Addiction Medicine Certificate Course by Muktaa Charitable Foundation Course Material by Dr Narayan Perumal Lecture conducted at Aga Khan Palace More material on Fullnasha.com

1. Types of smokeless tobacco
• Chewing pan with tobacco
• Mishri– dried tobacco leaves are roasted
• Gutkha
• Dried tobacco – areca nut(betel nut) products
• Sucking on dried tobacco with chuna
• ( known as chew, dip , snuff, spit tobacco)

2. Chaini khaini
Snuff (moist tobacco) Found in pouches like tea
bags.
Pouches are easy to hold in the lower lip
(also known as ck – calvin klien) by users.
Rs 10 a pack.

3. Chaini
khaini

4. Pan masala
• Non carcinogenic ----thats why it doesnt have
a warning on the pouch.( however acts as an
irritant and may cause cancer)
• Mixed with tobacco for flavor
Is usually stapled with tobacco pouches and
sold together
Eg)
Goa pan masala and gutkha

6. Goa gutkha
• Goa gutka is more harsh, made of areca nut,
tobacco, catechu, paraffin wax, slaked lime
and some flavor... gives a stronger buzz kind
of feeling.( was first promoted as a mouth
freshner)
• Found in light brown to white in color.
• Goa gutkha is sold with Goa panmasala.

8. gaichap
• Used by the very poor class(blue collared )
• Mixed with chuna

9. Baba
• Rs 340 a can
• usually eaten by the higher class
• very strong, a strong buzz
• Also known as the cuban cigar of tobacco
• Baba 140
• Baba 160

10. TOBACCO
Chewing tobacco takes a little LONGER to reach
the brain (25 to 30 mins)
tobacco kept in the cheek area
Absorbed by gums
bloodstream brain

11. The start of using tobacco
• To ease bowel movement
• Stay alert
• Weight loss
• Anti depressant
• Peer pressure
• Increased concentration

12. Severity!
The Person usually sleeps with the snuff or
the tobacco mix in the mouth
• Uses it even in family outings and social
gatherings like marriages
• No of yrs used.
• Stains on clothes, smelly clothes

13. Severity
• Less than 2 finger mouth opening
• Grade 3 staining of teeth
• Excess Salivation---- due to slaked lime
mixture
• Gum disease , burning sensation
• Unhealing wound
• Rough White patch or rough red patch in the
area where tobacco is kept.

14. Fagerstrom test
• F--- how soon after you are FRESH do you use
the FIRST dip?
• 5 mins -----3 points
• 6-30 mins-----2 points
• 31-60 mins---1 point
• After 60 mins-0 points

15. Fagerstrom test
• How often do you swallow tobacco juice?
• Always-------2 points
• Sometimes--1 point
• Never --------0 points

16. Fagerstrom test
• Which chew would you hate to give up?
• the first one in the morning----1 point
• Any other------0 points

17. Fagerstrom test
• How many cans /pouches/satches per week
do you use?
• More than 3-----2 points
• 1 to 3 ------1 point
• 1 ------0 points

18. Fagerstrom test
• Do you chew more frequently during the
first hours after waking up?( than rest of the
day?)
• Yes ----1 point
• No -----0 points

19. Fagerstrom test
• Do u still chew it when you are very ill ,that
you are in bed most of the day?
• Yes-----1 point
• No---- 0 points

20. Score Diagnosis
Fagerstorm test score
• Score More Than 7
•
• Score Of 4 - 6
•
• Score Less Than 4-
Patient is a ...
• Heavy user
• Moderate user
• Less dependent

21. 5 A approach
• Ask== tumhala tambaku, smoking chi saway ahe
ka kinwa hoti ka?
• Assess==how severe is the dependence?
What stage is the person in?
(contemplation, denial, action phase)
Has he quit before? When? For what duration
was he tobacco free?
Why did he slip?
• Advice ==use the word CONCERN instead of
irritate. No lecturing( docs have a higher
tendency to lecture )

22. 5 A Approach
• Advice== ask open ended questions (how,
when & why), hobbies, Ask the pt what
concerns him about the addiction? Or letting
go of tobacco.
• Assist == help them by counselling or by
pharmacotherapy..
• Arrange === a follow up on 3 rd day, give
extra nicotine gum on 3rd
day

23. HOW TO HELP?
• Counselling
• Pharmacotherapy
• Cold Turkey Method--- sudden quitting .

24. How Will Withdrawal Feel
While On Tobacco After Quitting
Easy Bowel Difficulty To Empty Bowel
• Alert Restless /Impatient
Concentration Concentration
• Weight Loss Weight Gain, Hunger
• Relaxed Irritable , Disturbed Sleep

25. How to help?
• Set up a quit date with them in the next 2 weeks
after pharmacotherapy esp on days like hanuman
jayanti, kids birthday, Ramzan, wedding
anniversary .
• Let Them Declare to their friends and family that
he is quitting.
• Avoid places things and ppl that trigger him of
smoking.(CUE)

26. How to help ?
• Let them take one day at a time.
• Cravings will last only upto 2 mins each time
• Ask them to carry cardamom, chewing gums,
clove each time in their mouth.( eat pungent
food to increase salivation)
• Keep hands busy with washing clothes,
utensils, watering plants, prayer beeds.

27. How to help
• Remove tobacco packets & LIGHTERS from
toilet and cars or bike compartments.
• Clean wallets and pockets.
• Wash all stained clothes to remove the smell
• Yoga & meditation & kirtan.
• Let them know about withdrawal symptoms.
• Reward themselves with the money saved.

28. How to help
• GET OUT OF ROUTINE
• Early morn drink 2 glasses of water instead of
smoking
• Wake up early than usual n do yoga.
• Rinse with a mouthwash or brush immediately
after meals.

29. Tips
• 4 D’s
• Delay for few minutes
• Distracting yourself
• Drinking water
• Deep breathing

30. Thankyou.
Dr Prineet Kekan
MANAGING DIRECTOR – CLEAN ROOM
Find us on Facebook
9657708584
prineetkekan@gmail.com