Smoking causes all sorts of insults to human and the environment. From polluting the ocean and the air that we breathe, to directly harming smokers and the people around them (passive smokers). Smoking is notorious for causing lung cancer as well as increasing your risk for other cancers and health conditions. Subsequently, managing smoking-associated conditions poses a massive chronic burden on the health-care system, making the case against cigarettes all the clearer. The strategies to control smoking involves preventing more people from becoming smokers and helping current ones to quit.
Malaysia and Cigarette Smoking
According to the 2015 National Health and Morbidity Survey, 22.8% of Malaysian adults (of those aged 15 and above) are cigarette smokers. Gender-wise, men are clearly the cause of this, with 43% of men smoking cigarettes compared to only 1.9% of women. On the other hand, 74.8% of Malaysian adults had never smoked cigarettes in their entire life. In between the two extremes are Malaysian adults who are no longer daily smokers (1.7%) and those who have quit smoking completely (0.7%).
In the wake of the new government, the new minister of health, Datuk Seri Dr. Dzulkefly Ahmad, has led a more aggressive and vocal campaign against smoking. His most notable action was the enforcement of a 3-meter radius buffer distance from smokers and public dining places. While all government efforts (restricting sales of tobacco to only 18 years old and above, outlawing tobacco advertisement and the recent 3-meter radius rule) help protect the interest of the non-smoking majority, what about the smokers? What can they do to stop smoking successfully?
Steps to A Successful Cessation
Willingness to change
The most important prerequisite when it comes to smoking cessation is acknowledging that you have an addiction problem – it’s a problem that is bad for your health and it’s also burning a hole in your pocket. From here, develop a strong motivation to quit and be rehabilitated. Motivation can come from various sources so take your time to reflect on your priorities and what is it that makes you appreciate life more.
Seek Professional Help
Once you have the motivation to quit, the next step is to seek professional help from healthcare professionals such as doctors or pharmacists. Most outpatient clinics and pharmacies across the country provide smoking cessation services. However, it is important to note that while the healthcare professionals are there to help, the journey is a joint effort between them and you. A comprehensive approach combining the use of nicotine replacement therapy, medication (pharmacotherapy) and behavioural counselling may be used to augment the effectiveness of the program.
Treatment providers will help to guide your preparation as well as provide treatment wherever necessary. Preparatory steps include:
- Setting a quit date – Ideally, the quit date should be within 2 weeks after initiation of treatment. The strategy here is to gradually reduce the number of cigarettes before the set date. After the set date, total abstinence is essential. This is crucial for the long-term success of smoking cessation so make sure to not smoke even a single puff after the quit date.
- Tell family, friends, and co-workers about your intention to quit and request their understanding and support. Healthcare professionals may also help you to obtain social support from self-help groups. If there are other smokers in the household, either encourage household members to quit with you or at least not smoke in your presence to minimise the risk of treatment failure and exposure to second-hand smoking.
- Anticipate challenges, particularly during the critical first few weeks. What any ex-smoker can tell you is that throughout the journey, a smokers’ motivation, beliefs and feeling about smoking and quitting will conflict one another from time to time – you will go through fragile and volatile phases that can be very overpowering. These include nicotine withdrawal symptoms. Fortunately, healthcare professionals are there to discuss these challenges. Doctors can offer problem solving/skills training as well as nicotine replacement therapy or other pharmacotherapy to control or prevent withdrawal symptoms.
- Healthcare professionals will also help you to modify your lifestyle and environment to avoid triggers. This includes removing tobacco products from your environment as well as limiting/abstaining from alcohol while quitting, as alcohol consumption can often cause relapse.
Pharmacotherapy aids quitting by relieving nicotine withdrawal symptoms. There are three categories of first line pharmacotherapy and the usage is determined based on the efficacy, safety, suitability and cost. The three medications used are:
- Nicotine replacement therapy (NRT) – NRT helps to reduce withdrawal symptoms associated with stopping smoking by replacing the nicotine from cigarettes. In Malaysia, NRT is available in the form of chewing gum, skin patches, lozenges, inhalers/inhalators, oral mouth sprays, microtabs, and nasal sprays.
- Bupropion (an antidepressant) – Although it’s an antidepressant, it increases smoking cessation rates independent of its antidepressant effect.
- Varenicline – Helps people stop smoking by a combination of maintaining moderate levels of dopamine (neurotransmitter associated with addiction) to counteract withdrawal symptoms and reducing smoking satisfaction.
The highest risk of relapse is within the first 8 days of quitting. Therefore, frequent initial follow-ups with the doctor after the quit date are crucial to ensure continuous abstinence. Achieving abstinence of 12 months is a good indicator for long term abstinence. During follow-up, doctors will help to instill motivation by congratulating you as well as reminding you of your motivation. Follow-ups are also important to assess pharmacotherapy use and problems. If tobacco use has occurred, doctors will review circumstances that led up to it and help elicit commitment to total abstinence.
The smoking cessation journey is a life-changing experience as it unshackles you from the bane of addiction. While it is not easy and chance of relapse is there, healthcare professionals are there to help you go through it. Say ‘NO’ to cigarettes.
Hello Health Group does not provide medical advice, diagnosis or treatment.
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