Though many Indians may regard smoking or chewing oral tobacco to be a relatively harmless addiction, it actually kills more people than alcohol.
By Dr Dharav Shah & Dr Pooja Patwardhan
A Cochrane review is regarded to be a highly reliable source of evidence in the medical world. A recent Cochrane review by researchers in the UK examined evidence published across the world on what happens to the mental health of a person when he/ she quits smoking. This review of 102 research studies, involving data on experiences of 1,69,500 people, concluded that quitting smoking reduces the anxiety and depression experienced by a person and the magnitude of this change (effect size) is similar to that of antidepressant medications!
What is more is that compared to people who continued to smoke, people who stopped smoking showed greater improvements in scales that measured stress, positive affect and psychological quality of life. Many people who smoke are concerned that if they quit smoking they will lose their circle and become lonely. Hence this review also included evaluation of impact on social quality of life – which included measures like social satisfaction, interpersonal relationships, isolation and loneliness. As per the evidence reviewed, people who stopped smoking did not have any reduction in their social well-being. In fact, some studies showed slight improvement in social well-being as well.
This news could not be more timely: this World No Tobacco Day (May 31st), the World Health Organization (WHO)’s theme is “Commit to Quit”.
There is good news even for those smokers who currently may not be facing any anxiety or stress. As per 5 studies (including 10978 people), in people who stopped smoking, new cases of anxiety and depression were fewer than in those who continued to smoke.
There is a belief amongst people dealing with mental illnesses as well as some healthcare professionals that patients smoke to cope with their mental illness and so quitting may worsen their symptoms. Consequently, some mental health professionals don’t feel too enthusiastic about encouraging their patients to quit smoking. This is particularly concerning because people with severe mental illnesses, such as schizophrenia, die on an average around 20 years earlier than those without them; and the higher prevalence of smoking in them is one of the most important modifiable risk factors responsible for this health inequality.
This review also included 23 studies done on people with psychiatric conditions. The positive impact on mental health of quitting smoking was noted in this sub-population as well. And the effect sizes were similar to those seen in the general population. Based on all this evidence, people who smoke, including those who have psychiatric illnesses, can feel reassured that stopping smoking will not worsen their mood. Quitting the use of tobacco will actually improve it. The stress relief experienced on smoking is only fleeting. Like other addictions, tobacco only worsens emotional well-being in the long run.
Another advantage of quitting tobacco is that it can add a lot of years to your life. Though many Indians may regard smoking or chewing oral tobacco to be a relatively harmless addiction, it actually kills more people than alcohol. Globally, alcohol is responsible for around 30,00,000 deaths/ year while tobacco is responsible for around 80,00,000 deaths. Amongst adult males ≥30 years, it is responsible for 32% cancer deaths, 16% heart attack deaths, 10% stroke deaths , 9% TB deaths and 14% of deaths due to other lung infections. Stopping tobacco use can help one reclaim the lost years back to life!
Lack of awareness about these facts helps in maintaining the popularity of tobacco use in our society. It is our collective responsibility to make everyone in the society informed of this evidence and empower them to make a healthy choice. Another reason why people don’t attempt to quit is past failed attempts and a consequent belief that they will not be able to quit. Hence it is important to give them hope that it is possible to quit. There is strong evidence now that with the help of counselling and nicotine replacement therapy (NRT) products such as nicotine gums/patches or with a prescription medication called Bupropion, the probability of a successful quit doubles. While with a medicine called Varenicline or with combination NRT (patch + gum) quit rate gets tripled.
Many still fear using NRT. It is useful to understand that while nicotine is the addictive component of tobacco, the components which are mainly responsible for its harmful effects on body are from the burning of tobacco (smoke, in case of cigarettes and bidis) and toxic additives and nitrosamines formed on the tobacco (in case of oral smokeless tobacco products such as gutkha and zarda). NRT has been in use for 30 years now and has been found to be a medication with a good safety profile. It helps manage cravings and overcome withdrawal symptoms. The WHO has included NRT in its recommended list of essential medicines. In countries such as the UK, if one is at a risk of relapsing back to smoking if they stop using NRT, then long term use of NRT is supported.
To summarise, there is unequivocal evidence that tobacco harms your physical and mental health. Smoking causes damage to the lungs and airways, and harms the immune system, reducing one’s ability to fight infections. People who smoke, generally have an increased risk of contracting respiratory infection and in times of Covid-19, it is important that we all look after our lung health and do everything to improve our immunity. So, don’t give in to peer pressure or to the false messages of success and happiness by using tobacco pushed through advertising campaigns. You can confidently trust your decision to not experiment with using tobacco. And for those who are already addicted, there is a good reason to cheer up. Seeking professional assistance and available proven forms of nicotine replacement products and medications can help you quit successfully. So this 31st May 2021, on the occasion of World No Tobacco Day, ‘Commit to Quit’ and move towards living a healthier and longer life!
(The authors – Dr Dharav Shah is a NIMHANS-trained Psychiatrist and Senior Consultant at CHRE. He is an addiction treatment specialist and Dr Pooja Patwardhan is British-Indian doctor and Medical Director of Centre for Health Research and Education (CHRE), and is a cancer prevention and smoking cessation expert. The article is for informational purposes only. Please consult experts and medical professionals before starting any therapy or medication. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)