May 31 is World No Tobacco Day. The author throws light on the efforts of the Tobacco Cessation Clinic at the Regional Cancer Centre to help stub out the use of tobacco

Over the phone, Praveen T.V., a 47-year-old electronics salesperson, doesn’t sound as raspy or as wheezy as you would expect for someone who once smoked upwards of 20 cigarettes a day, for almost 20 years. Neither does 58-year-old S. Jyothikumar, an ex-serviceman and another chain smoker, who puffed more or less the same number of ‘sticks’ a day. The same goes for 20-year-old Tom Mathew (name changed on request), an undergraduate degree student at a city college, who was also, until recently, addicted to smoking at least a packet (that’s 10 cigarettes) a day.

If today none of them has even a puff, let alone, “think about smoking”, it’s largely thanks to the intervention efforts of the Tobacco Cessation Centre (TCC) at the Regional Cancer Centre (RCC). Set up in 2005 by the World Health Organisation, in conjunction with the Ministry of Health, Government of India, the clinic aims at helping people to stop the use of tobacco and tobacco products. When it was started, it was the first of its kind in the State and is still one of a handful of such centres in Kerala.

“We provide intervention to around 200 to 220 tobacco users every year. We have had many positive results, whether is it completely quitting smoking or at least, reducing their daily habit of excessive smoking. Of course, there are many failures also,” says Dr. R. Jayakrishnan, Assistant Professor of Community Oncology, who is in charge of TCC. “Praveen, Tom and Jyothikumar are some of TCC’s many success stories,” adds Jayakrishnan.

As in most cases with tobacco addicts, Praveen and Tom both lit their first cigarettes in their teens “due to peer pressure.” Jyothikumar started smoking when he was 18, the year he joined the army. “The addiction began taking a toll on my physical and mental health. Moreover, it was a strain on the purse too, costing me Rs.80 or so a day to feed my habit. In retrospect, going to the clinic probably saved my life,” says Jyothikumar, who now works as a security officer, echoing the thoughts of the others.

All three of them voluntarily checked themselves into intervention at TCC. While Praveen and Jyothikumar have been “clean” for some six years now, this is Tom’s fifth month without a puff. However, such self-motivated de-addiction is an exception rather than the norm. “Without intervention, for every 100 habitual smoker, studies show that 70 of them have the desire to quit. Of this, 30 smokers will at least make an attempt to kick the habit, and among them only two to three percent – say six – will end up quitting,” says Dr. Jayakrishnan, who has been with TCC from the beginning.

Once a user is registered on the clinics’ rolls intervention begins, with follow up sessions at regular intervals. Many relapse into smoking. “Perhaps they don’t see tobacco use as a problem,” says Dr. Jayakrishnan. “The urge to light up is a constant battle, especially if you hangout with those who smoke,” muses Tom, who kicked the habit after admitting himself into the clinic last October – in itself quite a rare occurrence for someone so young.

“It all depends on the mind. Where there is a will there is a way. It helps when you have a good guide as I did at TCC and lots of support from family and friends,” avows Praveen, who has introduced several other habitual smokers to intervention. In fact, introducing other addicts to intervention is seen as a socially responsible progression of de-addiction.

Along with direct intervention, TCC also runs a wide range of State-level advocacy programmes and awareness campaigns on tobacco abuse, especially in schools and colleges and in ‘vulnerable’ communities such as tribal and fishing hamlets. It also trains and sensitises medical practitioners to intervene if they encounter habitual smokers who desire to quit smoking.

Subjective therapy

TCC is a couple of tables and chairs and a computer, set up inside the Department of Community Oncology, and manned by Dr. Jayakrishnan and a clinical psychologist. All patients, whether they are self-motivated or mandated into de-addiction, are given individual intervention through behaviour counselling and also nicotine replacement therapy (usually a non-toxic noctine chewing gum), if needs be. “Each intervention is subjective but we generally go by the standardised process – ask, assess, advice, assist and arrange. We figure out the extent of a patient’s commitment to de-addiction and then based on those results we go in for the extent and method of intervention. Addicts with oral pre-cancerous conditions such as Leucoplakia (a lesion/sore in the oral cavity due to excessive use of tobacco) usually fall into line pretty easily. Intervention for self-motivated patients is more to do with helping them maintain the de-addiction urge, which is the toughest stage for any one,” explains Dr. Jayakrishnan.