Managing nicotine/tobacco addiction

As May 31 marks World No Tobacco Day, Dr Pratheesh P J writes about the deadly addiction and how to overcome it

Published: 30th May 2018 10:59 PM  |   Last Updated: 31st May 2018 06:25 AM   |  A+A-

Express News Service

KOCHI:World Health Organization estimates that worldwide 1.1 billion people smoke, aged 16 years and above. Eight hundred million of them are in the developing countries like India and China. Tobacco will become the single leading cause of death. Cigarette consumption is declining in developed nations, but unfortunately, it is increasing at the rate of 3-4% in the developing nations Smoking is probably the most important cause of morbidity and premature mortality in the world.

Half of all time smokers will die prematurely as a result of tobacco use. There are three main smoking products used by Indians; in order of use they are bidi, cigarette and chutta. Overall toxicity as measured for nicotine, carbon monoxide, hydrogen cyanide, carcinogenic hydrocarbons, benzapyrene and radioactive uranium is higher in bidi than in cigarettes . The

benefits of giving up smoking are unquestionable and extend beyond the smokers themselves. Individuals and their families gain from reduced spending on cigarettes and improved quality of life. The health care system benefits from reduction in the expenditure and workload caused by smoking-related diseases. The employers stand to gain in terms of better work attendance and productivity

When to see a doctor:

Most smokers make many attempts to stop smoking before they achieve stable, long- termn abstinence from smoking. Success in stopping smoking is achieved when you follow a successful treatment plan that addresses both the physical and behavioural aspects of nicotine dependence.

Nicotine is the chemical in tobacco that keeps you smoking. nicotine is very addictive when its smoked. it causes the release of neurotransmitter called dopamine which activates pleasure pathway in brain. Experiencing this effects from nicotine tobacco is what it makes so addictive.

Any one smokes uses other forms of tobaccos at risk of becoming dependent, features that influence nicotine dependence include

· Genetics

· Home and friends influence

· Age of onset, younger the onset , higher the chance for addiction


Its one of the severe most addiction and has highest rate of relapse than any addiction. Around 70 percent smokers want to quit smoking and they try frequently. Only around 3 to 4 % will be successful in stopping tobacco abuse.. Many medications including nicotine replacment therapy and non nicotine medications have been approved as safe and effective treating nicotine dependence. Using more than one therapy is helpful in treating addictions

When you stop there are 2 major symptoms , one is intense craving due to the absence of

nicotine in your blood and the other is mood symptoms like irritabily, palpitations, not able to concentrate , head ache. So when we are treating this we will have to address these main factors

Nicotine replacement therapy

Nicotine can be substituted for time being through various methods

Nicotine patch

Latest that is available is transdermal patches, its like a sticker which can be sticked on your

body. The amount of nicotine needed is calculated and delivered through the transdermal patch. It comes in 14mg, 21mg and 28mg patch. one patch to be used in a day


Nicogum is like any chewing gum, but the way its used is a bit different. We should chew it continuously as the nicotine is very irritant if it goes to the stomach. It should be crushed between the teath and parked between the gum and cheek line till you have a tingling sensation. once its over its should be spit out. This chewing and parking allows nicotine be gradually absorbed to the blood stream. Avoid drinking or eating just before and after you use the gum There are other methods like nicotine nasal spray and Nicotine inhaler, both of which are currently not available in kerala

Non nicotine medications

Bupropion: This medications are used in association with Nicotine replacement therapy. This medication will help to alleviate the mood symptoms associated with nicotine with drawal like irritation, head ache etc. Bupropion acts by increasing levels of dopamine and norepinephrine(neurotransmitters) which improves the mood in a person.

Varenicline: One of the most successful treatment in tobacco addiction. It acts on brains nicotine receptors , reducing the withdrawal symptoms and the best part of this medicine is you don’t get the high/pleasure when you smoke cigarettes when you are using the medications. So slowly your tendency to smoke cigarettes reduces.

Counseling, support groups and other programme

Medications with cognitive behavioural therapy will have the best result

Medications help you to cope with withdrawal symptoms, while behavioural treatment helps you develop the skills to avoid tobacco over the long run

Internet based programmes: Certain websites offer support and stratergies for people who wants to stop smoking. Finally once you have stopped, don’t ever try to take one drag because this will cause a relapse even after months of stopping tobacco. The one drag/one cigarette will activate the depenedence system in brain and the person will go to his old ways of smoking in a week time. This is how the dependence centre in brain is programmed.

So if you have stopped, keep off from that one first cigarette or a drag.

Dr Pratheesh P J

Consultant Psychiatrist

Lourdes Institute of Behavioral Sciences

Lourdes Hospital

(The views expressed by the author are his own)

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