beedis ( or bidis ) are the commonest smoked form of tobacco in india . according to the global adult tobacco survey , 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 .
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 .
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 .
the diagnosis of nicotine dependence syndrome along with undifferentiated schizophrenia 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 .
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 has stopped chewing beedies since the last 8 months and is not using any other form of tobacco .
tobacco has been used in smokeless ( chewing ) and smoking forms throughout the world . chewing tobacco products
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
there are no data available on this form of cross - tobacco use in the published literature . in the reported case ,
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 .
unusual patterns of tobacco use , especially in psychotic patients are known , but not published .
clinicians should be sensitive to unusual patterns of use , as highlighted by this case .
 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 . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION