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Year : 2012  |  Volume : 34  |  Issue : 4  |  Page : 394-395  

Chewing Beedis: A Case of Cross-Tobacco use in a Patient with Schizophrenia

1 Department of Social Work, School of Social and Behavioral Sciences, Central University of Karnataka, Gulbarga, Bangalore, Karnataka
2 Department of Psychiatry, Ramaiah Medical College and Research Institute, Bangalore, Karnataka
3 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka
4 Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka

Date of Web Publication7-Mar-2013

Correspondence Address:
Govindappa Lakshmana
Department of Social Work, School of Social and Behavioral Sciences, Central University of Karnataka, Gulbarga - 585 106, Karnataka

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0253-7176.108232

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While tobacco use occurs in many forms all over the world, there is little information on cross-tobacco use. Authors report an unusual case of tobacco use in the form of chewing beedies which are normally smoked (cross-tobacco use). A 22-year-old single female, diagnosed with schizophrenia for the last 6 years, started chewing beedies from the age of 15 years and was using it in a dependent pattern since 7 years. After 3 years of treatment for her schizophrenia, patient's family pressured her to seek tobacco cessation treatment. Initial treatment with nicotine gum replacement and behavioral counseling did not prove useful. Subsequently she was treated with bupropion 300 mg/day and able to successfully abstain. Cross-tobacco use is relatively rare, and merits further study, especially in the mentally ill population.

Keywords: Beedies, chewing, schizophrenia, tobacco

How to cite this article:
Lakshmana G, Manjunatha N, Pandian RD, Murthy P. Chewing Beedis: A Case of Cross-Tobacco use in a Patient with Schizophrenia. Indian J Psychol Med 2012;34:394-5

How to cite this URL:
Lakshmana G, Manjunatha N, Pandian RD, Murthy P. Chewing Beedis: A Case of Cross-Tobacco use in a Patient with Schizophrenia. Indian J Psychol Med [serial online] 2012 [cited 2020 Feb 28];34:394-5. Available from:

   Introduction Top

Tobacco has been used most commonly in two forms, as chewing or smoking. Less common forms include using it as snuff or dentifrice. Generally males tend to use more smoking tobacco and females tend to chew tobacco. Beedis (or bidis) are the commonest smoked form of tobacco in India. According to the Global Adult Tobacco Survey, [1] 34.6% of adults are current tobacco users. A greater proportion of males (47.9%) use tobacco compared to females (20.3%). Among females, while only 2.9% smoke any form of tobacco and 1.9% specifically smoke beedis, a majority are chewers. A majority of tobacco users in India are daily users.

Cross-tobacco use refers to the use of tobacco in the form other than for what it was primarily intended. A review of the literature shows no data on cross tobacco use (e.g., chewing what is primarily meant for smoking). The authors report what to our knowledge is the first case of cross-tobacco use (chewing beedies meant for smoking) in a female patient with schizophrenia.

   Case Report Top

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.

Only 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.

At 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 [2] was considered.

Despite 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.

   Discussion Top

Tobacco has been used in smokeless (chewing) and smoking forms throughout the world. Chewing tobacco products is the commonest smokeless form of tobacco use in India. There is a gender difference in the preference for different forms of tobacco in India. While males smoke beedies or cigarettes, females who use tobacco are generally chewers. In the reported case, unusual form of cross-tobacco use is present. There are no data available on this form of cross-tobacco use in the published literature.

In the reported case, the patient initiated beedi use out of curiosity. She was also biologically predisposed to tobacco use, with both her parents likely to have been dependent on tobacco, the father a chronic beedi smoker and the mother likely to have been dependent on both tobacco and areca nut. In addition to a vulnerability to dependence, the presence of schizophrenia is yet another risk factor, and nicotine use in the form of tobacco is well known.

   Conclusion Top

Unusual patterns of tobacco use, especially in psychotic patients are known, but not published. The use of tobacco is also influenced by gender and societal attitudes. Clinicians should be sensitive to unusual patterns of use, as highlighted by this case. The phenomena of cross-use of tobacco merits further study and research.

   References Top

1.Global adult tobacco survey (GATS) India report 2009-2010. Available from: [Last cited in 2011 Dec 21].  Back to cited text no. 1
2.World Health Organization. The ICD-10: Classification of Mental and Behavioral Disorders- Clinical descriptions and diagnostic guidelines (Indian ed.). Geneva: AITBS, Delhi; 2004.  Back to cited text no. 2


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