Health Talk

Willpower is not Enough to Quit Smoking

Smoking tobacco dramatically increases the risk of developing many diseases. It is responsible for a substantial majority of lung cancer and chronic obstructive pulmonary diseases, and most smokers die either from these respiratory diseases or from ischemic heart disease. Smoking also causes cancer of the upper respiratory and gastrointestinal tracts, pancreas, urinary bladder and kidney, and increases risk of peripheral vascular disease, stroke and peptic ulceration. Maternal smoking is an important cause of fetal growth retardation. Moreover, there is increasing evidence that passive (or "secondhand") smoking has adverse effects on cardiovascular and respiratory health.

When the ill- health effects of smoking were first discovered, doctors imagined that warning people about dangers of smoking would result in them giving up. An initial decline in smoking rates in the 1960s suggested that these assumptions were correct, but in most countries of the developed world this decline has since slowed or plateaued, while rates are increasing amongst young women and in many developing countries where tobacco companies have found newer markets. World-wide there are one billion smokers, and three million die prematurely each year as a result of their habit. In the USA, it has been estimated that more than five million years of potential life and 90 billion dollar of productivity are lost each year due to smoking.
In reality, there is a complex hierarchy of systems that interact to cause smokers to initiate and maintain their habit. At the molecular and cellular levels, nicotine acts on the nervous system to create dependence, so that smokers experience unpleasant effects when they attempt to quit. So, even if they know it is harmful, the role of addiction in maintaining the habit is important. Influences at the personal and social levels are just as important. For example, research has shown that many individuals bolster their denial of the harmful effects of smoking by focusing on someone they know personally who smoked until he was very old, went to pub everyday and died peacefully in his bed at home. Such strong counter examples help smoker to maintain internal beliefs that comfort them when presented with statistical evidence.
Will Power is Not Enough
The majority of adult smokers say they would like to give up smoking but only 2% of smokers manage by will power alone. Even if a smoker decides to quit, there are a variety of influences in the wider environment that alter the chances of sustained success, including peer pressure, cigarette advertising, and finding oneself in circumstances where one previously smoked. 
Health professionals can work with the individual smoker to understand his or her beliefs and motivations. Participation in groups has also been shown to be effective. Nicotine Replacement Therapy (NRT) or use of bupropion (an antidepressant which acts centrally) can reduce cravings. 
If intensive support is combined with pharmacological aids, quitting rates are significantly improved. Although the absolute quit rates seem modest, smoking cessation intervention are cost effective and, if widely available, can contribute to reduction in smoking prevalence. However, action at the societal level, such as bans on tobacco advertising, increasing taxation on tobacco, and regulation of the sale of tobacco, making sure all workplaces and public places are smoke free, and placing clean warnings on cigarette packets may be more effective.
Q. I found your contact number in mélange magazine. I am 24 years old and I want to plan for my aunt's future life. I am tense for I feel unable to do so. She is mentally abnormal. She does her household work fine but she talks and laughs alone, and sometimes while working also. Tell me what to do.
(Name withheld)
Ans: I am sorry to hear about your aunt. Appreciate the fact that you think about your family members. Going through the symptoms, it appears your aunt is suffering from a psychiatric problem. However, it is important to meet your aunt to make a clinical diagnosis. My suggestion is please consult with a Psychiatrist at the earliest. The sooner a confirmed diagnosis is made, medications can be started. This will help control and gradually eliminate the symptoms. Do feel free to discuss further with me. Take care.
Q. Dear Madam, I have been facing a particular problem. I have noticed that people I meet just become friendly for a short period of time and then stop being friendly with me. Even when I think that I can build a lifelong friendship with someone, it does not work out. Is anything wrong with me? 
(Name withheld) 
Ans: You have to conduct a self analysis for this problem at hand. Introspect if you treat the people in your life with care and respect. Or do you tend to use them for your own gain? These are issues you need to think over. Simply having a long list of friends is not sufficient. We need to be able to give them time, our adequate concern and also make them feel important in our lives. Are you doing that? How is your behaviour towards your friends? Think over these points at length. You shall get your answer!
Q. I tend to get very tense and anxious at all times. I end up thinking too much usually. I also get very emotional at times. Please give me some tips to be patient. I lose my patience even on trivial matters. 
(Name withheld)
Ans: What you have described usually depends a great deal on your personality - some of us are able to manage stress better than others. Since there is only so much you can do to alter your personality, here are some suggestions that might help:
- Try to distance yourself from the stressful situation when you can: If, for example, you're having an argument with someone that is causing you stress, move away. Say you will discuss the matter later and go do something else to take your mind off it. Go for a walk, watch TV, talk to a friend, anything that will allow you to forget about the argument for that time.
- You can even take up Yoga or some such meditational activity that'll help you to relax.
- Join some hobby/crafts clubs and make new friends. 
Hope this helps. Best of luck!
Ms.Gariasi Dutta, MSW (TISS) is Psychological Counsellor with Down Town Hospital, Guwahati. She can be contacted at 98640-55560 or