Up in smoke
Tue, Oct 19 06:25 PM
As Mark Twain once famously said, "Giving up smoking is easy. I ought to know, I've done it a thousand times." Every one of us has probably felt the same way when trying to kick the butt. The best efforts are quashed by that one last cigarette at a party, reaching out for it on a stressful day at work or just hanging out with friends. So why exactly is it so difficult to quit even when we are well aware of the harm it's doing?
- What's stopping you
To understand why smoking is so addictive, one needs to understand how nicotine behaves in the body. Dr Neha Malhotra, Consultant Psychologist, Asian Institute of Medical Sciences, Faridabad says, "Nicotine's molecule shape is very similar to that of acetylcholine, a natural neurotransmitter that is responsible for controlling muscle movements, breathing, heart rate, mood, appetite, memory, and most importantly, chemicals that stimulate the pleasure centres of the brain. Instead, nicotine begins to stimulate the brain to release large doses of dopamine, the hormone responsible for a happy feeling.
A smoker quickly learns to associate that euphoric feeling with smoking and the addictive damage is done." The second part of this psychological reaction is environmental. For instance, most smokers light up after a meal, while driving or when they are bored. This means that the person not only associates this new inner-high with smoking, but also with what they're doing when they're smoking. And here lies the answer towards making quitting a little easier. If you can replace this feeling of happiness with something like exercise or talking to someone when you feel the urge to smoke, you can control yourself.
- On the road to quitting
From self-motivation to counselling to prescription, there are several ways to stub the stick. Quitting cold turkey works for those whose addiction is limited to few cigarettes a day. Dr Bhawna Sirohi, Head, Medical Oncology, Artemis Health Institute, Gurgaon, says, "It helps to write down your reasons to quit and have them ready every time you want to smoke. Know your triggers and keep away from them.
These could be people, places and feelings you associate with smoking." If you physically and psychologically require the substance to function, it's time you headed to a doctor. "Smoking needs to be seen as a medical illness, and that's the key to its treatment. It's a medical problem with a scientific treatment, and not merely a habit, or social influence," says Dr Samir Parikh, Consultant Psychiatrist, Max Healthcare.
An often used method for serious addicts is nicotine replacement therapy (NRT) that includes nicotine gum, lozenges and patches. However, the use of these is debatable as you are quitting smoking with the help of another nicotine product. Knowing how addicted you are can help you decide whether you need extra support such as a cessation programme or medication. Drugs designed to help smokers act at the same receptors in the brain where nicotine goes and binds, and release dopamine.
It's important for a person to report any mood changes or sleep disturbance during the treatment and it should be done under the combined supervision of a physician and a psychiatrist.
- What's in it for me
Dr Vijay Surase, Consultant Interventional Cardiologist, Jupiter Hospital, Mumbai, elaborates on the physiological effects of smoking. "Smokers have a four-fold risk of developing a heart attack compared to non-smokers. Over a period of time, they develop deposits of fat inside the lining of the blood vessels, causing them to become hard and develop cracks."
For women on oral contraceptive pills, the risk increases as they are more prone to blood clots, strokes and cardio-vascular trouble. "Besides respiratory problems, half of the lung cancer cases and 70 per cent oral cancer cases can be attributed to tobacco," Says Dr Sirohi.
The effects of smoking on women are greater than on men in the same age group, as women have relatively smaller blood vessels and these get further constricted due to smoking. It disrupts menstrual cycles, causes pelvic inflammatory disease and can advance the onset of menopause. Nicotine has a serious impact on women's reproductive health and lowers chances of conceiving if either partner is a smoker. "Components in cigarette smoke affect estrogen production and cause a woman's eggs to be more prone to genetic abnormalities.
Long-term smoking can have an irreversible effect on ovarian function," says Dr Nandita Palshetkar, infertility specialist, Lilavati Hospital, Mumbai. It can cause miscarriages, low birth weight babies and pre-term deliveries. If you are planning a pregnancy, quit at least three months before you conceive.
The incidence of osteoporosis is also greater among women who smoke as nicotine has a tendency of eroding bones. A lot of women tend to think that puffing away will kill appetite, and are even wary of putting on weight if they quit as the metabolic rate slows down. But what they don't realise is that it's harder to build muscle and tone up as one's stamina goes for a toss.
- Never too late
Even if you have been smoking for a few years, there's no reason to think that the damage is permanent. Smoking is the most preventable cause of death and India has the third highest number of women smokers (over one crore) in the world with the figures constantly rising. Within three months of quitting, your heart attack risk begins to drop and lung function improves. A year after quitting your added risk of heart disease is half that of a smoker and five years after quitting, the risk of a stroke is reduced to that of a non-smoker. It's time you took that statutory warning a little more seriously.
- Stub the butt
1. Try to avoid the places or people with whom you tend to smoke more often.
2. Use gum, or cloves, to delay the impulse to smoke.
3. Buy one cigarette at a time and never keep packs.
4. When you smoke, smoke only half the cigarette and throw away the rest.
5. Keep a count of how much you smoke each day and try to reduce every week.
