According to WHO, Indian smokers make 12% in worldwide smokers. More than 1 million die each year in India due to smoking related causes. Around 30% of adult males in India, smoke, according to WHO estimate in 2002. In adult females in India, 3-5% smoke.

What are the harms done by smoking?

According to Centres for Disease Control and Prevention (CDC) fact sheet,                                                  Smoking increases the risk of –

  • Coronary heart disease by 2-4 times.
  • Brain stroke by 2-4 times.
  • Lung cancer by 25 times.
  • Chronic bronchitis and emphysema
  • Berger’s disease in legs (leading to gangrene of legs)

Smokers find it hard to stop smoking. This happens because tobacco contains a very powerful addictive substance called They need help and support when they consider stopping smoking.


There is a complex interaction of bio-psycho-social factors at various levels of the Tobacco addiction.

During the initial phase, curiosity and imitation seem to play as key factors. Once the pleasure is sensed by the user, reward – reinforcement mechanism (operant conditioning) seems to set in.

It appears physical dependence is developed very quickly at this stage if the user continues the use and withdrawal symptoms are precipitated when the effects of Tobacco wear off, thereby leading to persistence of the addiction.

Meanwhile it appears that the mechanism of Pavlovian conditioning sets in individuals gradually. This leads to user getting conditioned to environmental cues in addition to physical dependence. This is why the user easily falls into the trap of Conditional Response to Conditional Stimuli (cues) like Tobacco related products, Adverts, cigarette packets, Ghutka packets, sales counters, other Tobacco users and even to the smell even after physical dependence is addressed.

In Ghutka use, it appears that some of the aromatic substances used the Ghutka tend to activate additional special senses like taste and smell as additional Conditional Stimuli, in addition to psychological ‘high’ caused by Nicotine (primary) and Dopamine (secondary).

It is for this reason, it is important to add weekly counselling sessions in addition to NRT. The use of Carbon Monoxide smokerlyzer is very powerful in providing feedback during these counselling sessions. The counselling improves compliance with the programme and reinforces abstinence.


Nicotine Replacement Therapy (NRT)

Additional medication as necessary

Monitoring of Carbon Monoxide levels


Consistent support


The benefits to the patient who stops smoking are formidable. In terms of health, stopping smoking can help prevent respiratory diseases like chronic bronchitis, bronchogenic carcinoma, cardiovascular diseases, erectile dysfunction and infertility in women.

Our hospital provides Nicotine replacement therapy supported by routine measurement of carbon monoxide levels in breath. We have a good record of patients stopping smoking.