Tobacco addiction needs to be treated as mental health disease in view of growing cases of COVID-19 and poor clinical interventions

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In view of rising cases of COVID-19, oral cancer and lack of clinical interventions, it has been recommended that tobacco addiction has to be treated accordingly as part of the spectrum of mental health diseases. It is considered to be a disease and thus classified by ICD10 and DSM4, as per International Psychiatric Classification.

While the coexisting mental illnesses have to be addressed appropriately, anxiety and depression arising as a result of withdrawals during a quit attempt should also be addressed by a qualified healthcare counselor.

“Healthcare providers are not providing advice to tobacco users, especially the smokeless tobacco users. Issues of stigma, triggers of tobacco use and cessation support in other forms of advice need to be provided by trained counsellors. Hence a quit attempt aided by a tobacco cessation counsellor has more chance of being successful,” explained Dr. Dinesh Jagiasi, senior manager, Narotam Sekhsaria Foundation (NSF).

Targeted approach can be an option to make tobacco users aware about the different interventions and existing mass media campaigns can be used to deliver messages about the required behaviour change.

“India introduced the National Tobacco Control Programme and Cigarettes and Other Tobacco Products Act. However, as the issue remains with most of the health programmes, implementation of the defined interventions remains a challenge,” Dr Jagiasi pinpointed.

Since coronavirus attacks the lungs directly and smokers tend to have weak lungs thus making them more prone to the virus, the most effective intervention to quit tobacco is behavioural counselling with or without pharmacotherapy.

“If someone wants to quit using tobacco (be it smoking or smokeless form of tobacco), she or he can go to a tobacco cessation centre wherein they may be provided with the required tobacco cessation counselling. If needed supplementing the behavioural counselling with use of Nicotine Replacement Therapy (NRT). However, using NRT for Smokeless tobacco can’t be considered as an evidence-based practice. Alternatively, tobacco users can use any of the available Quitline (1800-11-2356 – National Quitline; LifeFirst Quitline –1800-266-6431) for accessing tobacco cessation counselling,” Dr Jagiasi informed.

The counsellor may also decide to refer the client to a psychiatrist for prescribing the medicines like varenicline or bupropion which are anti-depressants to bring about the required quit.

NSF is working in the field of cancer care and hence has developed a tobacco cessation service, LifeFirst in collaboration with Salaam Bombay Foundation (SBF). NSF partners with Harvard School of Public Health, Massachusetts General Hospital and other such highly competent institutes/organisations having expertise in the domain of Tobacco Cessation. We are in pursuit of partnerships across healthcare providers so as to integrate tobacco cessation services within healthcare facilities.

“Scaling up of such services for tobacco cessation is the key as by GATS-2 survey findings reveal that more than half of tobacco users are wanting to quit tobacco, however, they are not aware of ways to go about it. The quantum of tobacco users, as informed by Global Adult tobacco Survey (GATS-2) is 267 million tobacco users across the country whereas we have Tobacco Cessation Centres limited to District Hospitals run by the state which have been scaled up to sub district health facilities and rural hospitals with its own limitations,” Dr Jagiasi further informed.

The intangible challenge with counselling as a therapy is applicable to all types of counselling wherein the perception of clients is the issue. Somehow clients/patients can’t relate counselling as a service – most of them ask for medicines instead of counselling. Counselling addresses the required behaviour change to introduce any change in pattern or any habit. Another challenge linked to the above stated aspect in tobacco cessation counselling is the cost factor. Very few clients are willing to spend money to get counselling support.

There is definite increase in risk of contracting and further spreading of infection through tobacco products and subsequent spitting of the chewed tobacco product/juices/remain. It is best to quit tobacco so as to do away with the risk of infection and possibly much severe risk of health effects of tobacco.

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