H o m e o p a t h i c S c o p e i n t o b a c c o
d e - a d d i c t i o n i n re f e re n c e
E c o l o g i c a l ,
E n v i ro n m e n t a l , S o c i a l &
H e a l t h H a z a r d s o f To b a c c o U s e
DR CHANDER MOHAN-
CMO(H) DTE OF AYUSH
WHY HOMOEOPATHY FOR TOBACCO ADDICTION?
Homeopathic remedies can give an enduring cure, physically, mentally and
Homoeopathy treat body as a whole, not single part of body or mind, which is
diseased (addicted). The detailed Homeopathic history taking will also
contribute in counseling which is a significant element of effective treatment in
Homoeopathy is a scientific mode of treatment that works on fixed principles.
Homoeopathy individualizes each and every case and as no two individuals
are alike, every case is taken individually and completely. This pathy has no
proven adverse side effects.
Common side effects seen in smokers using NRT are similar to nicotine
withdrawal symptoms. These include dizziness, drowsiness, headache,
irritability, sleep disturbances, vivid dreams, mild hallucinations, and
Homoeopathic medicines are non-addictive in comparison to NRT’s.
Any age & sex group can take the help of homoeopathy for quitting. NRT is
not to be used in special populations (pregnant women, light smokers,
adolescents and smokeless tobacco users).
Homoeopathy helps in quitting by producing distaste & aversion to
particular drug substance.
Homoeopathic medicines reduce the number & severity of withdrawal
symptoms and help in build motivation to defy our vulnerability,
substitute addictive activities with positive and rewarding behaviors, and
safely manage the symptoms of withdrawal associated with
quitting. Quitter can tolerate the withdrawal symptoms very well while
on homoeopathic treatment. By this he/she can achieve the target of
quitting easily and early.
Homoeopathy can also handle, tackle & treat the majority of bad
conditions arises from the substance abuse.
Homeopathic remedies support and re-vitalize the brain and nervous
system, enhances the immune, improve concentration levels, mental
clarity, memory and systemic circulation, thus, maintaining health and
More over in India this system is easily approachable & cost effective.
A scenario exercise conducted by the Indian
Institute of Forest Management, Bhopal estimated
that the historical use of fuel-wood between 1962
and 2002, for tobacco curing and manufacture of
cigarettes and other smoking consumables, has
destroyed and degraded 680 sq. km of forests, or
nearly 868 million tones of wood through
In calorific terms, the wood energy lost is enough
to run a thermal power plant to provide electricity
to Delhi and Western Uttar Pradesh for an entire
The production of cigarettes is very damaging to
It is estimated that one tree is consumed for
every 300 cigarettes produced.
Considering 5.6 trillion cigarettes are produced
annually worldwide, tobacco devours about
18.6 billion trees every year.
Filter-tipped cigarette butts are
toxic especially for marine life
even just one cigarette butt
alone soaking in water for a day
is hazardous enough to kill 50%
of fish in a litre of water.
A cigarette butt contains about 165 toxic chemicals.
95% of cigarette filters are made of cellulose acetate, a
thermoplastic formed by the reaction of cellulose, acetic
acid and acetic anhydride that is slow to degrade in the
It take 18 months to 10 years for the filter to degrade.
When placed in large bodies of water like oceans, the
toxins of the cigarette butt are harmful to marine life
Cigarette butt filters trap the dangerous by-products of smoking by
accumulating particulate smoke components and 165 toxic
chemicals. These chemicals leach into the environment:
Arsenic used in rat poison
Acetic acid in hair dye and photo developing fluid
Acetone main ingredient in paint thinner and nail polish remover
Ammonia a typical household cleaning fluid
Benzene found in rubber cement
Butane cigarette lighter fluid
Cadmium found in batteries and artist’s oil paints
Carbon Monoxide a poisonous gas found in car exhaust
Formaldehyde used to embalm dead bodies
Hexamine in barbecue lighter fluid .
Hydrazine used in jet and rocket fuels
Hydrogen Cyanide used as a poison in gas chambers
Lead a highly poisonous metal
Naphthalene used in explosives and moth balls
Nitrobenzene a gasoline additive
Phenol used in disinfectants and plastics
Polonium-210 a highly radioactive element
Stearic acid found in candle wax
Toluene found in embalmer's glue
What Makes Plastic pouch Harmful to the
Plastic pouches for gutkha are made of various chemicals
which are mainly toxic & very harmful to the human
health and the environment.
The chemicals used to make plastic bags are xylene,
ethylene oxide and benzene. These toxic chemicals are
sources of various diseases & disorders in humans.
They also provide negative effects on the water, air &
Plastic pouches are among the items
that are non-biodegradable. or, in
simpler terms, they do not decay.
Do you know that it takes thousands
of years before one plastic bag/pouch
can turn into small particles?
Tobacco contributes to Deforestation in
Forests cleared for cultivation of tobacco,
Fuel wood stripped from forests for
Forest resources used for packaging of
tobacco, tobacco leaves,cigarettes, etc.
Approximately 2 lakh hectare of forests/woodlands are removed
by tobacco farming each year.
Trees from a hectare of land may be needed to cure 1 tone of
An average of 7.8 kg of wood is needed to cure 1 kg of tobacco.
One acre of tobacco plants displaces 150 trees. For cigarette
paper and packaging 80 more trees are needed. Since high-
quality card paper used to make cigarette boxes and cartons are
not recycled, an additional loss of 20 trees occurs.
One acre of tobacco plants displaces 250 tress
Fertility of the soil
Tobacco growing depletes soil nutrients at
a much faster rate than many other crops,
thus rapidly decreasing the fertility of the
Tobacco plants do not offer much
protection to top soil from eroding agents
such as wind and rain.
Tobacco plant depletes nutrients at a heavy rate, so it
requires regular inputs of chemical fertilizers.
Tobacco depletes the nitrogen, phosphorus and
potassium in soil at higher rates than any food crop
and, in most cases, higher than cash crops such as
coffee, tea and cotton.
It is particularly potassium-hungry, absorbing up to six
times as much as other crops.
Tobacco when grown singly was the most erosive crop,
causing a loss of 45 kg of top soil on every acre per year.
In comparison, cotton crop lost 7.5 kg, grapes about 11 kg
and groundnut 12.5 kg. 15
Erosion of soil does not only mean the loss of a
large volume of soil but also includes the loss of
selective nutrients and organic matter that deposit
on the top layers at a greater frequency.
Due to this, the lower layers get exposed to
eroding agents and lose their fertility, and
therefore become prone to erosion in rapid
succession. As a result of soil erosion, water
retention in the soil becomes poor.
Planting a single crop for several successive seasons is the
cause of local biological diversity. Conversion of forests to
tobacco farms caused the local disappearance of several
animal and plants species.
Another measure of biodiversity loss is the collapse of the
food web, thereby destabilizing the predator-prey
relationship. It is most acutely seen in the insect and
small rodent population, which lives in the forest fringes.
Tobacco engages the land for a longer period than other
Tobacco is a sensitive plant prone to many diseases, especially
during early growth. It therefore requires huge chemical inputs:
up to 16 applications of pesticide are recommended during
Such chemicals may run off into water bodies, contaminating local
water supplies. High levels of pesticide use may also lead to the
development of resistance in mosquitoes and flies.
Frequent contact with and spraying of chemicals and storage of
tobacco in residential premises of farmers have adverse health
Pesticide for tobacco crop & its Health Hazards
Aldicarb, One of the most acutely toxic pesticides. Less than 1000th of an ounce is a lethal
dose for humans. It causes chronic damage to the nervous system, suppresses the immune
system and adversely affects fetuses. In human cells, aldicarb causes genetic damage. Also
causes damage to hearing, vision, the kidneys and liver, and is both carcinogenic and
Telone -A highly toxic soil fumigant that causes respiratory problems, skin and eye irritation,
and kidney damage.
Chlorpyrifos has chronic neurobehavioral effects such as persistent headache, blurred vision,
unusual fatigue or muscle weakness, and problems with mental functions including memory,
concentration, depression and irritability.
Acephate is a carcinogen and have mutagenic effects and reproductive toxicity.
Imidacloprid, acute effects of exposure are difficulty in breathing, loss of the ability
to move, staggering, trembling and spasms. Exposure may causes thyroid lesions.
Thiamethoxam is a carcinogen.
Acephate is a carcinogen. Acute exposure causes dermal and inhalation toxicity. It is
also an eye irritant.
Endosulphan affects the kidneys, developing fetus and liver. It is immunosuppressant
& mutagenic, decrease in the quality of semen, increase in testicular, prostate and
breast cancer, and increase in defects in male sex organs.
Methomyl is a possible carcinogen.
Carbendazim is a possible human teratogen.
Monocrotophos It affects the central nervous system.
Bordeaux mixture is corrosive to the mucous membranes and cornea. Causes
irritation of the skin, eyes and respiratory tract. Has a metallic taste and causes
nausea, vomiting and stomach pain.
Ziram adversely affects the reproductive system and also causes endocrine
Ridomyl It is a possible human teratogen may cause birth defects.
Carbendazi is a potential human hormone-disrupting chemical and reduces the
sperm count and affects the development of the testicles.
Basamid Causes eye irritation and may cause irritation of the skin and mucous
Oxydemeton methyl is a possible carcinogen
Calyxin adversely affects the reproductive system and also causes endocrine
Tobacco is heavily dependent on fertilizers,
its application causes excessive leaching,
including that of nitrogen and potassium.
Depending on the soil type, anywhere
between 80 and 200 kg of chemical fertilizers
are applied per acre before transplantation.
Tobacco displaces the indigenous
flora and fauna and will thus
gradually become a source of pests
for other crops.
It leads to collapse of the food web,
thereby destabilizing the predator-
In India, according to a report by
an advocacy group, Global March
against Child Labour, New Delhi,
an estimated 20,000 children work
in tobacco farms and another
27,000 children work in beedi
making or packing cigarettes.
The child-laborers complained of low pay, long hours as
well as physical and sexual abuse by their supervisors.
They also reported suffering from “green tobacco
sickness,” a form of nicotine poisoning. When wet leaves
are handled, nicotine from the leaves gets absorbed in the
skin and causes nausea, vomiting, dizziness, & rashes.
Children were exposed to 50-cigarettes worth of nicotine
through direct contact with tobacco leaves. This level of
nicotine in children can permanently alter brain structure
Economic Cost of Tobacco use
The cultivation of tobacco is economically inimical to
the countries that produce it, especially those that are
still developing. When resources are put into tobacco
production, they are taken away from food
production. Large amount of firewood, that could be
used domestically for fuel and heating, are instead
used for the curing of tobacco. A large percent of the
profits from tobacco production go to large tobacco
companies rather than local tobacco farmers.
Direct medical costs of treating tobacco related
diseases in India amounted to 907 million $ for smoked
tobacco and 285 million $ for smokeless tobacco.
Indirect morbidity costs of tobacco use, which includes
the cost of caregivers and value of work loss due to illness,
amounted to 398 million $ for smoked tobacco and 104
million $ for smokeless tobacco.
The total economic cost of tobacco use amounted to
1.7 billion $. Tuberculosis accounted for 18% of tobacco-
related costs (311 million $) in India.
Of the total cost of tobacco, 88% was related to men.
The total economic cost of tobacco-use in India for
2004 was 1.7-billion$, which is 16% more than the
total revenues collected from all tobacco products in
Tobacco-related direct costs accounts for 4.7% of
India’s total national healthcare expenditure in 2004
Social effects of tobacco
WHO emphasizes the rate of tobacco consumption especially in developing countries like
India as an epidemic
Medical researchers have found that smoking is a predictor of divorce. Smokers have
53% more divorce than nonsmokers
Second hand smoke --- passive smoking constitutes the social problem.
Person who are taking tobacco are more prone to start other addictions like alcohol,
ganja, bhang etc and also may attracts towards gambling and other anti social
It may pass from generation to next generation* and from family to society and thus
become social problem.
Now the person start thinking of tobacco use, because of family & social exposure , in
this way cycle repeats again & again . In this way personal problem becomes social
*If father is smoker then he can’t ask his son to stop smoking
*Increased nicotine receptors noted in baby's brain ( effects of maternal smoking)
Smokers have a sense of low-
self esteem. Usually they do not
have a sense of self-worth, they
mostly have dysfunctional
families and this is the possible
source of social issue.
H a z a r d t o H o m o e o p a t h y
Tobacco intake during the course of treatment
especially in chronic diseases may act as a Obstacle
Considering the minuteness of the doses in
homoeopathic treatment, we can easily understand that
during the treatment everything must be removed from
the diet and regimen which can have any medicinal
action, in order that the small dose may not be
extinguished or disturbed by any foreign medicinal
Health Hazards In
reference of Tobacco Use
The toxic effects of tobacco
Tobacco is the only legally available consumer
product that kills people when it is used directed.
Tobacco addiction, which is the foremost cause of
preventable death in the world today by causing a wide
range of major diseases which impact nearly every
organ of the body.
Tobacco use is the second leading cause of death, &
fourth leading cause of disease.
Globally, tobacco is responsible for the death of 1 in
10 adults (about 5 million deaths each year)
The leading causes of death from smoking were found to be
Cardiovascular diseases (1.69 million deaths), COPD (0.97
million deaths) and Lung cancer (0.85 million deaths).
Fifty per cent of unnecessary deaths due to tobacco occur in
middle age (35-69 years), robbing around 22 years of normal
By 2030, it is estimated that the number of premature
deaths attributable to tobacco would double to 10 million
deaths every year, with about 7 million of the deaths taking
place in developing countries.
Overall, smoking currently causes about 7 lakhs deaths
per year in India according to WHO.
Among people alive today in the world, about 500 million
would die prematurely due to tobacco use; most of these are
children and young adults of today.
At least one death every minute from tobacco in
India.50 Lakh deaths in world every year due to the use
of tobacco, this figure will be double by 2020.
In India about 40% health related disease are
because of tobacco.
One in two lifetime smokers will die from their habit.
Half of these deaths will occur in middle age.
Tobacco smoke contains over 4,000 different
chemicals. At least 43 are known carcinogens (cause
cancer in humans).
The primary risks of tobacco usage include many forms
of cancer, particularly lung cancer, kidney, head and neck,
breast cancer, bladder, esophagus, pancreas, and stomach.
Increased risk of myeloid leukemia, squamous cell Sino
nasal cancer, liver cancer, cervical cancer, colorectal cancer
after an extended latency, childhood cancers and cancers of
the gall bladder,pancrease, adrenal gland & small intestine.
Cigarette smoking accounts for at least 30% of all
Smoking is responsible for about 87% of lung cancer
deaths. Lung cancer is the leading cause of cancer death in
both men and women. 37
A smoker (avg. 4 cigarettes) is 4 times more likely to
have heart attack than someone who never lights up. The
risk goes up to 9 times for a heavy smoker (more than 10
Tar coats your lungs like soot in a chimney and causes
A 20-a-day smoker breathes in up to a full cup (210 g)
of tar in a year.
The top five cancers in men are all tobacco-related
cancers: of the lung, oral cavity, larynx, oesophagus &
pharynx. In women, the leading cancer sites include those
related to tobacco: cervix, oral cavity, esophagus & lungs.
Male smokers lost an average of 13.2 years of life
Female smokers lost 14.5 years of life because of smoking.
WHO concluded that nonsmokers are exposed to the same
carcinogens as active smokers. Side stream smoke contains more
than 4,000 chemicals, including 69 known carcinogens.
Passive smoke contains numerous chemicals that are poisonous;
passive smoking is harmful especially to children. These toxic
chemicals also stick to clothes, furniture, walls and inside your car.
Teenagers are known to be impulsive, but a new study
suggests that if they use tobaco, they might become even more
reckless & less able at making decisions.
Nonsmokers who are exposed to secondhand smoke at home or
work increase their lung cancer risk by 20–30% & heart disease risk
According to WHO, passive smoking increases a child’s risk of
developing heart disease and cancer as an adult. In some children, it
may also be a contributing factor in learning and language
difficulties as well as behavioral problems.
Second hand smoke causes 30 times as many lung cancer death as
all regulated pollutants combined.
The Environment Protection Agency (EPA) has classified
secondhand smoke as a Group A carcinogen.
In crowded restaurant, second hand smoke can produce 6 times the
pollution of a busy highway.
Eating lots of vegetables and fruits, losing weight and exercising
regularly have little benefit on health if you do not stop tobacco use.
WHO estimates that of 1000 tobacco users today, 500 will die of
tobacco related disease, 250 of them in their middle age.
In India tobacco related death shoot up from 1.4% in 1990 to 13.3 %
Toxicology:. 40–60 mg (0.5-1.0 mg/kg) can be a lethal dosage for
adult humans. Nicotine therefore has a high toxicity in comparison
to many other alkaloids such as cocaine.
Global studies show the association between
active and second-hand smoking, and Cardio
vascular disease (CVD), cerebro-vascular stroke,
peripheral vascular disease and sudden cardiac
CVD-related deaths in India are expected to
rise from about 3 million in 2000 to 4.8 million in
2020. By 2020, about 42% of the total deaths in
India are projected to be due to cardiovascular
In India, COPD affects over 5% of males and 2.7% of females
who are over 30 years of age. Till date, smoking remains the
most important causal factor for COPD.
Tobacco smoking is responsible for over 82% of COPD,
which accounts for about 12 million adults suffering from
smoking-related COPD in India.
Exposure of non-smokers, especially children and women, to
second-hand smoke from others is an important cause of
respiratory infections, worsening of asthma and poor lung
Smoking more than 20 cigarettes a day
increases the risk of tuberculosis by two to
Two million individuals die each year of TB.
Mortality from TB is three to four times
higher in ever-smokers than in never-smokers.
Smoking harms the sexual and reproductive
health of both men and women from puberty
through young adulthood and into middle age.
Men who smoke have a lower sperm count and
poorer sperm quality than non-smokers.
The effects of maternal smoking during pregnancy leads
Decreased foetal growth & low birth weight,
Spontaneous abortions, foetal deaths,
Pregnancy complications including those that predispose to
preterm delivery, and long term effects on the surviving children.
Birth defects, e.g. Congenital limb reduction.
Increased nicotine receptors noted in baby's brain.
Fetal death rates are 35% higher among pregnant women who
smoke cigarettes than among non-smokers.
Tobacco use in any form, either smoked or
smokeless, can cause a wide spectrum of oral
Precancerous lesions include leucoplakia &
The dramatic increase in Oral sub mucosal
fibrosis (OSMF) among young people in India
has been attributed to chewing gutka and paan
Smoking is one of the leading risk factors that can
lead to End Stage Renal Disease (ESRD).
Medical researchers have found that smoking is a
predictor of divorce. Smokers have 53% more divorce
The usage of tobacco also creates cognitive
dysfunction, which includes: increased risk of
Alzheimer's disease and decline in cognitive abilities,
reduced memory & cognitive abilities in adolescent
smokers, Risk of brain shrinkage (Cerebral atrophy)
is also high.
Risk of Passive Smoking to children:
Cancers, Sudden infant death syndrome (SIDS),
Lung infections , More severe illness with bronchiolitis
Increased risk of developing tuberculosis if exposed to a
carrier, Prone to various allergies,
Low immunity, takes more time for recovery
Learning difficulties, developmental delays, and
Neuro cognitive problems.
An increase in tooth decay has been associated with
passive smoking in children,
Increased risk of ENT infections. 49
Passive smoking kills over 6 lakhs people, including
more than 1.65 lakhs children under five, every year in
The Lancet in 2010 is the first to estimate worldwide
impact of passive smoking. It found more than half of
the deaths are from heart disease, followed by deaths
from cancer, lung infections, asthma and other
"Children's exposure to second-hand smoke most
likely happens at home,“
Smoking by either parent, particularly by the mother,
increases the risk of asthma in children. 50
•Animals like dogs, cats, squirrels, and other
small animals are affected by not only second-
hand smoke inhalation, but also nicotine
•Filter-tipped cigarette butts are toxic
especially for marine and fresh-water fish even
just one cigarette butt alone soaking in
water for a day is hazardous & enough to
kill 50% of fish in a litre of water.
References from literature mentioning that Homoeopathic
medicines are capable for reliving the tobacco addiction and
its consequence's , some of these are :
Caladium Modifies craving for tobacco . Materia Medica by William Boericke,
Plantago Major. Causes an aversion to tobacco. Depression and Insomnia of chronic
Nicotinism. Materia Medica by William Boericke.
Nux Vomica : Desire stimulants, Materia Medica by William
Boericke. Person addicted to stimulants , EB Nash:Leaders in Homoeopathic
Tabacum : Relieves terrible craving when use is discontinued . H.C.Allens Keynotes,
Materia Medica S.K Dubey.
There are several other references in the homoeopathic literature for the treatment of
tobacco related ill effects. Some of them are from Materia Medica (William Boericke ,
S.K Dubey, H.C.Allens Keynotes, ) ,Therapeutics (Dewey) and Repertory (Kent’s) are:
o For ailments from tobacco chewing – Arsenic album.
o For hiccough from tobacco chewing – Ignatia.
o For excessive nausea & vomiting – Ipecac .
o For impotency caused by tobacco smoking – Lycopodium.
o For palpitation, tobacco heart & sexual weakness – Phosphorus.
o For tobacco dyspepsia, neuralgia & chronic nervousness – Sepia.
o For occipital headache & vertigo from excessive smoking –Gels.
o For vertigo from excessive use of tobacco -Conium.
o For tobacco toothache – Clematis & Plantago.
o For cough excited by tobacco smoke – Staphysagaria & Spongia.
o Craving for tobacco – Staphysagaria.
Drug Addiction and its side effects- A Homeopathic Approach, (ISBN: 81-
8056-886-5) published by B Jain publishers, New Delhi, by Dr Muhammad Rafeeque.
Addictive personality: Carc, lach, med, nux.v, op, thuj.
Ailments after intoxication: Am.m, bry, caps, carb.v, cocc, coff, gels, laur, NUX.V,
OPIUM, puls, spong, stram.
Ailments from indolence and luxury: Carb.v, helon, nux.v.
Besotted expression: Ail, BAPT, bell, bry, bufo, cench, cocc, crot.c, crot.h, gels, lach,
led, mur.ac, nux.m, op, sol.ni, stram.
Disposition to become a criminal, moral feeling wanting: Ars, bell, hep, lach,merc.
Gambling, passion for gambling: Ars, bell, calc, caust, chin, lyc, merc, nux.v, sulph,
Intoxicated easily: CON, naja, zinc.
Chapter Toxicity in Murphy’s Repertory is unique in that this
chapter is not present in Synthesis, Kent, Boenninnnghausen’s or
Rubrics related with alcohol, drugs, chemicals, poisons, tobacco
& vaccinations are included in Toxicity Chapter.TOBACCO,
agg: ARS, IGN, NUX-V, PLAN, PULS, SPIG, SPONG, STAPH.
ailments, from: CALAD, NUX-V.
aversion, to tobacco: CALC, IGN, NUX-V, PULS.
aversion, to smoking: IGN.
chewing agg: ARS.
desire for, smoking: CALAD, TAB.
headache, from smoking: IGN, NAT-A.
nausea smoking after: IP, NUX-V.
CIRCULATORY SYSTEM - Heart - Palpitation - Cause - Tobacco
agar. ars. cact. Gels. nux-v. stroph-h.
RESPIRATORY SYSTEM - Cough - Aggravation - Tobacco smoke
menth. merc. spong. Staph.
NERVOUS SYSTEM - Sleep – Tobacco
NERVOUS SYSTEM - Nervous affections - From - tobacco, in sedentary
persons; dyspepsia, right prosopalgia
GENERALITIES - Complaints, abuse of - Tobacco
Abies-n. Ars. calad. calc-p. camph. chin. chinin-ar. Coca Gels. Ign. Ip. kalm. lyc.
mur-ac. Nux-v. Phos. Plan. plb. Sep. Spig. staph. tab. verat.
GENERALITIES - Complaints, abuse of - Tobacco, in boys
arg-n. ars. verat.
Treatment Three effective components of tobacco cessation treatment: medicinal
support, social support (clinician-provided encouragement and assistance), and
problem-solving/skills training (focusing on achieving and maintaining abstinence)
Behavioral treatments employ a variety of methods to assist smokers in quitting,
ranging from self-help materials to individual counseling. These interventions teach
individuals to recognize high-risk situations and develop coping strategies to deal
Interventions that offer person-to-person contact (i.e., group or individual
counseling) provide a substantial treatment advantage over unassisted interventions.
In comparison to self-help interventions, the more time providers spend (intensity
level) with smokers in a treatment session, the higher the likelihood of cessation.
“Minimal/brief” interventions require little cost and/or time
from the intervener. There is strong evidence that patients who
are consistently advised by health care providers to quit
smoking are more likely to take steps to stop.
Interventions as short as 3 minutes may substantially increase
cessation rates. One common brief intervention designed for
health care providers is the “5 A” method, which involves the
Asking about tobacco status at each visit
Advising all tobacco users to quit
Assessing the patient's willingness to quit
Assisting the patient in quitting
Arranging for follow-up contact
Physician can assess a patient's readiness to quit using the trans-
theoretical model of behavior change. If the patient has not thought
about quitting or is considering quitting but not in the next few months,
they are in the Precontemplation/Contemplation stage. At this stage, the
provider can use motivational interviewing skills to help increase
readiness for cessation.
Physician can use the “5 Rs” to help enhance a patient's motivation to
Discuss why quitting is personally relevant.
Identify potential risks associated with tobacco addiction.
Identify potential rewards and benefits related to quitting.
Identify potential barriers or roadblocks that might impede the quitting
Repeat motivational interventions at each visit.
In general, patients at this stage are unlikely to benefit from advice-giving
as much as a non-threatening discussion of what is keeping them from
quitting at this time.
Patients who have made plans to quit or who are in the process of quitting
are in the Preparation/Action stage. These are the patients who will most
benefit from brief interventions such as:
Helping the patient identify a “quit date”
Asking the patient to elicit support from friends and family
Having the patient write down the reasons for quitting or coping strategies
Having patients remove tobacco products from their environment
Discussing coping strategies such as replacements (sugar-free gum, water)
and distraction (keeping busy, exercising)
Referring the patient to an intensive smoking cessation counseling program
Providing the patient with advice about remedial aid.
Relapse prevention is important for patients in the maintenance stage (those
who have quit smoking). Patients who quit smoking but relapse more than six
weeks later are not smoking to relieve withdrawal symptoms; their relapses are
caused by a desire to smoke (craving) induced by internal or external events
Physician at this stage can educate individuals in issues important in preventing
relapse, such as being aware of the potential impact of stressful events. In
patients who have never smoked, providing reinforcement and encouraging
continued abstinence can be effective strategies for prevention. In patients who
have relapsed, it is important to deflect guilt and self doubt with reminders about
the frequency of relapse and the need for a renewed commitment to abstinence.
Consistently working with patients on tobacco cessation increases the chances of
Scheduled tobacco intake (smoking or eating tobacco) is a unique behavioral
approach that gradually weans smokers from their physiologic dependence on
nicotine without concomitant nicotine replacement. Smokers are instructed to
smoke on a fixed time schedule (eg, one cigarette at the beginning of every hour)
with gradually increasing inter cigarette intervals. In this way, individuals receive a
steady, although declining, dosage of nicotine independent of environmental cues
With the help of counseling the smoker handle the physical and emotional
side of giving up this addiction, it is also about understanding the
withdrawal. Counseling may be undertaken on an individual or group basis.
Counseling is far more effective than NRT, because with NRT you are still
putting this addictive drug into your body.
Medical research has shown that individuals who receive counseling are 4
times more likely succeed than by using any other method to stop smoking.
The combination of medication with counseling is more effective than
Repeated face-to-face contact in an individual or group.
Counseling is far more effective than NRT, because with NRT you are still
putting this addictive drug into your body. Medical research has shown
that individuals who receive counseling are 4 times more likely succeed
than by using any other method to stop smoking.
Self care measures for Nicotine addiction:
To rise above your weaknesses is easier said than done, and time and again
your attempts may fail. However, don’t be discouraged, the fact that you have
decided to quit even though you may falter means that you are half way
The choice and responsibility to quit is yours alone. Have desire to quit
1) Healthy diet. Poor nutrition combined with high consumption of saturated
fats, salt and alcohol, all increase a smoker’s risks of developing a serious
2) The cravings associated with the withdrawal of nicotine might be reduced
if the rate of excretion of nicotine through the kidneys is reduced. This is
possible when urine becomes more alkaline. Hence, increase the intake of
alkaline foods and decrease the intake of acidic foods. Milk products can be
taken as they have high calcium content in them and calcium is alkaline in
3) Exercise and practice relaxation techniques (Deep breathing
exercise/yoga/physical ) Listen to soothing music, go for a walk or get a
massage to curb the restlessness from the craving, squeeze a stress ball,
and have a work-out at the gym, go running, or phone a friend who can
4) Take deep breath and take some sips of water ,take a walk for few steps
and try to hold the urge of tobacco intake for 2-5 minutes, urge will vanish
.Just deviate your mind from the urge of tobacco. Wait out the craving.
5) Stay well hydrated.
6) Change your activity and friends (spend more time with non-smokers) to
overcome phases of Nicotine craving. Replace Addiction related activities with more
constructive and rewarding activities.
7) Avoid caffeine and other stimulants. Keep available things like Jaggery, Cardamom
,Ginger , Mishree, Toffee, Chocolate, Chewing-gum, Shauf etc
Develop a habit of saying “No” when offered. The more you refuse, the more you
will be testing your willpower and the easier it will become.
8) Request family and friends to support and encourage you in overcoming your
addiction by seeking and reinforcing your treatment.
9) Parents can help their obsessed children by educating them about consequences
of addictions, open communication and good role modeling can help.
10) Time to time fix a day when you could not consume tobacco for a whole day and
slowly increase the duration from one day to two days and keep on increasing.
11) Postpone each tobacco intake by 1hr.Do not buy in packs and not keep a stock.
Throw all tobacco related things (lighter, ashtray) from yourself.
12) Keep on comparing the bad effects of tobacco intake from good effects of
After 20 min blood pressure comes down to normal value.
Level of carbon-monoxide comes to normal after 8 hrs. Oxygen level returns to
In 1 month skin loses its gray tinge and becomes less wrinkled.
Within 3 months working capacity of lungs increases. Blood flow normal by 30%.
Within 9 months there is improvement in cough, symptoms of sinusitis, lethargy
and difficulty in breathing.
Within 1 year chances of Cardiac Disease reduces to minimum.
Within 5-15 years risk of Stroke reduces to minimum.
After 10 year risk of Lung Cancer is negligible.
13) Set a date & tell your quitting plan to family and friends.
14) Don’t afraid of Withdrawal Symptoms while thinking of quitting. Go ahead these
symptoms are caused as a person re-adjust to the physical and psychological
addiction to nicotine. Most withdrawal symptoms peak 48 hours after you quit and
are completely gone in six months.
Light headedness - less than two days
Interrupted sleep – less than one week
Craving – about two weeks
Irritability & aggression – less than one month
Depression / Restlessness – less than one month
Poor concentration – less than two weeks
Increased appetite – less than ten weeks
15) Regular Participation in anti-tobacco activities.
16) Take help from your family doctor.
Few reasons for quitting
You and your family will be healthy.
Life expectancy will be increase by 10 to 15 years
Financial gain, 20 Rs daily on tobacco means Rs 7200 yearly and Rs 72000 in 10 yrs
and by daily 40 Rs the amount will be 1.5 lakhs in 10 yrs. This amount can be use
for good education and marriage of your child or any other important work.
Also if you will get any tobacco related disease then again there is financial loss.
Tobacco quitting is good for your environment and society.
If you are not consuming the tobacco then there is chance that your child will not
get attracted towards tobacco because parents are role model for there
Peace full environment at home.
• www.personalityresearch.org/ papers/ beystehner.html
• Hahnemann, Samuel. Organon of Medicine, 6th edition, Translated
• with Preface by William Boericke, B. Jain Publishers (Pvt.) Ltd., New Delhi.
• Life of Smoking Women: My Doctor 2008; 16(2):13-14(7656); effect of smoking on atopic
predisposition & sensitization to allergens.
• The Lancet: 365 (9471) 2005 1629-35(3120); smoking cessation & lung infection.
• The Lancet: 365 (9474) 2005 1855(3115); on giving up smoking.
• The Lancet: 365 (9474) 2005 1849-54(3114); free nicotine patches.
• Indian Journal of Chest Disease: 2006; 48(1):37-42(4082); tobacco smoking in India
DR CHANDER MOHAN
DISM&H GOVT. OF DELHI
DR CHANDER MOHAN (CMO-H) ,
DIRECTORATE OF AYUSH.
GOVT OF DELHI.