Among all the stimulants and intoxicants introduced to Europe over the centuries, from spices in the age of the Crusades to alcohol, coffee, tea and chocolate in recent centuries, tobacco occupied a special position because of the completely new form of consumption and enjoyment associated with it.
Tobacco had been imported from the New World at the beginning of the 16th century. Jean Nicot introduced the tobacco plant to France. However, the "dry drunkenness of tobacco", the "boozing of the fog", the "drinking and slurping of tobacco", as smoking was initially referred to, only began to become fashionable in the 17th century. Smoking at this time was associated with tranquility and contemplation. Drinking tobacco" was used during mental work or for relaxation, as it was expected to improve concentration and sharpen the mind. Tobacco had to be stuffed into a pipe and smoking was always prevented from going out - smoking still took up quite a lot of time.
As society changed, so did the form of tobacco consumption: smoking was simplified, first by the introduction of the cigar and finally, in the mid-19th century, by the mass production of cigarettes. This gave rise to a development whose result we have to deal with today. As early as the turn of the century, the harmfulness of tobacco consumption was recognized, the rapid increase in smoking rates and the developing passion for smoking among women were deplored, and efforts were also made on the part of physicians to put an end to the increasing spread of this vice by organizing the first societies to curb smoking.
It is not difficult to transfer the reports and problems from the turn of the century to our situation today: In the Federal Republic of Germany, the number of cigarettes consumed annually rose from an average of about 500 per person to about 2000 between 1950 and 1975.
The Microcensus of the Federal Statistical Office from 2017 shows: overall, 22.4% of the German population smokes. Of these, an average of 18.4% of women and 26.4% of men smoke. Since 1999 (35% of men and 22% of all women smoked), a slow but steady decline can be seen.
In the meantime it is out: Smoking is addictive! Even big tobacco companies no longer deny this. But this does not automatically mean that every smoker is addicted. Estimates on this are only imprecise, but it is assumed that at least every fourth smoker, maybe even three out of four are addicted to tobacco! But what constitutes tobacco dependence?
Tobacco addiction includes both psychological and physical components - the "power of the habit" and the "nicotine craving," as it is commonly called. In the medical sense, a person is considered to be addicted to tobacco if he or she feels a strong desire or some kind of compulsion to smoke, is unable to live abstinently, develops withdrawal symptoms when smoking is restricted or given up, has already tried unsuccessfully to quit smoking, or continues to smoke even though harmful consequences have already occurred. Besides the habit, among all the substances in tobacco smoke, nicotine is responsible for addiction.
In addition to nicotine, almost 4000 ingredients have been registered in tobacco smoke, a not inconsiderable proportion of which have clearly harmful effects. Thus, more than 40 carcinogenic components and additional harmful ingredients are to be mentioned. Benzene, carbon monoxide and heavy metals are only mentioned as representatives.
The dangers of smoking are high for the smoker. Every year between 90,000 and 140,000 people in Germany die from the consequences of smoking: from cancer, heart attacks, strokes and lung diseases.
Many smokers are aware of the expected damage to their health, but either consciously take the risk or suppress the knowledge of the dangers of smoking.
But what about non-smokers? The smoke inhaled by smokers contains significantly less harmful substances, nicotine or carbon monoxide due to the high combustion temperatures than the "smoke" that is produced when the cigarette is smouldering and which is inhaled by everyone, including non-smokers (the "passive smokers"). In Germany, at least 400 people die every year as a result of lung cancer caused by passive smoking. According to information from the German Cancer Research Centre, the risk of lung cancer in non-smokers from the vicinity of smokers is increased by 30-40%!
The knowledge of the danger to the non-smoker and the self-endangerment of the smoker have favoured numerous developments in recent years: In the foreground is research into suitable smoking cessation methods to help the dependent smoker who is willing to give up smoking, and efforts to prevent smoking. The latter aims to reduce smoking rates through improved and more targeted education not only of smokers but also, in particular, of the most vulnerable groups in society. These include, in particular, children and adolescents, in whose experience smoking is not yet the uncontrollable source of danger but the desired ticket to the adult world.
Research into smoking cessation and the development of various forms of smoking cessation began in the USA in the 1960s. Based on the realization that in tobacco addiction both physical and psychological factors determine the addiction, in addition to research into medicinal methods, especially psychologically effective methods were developed.
In the course of these efforts, however, many ineffective and sometimes even dubious methods were developed. In order to be able to separate the promising and scientifically founded methods from the less respectable offers, the following evaluation criteria were set up:
According to this, smoking cessation methods must be
The same applies to hypnosis as to acupuncture as it is the most important form of suggestive methods. It achieves very good short-term results, but the long-term efficiency could not be proven in good, controlled studies.
The disadvantage of both methods is that they do not provide smokers with any means of coping with crises and temptation situations.
Autogenic training and muscle relaxation training are commonly used as building blocks of smoking cessation treatment, but they are not sufficiently effective on their own.
Behavioral therapies are the most comprehensive, but also the most effective, smoking cessation treatments. They are mostly conducted in groups, but also individually, and consist of three phases: the self-monitoring phase, the acute cessation phase, and a phase for stabilizing the success of cessation and for relapse prevention.
Among the medicinal methods, the temporary administration of nicotine (nicotine patches, gum, lozenges, sublingual tablets, inhalers or nasal spray) or the use of the drugs bupropion (Zyban®) and cytisine (Asmoken®), which are approved for smoking cessation, are available. The active principle of drug therapy is the alleviation of withdrawal symptoms and smoking cravings in order to facilitate the cessation process. Nicotine replacement therapy as well as bupropion and cytisine are effective methods. Individual use should be determined by a physician.
What determines the success of a smoking cessation? Quite clearly: only those who really want to quit will succeed. But even with a high level of motivation, things can still go wrong.
Since, as already mentioned, tobacco addiction is determined by both a physical and a psychological component, both components must also be addressed in a smoking cessation. The physical component is characterized by nicotine dependence and leads to physical withdrawal symptoms when quitting smoking. These include sleep disturbances, fatigue, lack of concentration, nervousness, restlessness but also constipation or hunger pangs. Psychological dependence manifests itself in a strong desire to smoke, the inability to refrain from smoking in certain situations and the so-called "power of habit". Smoking has been "learned" and has become an integral part of the individual's behavioral repertoire.
Any serious attempt at smoking cessation treatment must deal with both conditions of addiction: the physical withdrawal symptoms, which can be so severe that they lead to relapse despite a high initial motivation to abstain, must be alleviated, temptation situations must be overcome, habits must be broken.
The long-term abstinence rates (after 12 months) are decisive for assessing the effectiveness of a treatment method. The spontaneous decision to quit smoking leads to abstinence in only 1 to 5% of smokers; medical advice can still be successful in 5% of smokers. While the administration of nicotine alone for smoking cessation mediates success rates between 10 and 15%, the use of behavioral self-help manuals achieves between 15 and 20% abstinent smokers, and behavioral group treatment is effective in up to 25% of smokers, combination treatments of behavioral therapy and nicotine substitution can achieve up to 35% abstinence after one year. The effectiveness of treatment with bupropion is estimated to be similar.
The chances of success of smoking cessation are almost doubled by drug support.
The instructions for use require the patch to be applied to the trunk or upper arms for 24 hours or 16 hours respectively. The skin tolerance of the patch is good. Rarely skin irritation, headaches, nightmares and sleep disturbances or gastrointestinal complaints occur. Three different patch strengths are usually available. Usually the highest dose level is started, after 4-6 weeks the next lower dosage is chosen and after another 2-4 weeks the lowest patch strength is chosen before treatment is stopped after another 2-4 weeks.
Disappointment due to alleged lack of efficacy is avoided by observing some common mistakes in recommending or prescribing patch use. Common errors include wearing a patch for several days (beyond the effective period), wearing the nicotine patch at night when physical withdrawal symptoms are only mild, concurrent cigarette use, and single doses that are too high or too low. Even without an accompanying behavioural therapy-oriented group treatment - currently the most effective method in smoking cessation - the effectiveness of the treatment can be increased by weekly short contacts with doctors or pharmacists to clarify dose issues and to check for undesirable effects.
Nicotine gum is used whenever strong smoking cravings or other withdrawal symptoms occur. When chewing nicotine gum, the nicotine is absorbed through the oral mucosa.
When using nicotine gum, it is important to chew the gum slowly for about 30 minutes with breaks so that all the nicotine is released from the gum. At most, you should chew one piece of gum per hour (i.e., no more than 16 pieces per day). You will usually find that you need considerably less. After 4-6 weeks, the dose should be gradually reduced. The nicotine gum is available in two strengths: 4mg as well as 2mg. The 4mg gum has been found to be more effective. The nicotine gum should be used for a maximum of three months.
The prescription nicotine nasal spray is intended for use by heavy smokers. The nicotine is administered by spraying one puff into each nostril. It is possible to use it on a regular basis as well as when needed. The nasal spray is the most effective form of nicotine substitution, but may cause dependence on this form of administration.
Support smoking cessation by relieving nicotine withdrawal symptoms. Nicotine lozenges are available in two different dosages (2mg and 4mg ingredient). The initial dosage required is initially based on the individual need to relieve withdrawal symptoms. Heavy smokers should use 4mg tablets and less heavy smokers should use the 2mg version. The maximum dosage should not exceed 15 lozenges per day. The tablets dissolve slowly in the mouth. They should not be chewed or swallowed.
After 4-6 weeks, it is advisable to reduce the daily number of nicotine lozenges, e.g. by using them at increasingly longer intervals. The first discontinuation attempt should be made when the average consumption during the preceding week was 1-2 lozenges per day. After 10-12 weeks the consumption of nicotine lozenges should have been stopped. In exceptional cases, nicotine lozenges may still be used after this time in situations where there is a strong desire to smoke. Treatment lasting longer than six months is generally not recommended.
The nicotine sublingual tablet contains 2mg of ingredient. The required initial dosage is initially based on the individual need to relieve withdrawal symptoms. 1 nicotine sublingual tablet can be used every 1-2 hours. Heavy smokers may also use up to 2 nicotine sublingual tablets per hour, but not more than 40 tablets per day. The sublingual tablets are placed under the tongue where they slowly dissolve, releasing nicotine. They should not be chewed or swallowed.
After 4-6 weeks, it is advisable to reduce the daily number of tablets, e.g. by using them at increasingly longer intervals. The first discontinuation attempt should be made when the average consumption during the preceding week was 1-2 tablets per day. After 10-12 weeks, the consumption of nicotine sublingual tablets should have been stopped. In exceptional cases, nicotine sublingual tablets may still be used after this time in situations where there is a strong desire to smoke. Treatment lasting longer than six months is generally not recommended.
The withdrawal drug bupropion (Zyban®), which was approved in Germany in July 2000, takes a different approach: users report a significant reduction in the desire to smoke. The presumed effect of the substance lies in a regulation of messenger substances in the brain. Common side effects are sleep disturbances and dizziness. Initial studies have shown an abstinence rate of almost 20% (continuous abstinence) after one year; further studies must prove the effectiveness in comparison with other forms of therapy.
According to the recommendations for use, the prescription drug should be taken for one week while still smoking. Once abstinence has begun, use should continue for at least 6 weeks. Smokers with epilepsy, diabetes, mental illness, or other serious medical conditions should only use this medication in consultation with their doctor.
Asmoken has been approved since 2020 to reduce nicotine cravings in smokers who are willing to quit.
A treatment with Asmoken lasts 25 days. During this time, the drug is dosed down according to a specific schedule. It is started with one tablet every two hours and a maximum of six tablets a day, until finally, from the 21st day, only one or two tablets a day are taken. The patient should stop smoking completely by the fifth day of treatment at the latest. During therapy, cigarettes and other nicotine-containing products are taboo, as they can intensify the side effects. If the patient is unable to stop smoking, the treatment should be discontinued. A new attempt can then be made after two to three months.
It is not recommended for use in patients with liver or kidney dysfunction and in people over 65 and under 18 years of age.
Asmoken should be used only with special caution in coronary artery disease, heart failure, hypertension, pheochromocytoma, atherosclerosis and other peripheral vascular diseases, gastric/duodenal ulcers, gastroesophageal reflux, hyperthyroidism, diabetes, and schizophrenia.
Children must not use the chewing gum and other nicotine products!
During pregnancy and breastfeeding, nicotine replacement should only be used after consultation with the doctor and after an unsuccessful attempt at tobacco abstinence.
Focus: Top Nationales Krankenhaus 2024
Kooperation für Transparenz und Qualität im Gesundheitswesen
Qualitätspartnerschaft mit der PKV
Erfolgsfaktor Familie
Die Altersvorsorge für den Öffentlichen Dienst
