The World Health Organisation estimates there to be 1.1 billion smokers on planet earth, 80 % of whom live in low and middle income countries. Up to 50% of those exposed to tobacco smoke die as a result of the habit and the harm is all the more vivid when one considers that deaths are at a rate of 8 million people annually.
This is equivalent to wiping out the sum of the populations of Nairobi, Kampala and Mombasa annually. More than an eighth of these deaths are amongst people who choose not to smoke but inhale second-hand smoke from people smoking around them. The list of health conditions associated with the habit is long and includes 14 different cancers; long term and irreversible life limiting lung conditions and cardiovascular illnesses that lead to heart attacks and stroke; impotence and infertility, and diseases affecting bone health amongst many others. Smoking tobacco increases the risk of contracting pneumonias and respiratory tract infections including Covid-19, and also worsens the outlook of those infected.
There are many public health and policy strategies employed to reduce tobacco use and dependence and these campaigns climax on the 31st of every May, dubbed the ‘World No Tobacco day’
Never too late to stop smoking
It is never too late to stop smoking and the earlier one quits the better. The benefits are varied and kick in within twenty minutes of putting out a cigarette. They range from immediate important physiological benefits to reversal of heart attack and stroke risks to normal levels within five to fifteen years of quitting. Studies have shown that people diagnosed with lung cancer have better outcomes when going into cancer therapy if they quit, and have a higher success rate at sustaining cessation.
What stimulates addiction?
The mechanisms behind addiction are complex and involve both the physiology of the central nervous system, and psychology. Most career smokers will attest to multiple failed attempts to quit through their lifetimes. In my youth I witnessed my erstwhile mentor and a great Kenyan that arguably had the biggest lasting positive impact to Kenyan society, struggle with the habit. Despite his phenomenal will power, sacrifice and discipline he struggled for years to quit dependence on tobacco.
Seek Professional help
Observational and comparison studies prove that enrolling on a cessation support program that is run by professionals significantly increases quit rates compared to going it alone. These programs employ the use of pharmacological agents including nicotine replacement and other medication affecting the neurophysiology of addiction, together with cognitive behavioural therapy and, or the use of common interest support groups.
Whichever route one takes, the biggest player in the process is the quitter. A will to quit is a key and necessary ingredient. For the smokers who are not ready to quit, the first step is always to understand the health and economic harm caused by the habit, on both oneself and one’s family; and the benefits of quitting, which go over and beyond just reversing the harm.
Remaining focused
One must never feel let down by previous failed attempts, however numerous and spectacular. Conversely, each failed attempt is a treasure trove with lessons on the hurdles one tripped at and what to do differently. Incremental targets are useful. This means quitting for a day with respite, then trying for two days, and so forth to the point where there is too much to lose by smoking that one cigarette. Seeking inspiration from successful quitters is a useful tactic, and there are always important lessons on what works, and what does not. It is not uncommon that stress, anxiety and fear burden a quitter, especially when ponders the onerous task ahead.
Fill your life with other things
Yoga and meditation, adopting alternative relaxation techniques and surrounding oneself with friends who cherish and support the quit process works well to mitigate the negative energy. Adopting a healthy lifestyle with exercise and healthy diet usually helps condition the mind to an overall positive constitution. Naturally, for many there is a lot of procrastination that beats this approach back, but it is surmountable, and the strategy is replete with synergy that helps one achieve the quit target together with the desired health benefits a lot faster.
Get support from those close to you
When ready, a quit date is set and a brief run up period helps maintain focus and sustain the energy. Do set a quit date weeks ahead and inform those around you of the date and ask for their support and understanding. This includes family, colleagues and friends.
The first few days and weeks are the hardest and this is characteristic to the process of breaking any habit, but more so for one that is driven by physical addiction to nicotine. So it behooves one to remove tobacco products and cues from one’s environment.
Overcoming withdrawal symptoms
Addiction to nicotine is perhaps the biggest challenge in the first two to four weeks, and withdrawal manifests with coughs and headaches, cravings and weight gain from an increased appetite. Some experience a volatile mood, difficulty concentrating, poor sleep and even symptoms that mimic the ‘flu. People experience these symptoms to varying extents and degrees and they rarely last longer than a month.
Cognitive behavioural therapy and medication use can successfully be employed to overcome them., including:
- Adequate sleep,
- physical exercise,
- sticking to a routine,
- Adequate hydration and eating regularly helps with the headaches.
- Deep breathing and distracting oneself.
- Prescription and some over the counter medication can augment these tactics.
If one has made a decision to give in, delaying this for as long as possible is very useful, and the incremental tactic works well here. It helps to focus on the bright side of the journey, look to the benefits that are promised, employ relaxation techniques and surround oneself with positive people and uplifting music when mood swings are over-bearing.
Defeating the myths
There are some dearly held beliefs that are an enemy to the cessation strategy, and these include the myths that “smoking helps one relax”, or that “smoking is cool”. Some feel that smoking helps them manage their weight better. One needs to engage adequately to debunk these myths effectively, and realisation of the alternative helps overcome cravings. Some habits associate smoking with day to day practices, like having a cigarette after a meal or with a drink, on the loo, whilst reading or after intimacy. Finding alternative practices or simply learning to do things differently is a very useful strategy, and this can be actively thought about and a conscious effort to plan one’s life differently is part and parcel of the cessation process. Positive reinforcement is an excellent tactic and may include giving oneself a treat for hitting targets, or receiving one from a loved one.
Dangers of electronic cigarettes
Electronic cigarettes have been shown to have some efficacy as a cessation strategy, and they have been promoted as such, with the additional benefit of heat and not burn mechanism said to reduce dissipation of noxious fumes to the surrounding. However, they are harmful to the nervous systems of the youth who are more vulnerable to getting hooked on to them even more than to cigarettes, and to developing foetuses. There are well documented case series in medical literature, of death and severe disability from destructive lung disease caused by vaping. Mainstream smoking cessation strategies work well, are cheaper on the long run, and for many vaping tends to replace one vice with a more sophisticated one.
By Dr Jumaa Bwika, Consultant Pulmonologist at Aga Khan University Hospital, Nairobi
