How to quit gutka, khaini and paan masala

What is actually in gutka, khaini and paan masala?

Know what you're quitting. Khaini is sun-dried tobacco mixed with slaked lime.^{Source 5} Gutka and paan masala with tobacco are mixtures of areca nut and tobacco.^{Source 5} The lime matters: it makes the nicotine in the tobacco easier for your body to absorb.^{Source 2}

Since gutka was banned, many makers sell the areca nut and the tobacco in separate packets, sometimes under the same brand names.^{Source 5} If you mix a packet of paan masala with a packet of tobacco, you're still chewing gutka.

Plain paan masala has no tobacco, but it isn't safe either. WHO's cancer agency found that areca nut, part of many chewing habits, causes cancer in humans, and that products like paan masala cannot be considered safe.^{Source 6} If you're quitting gutka, don't switch to supari or plain paan masala. Quit the areca nut too.

Is chewing tobacco safer than smoking?

No. All forms of tobacco use are harmful, and there is no safe level.^{Source 7} Smokeless tobacco causes cancer of the mouth, the oesophagus and the pancreas. It can also cause heart disease, gum disease and white precancerous patches in the mouth.^{Source 8}

India carries the highest burden of oral cancer in the world, because of how many people chew tobacco.^{Source 2} Areca nut, in gutka, paan and mawa or on its own, causes oral submucous fibrosis, a high-risk precancerous condition of the mouth.^{Source 2} If you're pregnant, chewing tobacco raises the risk of a low birthweight baby and of stillbirth two to three times.^{Source 2}

Why is it so hard to stop chewing?

Nicotine. People who chew tobacco have levels of nicotine in the blood comparable to people who smoke cigarettes.^{Source 8} Nicotine has the same effect on the brain whether the tobacco is smoked or chewed, and stopping can bring on withdrawal.^{Source 2}

Withdrawal usually means irritability, trouble concentrating and cravings. It tends to peak within the first week and ease after that.^{Source 9}

Then there's the habit. Cravings are often set off by stress, certain situations and your daily routine:^{Source 3} the pouch after lunch, the pinch with chai, the packet you buy on the way to work. Know which ones are yours before quit day.

How do I get ready for quit day?

• Pick the day. Choose a day within the next month. A date too far away gives you time to change your mind.^{Source 1}
• Clear it all out. Get rid of every smokeless tobacco product in your home, your vehicle and at work.^{Source 1} The pouch in your pocket goes too.
• Have something else to chew. Stock up on substitutes like sugarless gum and carrot sticks.^{Source 1} Not supari, not plain paan masala. That's areca nut again.
• Tell people. Tell your friends and family about your quit day.^{Source 1} Tell the paanwala too, if you like.
• Practise waiting. Before quit day, put off each chew when a craving hits. Try for at least 10 minutes, then longer as quit day gets closer.^{Source 1}

What do I do when the urge to chew hits?

Remember it won't last. Most cravings pass within a few minutes,^{Source 3} and after five minutes the urge weakens.^{Source 10} That's the Five-Minute Rule. You only have to get through the next five minutes. How long does a nicotine craving last? explains why.

• Wait it out. Delay as long as you can before giving in.^{Source 11}
• Breathe slowly. Breathe in through your nose for 4 seconds, hold for 5, and breathe out through your mouth for 6.^{Source 3}
• Put something else in your mouth. Sugarless gum, a toothpick, a carrot.^{Source 12} Or drink some water.^{Source 11}
• Get moving. Physical activity helps relieve the urge to chew.^{Source 12}
• Text someone. That's what the TobaFree Coach is for. Message it on WhatsApp the second the urge hits, and it stays with you through the five minutes.

Can medicines help me quit smokeless tobacco?

Possibly, so ask a doctor. Quitting smokeless tobacco can be a lot like quitting smoking, and there may be some benefit to using medicines for it too.^{Source 13} WHO's 2024 treatment guideline covers smokeless tobacco. It recommends varenicline, nicotine replacement therapy (NRT), bupropion and cytisine, along with counselling.^{Source 14}

Don't start a medicine on your own. A doctor can tell you if one is right for you.

What if I slip and chew one?

Don't panic, and don't throw away your quit. Go back to your quit plan right away, and work out what set you off so you can plan for it next time.^{Source 12}

One packet is a slip. It doesn't have to be the end of your quit.

Where can I get free help in India?

India's National Tobacco Quit Line is free: call 1800-112-356 (toll free) or give a missed call to 011-22901701. Counselling is available in regional languages.^{Source 4} A doctor can talk to you about medicines.

TobaFree is behavioural support on WhatsApp, not medical treatment, and it doesn't replace your doctor. If you smoke beedi or cigarettes as well, read How to quit beedi and cigarettes.