary deaths per year. 11,000 every day. It is rare—if not impossible—to find examples in history to match tobacco's programmed trail of death and destruction. I use the word programmed, carefully. A cigarette is the only consumer product, which when used as directed kills its consumer", says Dr Gro Harlem Brundtland, Director-General Emeritus, World Health Organization.

Quit the butt

Ask a confirmed smoker if he or she enjoys smoking and chances are the answer will be 'yes.' Ask the same person if he or she would like to quit. You'll probably get the same answer— 'yes.' Smokers usually have a love-hate relationship with the cigarettes they smoke; they smoke and yet they hate to smoke!

As a Tobacco Cessationist, I did learn that extremely dependent smokers are really unhappy to smoke. Researchers say, majority of smokers [70 per cent] want to quit smoking. But what stops them from making an attempt of quitting? Most smokers are entangled in a fear that they will never be able to quit, and that nicotine is very addictive. Smokers adopt the learned helplessness very early in life, and continue to smoke all their life.

Tobacco dependence is a chronic condition that requires professional intervention. Tobacco products are highly addictive. They are designed to undermine efforts to quit using them, which is not simply a matter of choice for the majority of tobacco users. Instead, it involves a struggle to overcome an addiction. Tobacco use is typically woven into everyday life, and can be physiologically, psychologically and socially reinforcing. Nicotine dependence makes quitting difficult; and most attempts fail without treatment. 97 per cent of quitting attempts end in failure.

Smoking cessation requires a structured intervention by a comprehensive tobacco cessation programme. It addresses both the physiology and psychology of tobacco addiction and the smoker is provided with step-by-step assistance during the attempt to quit. It is essentially a 'Lifestyle Treatment Program', comprising of seven to eight intensive counselling sessions, to help the smoker quit the habit successfully and to maintain abstinence for life.

Psychotherapeutic intervention

The psychotherapeutic interventions include a harmonious mix of motivation enhancement therapy, cognitive therapy, behavioural skills training and relapse prevention. The behavioural interventions are based on the theory that learning process operates in the fields of development, maintenance and cessation and smoking. Major goals of the therapy are to change the antecedents to smoking, to reinforce non-smoking and to teach skills to avoid smoking in high-risk situations.

Medicinal Nicotine

Nicotine replacement therapy [NRT]: It describes a group of products delivering nicotine that are licensed for the relief from withdrawal symptoms and as an aid to smoking cessation. Nicotine replacement products provide an alternative source of nicotine. Nicotine replacement is provided through the skin [nicotine patches]; buccal absorption [nicotine gums], nasal membranes [nicotine nasal spray] and nicotine inhalers.

Buproprion HCl therapy

Works on the biology of nicotine addiction. It is a non-nicotinic oral pill that leads to reducing the urges and withdrawal symptoms.

Varenicline Tartrate therapy [Champix]

It is the first non-nicotine drug developed specifically for smoking cessation. It was developed to work as the same receptor in the brain as nicotine [the ?4?2 receptor] to help relieve the craving and withdrawal symptoms while at the same time blocking the reinforcing effects of nicotine. So the smoker experiences reduced craving and withdrawal symptoms when he/she stops smoking; and they also experience less pleasure in smoking when the patient relapses.

A future free of tobacco

Tobacco is pandemic which cripples humans, making them physiologically, psychologically and socially addictive. We need to break this vicious cycle of death and destruction. Quitting is the first step towards a tobacco-free world. A time has come when we need to synergise our efforts and fight united to uproot this scourge. Only then can we give our future generations a 'Future Free of Tobacco'.

Five ways to help you quit

  • Take fluids and drink lots of water once you quit. They help to flush out the nicotine and other poisons from your body.
  • Stay away from alcohol, sugar and coffee as they tend to stimulate the desire for a cigarette. Avoid fatty foods because metabolism slows down without the nicotine, and you may gain weight. Discipline your diet, nibble on low calorie foods like celery, apples and carrots. Stretch your meals, eat slowly and wait in between bites. After dinner, instead of a cigarette, treat yourself to a cup of mint tea or a peppermint candy.
  • Opt for a oral substitute. About 25 per cent of quitters found an oral substitute of great help. Cinnamon sticks, chewing gum or artificial cigarettes are good substitute options.
  • Exercise, go to a gym, and relax in the steam room. Change your routine; go for a walk or a jog around the block or in the local park.
  • Pamper yourself, get a massage, take a long bath or get yourself a hobby.

— Team CW

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Sajeela Maini
Sajeela Maini is a New-Delhi-based Tobacco Cessation Specialist, running a chain of Tobacco Cessation Clinics. She runs Tobacco Cessation Programs in Sir Ganga Ram Hospital, New Delhi; and National Heart Institute, New Delhi. She is also the President of Tobacco Control Foundation of India and Director of Quit Tobacco Consultancy.