Not an addict?

From specia­lity drugs to hypnos­is, smoker­s have tried many ways to quit. But what really works?

Ali had always lived his life in a haze of smoke. His parents, both smokers, had met in an airport’s smoking area. His two elder siblings, who also picked up the habit, always left a spare pack or two lying around.

So for Ali, smoking was the natural order of things, and when his classmates were busy eating popsicles and ice cream cones, he was testing various local and international brands of cigarettes.

Despite their chain smoking, however, both of Ali’s parents died of old age. One of them was diagnosed with lung cancer, one of the many diseases caused by smoking, but the cancer wasn’t fatal.

But Ali himself suffered from many problems. His stamina was poor and he had breathing issues: he always coughed up phlegmatic saliva in the morning. Doctors told him that he had to quit smoking if he wanted to live a longer and healthier life. But having seen so many others in his family breeze through life with a ‘cancer stick’ dangling off their lips, he remained unconvinced.

It was not health issues that eventually made him re-think his decision to continue smoking. “I decided something had to give around the time my first child was born,” reveals Ali. “Even though my parents died of old age and not some smoking-related ailment, I had a nagging feeling that they could have lived longer if they’d had a healthier lifestyle.”

And so Ali ventured out on a quest to find the best replacement for his habit.

“I think I experimented with most solutions,” he says. “I tried nicotine patches and gum, I tried alternative therapies such as acupuncture and homeopathy, I even tried hypnosis. I also chewed regular bubblegum and hung toothpicks in my mouth, hoping that a sort of placebo effect would kick in.”

“Then there was this mystery drug as well, Chantix,” he adds (see box for more information). “But I think it worsened my mood swings. I think I ultimately ‘gave up quitting’ when my doctor suggested that I see a therapist or join a rehabilitation centre,” he ends with a wry smile.

For Ali, nicotine gum was the most effective substitute to smoking, but by his own admission, even when he was chewing nicotine gum he only managed to stop smoking for about a month.

Dr Qureshi, who runs the Smoking Cessation Clinic at the Aga Khan University Hospital, validates Ali’s failure by pointing out the low success rates of quitting using such substitutes. The clinic itself has a success rate of 10 per cent, which drops to eight per cent with prescription drugs like Chantix. For Dr Qureshi, quitting cold turkey remains the best solution. “The smoker himself should want to quit,” he says. “Only an honest willingness to quit can help him succeed.”

This is what ultimately worked for Ali. “I just woke up one day and decided I had to quit. And just like that I went cold turkey.”

Ali, who is now in his mid-thirties, says that the decision to quit has to come from within. “I visited so many specialists and experts, and everyone had a different cure for my addiction. However, one recurring suggestion was that I should cultivate the desire to quit. And when I did, it happened. I couldn’t even do it for my son, who I love the most. But once I decided that I had to do it for myself, I just knew what I had to do.”

Ali says that when he went cold turkey, he was prepared to deal with intense withdrawal symptoms. So he tried to find solace in regular spiritual engagement. “I started reading the Quran. It served as a source of peace and helped keep my mind occupied,” he says.

The concept of engaging in a healthy mental or physical activity is another thing, besides having the will to quit, that most medical practitioners speak of.

Syed Abul Hassan, a qualified Hakeem, says that he advises all his patients with addictions to keep busy — and adds that he tells them to seek peace in reading the Quran. “There isn’t any specific medicine I can prescribe to help people quit smoking. I just help them realise the need to quit and help them attain the willpower,” says Hassan. “I generally prescribe ‘majoom’ to help them regain physical strength faster when they experience withdrawal symptoms; and I give them a concoction of illaichi (cardamom) or arq-e-gulab (rose water) to help them regain their mental strength.” However, Hasan said that not many people have come to him for their troubles with addiction. “I had one young man who was addicted to hashish (cannabis). I just talked to him and gave +him a harmless pill. The placebo effect worked for him.”

Interestingly, those who provide ‘alternative’ treatment claim to have a higher success rate. Dr Moiz Hussain, a hypnotist, stopped holding one-to-one sessions five years ago. But he says hypnosis can definitely help people quit smoking. “I’d usually have four to five sessions with a person, with each session lasting up to an hour.” He claims to have had an astonishingly high success rate of 80 per cent.

Colonel (retired) Dr Irshad Ahmad Khan, who runs the Institute of Alternative Medicine, combines Chinese, Japanese and French methods to treat his patients. The ancient Oriental practice of acupuncture, he says, is now considered to be the most effective method to help overcome any addiction. “To help people quit, we use traditional acupuncture, inserting needles at various pressure points in the arms, legs and the head. The French method of applying studs to the ear lobes is combined with this; and to help overcome any psychological problems I use Reiki to transfer energy to my patients and provide mental relaxation,” he says. “After going through the 24-day course, with a one-hour session every day, I can assure you that your problem — even if it is heroin addiction — will be gone. This combination is what makes me so effective,” he says proudly.

A former army surgeon, Dr Khan has been practicing since 1975, and says that he now dedicates all his time to healing through acupuncture because of its effectiveness. He opens up a Chinese book he claims is dated 435 BC, and points out how all the ‘acupuncture points’, and not pressure points, in the human body are identified in the sketches shown.

What about patients who are afraid of needles? For those, Dr Khan explains, a laser needle has also been developed. “But even with an actual needle, all you feel is a pinch,” he says. “There is no pain or blood loss.” Dr Khan says he sees about two patients on average per month, and he claims that he has yet to treat a patient who has not been cured. However, he also points out that it is necessary for the patient to not give in to his urge to smoke. “Every time the patient has the urge, he can use the stud on his/her ear lobe to activate that pressure point. This helps control it,” the doctor says.

The ‘will to quit’ is something that every doctor and alternative therapist talks about with regard to smoking. According to them, medical practitioners can only facilitate a patient’s recovery.

Medical students, however, said that scare tactics could be used to force people on the path to recovery. “Maybe you need to show people what awaits them if they continue smoking,” says Kiran, a student at Aga Khan University.

“If someone likes to drive, you can tell them how smoking can impair the faculties’ that are essential to do this ...  for example, blood vessels go into spasms or seizures due to the nicotine. Nicotine induces numbness at your extremities and your responses are slower,” says the future doctor.

Another chimes in: “Smoking exponentially increases the chances of contracting cancer.” Kiran continues where her friend has left off: “It can cause cancer of the digestive tract; and permanently limit or even eliminate your ability to eat or defecate.”

To Kiran and her friend, and to the doctor in charge of the smoking cessation clinic, what is needed is a mass campaign to make people aware of the consequences of their habit. They also recommend policy changes. “We should ban smoking in public places like Europe and the US. We need to make smoking inconvenient. That would be a great help. But I think implementation of the ban on sheesha would show how serious the authorities are,” says Ayesha, another medical student.

Dr Sabreen, a doctor at the AKUH, says that smokers generally know of the consequences of their habit. “The decision to put up the ‘oral cancer’ image on cigarette packs is a great decision, and it surely is a deterrent, at least to new smokers,” she says.

“Even sitting a smoker down and calculating how much money he/she spends on the habit can help them change their mind,” says Kiran. But she is of the opinion that fear is likely to be a lot more effective than reason or logic, when it comes to getting people to quit.

Maybe there is something to her hypothesis, because Farhad, who works at a bank, says he quit smoking because he didn’t like the image on the box staring back at him. Maybe the future doctors are right, and smokers need to be scared out of their stupor.

Published in The Express Tribune, Sunday Magazine, June 19^th, 2011.