Author: Dr. Pawan Gupta

Too long use of tobacco in any form – smoking or chewing, disturbs us and has become a part of our life and the tobacco consumer tends to associate lot of their routine activities with it. The timing of tobacco consumption have been such that many of the daily activities coincide with it, and we tend to associate performance with it and the routine activities becomes reminder as a part of 3Rs of habit loop.

Going back, when we started tobacco, the need was to hide and have it. So the best places or timings were when you are alone or away from the family.

• Washroom – the best hiding place, no one to disturb you
• On way to school/office – you are alone and travelling
• In the school/office – hiding places are ample and you have friends who are part.
• After lunch – free time
• Coming back home – from school/office
• Post Dinner – going for a walk

Initially what started as experiment later becomes reason and need. We associate with believe that tobacco enhances these activities. The physical dependency takes over and soon becomes part of life routine drawing one into the slavery of tobacco and justifying our actions.

These withdrawal symptoms need to be noted and addressed, it may require behavioural intervention and many times need medicines.

1. Dry Mouth – this is very common.
   • Water intake – One needs to be hydrated throughout the day(related reading – Controlling the Withdrawals –  first D – Drink plenty of water)
   • Glycerine rinse – water with glycerine gargles
   • Honey – a spoonful will help
   • Amla – put pieces in the mouth and crush
   • Vitamin C chewable tablets
   • Sugarless toffees/candies – vitamin C, Citrus or mint flavoured. It has to be sugarless as dry mouth is highly prone for dental caries
   • If the dryness persists – medicines are available in the market
     • Artificial saliva
     • Tab Xylitol 200 mg tab twice or thrice daily, as per recommendation of physician
2. Throat Irritation – this is specially more in smokers. The menthol added to cigarettes anaesthetises the throat to stop irritation from the other harmful chemicals. When you stop smoking the healing process in the throat may cause a little irritation
   • Frequent water intake – warm water is preferable
   • Steam inhalation
   • Non Alcoholic gargles for initial few days
   • Honey
3. Tingling sensation in oral cavity – this is more so in tobacco chewers, related to the long chemical assault of the buccal mucosa, making it white and parch like and dry mouth
   • Plenty of water
   • Curcumin (haldi) gargles, chewing gums
   • Aloe vera gargles, toothgel keep it in the mouth and rinse
   • Medicines – Folic acid, Vitamin C chewing tablets,
   • Aspirin Gargles – as per advice of the Specialists
   • Examination of Oral Cavity is a must to rule out any Premalignant conditions
4.  Withdrawal Cough – This is part of healing process and needs top be addressed early on (related reading – Coughing on quitting tobacco- What to do). This lasts for few weeks and is a manifestation of healing process
   • Steam inhalation
   • Saline gargles
   • Ayurvedic Khada, licorice
   • Mucolytics cough expectorants
   • Acapella respiratory devices
5. Constipation – one of the most important part of withdrawal symptoms (related reading – Managing Constipation – Withdrawal symptoms)

1. 1. Water intake as a routine. (Related Reading –
   2. Add fibres to your diet – fruits, vegetables etc
   3. Lemon water with honey in the morning
   4. Warm milk with haldi in the night before going to bed
   5. Ayurvedic Triphla can be quiet helpful
   6. Medicines – Isabgol, Lactulose, Rarely pegylated glycol may be required
   7. Medicines to increase motility of intestine may be given when absolutely required

6. Digestive/Gastric imbalance – there is been a tendency of many to smoke or chew tobacco after food associating it as digestive agent. There is no such enzyme or chemicals in tobacco which aids digestion. On the contrary it is a gastric irritant. Some of the abdominal symptoms associated with tobacco withdrawals like bloating, indigestion, hyperacidity etc may be taken care by both ayurvedic (home solutions) or allopathic

• • Water 2 glasses half an hour before food – keeps you hydrated avoids bloating and aids digestion
  • Clove, elaichi etc after food may have smoothening effect as an alternative to have something after food
  • Jeera water it has wonderful effect on your intestine
  • Ayurvedic Digestive preparation available in the market like panchnol etc
  • Allopathic medicines like Proton pump inhibitors, digestive enzymes, liver enzymes may be required and to be taken under guidance and prescription of specialists.

7. Anxiety – related to office/public activities. This has been reasons by many to smoke or chew before any major activity like going for a meeting, public talk, etc

• • Deep breathing exercise calms your nerves
  • Hold your hand close to your ears make it into a fist, take a deep breath and with a jerk and sudden exhalation throw away the tension. Repeat this three times. You would get magical relief and calmness
  • Some who have severe anxiety and palpitation may require anxiolytics (alprazolam) or beta blockers (propranolol) to be given for a very short period of time for the initial few days after symptom discussion when other things do not work.

8. Sleeplessness – This may trouble in the initial days and once accustomed to be nicotine free one tends to have sound sleep

• • Have an early dinner, a warm bath, mild exercise like walking, cycling or stretching.
  • No aerated drinks, tea or coffee after 6 pm
  • Avoid electronic gadgets which tends to keep your mind active and confused.
  • Deep Breathing Exercise before going to bed. Calms you down.
  • Sav aashan as in YOGA is wonderful to make you light and sleepy.
  • In unavoidable situations medicines may be prescribed

9. Vitamin, Mineral and Antioxidants Deficiency– Vitamin D, Folic Acid, Vitamin C many minerals like iron, calcium, magnesium, zinc, selenium etc. These may manifest in various ways like fatigue, tiredness, dry skin, abdominal discomfort, bony pain, muscle cramps and myalgia, general feeling of discomfort.

• • Most tobacco users would have deficiency. A laboratory tests would establish the grade of deficiencies. Testing for certain minerals like iron, calcium and magnesium may be indicative for other mineral deficiency, as testing for all may not be possible and costly.
  • Supplements of vitamins and minerals, with therapeutic treatment of laboratory guided deficiency would improve the general well being bringing back the liveliness and buoyancy of life.
  • Tobacco masquerades the deficiency, when the nicotine level in body depletes the person starts manifesting the symptoms, which may be a big deterrent for a person to quit.
  • This has to be taken care early on to make the transition smooth into the world free from slavery of tobacco.

Tobacco users justify the tobacco use with some of the above withdrawal symptoms. Following the first session, the client is asked to note the triggers which are addressed during the subsequent intervention sessions. The ICanCaRe Android APP records your triggers.

The ICanCaRe Tobacco Wellness Program incorporates all the above in the digitalised protocol based intervention program designed by Mr Rishabh Agrawal.

ICanCaRe team of Certified tobacco Cessation Specialists and Quit Coaches work with you to make your journey smooth, easy, interesting and achievable.

ICanCaRe Tobacco Wellness Centres with its India’s first digital protocol based assessment process guide intervention as per requirements.

Do visit the ICanCaRe Tobacco Wellness Centres or register online by visiting our page or call ICanCaRe quitline 011-43077695.