De-addiction is not that difficult

Dr Pratima Murthy apart from being a Professor of Psychiatry and heading the Centre for Addiction Medicine at the National Institute of Mental Health and Neuro Sciences, Bangalore, is the principal investigator of the WHO and Ministry supported Regional Centre for Tobacco Control (the resource centre for the country). She has a wide experience in providing clinical services for people with all forms of addiction, including tobacco, programme evaluation and consultancy to various national and international bodies on addiction prevention and management. Here are excerpts from the interview. How does the Nicotine Replacement Therapy work? Nicotine Replacement Therapy (NRT) is a treatment method where the nicotine in smoke or tobacco is replaced by a safer nicotine product. As a method of delivering nicotine into the bloodstream, NRT is far less dangerous as compared to tobacco smoking. It is a WHO recommended therapy that doubles the chances of quitting. NRT products can be used in isolation or as a combination of two products for maximum effectiveness, depending upon the level of tobacco dependence. Currently NRT products are available globally as chewing gum, lozenges, nasal sprays, inhalers and patches. Nicotine is the most addictive substance known to man. When regular smokers try to give up cigarettes they experience craving for tobacco and withdrawal symptoms. These include irritability, anxiety, dysphoria, difficulty in concentrating, restlessness, impatience, tiredness, decreased heart rate and increased appetite and weight gain. NRT products substitute some of the nicotine normally obtained from cigarettes with therapeutic clean nicotine, helping to prevent or relieve withdrawal symptoms. Once the ex-smoker overcomes the need to smoke, nicotine dependence is eliminated by gradually reducing the dose of nicotine replacement. On an average who are the people suffering from tobacco addiction in Bangalore? There are people from all sections of the society suffering from tobacco addiction. This includes young working adults in software firms or call centres, college students, people working in the media and fashion industry, police, industrial workers, construction labourers, etc. People in high stress jobs tend to use tobacco as a stress buster, but get addicted to it. How long does it take for a person to completely quit smoking? Are there certain steps to follow? The time period taken for a smoker to quit smoking completely depends from person to person based on their desire to quit, severity of their addiction and support to quit. As it is difficult to stop smoking immediately, a smoker has to plan this activity in advance, to make sure the attempt is successful. The smoker must have a schedule with his quit date decided and marked. The smoker can either quit completely on that date or reduce his/her intake from that date and gradually  stop. Quitting all at once is likely to be more successful than gradual reduction. At this point of time, the smoker’s body, which was addicted to nicotine, experiences withdrawal symptoms, particularly irritability and craving (urge to smoke) as it does not get nicotine, which it is used to earlier. Effective ways to deal with it are either to replace the nicotine with NRT or minimise the urges by using other forms of non-nicotine treatment. How early can the addicted person relapse? What is the percentage of people who tend to relapse? Studies indicate that a smoker goes through 7-8 quit attempts before he finally succeeds. Relapses are many due to the inability to overcome nicotine withdrawal symptoms, only one to three per cent of unaided cold turkey attempts succeed in the long run. Using a Nicotine Replacement Therapy product or non-NRT medication along with support from a healthcare professional can greatly increase chances of success.  Behavioural counselling helps greatly in supporting the person’s attempt to quit, by sustaining his/her motivation, finding simple ways of dealing with withdrawal – particularly craving, identifying elements in the environment as well as within self (tension, sadness, urge) that can lead to a relapse and learning alternative ways to deal with such elements. Lifestyle modification also helps the person kick the habit.