Why Homoeopathy for Tobacco Addiction?

Dr Jyoti Chhikara,Fakhra Zehra

The tobacco epidemic is one of the biggest public health threats the world is facing, and tobacco smoking, the most common form of tobacco use worldwide, is being practiced by over one billion people globally, of whom the majority are in developing countries. ^[1] India is the second largest consumer of tobacco products, with more than 200 million users of smokeless forms of tobacco and 276 million consumers of tobacco overall ^[2].

India accounts for 12% of the tobacco smokers in the world and of the estimated 1 million tobacco attributable deaths annually, smoking and exposure to second-hand smoke kill about 0.93 million people each year, while smokeless tobacco use kills an additional 0.02 million individuals in India annually, accounting for 74% of the global burden of smokeless tobacco.^[3]

Passive smoking may be invisible and odorless, but it can linger in the air for up to five hours. More than 60,000 children under 5 years of age die of lower respiratory infections caused by passive smoke and those who live are more likely to develop Chronic Obstructive Pulmonary disorders (COPD) later in life.

Homeopathic medicines strengthen a person’s overall constitution so that they are not only less physically addicted to tobacco but that they feel stronger emotionally and thus feel less addicted to tobacco smoking and chewing.

What is nicotine addiction?
Nicotine, a chemical in tobacco, reaches the brain within seconds and increases the release of neurotransmitters, which help regulate mood and behavior. As a result, dopamine, one of these neurotransmitters, is released in the reward center of the brain and causes feelings of pleasure and improved mood. The excess release of acetylcholine associated with nicotine consumption is related to improved attention, increased vigilance in the performance of repetitive tasks, and memory improvements. These pharmacological effects play a large role in maintaining smoking behaviour in the addicted smoker. Nicotine also affects metabolism by decreasing appetite and increasing metabolic rate.

Diagnostic Criteria for Dependence ^[4]
Both WHO in Classification of Diseases (ICD) and the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual (DSM-IV & DSM-IV-TR) have issued diagnostic criteria to assess dependence and withdrawal.

Dependence is a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in 12- month period:

Tolerance, as defined by either a need for markedly increased amounts of the substance to achieve the desired effect, or markedly diminished effect with continued use of the same amount of substance. Withdrawal, as manifested by either:

1. The characteristic withdrawal syndrome for the substance, or
2. The substance being taken to relieve or avoid withdrawal symptoms.
3. Taking larger amounts of the substance or over a longer period than was intended.
4.  A persistent desire for or unsuccessful efforts to cut down on substance use.
5. A great deal of time being spent in activities necessary to obtain or use a substance.
6. Abandonment or reduction of important social, occupational, or recreational activities because of substance abuse.

How to evaluate tobacco consumption in a smoker?
The consumption is measured using smoking index which is a unit used for measuring cigarettes consumption over a long period and is calculated using the following formula:

Smoking index = CPD × years of tobacco use (CPD- Cigarettes smoked per day)

Smoking categories are defined as: Non-smoker, <400, 400-799, >800

The CPD was estimated for current and former smokers. Heavy smoking was defined as ≥20 CPD and mild smoking as <20 CPD.

Certain risk factors encourage tobacco consumption are: 

1. Psychosocial Factors– Belonging to lower socioeconomic groups, peer smoking prevalence; the adolescent’s environment, attitudes and behaviours of friends, siblings and parents, lack of parental monitoring, low levels of academic achievement, and previous experimentation with tobacco products.
2. 2. Behavioural and Psychological Factors-The repeated dosing of tobacco coupled with the fact that withdrawal symptoms are often averted with each cigarette, makes nicotine one of the most addictive drugs. In addition to this, certain behaviours such as smoking after a meal, while on the phone, or driving a car, also become associated with smoking and reinforce continued use.
3. Social and Environmental Influences and Marketing- peer pressure, smoking attractiveness, tobacco use by family members, curiosity, and lack of appropriate options to reduce stress, exposure of children to cigarettes, adult and sibling smoking status, advertising activities of tobacco companies, easy access to cigar cigarettes, media, low cost of cigarettes, etc.

Impact of nicotine / tobacco on human health:

1. Cardiovascular health- Smoking acts synergistically with other risk factors like high cholesterol and blood pressure to increase the risk of Coronary Heart Diseases leading to increased deaths due to stroke and myocardial infarction.
2. Respiratory health- World Health Organization (WHO) highlights that over 40% of all tobacco related deaths are from lung diseases like cancer, chronic respiratory diseases and tuberculosis.

• Lung cancer: Tobacco smoking is the primary cause for lung cancer which is now the leading cause of cancer death in the world among men.
• COPD: 45% of all deaths from COPD are attributed to tobacco use.
• Tuberculosis- Tuberculosis (TB) damages the lungs and reduces lung function, and smokers are twice as likely to fall ill with TB and the standard treatment is likely to become less effective for them.

Cancers –Tobacco is also associated with cancer of respiratory tract, lung, upper gastrointestinal tract, liver, pancreas, kidney, urinary bladder, oral cavity, nasal cavity, cervix, etc. Smokeless tobacco is a major cause of cancer of the oral cavity.

Reproductive health-

• Women: Use of nicotine causes hormonal imbalance through its stimulation of growth hormone, cortisol, vasopressin, and oxytocin release, which in turn inhibits luteinizing hormone and prolactin leading to reduced fertility, decreased chances of conception, increased menstrual abnormalities, and early menopause in women.
• Men: Whereas in men, it leads to reduced semen quality including semen volume, sperm density, motility, viability, and normal morphology. Furthermore, reproductive hormone system disorder, dysfunction of spermatogenesis, sperm mutation process, and impaired spermatozoa function have also been observed in smokers.

Brain Health- Persons with mental illness are more likely to smoke and become addicted, as it serves as a coping mechanism. Smoking seems to exacerbate symptoms in anxiety disorders, schizophrenia and bipolar illness and makes psychiatric medications less effective. Use of illicit drugs or alcohol greatly increases the likelihood of tobacco use and dependence among adolescents.

Consumption of tobacco can also lead to leukemia, diabetes, eye disorders such as cataracts and macular degeneration, weakened immune system, loss of sense of taste or smell, gum disease and dental issues, the appearance of premature aging, peptic ulcer disease & osteoporosis, apart from direct impact on the heart, lung and brain health.

Role of homeopathy to deal with tobacco addiction
Homoeopathy is the best way to find an approach that solely works for you and eliminate the root cause of the disease. The nature of tobacco craving is characterized differently as per the individual, the physical and psychological factors that motivate it, alter it or enhance it could be totally different. The main road block a person can confront are the emotional triggers like: craving, mood swings and anxiety, these are due to the nicotine withdrawal and the lack of sense of verdict. Homeopathy fixes these emotional triggers and works at the safest and the deepest levels to help quitting smoking.

Smoking is not just a physical addiction but also a social addiction. One can be physically addicted to nicotine, and one can also be addicted to the image of themselves as a smoker. The unique benefits that homeopathic medicines provide is that they can strengthen a person’s overall constitution so that they are not only less physically addicted to tobacco but that they feel stronger emotionally, thus feel less socially addicted to what smoking represents to them.

The selection homoeopathic remedy is based upon the individualization and symptom-similarity by using a holistic approach i.e. according to fundamental laws of simplex and minimum dose, which is achieved by selecting homeopathic remedy on the basis of the uncommon, peculiar and characteristic symptoms of each individual patient.

As per Organon of Medicine, tobacco smoking and addiction is an advanced syphilitic miasm. So such cases should be treated with anti-syphilitic remedies in low potencies. To save the smokers from this habit, physician should create an interest for withdrawal from smoking before starting treatment.

Moreover, homoeopathy has shown good outcomes in dealing with with mental diseases, and thus offers great potential in dealing with addictions. It is important to treat addiction in its early stages because if left untreated it may lead to several corporeal diseases. ^[5] If addiction is predominantly from psychogenic causes and if they are of recent origin – psycho-therapy should also be considered. The physician to the patient should not only be his prescriber, but also his friend, philosopher and guide to keep the patient to resolve his complexes and revert to healthy growth and development of his personality. ^[5]

Rubrics Related To Tobacco Smoking

Rubrics related to complaints from tobacco in Kent’s Repertory are as follows:

RUBRICS	MEDICINE
Mind–anxiety, tobacco, from smoking -confusion, smoking, after -dullness, smoking, from -restlessness, smoking, after	Petr., sep.Alum., bell., ferr-i., gels., petr., thuj.Acon.Calad.
Head  -congestion, smoking, from– heaviness, smoking, agg. – pain, tobacco, smoking, from             – pain, smoking from              -pain, stunning, stupefying, smoking, while	Bell., mag-cFerr-i., gels.Acet-ac., acon., alum., antim-t., bell., brom., calad., calc., caust., clem., cocc., coc-c., ferr., ferr-i., gels., glon., ign., lob., mag-c., Nat-a., nat-m., nux-v., op., par., petr., plan., puls., sil., spig., thuj., zinc.  Calad., mag-c Ant-c
Stomach– desires, tobacco – desires, tobacco smoking – aversion, tobacco  – aversion, tobacco, smoking (his accustomed cigar)	Bell., carb-ac., daph., eug., kreos., manc., nat-c., nux-v., ox-ac., plat., plb., staph., Tab., ther., thuj.Calad., carb-an., card-m., eug., glon., ham., led., lyc., ther. Acon., ant-t., arn., bov., brom., bry., Calc., camph., canth., carb-an., chlor., cimic., cocc., con., ign., lach., lyc., mag-s., meph., nat-m., Nux-v., op., phos., psor., puls., spig., sulph., tarax., thuj., til., valer., zing.Alum., arg-m., arn., asar., bor., brom., bry., calc-p., calc., camph., carb-an., clem., coc-c., coff., euphr., grat., Ign., kali-bi., kali-n., lach., lyc., mag-s., nat-a., nat-m., nat-s., nicc., olnd., op., ox-ac., phos., psor., puls., sep., spig., sulph., tarax., tell.
Generalities-tobacco, amel -tobacco agg.    -smoke agg.	Aran., bor., carb-ac., coloc., hep., merc., nat-c., sep., spig.Acon., agar., alum., ambr., ant-c., arg-m., arg-n., Ars.,  bell., bry., calad., calc., camph., carb-an., carb-s., chel., chin., cic., clem., coc-c., coca., cocc., coloc., con., cycl., dig., euphr., ferr., gels., hell., hep., hydr., Ign.,  iod., ip., lach., lact-ac., lyc., mag-c., meny., nat-m., Nux-v., osm., par., petr., phos., Plan., Puls.,  ran-b., rhus-t., ruta., sabad., sabin., sars., sel., sep., sil., Spig., Spong., Staph., sul-ac., sulph., tarax., thuj., verat.Cal., caust., euphr., nat-m., nux-v., olnd., sep., Spig., sulph

Role of homoeopathic medicines in tobacco addiction

Homeopathic medicines offer a great scope for not just tobacco addiction but also while dealing with the withdrawal symptoms. Some of the most useful medicines for dealing with ailments from tobacco smoking:

• ARSENIC ALBUM: The Arsenicum type displays a classic picture of the recently ex- smoker: restless, anxious, constantly shifting, fearful, easily exhausted, emaciated and any area of pain often has a burning character. Also seen here may be great thirst for cold water drinks often but little at a time. Symptoms are worse in wet weather or cold, and better for heat and warm drinks. ^[6]
• AVENA SATIVA: Best homeopathic medicine for smoking addiction when dealing with withdrawal symptoms. The effects of tobacco are treated effectively with Avena Sativa. It is one of the best ways to overcome tobacco addiction. It works very well in treating nervous exhaustion, sexual debility; debility after exhausting diseases. ^[7]
• CALADIUM: One of the great tobacco craving remedies, it promotes a dislike for tobacco, often to the point of nausea or vomiting if used when smoking. A keynote symptom for this remedy is a dread of motion. Headaches, memory loss, dyspnoea and catarrhal asthma may also be noted here. Symptoms are worse for motion and better after sleep.^[6][8]
• COFFEA: Homeopathic medicine for nicotine addiction with marked insomnia after a phase of excitement. The patient experiences increased energy, ecstasy, sleeplessness on account of excess mental activity, and an increased flow of ideas. He is unable to sleep from an excessive intake of coffee. The patient experiences great loquacity, his brain feels clear, and he is extremely active. The patient also feels strong enough to do anything. ^[7][8]
• DAPHNE INDICA: It is effective for removing the craving for tobacco. It is prescribed when severe headache occurs as if head were separated from the body due to the effect of tobacco. The patient also experiences sleeplessness, profuse sweat, burning pain in stomach and fetid breath.^[8]
• EUGENIA JAMBOS: Eugenia is effective for quitting smoking where nausea is a predominant symptom which is better by smoking.^[8]
• HYOSCYMYUS: Homeopathic treatment for tobacco smoking addiction accompanied by hallucinations and delusions. The patient experiences a confused mind and seems intoxicated, laughs, sings, recites poetry, and babbles deliriously. The patient does foolish things and does not behave normally. Hyoscyamus also helps patients with an addiction to alcohol and those who experience intoxicated rages. In such cases, there is involuntary urination along with hallucinations.^[8]
• IGNATIA AMARA: It is the best antidote for the bad effects of smoking. Ignatia patients cannot bear tobacco and have great excitability and sensory hypersensitivity. It is prescribed when marked mood swing, depression, headache, sour taste in mouth, sour eructations, dry spasmodic cough , cramping pain in abdomen , neck or back are present. Sleeplessness is also found due to smoking habits. Symptoms are worse in the morning, from coffee or smoking and better from sitting or changing position.^[8]
• LOBELIA INFLATA: For individuals to quit smoking and also in treatment of asthma, bronchitis cough ,depression , pneumonia and smoking addiction .Cough and shortness of breath. Persons cannot bear smell and taste of tobacco
• MORPHINUM: Homeopathic medicine for drug addiction with heart symptoms. In cases indicating the use of homeopathic medicine Morphinum, there is a violent throbbing in the heart along with a small and weak pulse. There may be a sudden alteration in the heart rate which is known as tachycardia or fast heart rate, and bradycardia or slow heart rate. The patient may be delirious and suffer from depression. ^[8]
• NUX VOMICA: It is an effective remedy for quitting smoking habits. It helps in the detoxification of the toxic material absorbed from tobacco smoke and is prescribed when there is headache, vertigo, insomnia, food craving, constipation and dyspnoea are present. Nux vomica patients having great depression, irritation, stress and anxiety when trying to quit smoking. The symptoms are worse from morning and mental exertion and better from rest and sleep.^[6]
• PLANTAGO: Plantago is specified for nicotinism, its natural variety has been found to create an aversion to tobacco. When the patient complaints are depression, sleeplessness, constipation, eye pain and bad temper then it may indicate a need for its use.^[8]
• TABACUM: Those who are having the issues like nausea, vomiting, motion sickness, indigestion, hypertension, confusion and lack of concentration are given tabacum, as it assists in elimination of the toxins carried by tobacco. It has a significant effect on tobacco craving.^[8]

It is critical to remember that all tobacco products can be deadly and addictive, regardless of their form or disguise. It is a need that homoeopathic medicines should be incorporated in the treatment of tobacco cessation, which are quite effective and will have no side effects.

It is revealed that 55% of smokers and 50% of smokeless tobacco users were planning or thinking of quitting smoking. Tobacco users are in need of support while quitting tobacco and homoeopathic therapeutics can help in reducing craving for tobacco. It is essential that effort should be devoted to developing research strategies in homoeopathy on the addiction process in all types of tobacco use. Therefore, a multifaceted homoeopathic approach and research strategies is the imperative need of the hour.

REFERENCES

1. Tobacco| keyfacts | 24 May 2022| World Health Organisation. Available at: https://www.who.int/news-room/fact-sheets/detail/tobacco
2. State of Smoking in India| Tobacco use and trends| 13 July 2022| Foundation for a smoke- free world| https://www.smokefreeworld.org/health-science-research-2/health-science-technology-agenda/data-analytics/global-state-of-smoking-landscape/state-smoking-india/#:~:text=There%20are%20267%20million%20tobacco,and%20older%20use%20smokeless%20tobacco.
3. Smoking in India| Prevalence| (no date)| Wikipedia. https://en.wikipedia.org/wiki/Smoking_in_India
4. 4.     DSM-IV-TR Criteria for Substance Abuse and Substance Dependence| National Library of Medicine| https://www.ncbi.nlm.nih.gov/books/NBK92053/table/ch2.t5/
5. Hahnemann S, Organon of Medicine, 5th & 6th edition Delhi: B Jain Publishers: 2016
6. H C Allen, Allen’s keynote, 10th edition, Delhi: B Jain Publishers: 2017
7. Dr S R Phatak, Materia Medica of Homoeopathic Medicines, 2nd edition, Delhi: B Jain Publishers:2019
8. William Boericke, Boericke’s New Manual of Homoeopathic Materia Medica with Repertory,3rd revised & Augmented edition based on 9th edition, Delhi: B Jain Publishers:2019

Jyoti Chhikara, MD (Hom.), Consultant Physician
Fakhra Zehra, BHMS, 4^th year, Bakson Homoeopathic Medical College, Greater Noida, Uttar Pradesh