Over half of all long-term tobacco users die from health issues caused directly because of their habit. It also severely affects their quality of life. Most users are aware of these consequences and have also tried to quit at various times. However, the majority of them are unable to quit, or relapse after quitting.
Tobacco is an addictive substance, mainly because of nicotine, an alkaloid present in tobacco leaves. Most commercial tobacco products also contain additives to increase the addictive properties. Thus, quitting tobacco is no easy task. Just plain willpower is not enough for most users and that is the main reason nearly 95% of ‘cold turkey’ quit attempts fail.
The prerequisite for a quit attempt to be successful is that the user themselves should want to quit. While they may make promises on the insistence of a loved one, such forced attempts usually fail.
There is ample material available to convince one that tobacco is harmful and quitting is the right step. Stigmatising and ostracising the user does not help. The user will want to quit on their own if they are properly sensitised and motivated.
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Trained professionals are available to help encourage users by highlighting the perils of continued use and the benefits of quitting. They also play a vital role in the quitting process by counselling and guiding the user through their journey out of tobacco use.
Experiences of previous quitters have shown that strategies can be employed to make the experience not only easier, but enjoyable as well. One should try to find successful quitters and interact with them. It also helps if they can find a ‘buddy’ and both try to quit together while sharing experiences and giving each other encouragement. A ‘savings jar’ where they deposit the daily tobacco budget can grow quickly and provide further motivation.
Counselling and quit plans can be helpful but it is seen that dependence on a substance like nicotine is yet harder to break. Harm reduction is an effective intervention strategy we use in all walks of life, and is most significantly deployed in de-addiction from narcotics.
The idea is to replace the harmful addictive substances with less harmful and less addictive options. Once the habit is broken and the user is free from the addiction for a reasonable period of time, the lesser habit can be much easier to quit.
Global statistics show that tobacco harm reduction (THR) through nicotine replacement therapy (NRT) is the most successful method of quitting tobacco. By using an NRT product, the user can wean away from the harmful use of tobacco while still using nicotine in a less harmful form. Studies show that NRT-assisted quit attempts significantly improve the chances of success.
NRT’s contain nicotine to satisfy the craving but do not contain the other harmful chemicals like tobacco products. No additives are present to increase the addictive potential. They are available in a range of strengths so that the user can reduce the dosage and consumption over a few weeks or months. Thus, they offer an important stepping stone by letting the user reduce harm immediately while breaking the addiction slowly.
There are a myriad of NRT options available. Their suitability depends on the form in which the user was consuming tobacco, as well as personal preference. Nicotine lozenges and gums from pharma companies are effective for smokeless tobacco (SLT) users.
However, they are expensive and may not be affordable to most gutka and khaini users. Snus is a much more affordable option for SLT users. Snus is made from tobacco, but the tobacco is bleached and treated in other ways to drastically reduce its harmful effects. White snus is slightly more expensive but it contains no tobacco at all.
Nicotine patches work by slowly releasing nicotine through the skin for 16/24 hours. They may be an effective NRT option for a small number of users.
Smokers have a different method of consumption and are usually not satisfied with the same options as SLT users. Vapes (also known as e-cigarettes) are the most effective NRT for smokers, but their sale was unfortunately banned in India over concerns regarding underage use.
Vapes work by electronically heating a liquid to produce a flavoured aerosol of glycerine and propylene glycol, with a small amount of nicotine. The user inhales this vapour as he would smoke a cigarette or similar product. This close resemblance to the act of smoking makes it easy for smokers to switch to vaping and gradually move to extremely low dosage of nicotine. It is significantly easier to quit vaping than it is to quit smoking.
All of these NRTs eliminate the harm from tobacco use and provide a benign method of nicotine consumption. Health experts no longer prescribe a time limit to NRT use. Thus, even if a user was to continue to use an NRT for many years, it would not affect their health or quality of life. They can enjoy all the benefits of quitting tobacco even with continued NRT use.
Finally, there are some pharmaceutical drugs available to help in quitting but their effectiveness is questionable and some of them have significant side-effects, and hence their use is not encouraged. However, they may be suitable for some individuals and may be tried if all other methods fail, but only on prescription by a qualified medical practitioner.
The UK and Sweden have seen a historical reduction in tobacco use and their success is due to public awareness and THR through NRTs. India should also make affordable NRTs available everywhere and educate the public about them.