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Deaddiction Clinic

Deaddiction Clinic

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India is currently facing a 'Tobacco Epidemic'. As per the Global Adult Tobacco Survey 2010 more that 1/3rd of Indian Adults use Tobacco either as smokeless tobacco (26%) or as smokers (14%).

What is addiction?

It is a chemical change that occurs in the brain that makes the brain 'tolerant' to the ongoing use of a substance and causes 'withdrawal' symptoms when stopped. There are two types defined clinically:

  • Dependence or Regular use
  • Abuse or Harmful use

Why one needs to be aware?

Tobacco use is a risk factor for six of the 8 leading causes of death. In India, 8-9 lakh persons die every year due to tobacco related diseases like heart attacks, strokes, PVD causing gangrene, Chronic Obstructive Pulmonary Disease (COPD), emphysema, and cancer (particularly lung cancer, cancers of the larynx and mouth, and pancreatic cancers).

Tobacco and Nicotine Information
(Tobacco Free Initiative, National Tobacco Control Program, Govt. of India)

What are the common signs and symptoms?

The Fagerstrom Test for nicotine dependence is widely used as a screening test for the physical aspects of nicotine dependence. There are scales for both smoking and smokeless tobacco. Based on the score, the level of addiction can be low (score less than 4), medium (score 4-6) or high (score more than 6).

Fagerstrom Test For Smoking

1. How soon after you wake up do you smoke your first cigarette/bidi?
Within 5 minutes 3
6 to 30 minutes 2
31 to 60 minutes 1
More than 60 minutes 0
2. Do you find it difficult to refrain from smoking in places where it is forbidden?
Yes 1
No 0
3. Which cigarette/bidi would you hate to give up most?
The first one in morning 1
All others 0
4. How many cigarettes/bidis do you smoke per day?
10 or less 0
11-20 1
21-30 2
31 or more 3
5. Do you smoke more frequently in the first hours after waking up than during the rest of the day?
Yes 1
No 0

Modified Fagerstrom Test For Smokeless Tobacco Users

1. How soon after you wake up do you use your first dip/chew?
Within 5 minutes 3
6 to 30 minutes 2
31 to 60 minutes 1
After 60 minutes 0
2. How often do you intentionally swallow tobacco juice?
Always 3
Sometimes 1
Never 0
3. Which tobacco chew would you hate to give up most?
The first one in morning 1
All others 0
4. How many cans/pouches of tobacco do you use per week?
More than 3 2
Around 3-2 1
Less than 1 0
5. Do you chew tobacco more frequently in the first hours after waking up than during the rest of the day?
Yes 1
No 0
6. Do you chew tobacco when you are so ill that you are in bed most of the day?
Yes 1
No 0

Total Score for Level of Dependence:
6: High 4-6: Moderate Less than 6: Low

What are the various methods of management and prognosis?

1) Specialist Consultation to make a QUIT PLAN 2) Counselling and/or Therapy 3) Individually Tailored Medication plans:

Quit with a little help from stop smoking medicines. The first few weeks without smoking can be the hardest. This is when your body is fighting the physical addiction. This passes, but you might find stop smoking medicines helpful to get you through these early stages. Once the physical cravings pass you'll find it much easier to stay the course.

Increased Success
Nicotine replacement Therapy (NRT) gives your body the nicotine it craves without the toxic chemicals you get in cigarettes like cyanide or carbon monoxide, so it doesn't cause cancer. There are six types available: patches, gum, lozenges, microtabs, inhalator and nasal spray. All of them are available on prescription, or to buy over the counter. A full course of treatment usually lasts 10-12 weeks. It's suitable for most adults, but if you have a heart or circulatory condition, or are on regular medication, you should get the OK from your doctor. If you are pregnant, you should also ask your doctor or midwife before using NRT.

Try and try again
If one type doesn't work at first, then try another or try a combination. Using more than one NRT product can be very effective if you have strong cravings. For the best results remember to check out the instructions, or talks to your pharmacist, local NHS Stop Smoking adviser or doctor about how to use the various products.

NRT Products:

  1. Patches
  2. Gum
  3. Lozenges
  4. Microtabs
  5. Nasal Spray
  6. Inhaler
Quitting with the help of NRT products is about using the product to fit with your lifestyle. There's a 'trick' to how to use these products effectively, so knowing a bit about the options can help you get it right?

Quit with the product that's best for you!

Patches get you through the day, without worrying about cravings. They come in 16 hour and 24 hour types, and constantly release small doses of nicotine through the skin. They take a while to get going (30 minutes), so if you need a quicker hit to get you through you may need to look at other types available.

Gum, microtabs and lozenges are all taken by mouth and help you when you need them throughout the day. Gum is good for day-long treatment. use about 10-15 fresh pieces through the day. For maximum effect, chew the gum slowly, then park it in the side of your mouth. 2 mg or 4 mg doses are available to help beat the different strengths of craving.

Microtabs contain nicotine and dissolve when you place them under your tongue.

Lozenges slowly release nicotine, and can take up to 30 minutes to dissolve.

Patches get you through the day, without worrying about cravings. They come in 16 hour and 24 hour types, and constantly release small doses of nicotine through the skin. They take a while to get going (30 minutes), so if you need to look at other types available.

An inhaler releases nicotine vapour which gets absorbed through your mouth and throat. This might suit if you miss having something to do with you hands when not smoking.

A nasal spray might come in handy if you need a more instant dose of nicotine (such as first thing in the morning, or if you find the slower release products take a bit too long at first). This delivers a swift and effective dose of nicotine through the lining of your nose.

Or do you want to consider alternatives to nrt?

As well as NRT, there are other products available on prescription that cons help you quit smoking by changing the way your body responds to nicotine.

Champix (Verenicline) and Zyban (Bupropion Hydrochloride) work to reduce your cravings. They come in tablet form and you start taking then one or two weeks before you quit. Treatment usually lasts 8-12 weeks. They are only available on prescription and are not available if you're pregnant or under 18.

What is the possible prognosis?

Think about your health! Quitting dramatically increases your chances of living a longer life. It takes just 20 minutes for your body to start healing once you quit smoking, repairing the damage done by all those years smoking.

Things get better straight away when you quit smoking. After 20 minutes After 8 hours After 24 Hours After 48 hours
Your blood pressure and pulse go back to normal. Circulation improves – especially in your hands and feet. Nicotine and carbon monoxide levels in the blood are reduced by half. Oxygen levels return to normal. Carbon monoxide will be eliminated from the bosy. Your lungs start to clear out mucus and debris. Your body is now nicotine free. And you'll notice how your senses of taste and smell have improved.

After 72 Hours In 2-12 weeks In 3-9 Months After 5 years After 10 years
Your breathing is easier. You have more energy. Circulation is now improved throughout your body. It is easier for you to walk and exercise now. Your lung capacity can improve buy 5-10% and you can say good bye to coughing, shortness of breath and wheezing. You now have half the chance of having a heart attack compared to a smoker. The chance of getting lung cancer is half of that of a smoker. Your chance of having a heart attack is the same as someone who has never smoked.
  • Reduce that clogged feeling in your lungs and lose that nasty cough in the morning
  • Reduce that tired feeling and do more of the things you love
  • Reduce your chances of getting lung cancer and breathe more easily
  • Reduce your chances of having a heart attack and exercise more comfortably

Why kokilaben dhirubhai ambani hospital?

Here we have the 'New Leaf Program' which involves individualised treatment plans for patients taking into consideration:

  • Medical Issues
  • Motivational Interviewing to encourage patients to quit addiction
  • Multi-disciplinary team approach with Psychiatrist, Clinical Psychologist and Rehabilitation Department as required.
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