Tobacco is a virulent epidemic that annually kills millions of people in the world. The vicious tobacco vapour contains thousands of poisonous chemicals, and smoking tobacco alone has been shown to cause about 25 life threatening diseases. More than one million Indians die every year from tobacco-related diseases.
This is more than the number of deaths from motor accidents, AIDS, tuberculosis, alcohol and drug abuse put together. While natural disasters and cataclysms such as the tsunami hit only once in several decades, tobacco goes on killing people recklessly and relentlessly - every year, every month, every day, every hour and every minute without any break, inflicting premature death and crippling disability on millions world over. People who are light smokers, who are highly motivated to quit, or who have limited access to medical or behavioural cessation programme can achieve success in their cessation efforts if they employ an appropriately individualised, self-directed cessation programme. Every smoker who quits smoking needs a strategy which will work for him. Studies have shown that a substantial number of adult smokers would like to quit. Nicotine is a highly addictive drug; so quitting smoking will not be easy, even for a highly motivated individual. We know that in many cases initial smoking cessation attempts are often not successful. Therefore, the smoker determined to quit must be prepared to make multiple attempts.
The chances of succeeding in a single quit attempt are no better than about one in a hundred. Researchers have found that the key clinical observation in smoking cessation is that attempts are cyclical, so that smokers who quit are at risk of relapse. For example, a population at high risk for relapse are postpartum women who have quit smoking during pregnancy.
Those smokers who are not clearly motivated to actively attempt a cessation programme may be persuaded and encouraged to adopt a method of progression spanning from pre-contemplation to contemplation, to preparation, and finally to action.
Here, though successful cessation may not be achieved in one stroke, the smoker may at least progress from one step to the next- for example from pre-contemplation to contemplation. With the next intervention, this smoker may progress further to preparation and eventually to action and a successful cessation. At the pre-contemplation stage, smokers need motivation, at contemplation, smokers need information; at preparation and action, smokers need to establish a programme and set a quit date
This programme has the added advantage as it requires no outside expenses or materials. All that is needed is dedication and will power on the part of the smoker to quit.
A combination of cessation interventions is found to be most effective. For example, behavioural therapy can be combined with nicotine replacement or non-nicotine pharmacological therapy. Since the smoker is addicted to the nicotine in tobacco, a substitute form of the drug administered through a pill, a patch or gum, satisfies the smoker’s craving for nicotine. Nicotine Replacement Therapies (NRT) have been shown to be twice as effective in successful cessation attempts as attempts without them. To many quitters, NRT eases withdrawal symptoms and is a psychological as well as physical aid to the cessation process. Besides, and more importantly, we shall have to create an environment that will help more people decide to quit, succeed in quitting, and stay quit for ever. A successful global smoking cessation programme necessitates a multi-pronged approach. Health education through the media, schools etc, formulation of public policy and information dissemination programme are all vital components in a comprehensive cessation effort. Let us make a beginning. A journey of thousands of miles begins with the first step- let us take that first step now. There is no time to lose, no scope for complacency. Any lapse on our part to act swiftly will be taken as criminal abdication of duty by posterity. Let us, therefore, act and success will be ours.
(The writer is former Acting Chief Justice, Madras High Court. The views in the article are the writer’s own.)