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Expert Speak

Quitting Smoking

“Quitting Smoking is not difficult. It is only a question of attitude,” says E Vidhubala, Psycho Oncologist, at the Tobacco Cessation Clinic at the Cancer Institute, Chennai.

  • Smokers’ Arguments

  • Quitting and Mental Make up

  • Quitting Techniques

  • Withdrawal Symptoms

  • Smoking Substitutes

  • Age and Quitting

  • Effective Professional Help

  • No Tobacco Day: “Tobacco and Poverty”

  • Government Initiatives

  • What are the most common arguments that smokers offer against quitting?

    The arguments are many. The Foremost argument is the feeling that “Nothing will happen to me”. Here are some of the myths they hold on to and clarifications:

    “Oh come on, don’t get preachy… You can get knocked down by a bus on the road tomorrow.”

    A: Yes you can. But you can minimise your chances of that not happening by not dashing out in the middle of the road amidst traffic. Likewise, you can minimise the chances of your cells turning cancerous by quitting.

    My Grandfather smoked till he was eighty. He did not get cancer!

    A: If you look hard enough you will find that he would have suffered from some tobacco related illness such as: Heart Disease, Chronic Bronchitis, Emphysema, Stroke, Cataract etc. Besides we live in an environment that is more polluted, our food has more chemical/carcinogenic elements than that was consumed by our grandparents and our susceptibilities are higher.

    Smoking helps me relax

    A: Your body's used to nicotine, so you feel good when you give your body a substance it's come to depend on. But nicotine is a stimulant - it raises your heart rate, blood pressure, and adrenaline level. Most ex-smokers feel much less nervous just a few weeks after quitting.

    Smoking makes me more effective in my work; It helps concentration.

    A: Smoking actually deprives your brain of oxygen. Smoking is not an aid to concentration in the long run.

    What is wrong with a small vice? It is boring to be perfect…

    A: Take a look at patients who have had surgeries and smoking related cancers. Listen to the distress they have undergone physically, monetarily and psychologically. Decide on whether the high from smoking is worth it.

    What kind of mental make up is necessary for quitting?

    It is all a question of attitude. Information about the impact of smoking and the contents of a cigarette can create a feeling of aversion that can wean a smoker away from cigarettes. It is not actually a trial for a person’s will power. Talking to a counsellor will help the smoker to realise how he has conditioned himself to smoking and why he has a block to quitting. Once the smoker is able to isolate these reasons, he can work his/her way to quitting. Thousands of people are doing it and succeeding.

    Are there any specific techniques for quitting?

    Several techniques are being tried.

    • Increasing aversion by switching brands

    • Cutting down the number of cigarettes.

    • Postponing the smoke; avoiding buying in cartons

    • Reconditioning by substitutiing associations.

    We recommend quitting at a go as the best. No other technique has given us results comparable as these. We feel “gradual” quitting does not work.

    What are the common withdrawal symptoms smokers experience?

    The most common withdrawal symptoms smokers who try to quit experience are the following:

    • A dry feeling mouth in the mouth. (Drink plenty of fluid, have salads and fruit).

    • Headaches (Take a warm bath. Try meditation)

    • Difficulty sleeping. (Get into exercise routines/ relaxation techniques).

    • Trouble passing motion.(Add more fibre and fluids to diet).

    • Anger, irritability. (Try breathing techniques)

    • Coughing (Take warm water/ fluids)

    • Hunger and increase in weight. (This too can be handled by increased fluid and fruit/vegetables intake)

    • Craving: there is almost an irresistible impulse to reach out for a cigarette. (This will last a few minutes. Wait it out.)

    It is important to know that these symptoms last only for a week or so. Simple lifestyle changes can reduce the impact of these. Remembering the effects of tobacco related diseases and the anguish that they cause reduces the annoyances caused by quitting to insignificance.

    How long do withdrawal symptoms last?

    Withdrawal symptoms last for a week or so. The first few days after stopping are the worst. Then the effect is reduced. After a week to 10 days all withdrawal symptoms should be gone.

    What about smoking substitutes?

    Different types of smoking substitutes are available. These include nicotine patches, chewing gum and medication. But there is a catch to all of these.

    Nicotine patches also deliver nicotine and feed the craving. Gum is banned in India. Medication has its own set of problems. In some it creates sleeplessness. Medication is contra indicated in may cases: that is, it does not agree with most people. A thorough examination is required before such medication can be prescribed.

    We have not found a satisfactory quit rate in any smoker who has tried substitutes.

    Is there a pattern to successful quitting: age, education, economic status or any other?

    It is a question of attitude and awareness. We find that education and economic status are not significant parameters.

    More young people try to quit, but they are also more prone to relapses.

    Older people are forced to quit, often because they are detected to have conditions that may be made worse by tobacco. Therefore there is a better success rate.

    What is the method you adopt/advise?

    As smoking is part of attitudinal behaviour, I feel this is problem that psychologists can handle best. We offer counselling and follow up.

    Listening

    We do not offer advice. We listen to the smoker. Each smoker has a different reason for smoking:

    • Rebellion

    • A sign of protest against someone who is trying to decry it.

    • Various imagined benefits.

    • Association with other pleasurable activities: peer interaction, release of tension etc.

    • A block against rationalising the ill effects of tobacco.

    Accepting the smoker’s needs but isolating these from the act of smoking is the main challenge. I feel this can be handled best by someone who is trained.

    Meeting those who have not done it in time

    This is the most powerful device we employ. Meeting people who have been through chemo, laryngectomy (partial removal of the voice box, rendering the person speechless) and other agonies caused by tobacco related diseases brings home the point forcefully.

    Images of these people and their experiences are real and haunt the smoker, while advice only annoys them.

    Reconditioning

    A psychologist is able to understand the activity that is associated with smoking: hanging out with friends, dinner, work related tensions, toilet routines, driving, waiting for someone, or just about anything.

    The psychologist works with the quitter and finds substitutes that can be linked to these activities instead of smoking. This process is called reconditioning.

    Dealing with withdrawal symptoms

    Most quitters need support during this phase.

    Do you think observances like the “No Tobacco Day” have any impact?

    Definitely. This gives us an opportunity to reach the masses through media. The choice of a theme each year brings into focus various dimensions of the issue. For instance, this year’s theme is “Tobacco and Poverty – A Vicious Circle” This brings to light the fact that the farmers are not benefited by growing tobacco. Infact, they are pushed into penury and ill health. It is a myth that governments gain economically from tobacco and tobacco product production, as the state spending on tobacco related diseases outstrips the earnings.

    Every year thousands of youngsters start smoking. With these observances at least some of them can be dissuaded.

    What are the initiatives that the government has to adopt to reduce/ eradicate tobacco usage?

    The government has banned advertisements completely on all media as well as sponsorships. For instance, banning advertisements, but having Sachin Tendulkar wear a T Shirt with a cigarette brand displayed on it, hardly served the purpose. Now even endorsements are out. Low visibility will kill the demand slowly.

    Besides, social unacceptability and awareness that passive smoking is damaging to children, are catalysts to quitting. If you cannot smoke in comfort, but have to do it in bathrooms or crowded smoke filled spaces outside buildings etc, it becomes a low brow activity. This should also discourage smoking.

    The fact that cigarette companies are diversifying into non tobacco areas is a sign of the times to come. I am very hopeful.

    Dr. E Vidhubala is a PhD in Psychology from the University of Madras. She has been with the Tobacco Cessation Clinic since the year 2000. Her area of interest is Cancer therapy and quality of life. She is deeply interested in onco related research.

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