Renowned oncologist says one needs to move on from traditional methods to quit smoking towards adopting the Nicotine Displacement Therapy.
Published Jul 28, 2024 | 7:00 AM ⚊ Updated Jul 28, 2024 | 7:00 AM
Dr US Vishal Rao. (Supplied)
Smoking addiction is the reason for many health issues, including lung cancer. While it is tough to break free of the addiction, for people involved, there is also a need to look at a wider aspect of why people get addicted to smoking.
The majority of smokers would like to stop smoking, and each year, about half try to quit permanently. Yet, only about 6 percent of smokers are able to quit in a given year.
In this regard, South First spoke to the renowned oncologist Dr US Vishal Rao, Dean and Country Head of the Department of Head and Neck Oncology at HCG Hospitals and also the international advisor for Allen Carr’s Organisation.
He spoke about some interesting approaches to help smokers break free from their addiction, emphasising the need to move beyond traditional methods and address the psychological and physiological triggers of smoking.
In an exclusive interview with South First, Dr Rao elaborated on his strategy, which is rooted in understanding the smoker’s mindset and providing practical, immediate solutions. Here are excerpts from the interview:
Dr Rao highlighted that a significant factor behind smoking is the lack of self-esteem and the desire to appear confident or “cool.”
Peer pressure often initiates this habit, and the addictive nature of nicotine makes it extremely challenging to quit. He pointed out the paradox of the tobacco industry, specifically mentioning that even companies like Philip Morris run their own de-addiction centres, showcasing the immense challenge posed by nicotine addiction.
Dr Rao says smoking is not just a physical nicotine addiction, “it is also deeply intertwined with psychological factors.”
He added, “Smokers often develop habits and routines that are closely linked to their emotional and mental states. For instance, stress, anxiety, and social situations can all act as triggers that prompt the urge to smoke.”
He says no amount of fear of cancer, erectile dysfunction or any other disease awareness or threat might work when that trigger point takes over. “If it’s a boss at work, then the moment he/she sees the phone buzz the name the only thing they might think is to up the nicotine level by smoking.”
“So if one needs to think of quitting then that can happen only by addressing these psychological triggers, it is possible to identify the underlying reasons why individuals turn to smoking, which is essential for developing effective cessation strategies.”
Dr Rao explains that research shows that interventions targeting the psychological aspects of smoking can significantly enhance quit rates.
“Programs that include cognitive-behavioral therapy (CBT) and other psychological interventions help individuals develop coping mechanisms to deal with stress and anxiety without resorting to smoking.”
Speaking about the methods, he added, “These methods can be more effective than those focusing solely on the physical aspect of nicotine addiction. Relapse is a common challenge for individuals trying to quit smoking. Psychological triggers often play a significant role in causing relapse. By equipping individuals with strategies to manage these triggers, such as stress management techniques and mindfulness practices, the likelihood of relapse can be reduced.”
Dr Rao praised the Allen Carr method, known for its high success rates, which can reach up to 80 percent.
“This method is unique as it allows smokers to continue smoking while they are in the process of quitting. Instead of focusing on the reasons to quit, it delves into understanding why individuals smoke in the first place, identifying their trigger points, and providing alternative ways to cope with these triggers,” he adds.
To combat the immediate urge to smoke, Dr Rao recommends three practical steps:
Deep Breathing Exercises: Often referred to as “smoking yoga,” deep breathing can help fill the lungs with oxygen, reducing the immediate craving for a cigarette. He says smoking can fill your lungs with carbon monoxide and taking a deep breath can fill it with oxygen.
Hydration: Drinking a glass or two of warm water can help wash away some of the chemicals associated with the desire to smoke and hydrate the body.
Diversion: Engaging in an activity one enjoys can help shift focus away from the craving and provide positive reinforcement. These fallback options needs to be decided priorly so that one knows what the activity is to ensure they start doing that.
Speaking of an alternative method, Dr Vishal Rao says, “This method of treatment is my own— Nicotine Displacement Therapy.”
He says, “I coined this term called nicotine displacement therapy. What people need is displacement therapy, not replacement therapy.”
Unlike traditional nicotine replacement therapies (NRT) that substitute nicotine with other forms such as patches or gum, NDT seeks to address the psychological and behavioural aspects of addiction by finding healthier substitutes for the reward mechanisms triggered by nicotine.
This approach recognises that smoking is often a coping mechanism for stress, anxiety, or other emotional triggers, and aims to provide alternative methods to achieve the same sense of relief and satisfaction.
Dr Rao cautions, “Because you’re replacing nicotine with nicotine. So six weeks later, he smokes again. Then after that, he goes back to chewing gum. Then again, he takes nicotine chewing gum, then goes back to… You may give nicotine as a short-term solution for one week, two weeks. You cannot say I’ll replace this, then I’ll replace that, then I’ll replace it, then I’ll replace that.”
He says techniques such as deep breathing exercises, hydration, and engaging in enjoyable activities are recommended to help displace the urge to smoke.
By targeting the root causes of nicotine dependence and offering practical, immediate solutions, NDT provides a comprehensive framework for sustainable smoking cessation, ultimately reducing the reliance on nicotine altogether.
Dr Rao leads the team of a high power committee for tobacco control, of the Government of Karnataka and works with the World Health Organisation (WHO) to ensure that interventions in their Framework Convention on Tobacco Control (FCTC) are effectively implemented.
He acknowledged the efforts of the WHO’s MPOWER strategy and highlighted the need for a decentralised approach to de-addiction.
The MPOWER strategy comprises six key measures:
Monitor tobacco use and prevention policies: This involves tracking tobacco use and the effectiveness of tobacco control interventions to ensure that accurate data informs policies and programs.
Protect people from tobacco smoke: Implementing smoke-free laws and policies to safeguard individuals from the harms of secondhand smoke in public places, workplaces, and other environments.
Offer help to quit tobacco use: Providing accessible cessation services and resources to support individuals who want to quit tobacco, including counselling, nicotine replacement therapies, and other evidence-based interventions.
Warn about the dangers of tobacco: Using effective health warnings on tobacco products, mass media campaigns, and educational initiatives to raise awareness about the health risks associated with tobacco use.
Enforce bans on tobacco advertising, promotion, and sponsorship: Restricting the marketing tactics of the tobacco industry to reduce the appeal and consumption of tobacco products, particularly among young people.
Raise taxes on tobacco: Increasing the price of tobacco products through taxation to discourage tobacco use, reduce consumption, and generate revenue for public health initiatives.
Dr Rao mentioned that Karnataka is being considered as a model state for offering robust de-addiction programs, integrating efforts from medical colleges, nursing colleges, and various medical associations.
He says a grand plan is in place and the recent meetings with the Rajiv Gandhi University of Health Sciences have yielded good implementation strategies.
He says, “We are trying to decentralise this approach by starting a quitline because, in today’s era, instead of aking the person to come to the centre, it is better if the centre will come to him on the phone, giving him solutions,”
Some ideas include:
National Quit Line: Making de-addiction support more accessible via phone lines.
Registration Desk Initiative: Automatically enrolling smokers into the quit line upon their visit to a registration desk at medical facilities.
Certified Programmes: Empowering paramedics and clinicians with certified programs to run de-addiction initiatives effectively.
Dr Rao concluded by stressing the importance of clinician involvement. He cited evidence that even a five-minute conversation with a healthcare professional about the need to quit smoking can significantly impact a patient’s decision and success rate in quitting.
Dr Vishal Rao’s approach is a comprehensive blend of psychological insight, practical steps, and systemic support, offering a promising roadmap for individuals seeking to break free from the grip of nicotine addiction.
(Edited by Sumavarsha Kandula)
