''CRUSH THE CRAVE'' - TOBACCO CESSATION COUNSELLING

 Tobacco dependence is a condition that frequently  calls for  professional intervention. Health care professionals are involved in tobacco control and cessation activities world-wide. Dental settings provide an excellent place for providing tobacco intervention and counselling.

This is because dentists are in the unique position in helping tobacco users as they can reach large numbers of tobacco users and have considerable potential in persuading them  to quit. Dental patients  usually are understanding of health messages at periodic check-ups. Oral effects of tobacco use provide visible evidence and a strong motivation for tobacco users to quit. Oral manifestations  boost the effectiveness among  users in the early stages of tobacco initiation. One important  aspect  is that some of the adverse health effects of tobacco use are clinically apparent in the oral cavity at an even relatively early stages of use . Effects like staining of teeth , pigmentation of mucosa and gingival diseases can act as potential motivators for quitting the habit.

APPROACHES TO PROVIDE TOBACCO CESSATION INTERVENTION ----

Tobacco cessation is  an integral part of quality dental care. Many tobacco users visit a dental office multiple times , so it is important that dentists provide effective intervention strategies.

Tobacco cessation is the process of stopping the use of tobacco products, such as cigarettes, cigars, and smokeless tobacco. In India, the Ministry of Health and Family Welfare has implemented a comprehensive approach to tobacco control through the "5 A's and 5 R's" framework.

The 5 A's are:

1.Ask: Health care providers should ask about the patient's tobacco use and document it in their medical record.

2.Advise: Health care providers should advise all tobacco users to quit.

3.Assess: Health care providers should assess the patient's willingness to make a quit attempt.

4.Assist: Health care providers should provide assistance to the patient in making a quit attempt.

5.Arrange: Health care providers should arrange follow-up care for the patient to increase the likelihood of successful cessation.

The 5 R's are:

1.Relevance: Raising awareness about the personal relevance of quitting tobacco use.

2.Risks: Communicating the health risks associated with tobacco use.

3.Rewards: Highlighting the benefits of quitting tobacco use.

4.Roadblocks: Identifying and addressing the barriers to quitting tobacco use.

5.Repetition: Repeating the message to increase the effectiveness of the intervention.

The "5 A's and 5 R's" framework is an evidence-based approach that has been shown to be effective in helping individuals quit tobacco use. Studies have shown that people who receive counseling and medication from a health care provider are more likely to quit successfully than those who try to quit on their own.

In India, the Ministry of Health and Family Welfare has also launched several campaigns and initiatives to promote tobacco cessation, such as the National Tobacco Control Programme and the National Tobacco Control Cell. These programs provide resources and support to individuals who want to quit tobacco use, including counseling and medication.

ROLE OF PHARMACOTHERAPY FOR TOBACCO CESSATION ---

Due to the addictive nature of nicotine, out of the many tobacco users who attempt to quit, only 3-5% succeed in complete quitting through behavioral intervention. To encourage tobacco cessation, pharmacotherapy, or use of approved drugs, has been widely accepted as an effective mechanism. It helps in reducing the symptoms of nicotine withdrawal and aids in cessation. The use of pharmacotherapy in treating tobacco dependence has been shown to double or even triple the cessation rates. A pharmacological treatment for tobacco cessation acts in dual ways: blocking the positive reinforcing effect of nicotine & preventing the development of withdrawal symptoms.

Nicotine replacement therapy (NRT) is a form of medication-assisted therapy that is used to help individuals quit smoking. NRT works by providing a low dose of nicotine to the body through various forms such as gum, patch, lozenge, inhaler or nasal spray, which can help to reduce withdrawal symptoms and cravings associated with quitting smoking.

In India, NRT is available over-the-counter in various forms like gum and patch and prescription based products like inhaler and nasal spray. These products are widely available in pharmacies and drugstores across the country.

NRT has been found to be effective in helping individuals quit smoking. Studies have shown that people who use NRT are more likely to quit smoking successfully compared to those who do not use any form of medication. The use of NRT in combination with counseling and support can also increase the chances of success.

The Ministry of Health and Family Welfare of India has implemented several programs and campaigns to promote smoking cessation, including the National Tobacco Control Programme and the National Tobacco Control Cell. These programs provide resources and support to individuals who want to quit smoking, including counseling and NRT.

However, it is important to note that NRT is not recommended for everyone. Pregnant women, individuals with certain medical conditions, and people who are allergic to nicotine should not use NRT. It is also not recommended for people who are still smoking, or who have recently quit smoking, as it can be dangerous to use NRT in these situations. It's always best to consult with a healthcare provider before starting NRT.

In conclusion, NRT is an effective medication-assisted therapy that can help individuals quit smoking. It is widely available in India and can be used in combination with counseling and support. However, it's important to consult with a healthcare provider before starting NRT to ensure that it's safe and appropriate for the individual.