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Address: Calwerstraße 14
72076 Tübingen


Person profile: 07071 29-82311


Fax number: 07071 29-4141


Tobacco

Smoke constituents

From a chemical point of view, tobacco smoke is an aerosol, a mixture of various gases (gas phase) in which particles 0.1 to 1 mm in size (particle phase) are dissolved. In total, more than 4000 different substances have been detected so far. It is not nicotine, but the numerous other smoke constituents that are held responsible for the extremely serious damage caused by smoking.

Effect

The substance decisive for the psychotropic effect is nicotine, the main alkaloid of the tobacco plant. The effect of nicotine is inconsistent. In small doses the stimulation predominates, in higher doses the deadening.

Tobacco - Diagnosis

Consequential health damage

In Germany, about 140,000 people die each year as a result of smoking; worldwide, the figure is about 3.5 million. Smoking is thus the most important preventable cause of disability and premature death in industrialised countries. Smoking is a major risk factor for:

  • Numerous cancers
  • Heart attacks and strokes
  • Chronic bronchitis and emphysema

Brief intervention

For the medical and nursing staff, discussions with affected patients about addictive substance use are therefore rarely purposeful and are often experienced as frustrating.

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Consultation service

In our prevention outpatient clinic for addiction you can get help and answers to questions about intoxication with alcohol, medication or illegal drugs as well as tobacco addiction.

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Diagnosis

The ICD-10 lists six criteria, three of which must have occurred simultaneously in the last 12 months for a diagnosis of tobacco dependence to be made:

  • Strong desire or compulsion to use the addictive substance
  • Limited control over initiation, cessation and quantity of use
  • Withdrawal symptoms upon reduction or cessation of use; use to alleviate withdrawal symptoms.
  • Development of tolerance: increasingly higher doses are required to achieve a consistent effect
  • Increasing neglect of other activities and interests in favor of use Continued use despite evidence of sequelae

In the treatment of tobacco dependence, the Fagerström test for nicotine dependence (FTND) has become established as a diagnostic tool, as it captures the dimension of dependence.

The FTND value is helpful for the dosage of the medicinal therapy with nicotine substitutes.
Perform test

  • Nicotine plasma concentration: not feasible in everyday clinical practice, also inaccurate
  • Thiocyanate measurement: not feasible in everyday clinical practice, also inaccurate
  • Cotinine level in serum, saliva and urine: Psychiatric clinic laboratory
  • Measurement of carbon monoxide concentration (CO) in exhaled air: can be carried out quickly, non-invasive, also certain measurement inaccuracy

Diagnostic criteria according to ICD

  • Evidence of discontinuation or reduction of a substance, following repeated use of that substance, usually of long duration and/or in high quantity.
  • Symptoms and signs consistent with the features of a nicotine withdrawal syndrome listed below. (see below)
  • The symptoms and signs are not explained by a physical illness independent of the substance use and are not better attributed to another mental or behavioural disorder

Nicotine withdrawal syndrome

  • Depressed/dysphoric mood
  • Sleep disturbances
  • Irritability
  • nervousness or aggressiveness
  • restlessness or anxiety
  • decreased ability to concentrate
  • slowed pulse
  • increased appetite or weight gain

Historical

Evidence of the use and consumption of tobacco by humans can be found as far back as about 10,000 years ago. At that time, the tobacco plant was used and consumed by the Central and North American peoples for religious, cultural and medicinal purposes. After the discovery of America by the Spanish conquerors, the tobacco plant reached the European continent in the 15th century.

In addition to the initial use of tobacco as a medicinal plant, the consumption of tobacco as a stimulant also increased among the European population from this time onwards. Whereas tobacco was initially consumed mainly in the form of pipe smoking and snuff sniffing, with the onset of industrialisation in the 18th century consumption shifted to cigars and cigarettes. Due to industrial mass production, cigarettes are now the most widespread form of tobacco consumption.

Certificates and Associations

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