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ImagePromising to quit smoking is one of the most common New Year resolutions. However, by the end of the first week of January, the craving for nicotine drives people to break the pledge.

Will power may not be enough to kick the habit, experts say. With some help from doctors and by using a nicotine substitute, chances are high to get over the craving.

"This is the third year in a row that I pledged to quit smoking on New Year's Day, but by the 2nd of January, I broke my resolution," Rashid, a 25-year-old software executive, confesses ruefully.

While work-related stress, lifestyle, and peer pressure are some of the basic reasons for people to take up smoking, kicking the habit is the most difficult thing for most.

"Nicotine is one of the most addictive substances known to humankind," P.C. Gupta, director, Healis Sekhsaria Institute of Public Health, Mumbai, said in an Interview.

"Cigarettes and chewable tobacco contain nicotine which makes them addictive. Cigarettes deliver nicotine via the lungs to the brain within approximately 10 seconds. It is this rapid nicotine delivery that makes the cigarettes highly addictive," he said.

Experts say while the craving for nicotine stops most from quitting tobacco, professional assistance may help.

"Studies have shown that help from stop-smoking aids, support from healthcare professionals, and medication can more than double the chances of quitting smoking. In India smokers rely solely on their will power to quit smoking. However, it's important to understand that nicotine is a highly addictive chemical and it is okay to use a smoking cessation aid to wean yourself off the nicotine addiction," Vijai Kumar, director of Pulmonary Medicine & Critical Care at the Yashoda Super Specialty Hospital, Secunderabad, said in an Interview.

According to WHO, around 5.4 million deaths a year are caused by tobacco use. By 2015, the number will rise to 6.5 million, and by 2030, the figure of smoking deaths will be 8.3 million, with the biggest rise in low-and middle-income countries.

Explaining how nicotine hooks a person, Gupta said: "During smoking or chewing tobacco, the nicotine gets absorbed in the blood and reaches the brain. It then activates the area of the brain which gives an individual the feeling of satisfaction."

"Soon the brain begins to seek this feeling regularly, making nicotine highly addictive. In the absence of nicotine, smokers experience irritability, insomnia, headaches, constipation, gas and stomach pain among other withdrawal symptoms, making it extremely difficult for them to quit."

According to Global Adult Tobacco survey, more than a third of Indians chew or smoke tobacco. Nearly a million tobacco-related deaths occur in India annually out of 5.5 million worldwide. India is also the world's third largest producer of tobacco.

However, doctors say that though quitting may be tough, a planned programme may help in kicking the habit.

"The first few weeks are the most difficult, and that is where self-control plus effective planning is needed," Gupta adds.

"It's important to understand situations that may lead to a craving for a smoke, such as drinking alcohol or coffee which can act as triggers. One should devise strategies to deal with such situations - either avoid them (alcohol and coffee) or control them appropriately," he said. "It is important to stay strong and focussed to support your effort through smoking cessation aids."

Experts also suggest a Nicotine Replacement Therapy (NRT). It is a WHO-recommended therapy that, according to doctors, can double a smoker's chances of quitting. NRT products substitute some of the nicotine normally obtained from cigarettes with therapeutic clean nicotine, helping to prevent or relieve withdrawal symptoms. Once the ex-smoker overcomes the psychosocial need to smoke, nicotine dependence is eliminated by successively reducing the dose of the nicotine replacement.

"Using NRT to replace cigarettes while quitting smoking has proven to be more effective than trying to cut down by using will power alone," said Gupta.

"NRT products provide a small dose of therapeutic nicotine which is sufficient to help control cravings for cigarettes and other withdrawal symptoms that smokers experience when they quit," explained Kumar.

"It was first developed after finding that Swedish submariners performed poorly due to craving and withdrawal symptoms experienced when unable to smoke while at sea. As a method of delivering nicotine into the bloodstream, NRT is a much less dangerous method compared to tobacco smoking," he said.

NRT products are available globally as chewing gum, lozenges, nasal sprays, inhalers and patches. Doctors however warn of possible side effects NRT may have, as has been seen in some cases.

"Though NRTs are safe, for some prescription NRT products, a few neuropsychiatric symptoms such as 'changes in behaviour, agitation, and depressed mood' have been noticed. In such cases smoker management and adaptation to dosage is required," he added.

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