Chewing Beedis: A Case of Cross-Tobacco use in a Patient with Schizophrenia
A 22-year-old single lady was brought to the Centre for Addiction Medicine with a request for help for tobacco cessation. She had been on treatment for schizophrenia for the last 6 years which had responded well to treatment and she was on maintenance with risperidone 4 mg/day and trihexyphenidyl 2 mg/day.\nOnly following 4 years of regular follow-up, following pressure from family, she reported the use of beedies in the form of chewing. Her father was a habitual beedi smoker and her mother used areca nut and betel leaf with tobacco. The patient had begun chewing beedies at the age of 15 years, after having observed her father smoking beedies, which she was often sent out to procure. She said she had begun chewing as she could not smoke (female smoking is not socially acceptable in most sections). Initially, she would chew the stubs her father had dropped around, but later began procuring beedies for her own use. While buying the beedies, she would say it was for her father. The patient had developed a dependent pattern of tobacco use since the age of 18 years. On average, she was chewing up to one pack, which contains 24 beedis.\nAt the time of her consultation for tobacco cessation, the positive symptoms of schizophrenia were well controlled, and she had minimal negative symptoms. She had been able to work as an office assistant. A general physical examination did not reveal any abnormality. Routine biochemical and hematological parameters were within normal limits. The diagnosis of nicotine dependence syndrome along with undifferentiated schizophrenia[] was considered.\nDespite significant improvement in her psychotic symptoms and occupational work function, treatment for tobacco dependence was challenging since patient reported very severe intense craving early in the morning and a wavering motivation for abstinence. Both pharmacological and psychosocial treatment measures were used for supporting tobacco cessation. A trial of nicotine gum 4 mg up to 12 mg per day and behavioral counseling was not useful to contain her tobacco use. She was subsequently prescribed bupropion 300 mg and was subsequently abstinent from tobacco use. She has stopped chewing beedies since the last 8 months and is not using any other form of tobacco.