It would start in the morning. The familiar urge to light a cigarette to start his day had become part of Michael Semper’s routine. It began with a cigarette offered to him by a friend over a decade ago. Now, he’s up to a pack a day; twenty cigarettes inhaled on a daily basis. ’I really want to quit. I’ve tried quitting three times before but something would stress me out and in no time, I’d be back in the shop buying a pack. I know it’s not healthy but I don’t think people understand the intensity of the craving. It’s like a voice in the back of my head insisting that I get a smoke and if I don’t, the voice just nags until I give in,’ Semper shared.

Semper is not alone. In fact, according to Parliamentary Secretary in the Ministry of Health Senator Wesley George, there are over 200,000 smokers in Trinidad and Tobago. George shared the figures during his speech on the Tobacco Control Bill at the Association of Psychiatrists of Trinidad and Tobago’s recent symposium at the Kapok Hotel, the theme of which was ’The Social ills of Cigarette Smoking’.

Statistics provided at the symposium showed that of the 1.22 billion smokers worldwide, 1 billion of these are in developing countries. Smoking is on the decline in developed countries such as the US but on the increase in the developing countries. Trinidad and Tobago has the fourth highest rate of smokers amongst secondary school children between the ages of 13 and 15 years.

Usually, lung cancer is the first ailment people think of as a consequence of smoking but Dr Tarif Dookie, an internist based at the West Shore Medical Centre reminded the audience of some of the other diseases caused by cigarette smoking.

The carcinogen Benzoaprine causes cancer not only in the mouth and lungs but also bladder, stomach, kidney and cervix. Additionally, he noted in smokers the incidences of lung diseases like bronchitis, emphysema and asthma are increased as well as cardiovascular disease, strokes and hypertension.

Quitting is difficult as Dookie said nicotine addiction is mainly due to its psychoactive(mood-altering) property where it affects the mesolimbic dopaminergic system in the brain, binding to cholinergic receptors releasing dopamine. This dopamine is responsible for the sensation of pleasure, relief of anxiety, better task performance and improve memory. This sensation of pleasure serves to reinforce the smoking habit. As the body gets used to the nicotine, tolerance develops where higher dosages are needed to produce the same pleasure sensation.

People who attempt to stop smoking experience withdrawal symptoms such as irritability, depression, insomnia, weight gain, headaches, nervousness and decreased concentration.

Family physician Dr Varma Deyalsingh noted: ’Seventy per cent of all smokers report that they want to quit, however fewer than 7 per cent of smokers who attempt to quit remain smoke-free after one year. The average smoker will try to quit 6 to 9 times in a lifetime. Smoking is also a social habit where smoking in some environments reinforces the pleasure response and the pleasure associated with smoking in certain areas such as clubs acts as a subconscious trigger, making it hard for the smoker to dissociate the behaviour from his addiction. Hence a successful quitter would need behaviour modification’.

According to the Association of Psychiatrists of Trinidad and Tobago, along with behaviour modification therapy, there are different drug therapies that can be used. The Nicotine patch or gum serves to replace the nicotine in cigarettes without the other harmful chemicals. These are given at decreasing dosages until the urges subside. Some psychiatrists were familiar with the use of Zyban (Bupropion hydrochloride) or Wellbutrine. This is an antidepressant which is used and is available at the St Ann’s Hospital Dispensary.

But the new weapon in the fight against smoking is the drug Champix (Varenicline). This has promising results and compared to Zyban, 44 per cent of smokers quit by the end of 3 months as compared to 30 per cent with Zyban.

Deyalsingh noted: ’Champix binds to the same receptors in the brain which nicotine affects. It decreases the cravings and withdrawal symptoms. Champix can be started 1-2 weeks before the set quit date and should be used for 3 to 6 months. However, Champix may cause side effects such as headaches, nausea, insomnia and dreams. And there is an incidence of increase in suicidal thoughts and mood swings’.