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by Naeema Zain Jiffrey

Tobacco addiction has taken the dimensions of a global epidemic that is similar in nature to a communicated epidemic, according to a World Health Organization, the difference being that it is an addictive disease. It is a disease, it has symptoms, it kills, it is treatable and it can be cured.

Tobacco has killed more people in the world than all wars; it has caused more deaths than HIV/AIDS, tuberculosis and all cancers put together. And the epidemic is global, not one country spared 4.9 million people die every year of tobacco related diseases, and, at current rates this figure is expected to double by year 2020.

It is said that in Sri Lanka over 70% of men and 40% of women smoke, and there is a rapidly increasing trend amongst young men and women. Over 2 million kgs of tobacco in 2001, and 4699.9 million cigarettes in 2002 have been issued by the Department of Excise, according to information published by National Dangerous Drugs Control Board.

Tobacco addiction kills 50% of all life time users. Up to 24% of all men and women over age 35 in South East Asia die from tobacco caused diseases, namely, cancer, emphysema, heart disease, and strokes. Pain, suffering and emotional trauma caused by these deaths and diseases, although cannot be measured in financial terms, add to these costs.

Secondary smoking means inhaling the smoke by being exposed, and, the victim of secondary smoking is subjected to heightened risk of developing pneumonia, bronchitis, worsening asthma and other breathing illnesses, middle ear disease, and cancer. Pregnant women who smoke can cause fetal death or mental retardation and/or brain damage to the fetus. Victims of secondary smoking are mainly,

(a) children exposed by parents, (b) non-smokers exposed in work places and in public places, (c) damage to fetus by pregnant women who smoke.

Financial Costs

* Smoking is an expensive habit. A substantial percentage of family income which could otherwise be diverted to food, shelter, clothing, education, health and well-being is burnt in cigarettes.

* Cost of health care by families and by the State for tobacco related diseases. * Cost of work time lost by the often taken smoking breaks and time taken off from work due to tobacco related diseases.

* 25% of all smokers die during their working age which means for the families loss of their primary source of income

* loss of productivity

The only gain derived from tobacco addiction is the great deal of profit gained by the manufacturers and sellers at the expense of the well being of a great majority of others. Socio-economic benefits to the world community provided by multi national industries based on tobacco consumption, such as employment, vast amounts in government revenue, etc., when compared with the ills inflicted by tobacco seem so irrelevant and immaterial, and only serves to expose the industries' weird mask.

Action by governments and international agencies

With the objective of saving millions of lives and improving public health, many governments have taken action, which include a combination of raised cigarette taxes, bans on tobacco advertisements and promotion, limited smoking in public places and work places, increased access to stop smoking programs, anti tobacco advertising, crack-down on smuggling ban on sale of cigarettes to children. The World Health Organization, in February 2003, began negotiations for a framework convention on tobacco control.

Despite all these efforts, tobacco consumption has been on the increase universally, and, it is necessary to compliment these efforts with grass roots level education on the ills of tobacco use, the dynamics of the addiction and on the availability of stop smoking programs. Attempts should also be made by the governments and health agencies to make these programs widely available. Practically many smokers in the under-developed parts of the world still do not understand the grave effects of their addiction, and nor are they aware that it can be cured. Unfortunately it is not even a matter of concern for most of them.

Most smokers subconsciously perceive tobacco as fulfilling a need for company, for emotional support, for physical and / or mental stimulation, etc. Many also perceive cigarettes as providing an escape/temporary relief from/or medication for stress, nervousness, anxiety, fears, anger, feelings of loss of control, worries, need for company, and a means of relaxation, etc. Relaxation effect derived from smoking is due to the repetitive deep inhalation and exhalation involved in smoking and one can obtain the same degree of relaxation by regular systematic deep breathing exercises without smoking as well.

For some people smoking is a coping mechanism in the face of emotional problems, in which case, the quantity smoked increases in times of stress and emotional difficulties, such as followed by loss of a loved one, loss of a relationship, financial failures, disappointments in life, etc. For some it is a way of enjoyment, a means to having pleasure. This fact is most apparent in chain smokers who send out the smoke in chains and watch those chains.

It is a common fact that one who starts smoking as a means to feel the connection, or, to satisfy the perceived need for replacement of something/some body that is missing, will in due course develop dependency on tobacco as a coping mechanism, for emotional support, and for stimulation. Further, when one has been smoking for a while, the habitual instincts become so powerful, and he/she becomes a compulsive habitual smoker lighting cigarettes without even being consciously aware of doing it. Whatever the case may be, rarely a smoker derives one single kind of satisfaction from smoking; as one plunges more deeply into the addiction the tendency is one develops dependency to have a multitude of needs met.

Like all behaviours smoking is a learned behaviour, and all learned behaviours can be unlearned. It has been observed that 25% of people can quit by themselves when they have sufficient motivation coupled with strong will power. Others need some form of help.

Hypnotherapy, acupuncture, cognitive behaviour therapy, use of nicotine patches and nicotine gums as aids to quitting are various methods currently being utilized to help quit smoking. Quitting is a difficult process; one can easily lose motivation purely because the process involves physiological and psychological discomfort and perceived deprivation; but the benefits to self and family far outweigh these discomforts. Besides, these discomforts are only temporary. One can overcome these with the right motivation and commitment to the decision to quit.

Hypnotherapy has been effective in this area because bypnotherapeutic intervention deals with all aspects of the addiction and at the same time reinforces motivation and commitment during this difficult process, provides practical and healthy options to fulfil the perceived needs of the individual smoker. The change is brought about from within, i.e. from deep within the subconscious mind, which makes staying quit for life possible.

American Lung Association's Freedom from Tobacco Campaign published the following as benefits of stopping smoking:

1. There is much lowered risk of disability and death from coronary heart disease and smoking related lung diseases such as chronic bronchitis and emphysema.

2. Your taste buds come back to life. Your sense of smell improves.

3. Fire hazard is reduced.

4. Chronic irritation of the larynx is reduced so your speaking voice may improve.

5. Shortness of breath and coughs decrease.

6. Risk of intestinal ulcers reduce.

7. Risk of getting lung cancer is reduced, particularly occupation related lung cancer by exposure to asbestos and that of some chemical workers.

8. A pregnant woman eliminates possible smoking related injury to the unborn fetus.

9. Non smokers are more acceptable in public places and in the homes of non smoking friends.

10. Women on birth control pills have less side effects (smoking is known to aggravate side effects of these pills).

11. Fewer colds occur.

12. Circulation improves.

13. Frequency and severity of asthma episodes greatly decrease.

14. More spending money is available.

15. You have more energy and stamina.

16. The smell of tobacco doesn't cling to your clothes and hair.

17. You are a better example for your children. You increase the chance that they will never smoke.

18. You look better, become a healthier person. Gain control over your life.

19. Your peripheral and night vision improves.

20. You have two free hands again.

The positive changes that are apparent in the smoker, in addition to all health benefits, include a glow in the complexion and a healthy appearance due to detoxification taking place in the body as it clears of nicotine.

An effective treatment program

Counselling should be an essential part of a stop smoking treatment program because the cause and the process of addiction, the whole episode of smoking as a part of one's life are all deep rooted in the mind of the addict. Once the causational factors and the associative needs (the perceived needs smoking fulfils) are dealt with and the subconscious mind is programmed for change, the need for smoking disappears.

For tobacco addiction to be cured, a treatment program should deal with all three elements of the addiction, i.e., physiological, psychological and chemical aspects, if not there is a high risk that the person may revert back to the habit.

Treatment program should educate the person about issues of after effects and discomforts, while providing them with healthy, personalized and practical coping skills and solutions. Also it should address possible problems one may face during the process of quitting and after, such as feeling uncomfortable, fatigue, head aches, sugar cravings and perhaps irregular eating patterns, both of which result in weight gain, sometimes inability to sleep, depression, mood changes, irritability and low tolerance levels with others, carelessness etc. The program should inform them that these symptoms are only temporary and will dissipate as the body goes through detoxification and recovers from the need for nicotine.

It is also important that it provides ongoing counselling support and advice for reinforcement, to keep them with the program and to prevent possible loss of motivation.

Need for Support

A person in the process of quitting an addiction deserves respect and unconditional support. Only strong commitment and perseverance along with positive support can help them to free themselves from a physiologically and psychologically addictive drug such as nicotine.

Quitting is a difficult process for the user because of its deep rooted effects on the mind and body, and because the habit has been a large part of the user's life. The process of quitting is physically and emotionally demanding, and so, support from family and friends is vital. It is necessary to reinforce confidence in the process and in their ability to win over the addiction.

Quitting an addiction while in that process causes bodily discomfort and emotional difficulties in the person concerned, therefore, their need for being alone and for re-assurance and company when needed should be respected.

It is important to avoid exposure to smoke while in quitting process. Role of the significant other, family and friends should not be overlooked in this regard. On-going encouragement at positive progress and avoiding pointing to 'little slips' in the process is vital. At each 'slip' reinforcement of confidence and commitment will be of great help.

Being non judgemental; putting yourself in their shoes; and avoiding negative remark are all important. You know more about your near and dear ones. Think of some special way to help. And act on it.

The author is a certified clinical hypnotherapist, and behaviourial counsellor. She has had specialised training and extensive experience in the USA in addiction counselling.

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