Is smoking really such a pleasurable activity?

SMOKING dates back to the year 2,000BC. Through the centuries, people from all walks of life have succumbed to the addictive nature of tobacco. According to the World Health Organisation (WHO), in the 21st century alone, tobacco is expected to kill one billion people globally whilst its consumption is on the rise in developing countries.

“Smoking has often been wrongly depicted as ‘cool’, ‘fashionable’, ‘trendy’ and in certain societies, it is part of the social norm,” said Dr Zarihah Mohd Zain, a 16-year veteran epidemiologist who specialises in smoking-related issues. “In actual fact, smoking is the leading cause of preventable death. The health consequences of smoking are two-fold. First, the smoker rapidly becomes dependant on nicotine. The addictive properties of nicotine are well documented but are often underestimated by the consumer.

“Secondly, smoking causes fatal and disabling disease, and, compared with other high risk behaviours, the risk of premature death from tobacco is extremely high. Half of all long-term smokers will eventually be killed by tobacco, and of these, half will die during productive middle age, losing 20 to 25 years of life.”

Chronic diseases are the major cause of death in the world, led by cardiovascular disease, cancer, chronic lung diseases and diabetes. These leading diseases share some key risk factors, which include tobacco use. The global prevalence of all the leading chronic diseases is increasing, with the majority occurring in developing countries and projected to increase substantially over the next two decades.

According to Dr Zarihah, whenever a smoker lights up a cigarette, there are various cost implications, some of which might not even be evident to the smoker. The various costs resulting from tobacco use include social, environment, economic and health.

The social burden of smoking includes youth becoming nicotine dependant, which might lead to substance abuse later on.

Some examples of environmental cost is air pollution from second-hand smoke, which is just as harmful as smoking, soil degradation and deforestation from tobacco cultivation.

Economic costs include the smoker’s personal financial loss and decreased productivity at the work place or in their personal lives.

A research was conducted in 2005 to 2006, entitled Health Care Costs of Smoking in Malaysia, where costs from three smoking-related diseases – lung cancer, ischemic heart disease (heart attack) and chronic obstructive pulmonary disease (COPD) – were evaluated.

Between 23% and 25% of the Malaysian population are smokers and are hence vulnerable to these diseases. According to this study, sufferers of these three diseases have exhausted approximately RM3bil and this makes up 16.49% of national health expenditure or 0.74% of gross domestic product (GDP).

Dr Zarihah highlighted that there have been various measures to curb the habit of smoking, including prohibiting advertising and promotion, increased tax and pricing policies on tobacco products, youth access restriction, product regulation, restriction on smoking in public places and packaging regulation.

For the latter, pictorial graphic warnings will be implemented in Malaysia beginning January 1, 2009.

She added: “Most smokers are probably aware of the harmful effects of tobacco upon themselves and their loved ones who are subjected to second-hand smoke every time they light up. Amongst the smokers, some of them have also tried giving up cigarettes but found it difficult to fight the craving and the withdrawal symptoms that come with smoking cessation.”

The craving and withdrawal symptoms are indications of nicotine dependence. Nicotine dependence makes quitting smoking very difficult and is one of the main reasons many smokers do not succeed in their attempts to quit.

Dr Zarihah explained why it is challenging to quit smoking. “When smokers inhale smoke from a cigarette, nicotine reaches the brain within seconds and binds to nicotinic receptors, which activates the reward pathway in the brain circuitry. This stimulates the pleasure centre in the brain.

“However, the initial effects of pleasure recede quickly. The rewards or pleasurable effects reinforce a smoker’s physical dependence on the nicotine contained in cigarettes. Smokers then become accustomed to certain levels of nicotine in their systems and a drop in these nicotine levels result in a cycle of craving and uncomfortable withdrawal.”

Most smokers who intend to quit smoking choose the “cold turkey” method. There is a high level of relapse amongst smokers who quit “cold turkey” due to nicotine dependence.

According to the World Health Organization, 95% of smokers who attempted to quit without assistance do not make it. Most smokers take five to seven attempts, without assistance, before succeeding. Many are unaware that there is medical assistance available from healthcare professionals.

Dr Zarihah encourages smokers to discuss options for smoking cessation with their healthcare professionals (either doctors or pharmacists). Options for smoking cessation include non-nicotine oral tables and nicotine replacement therapy.

Non-nicotine oral tablets include buproprion and varenicline. Nicotine replacement therapy includes nicotine gum, lozenge, patch and inhaler.

Smokers who embark on a smoking cessation programme need help and support to overcome the physical and psychological challenges of quitting smoking. Up to 40% of smokers may be motivated to try to stop smoking following advice from a doctor during a routine consultation. As such, a support programme together with the healthcare professionals’ assistance is crucial. Between 3% and 20% will succeed depending on the smoker and the method used to stop.

Dr Zarihah stressed the importance of getting help and encouragement of family members and friends while trying to quit smoking. It has been proven that a combination of medication and a support programme increases the chances of quitting smoking, therefore reducing the chances of the vicious cycle of relapsing.

The health benefits of quitting smoking are many-fold. Regardless of the age of an individual or how long the person has been smoking, the health benefits are immediate the moment they stop smoking.

- The Star