Smoking Cessation Procedures

Smoking cessation is a necessary measure to combat tobacco addiction. As early as the 16th century, pipe tobacco was brought to Europe by the Spanish conquistadors. At that time as a privilege of the rich, today as a product of mass industry and available to everyone, dependence on the cigarette poison nicotine is one of the most common addictions in the 21st century. Nicotine addiction is characterized by both a social or psychological component and a biological component. Smoking behavior is socially reinforced by group acceptance, while nicotine use neurobiologically increases the release of the neurotransmitter dopamine in the mesolimbic system (release of neurotransmitters in the brain‘s reward system) via presynaptic nicotinic acetylcholine receptors. This explains the high addictive potency of smoking and the nature of addiction development. It further accounts for the complexity of smoking cessation procedures. The ICD-10 (International Classification of Diseases and Related Health Problems of the World Health Organization) defines the following criteria for the diagnosis of tobacco dependence, of which at least three must be met:

The consequential harms of tobacco use are immense. Annually, over 100,000 people die as a result of smoking. Deaths from smoking, between the ages of 35 and 69, are:

• 40-45% of all cancer deaths,
• 90-95% of all lung carcinomas (lung cancer).
• 75% of all chronic obstructive pulmonary diseases (group of diseases of the lungs characterized by cough, increased sputum, and shortness of breath on exertion, such as chronic obstructive bronchitis and emphysema)
• 35% of all cardiovascular deaths (e.g., myocardial infarctions/heart attacks)

Smoking, expectant mothers and passive smoking also pose a major health risk.

Indications (areas of application)

• Prevention of secondary diseases
• Secondary prevention of already existing diseases – e.g. chronic obstructive pulmonary disease (COPD) or hypertension (high blood pressure).
• (Part of the) rehabilitation after diseases associated with smoking.
• Protection of non-smokers
• Protection of the unborn child during pregnancy

The procedure

A variety of methods are available for smoking cessation. As mentioned above, tobacco addiction has a psychological component and a biological component. For this reason, cessation consists of drug therapy, mainly to reduce withdrawal symptoms, and a behavioral approach, mostly based on learning theories. The following is a brief description of the main withdrawal options:

• Acupuncture – This procedure is part of holistic traditional Chinese medicine (TCM). Needles are inserted at specific acupuncture points and affect the circulation of energies in the body and thus the desire to smoke. Widespread here is especially the ear acupuncture.
• Hypnosis – Hypnosis belongs to the suggestive procedures and aims to change consciousness in favor of freedom from smoking. During the treatment, the patient is in a psychogenic twilight state or trance. The patient does not lose touch with reality and is constantly aware of his ability to react. In this state, he is guided to overcome withdrawal symptoms and resist the temptation to smoke.
• Smoking cessation course – This group therapy takes place in a small circle (about 10 people) and is used to share experiences. In addition, the sense of community is used to successfully manage the difficult, smoke-free everyday life, thereby the course participants benefit from the experience of others.Individual strategies are taught and the participants are strengthened in their motivation.
• Drug therapy with bupropion – The exact mechanism of action of bupropion hydrochloride is not known, but it is believed to affect dopaminergic and noradrenergic (dopamine and noradrenaline are neurotransmitters) processes, respectively, at the neurobiological level.
• Nicotine replacement therapy – Nicotine replacement products are available in pharmacies in the form of nicotine gums, nicotine patches, nicotine sprays, nicotine inhalers (e-cigarettes containing nicotine), and sublingual nicotine tablets. The dosage of nicotine content of the chewing gums, for example, is reduced until complete abstinence is achieved. The chances of success of this therapy are high, but the risk of dependence on pure nicotine is discussed.
• Self-motivation – Independent smoking cessation with the help of books or with the help of audio tapes.
• Inpatient smoking cessation – Patients receive intensive inpatient care while different therapy options are exhausted. The success rate here is very good.
• Behavioral therapy – Behavioral therapy is delivered in groups or as individual therapy for 6-10 sessions and includes cognitive preparation for nicotine abstinence, problem-solving training, and coping strategies. For brief interventions, the 5-R schema has proven to be an effective approach: Relevance (make a connection), Risks (name the risks), Rewards (name the benefits of being smoke-free), Roadblocks (address and overcome obstacles), Repetition (repeat the steps). Behavioral therapy also consists of the following components:
  • Self-observation phase – awareness of the (smoking) behavior, situation and consequences.
  • Acute cessation phase – deciding on the method to stop using, e.g., quit method, as well as creating strategies in everyday life, building alternative behaviors, and establishing rewards.
  • Stabilization phase – relapse prevention and working out coping strategies.

The successful control of withdrawal symptoms is very important for the success of the procedures described above. This can be done as already mentioned supportive and controlled by medicinal means, for example, with nicotine patches, gum and nasal sprays. However, since these drugs are often used as nicotine substitutes instead of for withdrawal, they should only be used with due restraint. Accompanying relaxation techniques can also be used.

Benefits

Smoking cessation offers individualized assistance in the difficult process of achieving tobacco abstinence. Since it is an addictive disease, this process should not be underestimated and is very complex in its implementation. Smoking causes a variety of dangerous diseases, for this reason smoking cessation is necessary for maintaining health and vitality.