WORDS PANK JIT SIN

If you’re wondering what it is I’m asking you to stop, well, it’s smoking. I recently had a friend pass away from lung cancer. He had stopped smoking for 8 years by then and picked up healthy exercise habits. It wasn’t enough and after 3 years of battling the disease, he succumbed on 2^nd August this year. Smoking is very much a man’s disease as many more men smoke compared to women. The World Health Organization (WHO) puts the number of smokers at 1 billion—800 million are men and 200 million are women. As November is Men’s Health Awareness month, let’s see what we can do to help smokers quit. HealthToday speaks to reader Keo Chia who managed to kick the addiction some years back. Smoking cessation comes with many benefits, among which are improvements in lung function, reduction of cardiovascular disease risk and reduction of cancer risk.¹

Keo during his interview.

It’s not you, it’s me

We asked Keo what his main driver was behind the decision to quit. Was it his children? Was it his wife? Or was it his health? He says, “I tried quitting cigarettes a few times before finally succeeding. Before that, I couldn’t last more than 1 or 2 days before the overwhelming urge to smoke took over.”

Things stayed the same with Keo trying to quit smoking once every few months due to nagging from his family or urging from friends. This constant trial-and-failure cycle is a typical trait of those looking to quit smoking. According to the US Centers for Disease Control and Prevention (CDC), a smoker tries to quit between eight and 10 times before succeeding. However, a 2016 Canadian study says it could take a smoker almost 30 trial-and-failure cycles before finally winning the fight against smoking.²

Things remained pretty much the same until one day, Keo got fed up of failing and told himself, “I WILL quit this time.” Instead of going cold turkey or cutting down on cigarettes like he did previously, Keo decided to use a nicotine patch. He approached a pharmacist near his home and received some counselling on how to use them.

The first time he put the patch on, Keo discovered he was feeling nauseous and dizzy. “I thought I was sick,” he says. However, the patch worked, and he didn’t feel the urge to smoke at all. The symptoms went away gradually over the next few days and he used the patch for 2 weeks.

After 2 weeks, Keo cut the patch into two, effectively halving his dose. This is not recommended, as suddenly halving the nicotine dose could trigger an urge to smoke. Ideally, he should have purchased the patch with a slightly lower dose to reduce the risk of smoking relapse. Luckily, Keo did not face this problem. Again, he wore the patch, this time closer to 3 weeks. When he felt he was ready, he again reduced the dose by half. At the end of 2 months, he could go without cigarettes and even without the patch!

It was the happiest he had been for a long time. There was a sense of achievement and overwhelming pride that he no longer needed to subject his new family (he had just settled down and had a baby by then) to secondhand smoke exposure. He says, “Remember, the decision to quit must come from yourself. Until you make that decision, the urging and nagging by others won’t work.”

It is an addiction

More evidence is emerging that a lot of our vices is the result of an imbalance in our brain’s chemicals. Cigarettes contain nicotine and many other chemical compounds. While we tend to think nicotine is the only addictive substance found in cigarettes, a 2007 study discovered that many additives in cigarettes enhance the addictive nature of nicotine and some mask the side effects, thus making it more pleasurable to the smoker.⁶ In the study, the scientists arrived at the conclusion that “documented cigarette additives have pharmacological actions that camouflage the odour of environmental tobacco smoke from cigarettes, enhance or maintain nicotine delivery, could increase addictiveness of cigarettes, and mask symptoms and illnesses associated with smoking behaviours.” 

It is, therefore, no wonder that smoking is so hard to quit once a person begins. Of course, one could say that smokers shouldn’t have started smoking in the first place, but we all make mistakes. The most important thing to do now is to focus on what can be done to help a smoker should they decide to stop.

While the nicotine patch is a commonly used smoking cessation tool, there are other options out there. Another example is the nicotine chewing gum. For some smokers, the action of putting cigarette into the mouth is a harder habit to break than the actual act of smoking. The act of chewing gum can help to attenuate this condition and also prevent the weight gain associated with this behaviour.

If both the patch and gum are not helping, there’s also the option of taking a pill known as varenicline. This is a prescription medicine and may affect the mood of the person. This is because it affects the reward pathways of the brain, preventing one from getting any pleasure from smoking. One should seek a doctor’s advice before embarking on this option.

Smoking and cancer are definitely linked

When a cigarette burns, it releases 5,000 to 7,000 chemicals, of which about 60 are known cancer-causing agents. Apart from nicotine, these include tar, ammonia, acetone, methanol, butane, and hexamine.^3,4

We often think about lung cancer when talking about smoking. However, there are many other cancers which are linked to cigarette smoke. These include cancers of the mouth and throat; oesophagus, colon and rectum; bladder, kidney, stomach, and cervix. If we think about it, the chemicals from cigarette smoke stay in our mouth and as we swallow, they pass through the throat, into the stomach and come into contact with every part of our digestive system. Those of us who don’t smoke can always tell if the person using the toilet before us is a smoker based on the smell left behind after they urinate.⁵

Relapse

Just like any other addiction, a person who has quit smoking can relapse and pick up cigarettes again. Some people ‘slip’ during their journey to smoking cessation. This means the person sneaks a cigarette or a puff. This isn’t considered a relapse. Relapse refers to a return to regular smoking.⁷

It is important not to be judgmental about smokers who relapse. If you’re a smoker, remind yourself that this is a temporary setback and don’t look at yourself in a negative light. Remember that it is a battle with addiction and many battles will have to be fought before the war can be won. Even before a person starts his or her smoking cessation journey, it is helpful to know what happens should a ‘slip’ or relapse occur.

Did you know?

The nicotine patch does come with its own set of problems. Some side effects users often face include skin irritation, nausea, headache, vomiting, and diarrhoea. These symptoms are usually manageable and can be acceptable if the user is mentally prepared and properly counselled.

Did you know?

Lung cancer is the most common cancer occurring in men and the third most common in women. Approximately 2 million people were diagnosed with the disease in 2018.

Did you know?

Your risk of developing lung cancer takes many years to return to normal after stopping smoking? In total, it takes about 15 years before the risk of developing lung cancer drops to that of a person who has never smoked.⁸ HT

References:
1.https://www.who.int/tobacco/quitting/benefits/en/

2. Chaiton, M., et al. (2016). Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open;6:e011045.

3. Cancer Research UK. What’s in a cigarette? Retrieved from https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/smoking-and-cancer/whats-in-a-cigarette-0.

4. Irish Cancer Society. What’s in a cigarette? Retrieved from https://www.cancer.ie/reduce-your-risk/smoking/health-risks/whats-in-cigarettes#sthash.zAwkOexD.dpbs.

5. Siegel, R.L., et al. (2015). Deaths Due to Cigarette Smoking for 12 Smoking-Related Cancers in the United States. JAMA Intern Med;175(9):1574–1576.

6. Rabinoff, M., et al. (2007). Pharmacological and chemical effects of cigarette additives. Am J Public Health;97(11):1981–1991.

7. Smokefree.gov. Slips & Relapses. Retrieved from https://smokefree.gov/stay-smokefree-good/stick-with-it/slips-relapses.

8. World Cancer Research Fund. Lung cancer statistics. Retrieved from https://www.wcrf.org/dietandcancer/cancer-trends/lung-cancer-statistics. 

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