Unlike many fathers, holding and cooing over his baby daughter didn’t come instinctively to Amit Kaushik. Every cuddle had to be preceded with a methodical handwash to avoid getting tobacco on the infant; every kiss with a thorough brushing of teeth in a bid to mask the smell of tobacco his 20-year smoking habit had left him with.
‘To have to think twice before I could hold or kiss my daughter was the wake-up call that made me question if my habit was worth it,’ says the 39-year-old director of revenue management at Jumeirah Hotels in Dubai.
A couple of weeks later Amit signed up for a hypnotherapy programme, and in just three days he quit his smoking habit.
Until September last year, Amit was one of the UAE’s 25-30 per cent adult smokers. Although he had tried to quit several times in the past, it was after a five-course session of hypnotherapy that he joined the growing ranks of people who are saying no to cigarettes, shisha and dokha (a tobacco blend unique to the region) because of its disastrous health repercussions.
Not surprising, considering cigarette smoke contains around 4,000 toxic chemicals that in other situations we would go to great lengths to prevent from ingesting. A single puff of cigarette smoke introduces carbon monoxide (found in car exhaust fumes), hydrogen cyanide (a fumigant) and arsenic (a component of rat poison) into the bloodstream within 10 seconds of inhalation. Then there are other carcinogenic substances such as cadmium (used in battery acids), lead and nickel, among several others. The leading cause of preventable death in the world, six million people die every year due to tobacco usage, according to the World Health Organisation.
So what makes smokers reluctant to give up smoking?
Blame it on nicotine.
‘Nicotine is a psychoactive substance that produces patterns of dependence, tolerance, withdrawal, and gives smoking its seemingly pleasurable qualities,’ says Dr Usha Khatri, head of medical services at Dr Batra’s Homeopathic Clinics. According to the American Cancer Society, smoking is the fastest conduit to deliver nicotine to the brain, quicker even than intravenous injections. Experts say the euphoria that smokers claim they get from smoking is because nicotine triggers the release of dopamine, the endorphins that creates feelings of happiness.
‘Once you’re hooked, people use smoking for different reasons – from controlling appetite and overcoming stress to altering daily bowel movements (nicotine has a laxative effect),’ says Dr Sonia Gupte, clinical hypnotherapist and general practitioner at iCare Clinics. ‘The brain gets used to the pathway of receiving nicotine to perform functions that non-smokers do naturally.’
It is for this fear of losing out on the pleasure and the benefits of nicotine as a facilitator and coping mechanism that smokers continue lighting up, although aware of health hazards that range from 90 per cent of all cancers, especially of the throat, mouth and lung, respiratory diseases such as asthma and pneumonia, to cardiovascular diseases, strokes and infertility.
‘Smoking is that dangerous pest that hinders your immunity,’ Dr Gupte says. But the good news is that there is a steady decline in the number of smokers stubbing out their cigarettes for good in the UAE. According to a 2015 DHA (Dubai Health Authority) report, the number of quitters has increased from 11 per cent in 2012 to 17 per cent in 2014.
People are slowly yet steadily cottoning on to the many benefits of quitting smoking thanks to awareness programmes, government health initiatives and anti-smoking laws (smoking in enclosed public spaces has been banned in the UAE since 2009) – as well as the negative effects of passive smoking.
‘Second-hand smoke is almost equivalent to smoking. There is no safe limit – whether you stand in a smoke-filled room for one minute or five minutes it is equally bad,’ says Dr Gupte.
Sherry Katawala, a clinical psychologist and hypnotherapist conducting the smoking cessation programme at Illuminations Well-being Centre, Dubai, says: ‘Individuals in the age group of 30-40 are often the first to seek help. They find themselves piling on or losing a lot of weight and feel fatigued and exhausted frequently. The other reason is they notice they have to constantly step away from their family to take a smoke break or they can’t be with their child.’
But the moment one quits tobacco, the results are easily noticeable. Amit agrees: ‘My stamina improved. Earlier I could only swim two laps. Now I can do at least four. The best incentive is the amount of extra time I have for my family now that I’m not excusing myself for smoke breaks in the balcony and miss important moments.’
Whatever your reasons for wanting to put out that cigarette for life, the onset of Ramadan is a perfect opportunity, even if you missed out on World No Tobacco Day on Tuesday. Anti-smoking laws in public spaces are stricter this month during fasting hours and it’s difficult to come by smoking corners.
To make it easier, we’ve put together a host of cessation methods and therapies:
Going cold turkey
Around 90 per cent of the world’s one billion smokers try going cold turkey – like Amit first did – unassisted by medical professionals, nicotine replacement therapy or alternative treatments. ‘It’s ideal but it doesn’t work for everyone,’ Dr Gupte explains. ‘The rates of relapse are high (only 8 per cent succeed) when you’re without the tools to manage withdrawal symptoms and the cravings.’
To start with, its necessary to determine if you’re an identification smoker or a replacement smoker, says the doctor.
‘An identification smoker puffs away due to peer pressure or would have picked up the habit and become an addict after experimenting with smoking out of curiosity. These people are the ones who find it easiest to quit smoking. They are the ones who successfully go cold turkey because smoking was just a pattern of identifying themselves with their peers.’
A replacement smoker considers cigarettes a band-aid to help him during traumatic events in life – a divorce, breakup, death of a loved one or a major life change. Quitting smoking is more difficult for a replacement smoker as the chances of relapsing are higher.
‘In these cases clinical hypnotherapy provides successful results as it addresses the core psychological issues for which you use smoking as a coping mechanism.’ Some people who smoke may also start off as identification smokers but graduate to become replacement smokers, she says.
Amit was an identification smoker who started smoking at 15 because his friends thought it was ‘cool’. But over a period it became a habitual practice that he couldn’t get rid of, making him a replacement smoker.
‘I tried going cold turkey as part of a New Year resolution. But it lasted a week and then I was back to square one, puffing a dozen a day,’ Amit says. He tried quitting many more times, with the same effect. ‘That is when I decided to seek professional help with hypnotherapy.’
In simple terms, hypnotherapy is counselling that uses relaxation techniques to access your subconscious mind and figure out what is triggering your smoking habit. ‘In hypnotherapy, you’re actually changing the whole mindset related to smoking,’ says Dr Gupte. You will always return to smoking if you do not address the core issues behind cravings and associations stored in the mind. ‘Amit’s sessions revealed childhood traumas and events that egged him on to continue smoking.’ Once the associations were targeted, the hypnotherapist was able to tackle the root cause of the habit.
After two decades of being a heavy smoker, Amit today detests cigarettes. ‘I find even the smell repulsive,’ he says. The drastic change in his approach stems from how hypnotherapy rewires the subconscious mind’s associations of pleasure with smoking to that of repulsion, says Sherry.
‘This thought process is what we alter, which is why hypnotherapy has zero withdrawal symptoms.’
A strong will is the key factor to the success of hypnotherapy, says Sherry. ‘Some people are so eager that they quit in the first or second session itself. A 60-year old client who had been smoking 60 cigarettes daily for 45 years quit smoking on the third day.’
Nicotine replacement and prescription drugs
Nicotine replacement therapy provides the fix nicotine smokers require to slowly wean off without smoking or full-blown withdrawal symptoms such as headaches, insomnia, irritability, anxiety and weight gain. Available over the counter in pharmacies as patches, lozenges and gums, they are an option if you’re trying to quit without medical help.
‘If you’re attempting to quit for the first time then nicotine replacement is a great starter,’ says Dr Gupte. With a success rate of around 25 per cent, it can come with side-effects such as skin irritation, nausea and bloating, but nothing serious. ‘There is of course the risk of addiction over long-term use, like with any other substance, and this is where willpower plays an important role.’
The duration for use of nicotine patches and gums varies from individual to individual, taking anywhere from eight weeks to longer with the patient able to set their own pace.
The anti-smoking drug Champix is a medical alternative to nicotine replacement therapies if you’re a chain-smoker and if gradual weaning seems impossible. ‘It’s an FDA-approved tablet that blocks nicotine receptors in the brain so it works on controlling the cravings over the 12-week course it’s prescribed for,’ explains Dr Gupte.
‘The success rate is around 33 per cent. However, it can have serious side-effects such as mood swings, depression and suicidal thoughts for certain people, which is why it must strictly be administered only under medical guidance.
‘Not everyone has a negative reaction but it is necessary to educate the patient about them.’
Another method to quit smoking is the e-cigarette. But while e-cigarettes started out as a near fail-proof method, recent studies show that people become dependent on them. ‘We have a lot of patients inquiring about the benefits of vaping but again it’s a concoction of chemicals and a certain amount of nicotine.
‘Recent studies show that the vapours from vaping can be addictive. Also, there are no conclusive studies proving that vaping is absolutely safe or unsafe, which is why medical experts including the WHO are cautious about recommending it.’
What vaping does help with is the behavioural aspect of smoking, in that it imitates the actions and sensory experience of smoking, making it an easier transition to renouncing smoking completely.