Stopping tobacco is the single most effective thing most users can do for their health, outperforming any medication available. It is also difficult, and most people need several attempts.
In India the picture is complicated by smokeless forms, which are widely believed to be safer and are not.
Smokeless Tobacco Is Not Safer
Gutkha, khaini, zarda, paan masala with tobacco and similar products are used by a very large number of Indians, often by people who consider themselves non smokers.
They cause oral cancer, which India has among the highest rates of globally, and oral submucous fibrosis, a progressive condition in which the mouth stiffens until the person cannot open it more than a few centimetres. That is irreversible.
They also cause gum disease and tooth loss, and increase cardiovascular disease, stroke and pregnancy complications.
Beedis deserve mention too. They are frequently seen as milder than cigarettes and in fact deliver more tar, carbon monoxide and nicotine per unit because they require harder puffing.
Watch for Early Oral Changes
Oral cancer is usually preceded by visible changes, which makes it detectable early if anyone looks.
- White patches inside the mouth that cannot be wiped off
- Red patches, which carry higher risk than white
- A burning sensation when eating spicy food
- Progressive difficulty opening the mouth
- An ulcer that has not healed within two weeks
- A lump in the mouth or neck
- Loose teeth without obvious cause
- Numbness of the tongue or lip
Any of these in a tobacco user needs examination. Our dentistry and ENT departments examine for these, and a mouth examination is quick and painless.
What Actually Works to Quit
Willpower alone succeeds for a small minority. Combining approaches roughly triples success rates.
- Nicotine replacement therapy: patches, gum or lozenges. Combining a patch for background levels with gum for cravings works better than either alone
- Prescription medications that reduce cravings and withdrawal, discussed with a doctor
- Behavioural support: counselling or a quitline, which independently improves success
- Setting a quit date two to three weeks ahead and preparing for it
- Complete cessation rather than gradual reduction, which works better for most people
Nicotine replacement is often underdosed and stopped too early. It should be used at an adequate dose for eight to twelve weeks. Nicotine replacement is not the harmful component of tobacco. The tar and combustion products are.
Preparing to Quit
Preparation in the fortnight before improves the odds considerably.
- Set a specific date and tell people about it
- Identify your triggers: after meals, with tea, while driving, with particular friends, when stressed
- Plan a specific alternative for each trigger
- Remove all tobacco, lighters, ashtrays and paan from home, car and workplace
- Tell colleagues who use tobacco, and ask them not to offer
- Arrange your nicotine replacement or medication before the date
- Consider what previous attempts taught you about what went wrong
Most relapses happen in specific predictable situations rather than randomly. Planning for those situations in advance is more useful than general resolve.
What Withdrawal Feels Like
Knowing the timeline helps, because the worst of it is short.
- Cravings: peak in the first three days, then reduce. Individual cravings last only three to five minutes
- Irritability and restlessness: two to four weeks
- Difficulty concentrating: a few weeks
- Increased appetite: can persist for months
- Cough that temporarily worsens: the airway clearing itself, and a sign of recovery
- Disturbed sleep: the first week or two
The three to five minute point is genuinely useful. A craving will pass whether or not you use tobacco. Delay, drink water, walk outside or call someone, and it subsides.
How the Body Recovers
The timeline of recovery is a strong motivator and is not widely known.
- 20 minutes: heart rate and blood pressure fall
- 12 hours: carbon monoxide levels return to normal
- 2 to 12 weeks: circulation and lung function improve
- 1 to 9 months: cough and breathlessness reduce as the lung clearance mechanism recovers
- 1 year: risk of coronary heart disease is roughly half that of a continuing smoker
- 5 years: stroke risk approaches that of a non smoker
- 10 years: lung cancer risk roughly halves
- 15 years: coronary risk approaches that of a never smoker
Benefit begins immediately and continues for decades. Even quitting at sixty adds years of life expectancy.
Managing Weight Gain and Relapse
Weight gain after quitting is real, averaging a few kilograms, and it is a common reason for relapse.
It is worth stating plainly that the health benefit of quitting vastly outweighs the harm of a few kilograms. You would need to gain a great deal of weight to offset the cardiovascular benefit of stopping.
Manage it by anticipating increased appetite, keeping healthy snacks available, increasing activity during the quit period, and drinking water regularly.
If you relapse, treat it as information rather than failure. Most successful quitters made several attempts. Identify what triggered it, adjust the plan, and set a new date rather than abandoning the effort.
E Cigarettes and Other Products
E cigarettes are banned in India, so this is largely academic here, but the question comes up.
They are less harmful than combustible cigarettes but not harmless, and long term effects remain incompletely known. They are not appropriate for people who have never used tobacco, and particularly not for young people.
Similarly, herbal cigarettes still produce tar and carbon monoxide through combustion and are not a safe alternative.
Products marketed as tobacco free paan masala are worth scrutinising, as some are used with tobacco added separately and areca nut itself is carcinogenic.
Quitting tobacco outperforms every medication available for your future health. Combine nicotine replacement or medication with behavioural support, plan for your specific triggers, and remember that individual cravings pass in minutes. Smokeless tobacco is not the safer option it is believed to be.
Our general medicine department at T. Nagar provides tobacco cessation support and oral examination.
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