High drop-out rate hits Delhi's tobacco cessation centres

The sight of haphazardly placed posters and pamphlets saying 'Quit Smoking' and showing a stubbed out cigarette in an ashtray signals a smoker's failed attempt at kicking the butt. In what experts call 'been there, not done that', tobacco de-addiction centres are now grappling with a high drop-out rate coupled with a dismal quitting rate among tobacco users. "At public cessation centres, the motivation level among tobacco users(read more) is very low as most of them join under familial pressure," Harpreet Mehar, clinical psychologist at the department of rehabilitation in Delhi's Ram Manohar Lohia (RML) Hospital, told IANS.

 "Adding to this, tobacco is so addictive that they are not able to overpower their urge and leave course midway," he said. RML Hospital is one of three government-run de-addiction centres in the national capital. The other two are the Institute of Human Behaviour and Allied Sciences (IHBAS) and the V.P. Chest Institute. In these centres, most addicts leave mid-way due to lack of awareness about the harmful effects of tobacco consumption. "Of the 400 patients we have dealt with in the last three years, only 6-7 percent were able to quit tobacco. After some infrastructural issues, we integrated the cessation centre with our psychiatry department," Mehar said. For the country with nearly 274.9 million tobacco users, the Global Adult Tobacco Survey (GATS) says nearly 26 percent of them use smokeless tobacco, six percent are cigarette smokers, and nine percent smoke bidi. Tobacco is the leading cause of cancer deaths in India. 

Nimesh Desai, head of the IHBAS de-addiction centre, said apart from lack of awareness, many people also quit the clinic in between because there was no follow-up mechanism. "Tobacco cessation centres (TCCs) have evolved in a way that we now see participation from cancer specialists, psychiatrists, voluntary organisations and pulmonologists. Even then, low awareness, lack of follow-up and tracking mechanism are ailing the clinics," he told IANS. Desai also said that three clinics for over 16 million people in Delhi was insufficient. IHBAS gets 25-30 cases a month. But it recorded a quitting rate of 11 percent in 2011. Forty-six percent cases were lost to follow-ups. Like banker Mohnish Grover, who had been at a tobacco de-addiction centre for two years but could not quit smoking. "Corporate culture had made stress and smoking an inseparable part of life. I could not be regular with my counselling sessions and left the idea of quitting two months ago," Grover, 25, told IANS.

 Another roadblock is that the RML and IHBAS cessation clinics operate from psychiatry centres. This puts off many prospective quitters, say doctors working there. The third centre is housed in a TB clinic. "A cessation centre operating from a mental illness hospital means stigma for people. Small outreach clinics at markets, public offices and colleges are needed," Smita N. Deshpande, head of the department of psychiatry and drug de-addiction at RML Hospital, told IANS. "Funds, infrastructure, awareness, advocacy -- the approach to fighting tobacco needs to be on a war footing. It's when you talk to people at the cessation centres that you realise how firmly under tobacco's grip is our population," she said. There is a need for right societal approach and family support to help addicts quit tobacco, doctors said. "If the will power is missing, then these self-help tips and behavioural interventions don't make sense," said Mehar. "If your family and friends support you and stop you from indulging in this cancerous activity, then quitting tobacco is possible."