IS IT EASY TO QUIT TOBACCO???????

If a non-smoker is being questioned, he says YES

confidently…

But for a tobacco user, he says it is very difficult to come

out of the habit……………

Any idea why is it so??????????

Because there is something called as Addiction ! ! !

WHAT IS ADDICTION?

A mal-adaptive pattern of substance use,

leading to clinically significant impairment

or distress

Tolerance to a substance

Withdrawal from a substance

Taking a substance in larger amount or over

a longer period of time than intended.

So what causes addiction……….

NICOTINE

WHAT DOES IT DO?

Tobacco dependence is caused by Nicotine, which is a

neuro –chemical, anatomical and molecular basis of its

action is that of a psycho-stimulant

Sites of action

In Brain: midbrain, brain stem, cerebral cortex,

Other parts of body (muscles, adrenal glands, heart, etc.).

Mechanism Of Action

Through its nAChRS(nicotine acetyl choline receptors) By

causing secretion of dopamine, it produces reinforcing,

stimulant and dependence properties.

By acting on non-dopaminergic sites, it produces positive

rewarding actions and some of the withdrawal symptoms.

Nicotine - Dependence

The resultant release of acetylcholine,

noradrenaline, serotonin, vasopressin, etc., it

causes:

1.An immediate rise in blood pressure,

2. Increase in heart, respiratory and pulse rates &

3. Rise in blood sugar levels

In addition, it leads to alertness (arousal,

concentration and stress reactions),memory

enhancement and muscles contractions.

Y what happens if u don’t quit???????????? what happens if u quit???????????? How to encounter it or HOW TO QUIT?????

WHAT HAPPENS IF U DON’T QUIT???

WHAT HAPPENS ONCE U QUIT??? After 20 Minutes

• Blood Pressure and Pulse drop to a normal rate. • Temperature of hands and feet increases to normal

After 8 Hours

• Carbon Monoxide level in the blood drops to normal. • Oxygen level in the blood goes up to normal

After 24 Hours

• Chance of Heart Attack starts going down

After 48 Hours

• Nerve endings start growing again. • Ability to taste and smell begins to improve.

2 weeks to 3 months

• Circulation improves. • Walking gets easier • Lung function improves up to 30%

1 month to 9 months

• Coughing, sinus congestion, tiredness and shortage of

breath decrease. • Cilia grow back in the lungs to better handle mucus, clean

the lungs and reduce infection.

After 1 year

• Risk of coronary artery disease is half that of a smoker.

After 5 years

• Lung Cancer death rate goes down by one half • Risk of stroke becomes the same as a non-smoker. • Risk of cancer in the mouth, throat, esophagus, bladder,

kidney and pancreas goes down.

• Craving for tobacco • Reason: Reduced levels of nicotine

• Duration: Few days, up to months & years sometimes

• Dizziness • Reason: Increased flow of oxygen to the brain

• Duration: Few days

• Insomnia • Reason: An emotional and mental response to withdrawal besides the disturbed

sleep pattern

• Duration: 1 week

• Headaches • Reason: Increased blood flow to the brain; and, tension to stay quit

• Duration: 1 to 2 weeks

• Chest discomfort • Reason: Excessive mucus flow which blocks the airways and increased muscular

effort to cough out the mucus and tar deposited in lungs

• Duration: 1 to 3 weeks

WITHDRAWAL SYPTOMS

• Constipation • Reason: Transient reduction in intestinal movement; and, the psychological trigger

to move the bowels is missing

• 1 to 2 weeks

• Irritability • Reason: Due to craving for nicotine

• Duration: 2 to 4 weeks

• Fatigue • Reason: Inability to get the “kick/ stimulation” from nicotine

• Duration: 2 to 4 weeks

• Cough or nasal drip • Reason: Revived cilia action to clear the respiratory passages

• Duration: Few weeks

• Lack of concentration • Reason: Biochemical dysfunction due to relative deficiency of nicotine

• Duration: Few weeks

• Hunger • Reason: The appetite suppressant action of tobacco is no more there.

• Duration: Up to several Weeks

HOW TO QUIT?????

PSYCHO BEHAVIOURAL THERAPY

PHARMACOTHERAPY

•Nicotine Replacement Therapy (NRT)

•Non Nicotine Replacement Therapy

PSYCHO BEHAVIOURAL THERAPY

• Brief clinical interventions (i.e., when a doctor takes 10

minutes or less to deliver advice and assistance about

quitting)

• Counseling (e.g., individual, group, or telephone

counseling)

• Counseling along with medication

TCC

MEDIA GOVERNMENT

NGO

5AS

Ask-about tobacco use

Advise- to quit

Assess- commitment and barriers to change

Assist-users committed to change

Arrange-follow up to monitor progress

• Be positive -you should not get blogged down by negative

thoughts

• Distract yourself - engage yourself in some physical activity or

some hobby that you enjoy doing

• Eat healthy - Eats lots of fruits, vegetables, and whole grains,

enjoy a low-fat diet

• Pamper yourself - when you quit do not neglect yourself as

this is the time when you need to pamper yourself.

• Walk everyday - to stay healthy and fight cravings

• Drink lot of fluids -will keep you hydrated, help you detox

more quickly and work as a craving buster

• Know quitting is long and hard - quitting is a long process as

your body is coping with the withdrawal symptoms- you need to

be patient

• Reward yourself –on smoke free day

NICOTINE REPLACEMENT THERAPY (NRT)

Nicotine Gums

Nicotine Patches

Nicotine Lozenges

Nicotine Inhalers

Nicotine Nasal Sprays

NICOTINE REPLACEMENT THERAPY (NRT)

Dosage and

duration

Side effects

Contraindications

a. Nicotine gum For 1-24

cigarettes/bidis -

2mg gum (up to 24

pieces/day) for 12

weeks.

For ≥25 cigarettes/

bidis – 4mg gum (up

to 24 pieces/day) for

12 weeks

Chewers need about

half or a quarter of

the dose as

prescribed for

smokers.

Mouth soreness,

burning in the

mouth, throat

irritation, dyspepsia,

nausea, vomiting,

hiccups and excess

salivation

Gastric

Ulcers,myocardial

infarction or stroke

in the past two

weeks or poorly

controlled CVD

NICOTINE GUMS

Please note that the Tobacco

Cessation therapy is team effort of a

group of professionals

Its Dangerous to take medicine

without the guidance of Trained

Doctors

Dosage and

duration

Side effects

Contraindication

b. Nicotine patch 21mg/24 hours for 4

weeks then

15mg/24 hours for 2

weeks then 7mg/ 24

hours for 2 weeks.

Local skin reaction,

insomnia

myocardial infarction

or stroke in the past

two weeks or poorly

controlled CVD

c.Nicotine inhaler 6-16 cartridges/day

for 6 months

Local irritation of

mouth and throat

- As above -

d.nicotine nasal

spray

1-2 doses / hr for 3

to 6 months

Nasal irritation and

Irritation of throat,

coughing and

watering of eyes.

- As above -

NON NICOTINE REPLACEMENT THERAPY

First Line •Bupropion

•Varenicline

•Fluoxetine

Second-line

•Clonidine

•nortriptyline

Bupropion :

•It is a smoking cessation aid. •The drug is an antidepressant that has both dopaminergic and

adrenergic actions as its primary pharmacological action is

to reduce the craving of smokers for their cigarettes.

•After 1 -2 weeks of Bupropion treatment a person is

ready to quit. DOSE: 150MG/DAY x 1 TO 3 days

300mg/day x 7 to 12 weeks

Side effects: GI upsets, agitation,

restlessness, insomnia, headache, lowering

of seizure threshold, etc.

Contraindications: H/O Allergy, CNS tumors,

Uncontrolled seizures, Hepatic diseases,

Patients on MonoAmineOxidase

(antidepressent) drugs or undergoing

unsupervised alcohol withdrawal, Pregnancy,

lactation, Children below 18 years , etc

Varenicline: This is a partial nicotine agonist that selectively binds to the alpha (4) and

beta (2) nicotinic acetylcholine receptors in the brain. It lessens the physical pleasure from

taking in nicotine and helps lessen the symptoms of nicotine craving. Tobacco use may be

stopped one week after initiating treatment with Varenicline

DOSE : 0.5 mg / day x 1 to 3 days

0.5mg BID x 4-7 days

1 mg BID x 12 weeks

Side effects: GI upsets, depression, restlessness,

insomnia, headache, bad dreams, suicidal

ideations, etc.

Contraindications: Pregnant women, children and

people with H/O mental illnesses. Stop immediately

if changes in moods, & behavior, agitation, suicidal

ideation occur

THE WHO FRAMEWORK CONVENTION ON

TOBACCO CONTOL (FCTC)

The FCTC is the first international treaty negotiated

under the auspices of the WHO, aimed at curbing

tobacco related deaths and disease.

In a historic leap towards promoting public health,

the Govt. of India ratified the FCTC on FEB 5th

2004. India was the 7th country to ratify the

convention.

This exhibits a strong commitment to tobacco

control, in light of the fact that India is a major

tobacco consuming and producing nation

There is totally 38 articles.

FCTC - ARTICLE 14

Demand reduction measures concerning tobacco

dependence and cessation

1. Each Party shall develop and disseminate appropriate, comprehensive

and integrated guidelines based on scientific evidence and best

practices, taking into account national circumstances and priorities, and

shall take effective measures to promote cessation of tobacco use and

adequate treatment for tobacco dependence.

2. Towards this end, each Party shall endeavour to:

(a) design and implement effective programmes aimed at promoting the

cessation of tobacco use, in such locations as educational institutions,

health care facilities, workplaces and sporting environments;

(b) include diagnosis and treatment of tobacco dependence and

counselling services on cessation of tobacco use in national health and

education programmes, plans and strategies, with the participation of

health workers, community workers and social workers as appropriate

(c) establish in health care facilities and rehabilitation centres programmes

for diagnosing, counselling, preventing and treating tobacco

dependence

(d) collaborate with other Parties to facilitate accessibility and affordability

for treatment of tobacco dependence including pharmaceutical products

pursuant to Article 22.

Such products and their constituents may include medicines, products

used to administer medicines and diagnostics when appropriate