Hi I am 40 years old male. I am having habit of chewing masala tobacco from last 15 years. Tried lot many times but never been able to quit the same. Now the urge has increased and intake has become more. Please help me in this regard.

Dr. Saul PereiraPsychologist46yrs exp

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The urge to increase the consumption over time is what is called developing tolerance and dependence to the substance. This is why it is addicted and progressively damaging. Chewing tobacco is really harmful especially because it is known to cause oral cancer and oral submucous fibrosis (SMF). Since it is an oral habit there are many substitutes that can be used to replace the oral stimulation. Of course, since it is a stimulant you cannot get the same effect and that is worth the loss to give up this very addictive habit. A dense fibrous tissue is deposited in the submucosal layer of the soft palate and cheek, causing disabling symptoms like trismus. It contains betel nuts, tobacco, lime, catechu and permitted spices and flavors. The first four substances damage the sensitive mucosa, causing constant irritation and micro trauma to the mucosa. Chemicals present act as a toxin. The phenol in the betel nut, with its caustic burning effect, destroys the mucosa, causing oral ulcers. The betel nut also contains tannins, which act as astringents, precipitating protein and damaging the mucosa. Altogether, this substance is known to be physiologically addictive. You can use replacements like nicotine chewing gum (if you want the stimulant effect, especially in the beginning) or ordinary chewing gum, hard candy and any other orally satiating substance, especially when the urge is very strong. You would have got conditioned to the habit to different times of the day and different situations. You must particularly avoid those occasions and occupy yourself with something else attractive. You should get regular exercise, eat healthily, and get a good night?s rest every day. Visit a dentist and clean up your teeth and gums to wipe out all the reminders and damages of the habit. You may also get a thorough oral check up and treatment for any damages incurred. If you are unable to give it up on your own, you need to be admitted into a rehabilitation center nearby until you are completely out of it. They will have you deal with all other issues also. Even after you come out of the center, you must continue therapy and attend Smokers Anonymous meetings regularly. 

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