The Telegraph
Since 1st March, 1999
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It takes two to tame tobacco terror
- WHO report shows mix of therapy and medication works best against smoking

New Delhi, Sept. 4: Before you try to kick smoking on your own, drag on a mix of therapy and medication.

The smoke signals from a World Health Organisation (WHO) report indicate that professional help at a quit-smoking clinic produces better results than sheer grit and determination at home.

The WHO survey found that 30 per cent of smokers worldwide were able to quit the stick when they switched to medication and therapy for a short while.

And those who fought the battle on their own' Only 5 per cent of the bravehearts could keep away forever from the poison weed.

Fifteen per cent managed to give up smoking with the help of substitutes like nicotine patches, whereas 20 per cent each quit through medication and therapy.

The highest strike rate of 30 per cent came from mixed treatment of medication and therapy — a finding that lends weight to the Union health ministry’s decision to set up quit-smoking clinics across India two years ago.

But the impact of the clinics — both state-run and private — is yet to trickle down the social and economic chain with therapy still remaining an affluent preserve. “Therapy sessions cost anything between Rs 300 and Rs 500,” says Dr Sameer Parikh, a psychiatrist at a quit-smoking clinic run by Max Healthcare, a private health institution.

The number of sessions and the total time spent depend on the patient’s motivation — at two sessions a week, the therapy could be over in a month or may last a year. The time spent depends on how high the smokers’ nicotine-dependence is.

Dr Parikh says it is difficult to gauge how successful clinics are in India. “But people do turn up (at the clinics). The treatment hinges on the profile of the patient,” he adds. It is left to patients to decide which therapy they want. Sometimes relatives force smokers to undergo therapy but experts said the probability of success is high when patients go on their own.

The clinics need to distinguish between social smokers and those dependent on nicotine. Nicotine-dependent smokers need medication and therapy since they have to combat withdrawal symptoms.

“Since 1996, the Food and Drug Administration in the US has approved Bupropion as a suitable drug that can be used to quit smoking,” says Parikh. Each tablet of Bupropion, which is prescribed at times, costs between Rs 15 and Rs 20. The dosage varies with every smoker, and could be two tablets or more a day.

“But there are less expensive drugs like Serotonergic which we usually prescribe for combating withdrawal symptoms like over-anxiousness or restlessness,” Parikh says.

The medication goes hand in hand with therapy where smokers are encouraged to do some “introspective thinking”.

Motivation plays a big role. Abhishek (name changed) is a patient who has managed to turn things around after treatment at the clinic. The forty-year-old, facing problems in his marriage, was smoking 30 cigarettes a day when he visited the clinic three-and-a-half-weeks ago.

Today, Abhishek smokes barely a cigarette or two, and often restricts himself to a few puffs. His success can be attributed to his high motivation, the psychiatrist says.

“It is impossible to have any degree of success unless you have a comprehensive programme,” Dr Parikh says. “The success rate of the clinics is particularly high among non-heavy smokers.”

He adds that smokers should realise “from within” the harmful effects of smoking. Experts agree that smokers should approach clinics on their own instead of being brought there by relatives.

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