Why is it so hard to kick the butt?

Ahead of World No Tobacco Day on May 31, we look at how nicotine from tobacco romances the brain

Published: 30th May 2019 10:17 AM  |   Last Updated: 30th May 2019 07:27 PM   |  A+A-

Smoking, Cigarette, Smoke ban

For representational purposes

Express News Service

HYDERABAD: Tobacco is one of the most addictive substances present in the world today. A psychoactive substance called nicotine present in tobacco leaves is the reason why tobacco users find it so hard to quit using these products. In India, apart from smoking cigarettes, people consume smokeless tobacco products like gutkha, paan, khaini etc.

Receptors and pathways

Explaining how nicotine manipulates the brain, Jayant Mahadevan, assistant professor, Centre for Addiction Medicine, Department of Psychiatry in NIMHANS, says: “Nicotine is a plant-based alkaloid and it is the primary pysychoactive substance present in all tobacco products. Nicotine acts on certain receptors in the brain called nicotinic acetylcholine receptors.

These receptors are found in parts of the brain that are associated with motivation, attention, concentration, alertness, appetite etc. Through these receptors and an indirect mechanism, nicotine causes a final, common pathway of the brain which is called the reward pathway, wherein there is an increase of a chemical called dopamine. In fact, the same mechanism is followed in case of any addictive substance.”

Withdrawal and craving
“Nicotine is as addictive as some opioids. Whenever a person ingests any tobacco product, there is a sudden, huge surge of nicotine in the brain. It is said that when a person smokes, it takes only a minute for the nicotine to hit the brain. The surge wears off as easily as it rises. This is why people need to smoke more and more to maintain those levels of nicotine,” adds Jayant. 

“What makes it difficult to quit is that the user usually suffers from withdrawal symptoms like headache, lack of focus, irritability etc. These symptoms can persist for 2-4 weeks after quitting. The users also feel acute craving for tobacco after they quit. The receptors in a regular smoker’s brain adapt to the constant availability of nicotine. These adaptations make sure that the brain responds to cues which include seeing another person smoking, inhaling cigarette smoke etc. This craving phase can outlast the withdrawal phase, making it a tough job for the user to quit tobacco,” says Jayant. 

How to quit?
Dr Pawan Gupta, director at MAX Superspeciality Hospital, throws some light on how to   break up with tobacco. The intervention therapy includes  Behavioural therapy and Pharmacological therapy. Both are important and essential part of the treatment. The proper intervention includes individual and group counselling and treatment with medication to decrease the withdrawal symptoms. Now, medicines are available which decreases the withdrawal symptoms and at the same time blocks the nicotine receptor in the brain, he says.

Who can help me quit?
Most of the smokers have tried quitting multiple times before they seek help from a professional. There are two types of doctors   — AAR (ask, advise and refer) or 5A (ask, advise, assess, assist and arrange). Certificate courses have been introduced for the first time in India to upgrade the skills of the doctors to be able to treat these large number of patients of tobacco addiction. Recognised ICanCaRe Tobacco Wellness centres are coming up to specifically help these patients. A Tobacco Wellness App is available to keep track of the tobacco habit for the patient.

Effect on health
Smoking increases the risk of lung cancer by 25 times 
Smoking increases risk of heart disease two to four times 
Even people who smoke less than five cigarettes a day can develop early heart disease
Smokers are 12 times more likely to die of Chronic Obstructive Pulmonary Disease (COPD) than 
Smoking in pregnant women causes many dangers like premature delivery, ectopic pregnancy, low birth weight, still birth and sudden infant deaths
Smoking reduces bone strength, particularly among the elderly and increases risk of fractures
Smoking increases risk of cataract and age-related macular degeneration affecting vision
Smoking reduces sperm count in men and can lead to impotency and infertility

 30 to 40%increase in probability to get diabetes has been found among smokers

(As told by Dr Nalini N, senior consultant pulmonologist, Continental Hospitals), @KakoliMukherje2


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