Call it quits... stop smoking

Nicotine replacement therapy, avoiding triggers and seeking help are some ways to snuff out the habit of smoking, writes Dr Alok Kulkarni

Investment banker Sanjay, 42, was having problems breathing and was coughing violently. He had lost part of his vigour, was sleep deprived, and was worn out. His chest was enlarged, as shown by a standard chest X-ray. More examinations revealed that he had lung cancer that had spread. He had been a lifelong smoker. Today, nicotine addiction is becoming a bigger issue. According to the National Mental Health Survey (NMHS) 2015–16, 13.1% of adults have a problem with tobacco use over their lifetime. Specialised psychiatric support is needed in this situation. Those with mental illnesses, including those who concurrently battle other addictions, are much more likely to smoke than the general population. More than 7,000 distinct chemicals can be found in the smoke from combustible tobacco products.

The main tobacco ingredient that promotes smoking and feeds tobacco addiction is nicotine. Tobacco is given a number of chemicals to improve flavour and nicotine absorption.

The most common method of tobacco consumption is through smoking, but snuff and chewing tobacco are also highly preferred. E-cigarettes are becoming more and more popular because they give nicotine without the harmful chemicals found in tobacco.

An average smoker inhales 1-2 milligrams of nicotine in each cigarette. When smoked, nicotine soon reaches a blood-brain barrier-crossing peak in the bloodstream and enters the brain.

In a typical smoking session, a cigarette is lit, and 10 puffs are taken over a period of around 5 minutes. 200 “hits” of nicotine are delivered to the brain each day by a person who smokes about a pack (20 cigarettes) a day.

Smoking gives you a “kick” because nicotine stimulates your adrenal glands, which release adrenaline (epinephrine).

The body is stimulated by the adrenaline rush, which causes an increase in heart rate, blood pressure, and respiration.

The reward and pleasure centres of the brain are also activated by nicotine. Nicotine generates a temporary rise in pleasant chemicals in the brain circuits, which momentarily results in euphoria.

Nicotine encourages substance abuse by elevating dopamine levels in the reward circuits of the brain.

Psychiatrists must provide advice in order for patients to successfully cease using any drug. In Cognitive Behavioural Therapy (CBT), patients are taught coping mechanisms to help them put down their cigarettes in stressful circumstances.

Substance abuse can be brought on by people, places, and things that serve as triggers.

Motivational interviewing (MI), which examines and addresses a person’s ambivalence about quitting smoking, tries to increase that person’s motivation to make healthy lifestyle decisions.

MI prioritises the patient and stays out of the public eye.

The disconnect between patients’ goals and their actions at the moment is highlighted by MI. Psychiatrists help patients develop a sense of self-efficacy while addressing their resistance to change.

Gums containing nicotine can help support nicotine replacement treatment (NRT) by activating nicotine-targeted brain receptors and minimising withdrawal symptoms. NRT causes a 50–70% boost in quit rates.

Medicines like bupropion and varenicline have FDA approval.

When combined with the aforementioned treatments, these are quite helpful in assisting someone in ending their dependence on cigarettes.

(The author is a mental wellness expert.)