title: Gutkha Addiction: Nicotine Dependence or a Conditioned Reflex?
abstract: BACKGROUND
  A pre-packaged mixture of areca nut, tobacco, slaked lime, catechu, and flavoring agents is popularly known as Gutkha. Aim of study is to analyze the addiction biology of Gutkha chewing and to assess efficacy of a cessation program based on nicotine replacement therapy (NRT).
  
  
  METHODS
  Patterns of addiction of 400 Gutkha chewers were analyzed with a questionnaire-based survey. Urine cotinine levels of 60 subjects undergoing NRT were periodically estimated using gas chromatography.
  
  
  RESULTS
  Mean urine cotinine levels of relapse and relapse-free cases were 5800.38 µg/g of creatine and 5622.16 µg/g of creatine. The difference was not found to be statistically significant. A 83.3% of the subjects associated their chewing habit with day to day activities. Overall relapse rate was found to be 79%. The most common reported reason for relapse was unacceptable taste and form of nicotine chewing gums.
  
  
  CONCLUSIONS
  Repetitive coexistence in time of an indifferent act and the act of chewing Gutkha where, the act of chewing is almost always preceded by the indifferent act sets in a conditioned reflex. Gutkha addiction can be considered as a form of conditioned reflex, rather than actual craving for nicotine.
authors.affiliation: Senior Resident, Department of Oral and Maxillofacial Pathology, Dr. Vaishampayan Memorial Government Medical College, Solapur, Maharashtra, India.
authors.forename: Prathamesh Satish
authors.initials: PS
authors.lastname: Joshi
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India.
authors.forename: M C
authors.initials: MC
authors.lastname: Prashant
authors.affiliation: Senior Lecturer, Department of Oral and Maxillofacial Pathology, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India.
authors.forename: Neelu
authors.initials: N
authors.lastname: Nagpal
authors.affiliation: Senior Resident, Department of Oral and Maxillofacial Pathology, Dr. Vaishampayan Memorial Government Medical College, Solapur, Maharashtra, India.
authors.forename: Atulkumar A
authors.initials: AA
authors.lastname: Patil
authors.affiliation: Senior Lecturer, Department of Oral and Maxillofacial Pathology, People's College of Dental Sciences and Research Centre, Bhanpur, Madhya Pradesh, India.
authors.forename: Rinky
authors.initials: R
authors.lastname: Ahuja
authors.affiliation: Senior Lecturer, Department of Oral and Maxillofacial Pathology, People's College of Dental Sciences and Research Centre, Bhanpur, Madhya Pradesh, India.
authors.forename: Vidhi
authors.initials: V
authors.lastname: Mathur
keywords: Conditioned reflex; Gutkha; nicotine replacement therapy; urine cotinine