DR FAITH B YISRAEL
Coincidentally, May 31, the day we celebrated Indian Arrival Day in Trinidad and Tobago, was also designated as World No Tobacco Day. The member states of the World Health Organization (WHO) came up with World No Tobacco Day in 1987 to “draw global attention to the tobacco epidemic and the preventable death and disease it causes.” The theme for 2021 was: Commit to Quit.
Smoking and covid19
At the start of the campaign, WHO director general Dr Tedros Adhanom Ghebreyesus said, “Smokers have up to a 50 per cent higher risk of developing severe disease and death from covid19, so quitting is (the) best thing smokers can do to lower their risk from this coronavirus, as well as the risk of developing cancers, heart disease and respiratory illnesses.”
Covid19 is an infectious disease that primarily attacks the lungs. Smoking can cause lung disease by damaging your airways and the small air sacs found in your lungs. This damage makes it harder for the body to fight off coronaviruses and other diseases. Tobacco is also a major risk factor for non-communicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes which put people with these conditions at higher risk for developing severe illness when affected by covid19.
Why is it hard to quit smoking?
According to the American Thoracic Society, “Nicotine is a chemical that is present in all forms of tobacco. Nicotine is also found in electronic cigarettes and the liquid used in ends (electronic nicotine delivery systems).” Nicotine is highly addictive. When a person uses tobacco, either by smoking cigarettes, using chewing tobacco or by using another form of tobacco, nicotine enters the body and activates nicotine receptors in the brain.
The faster the delivery of nicotine to your body, the greater the addictive effect on the brain. Cigarettes have been designed to give high levels of nicotine to the brain very quickly. When you smoke a cigarette it only takes six to ten seconds for the nicotine to reach your brain. This makes smoking tobacco very addictive and difficult to stop.
Shortly after smoking their last cigarette, smokers start to feel a negative mood change. This “withdrawal” from the chemical nicotine makes the smoker uncomfortable. Many smokers report feeling anxious, irritable and restless when they stop smoking. This is because they are not getting what the brain feels it needs to work well. Smokers usually experience relief from these unpleasant feelings as soon as they smoke again, use other tobacco products, or nicotine replacement medications.
Ways to quit
It is clear that quitting smoking is hard. As a result, I did some research about techniques that have a proven record of actually working. Allow me to describe the National Institute for Health and Care Excellence (Nice) smoking cessation guidelines. Nice is an independent public body that provides national guidance and advice to improve health and social care in England. Although these services and medications may not be available in TT, here is what other jurisdictions are doing.
Nice recommends a combination of behavioural support (individual and group), bupropion, short- and long-acting nicotine replacement therapy (NRT), varenicline, and very brief advice.
Individual behavioural support involves scheduled face-to-face meetings between someone who smokes and a counsellor trained in smoking cessation. Typically, it involves weekly sessions over a period of at least four weeks after the quit date, and is normally combined with pharmacotherapy (the treatment of a disorder or disease with medication). Your “quit date” is the date you plan to start taking the various steps towards quitting smoking. It is recommended that you schedule your quit date for no more than a week or two ahead of time. You're likely to lose momentum if you try to plan ahead before that.
Group behavioural support involves scheduled meetings in which people who smoke receive information, advice and encouragement and some form of behavioural intervention, for example, cognitive behavioural therapy (CBT) – a treatment approach that helps you recognise negative or unhelpful thought and behaviour patterns. Many experts consider it to be the gold standard of psychotherapy. CBT aims to help you identify and explore the ways your emotions and thoughts can affect your actions. This therapy is offered weekly for at least the first four weeks of a quit attempt (for four weeks after the quit date). It is normally combined with pharmacotherapy.
Bupropion is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder, seasonal affective disorder, and to help people quit smoking.
Nicotine replacement therapy
NRT gives you nicotine – in the form of gum, patches, sprays, inhalers, or lozenges – but not the other harmful chemicals in tobacco. NRT can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological and emotional aspects of quitting.
Varenicline is used along with education and counselling to help people stop smoking. Varenicline is in a class of medications called smoking cessation aids. It works by blocking the pleasant effects of nicotine from smoking, on the brain.
Very brief advice
This includes the health professionals asking about current and past smoking behaviour, providing information on the consequences of smoking and stopping smoking, and advising on options for support and pharmacotherapy.
Help in Tobago
The reality is that the guideline offered by Nice may not be readily available in Tobago, but please do not give up hope. If you are currently smoking, and thinking about committing to quit, please contact one of the following organisations:
• Tobago Regional Health Authority, Mental Health Outpatient Department 660-4744 extension 3156 or 3157
• The Alcohol and Drug Prevention Programme (ADAPP), The Division of Health, Wellness and Family Development, 639-3395 extension 47204 & 47205
• Changing Lanes Recovery Programme, 781-9978, Changelanes868@gmail.com, https://www.facebook.com/changing.lanes.169
Dr Faith B Yisrael is a health educator, social scientist, public health specialist and politician.