Saturday, May 11, 2013


 Tobacco or nicotine is one of the most commonly abused substances in the world. The addiction potential of nicotine is such that it is the most difficult substance to abstain from, once dependence develops.

What is Nicotine dependence or addiction?

Presence of three of following criteria in span of one year is required for the diagnosis of nicotine dependence
       1.      Craving
       2.      Tolerance
       3.      Withdrawals
       4.      Use despite harm
       5.      Neglect of alternate pleasurable activities
       6.      Loss of control
Withdrawals of nicotine are characterized by
        a)      Tension
        b)      Irritability
        c)      Drowsiness
        d)      Increased appetite
        e)       Weight gain
        f)      Decreased heart rate and blood pressure
        g)   Difficulty concentrating
Nicotine withdrawals start within 2 hours peak in 48 hours and remain for months
Types of nicotine usage
        a)      Smoking
        b)      Chewing
        c)      Sniffing
50% of world’s total population has used tobacco in one form or other in their lifetime. Around 75% of habitual smokers have tried to quit smoking once in their lifetime.

Cessation of smoking has following health benefits

      1.      Decreased risk of heart attack and stroke
      2.      Decrease risk of lung diseases
      3.      Decreased risk of cancers
      4.      Decrease risk of newborn disorders like low birth weight if mother smokes in pregnancy.
Treatment of nicotine dependence is one of the most challenging tasks in addiction psychiatry. Due to its highly addictive nature quitting smoking is very much uphill task.

Various pharmacological methods used to quit smoking are as follows-

         1.      Nicotine replacement therapies- these include
a)      Nicotine inhalers
b)      Nicotine lozenges
c)      Nicotine patches
d)      Nicotine gums
e)      Nicotine nasal spray
         2.      Non nicotine medications include
a)      Bupropion
b)      Nortriptyline
c)      Clonidine
d)      Benzodiazepines
e)      Varenicline
The most efficacious medication found to help quit smoking is varenicline and the worst is nicotine gums.
Wishing you a healthy life ahead
Dr Hitesh Sharma
MBBS, MD (Psychiatry)
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