Smoking cessation program

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A smoking cessation program is a therapy aimed at relieving a smoker of the need to smoke for as long as possible. While the success rate of smoking cessation in a self-experiment is around 3–5%, this can be increased significantly to 30% or up to over 50% (depending on the studies and follow-up time) with professional help. In scientifically sound smoking cessation programs, patients are usually given psychosocial support over a longer period of time and a combination of different therapy options (multimodal therapy) according to individual choices, as individualized individual counseling is most effective.

Possible forms of therapy (selection)

Note: The current trade names are mentioned once in brackets in italics , then the associated substance names in the further course.

  • Medical therapy:
    • Nicotine replacement preparations (nicotine agonists) as
      • band Aid
      • chewing gum
      • Microtablet
      • Nasal spray (available from an international pharmacy, requires a prescription)
      • Inhaler
    • Varenicline ( Champix in the EU, Chantix in the US) - partial agonist and full nicotine antagonist
    • Bupropion ( zymban, an atypical antidepressant)
    • Other antidepressants e.g. B. Nortriptyline, in selected cases " off-label prescription "
    • Low-potency neuroleptics "off-label"
    • Individual substances used earlier or elsewhere with proof of effectiveness, but without approval in Germany:
  • Behavioral therapy (a form of psychotherapy ) / psychosocial forms of treatment:
    • Identification of individual situational risks
    • Self-control (either as a point-to-point method, i.e. an immediate smoking cessation, or as a gradual reduction in the amount consumed)
    • Strategies for special situations
    • Psychosocial support
    • Relapse analysis and management including relapse prevention
    • Aversion therapy (e.g. nicotine or silver acetate overdose for negative conditioning)
    • Contingency agreement
  • Further procedures:

The accompanying drug therapy is reserved for doctors who are experienced in this treatment due to limitations of use, contraindications and possible side effects. Some drugs require a prescription. Certain combinations of drugs are more effective, but some also have the opposite effect. Some medications are contraindicated, especially during pregnancy, but stopping smoking is particularly important for the fetus .

The most successful is a multimodal individual therapy after a previous analysis of smoking habits, triggers, social circumstances and the severity of the addiction e.g. B. can be estimated using the Fagerström test or the original FTND. Strategies should be developed to counter emerging addictive pressure (desire for substance ) and the motivation process must be strengthened at all times. Some forms of treatment, such as B. Aversion therapy or the conclusion of a contract are only effective in individual cases, while there is good scientific data on their effectiveness for accompanying medical drug therapy and cognitive behavioral therapy or psychosocial support. In particular, the combination of these two therapy principles represents the fundamental pillars of modern structured smoking cessation today. This is also reflected in the fact that it is i. d. Usually physical and psychological addiction is involved.

An important part of the overall concept should be a fixed date for quitting (" smoking cessation date" or English quit date ) on which the smoker ends his cigarette consumption. The beginning and the increase in dosage of any accompanying drug therapy is based on this appointment, which should be adapted to the patient's personal circumstances. Simply reducing the number of cigarettes is not effective in terms of improving lung function and is not an alternative to quitting smoking.

Therapy is also worthwhile if you have already diagnosed lung cancer or other secondary diseases. Studies show that the effectiveness of cancer treatment increases after successful abstinence.

In the meantime, the all-clear has been given with regard to both cardiovascular risks and increased suicidality (which the FDA suspected of varenicline and bupropion in 2013) for these drugs. Further studies are still ongoing (not yet published).

Web links

Individual evidence

  1. ↑ a b c T. Hering: Modern drug support for smoking cessation. In: Internist 2009, 50: pp. 95-100.
  2. ↑ a b M. C. Fiore, CR Jaen, TB Baker et al .: 2008 PHS Guideline Update Panel, Liaisons and Staff. Treating Tobacco Use and Dependence: 2008 Update. US Public Health Service Clinical Practice Guideline executive summary. Respir Care 53: 1217-1222.
  3. ^ A b S. Tonstad, P. Tonnesen, P. Hajek, KE Williams, CB Billing, KR Reeves: Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. Jama 2006, 296: pp. 64-71.
  4. ↑ a b c d e A. Zeller: Drug therapy for nicotine withdrawal. Therapeutische Umschau (review article) 2010, 67 (8), pp. 419-425.
  5. ↑ a b c d e f g Chr. Jenner: Combined strategy modules of smoking cessation. (see web link)
  6. ↑ a b c d e A. Batra: Therapy of tobacco addiction. Deutsches Ärzteblatt, vol. 108, issue 33, August 2011.
  7. ↑ a b c d e f g h i S. Andreas, A. Batra, JF Behr et al .: Smoking cessation in COPD- S3 guidelines of the German Society for Pneumonology and Respiratory Medicine. Pneumonology 2008, 62: 255-72. updated: December 21, 2013.
  8. ↑ Drugs Commission of the German Medical Association (Ed.): Recommendations for the therapy of tobacco addiction, drug prescriptions in practice. Volume 37, special issue 2, 2010.
  9. ↑ EJ Mills, P. Wu, I. Lockhart et al .: Comparison of high-dose and combination nicotine replacement therapy, varenicline, and bupropion for smoking cessation: A systematic review and multiple treatment meta-analysis. Ann Med 2012, 44: pp. 5880-5897.
  10. ↑ a b M. J. Carpenter et al .: Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: A review of the literature. Drugs 2013 Apr, 73 (5): pp. 407-426.
  11. ↑ a b L. F. Stead et al .: Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2012 Nov 14, 11: CD000146.
  12. ↑ a b Stead et al .: Nicotine replacement therapy for smoking cessation (Review). Cochrane Collaboration, The Cochrane Library 2012, Issue 11.
  13. ↑ D. Gonzales, SI Rennard, M. Nides et al .: Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. Jama 2006, 296: pp. 47-55.
  14. ↑ DE Jorenby, JT Hays, NA Rigotti et al .: Efficacy of varenicline, an alpha-4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. Jama 2006, 296: 56-63.
  15. ↑ DP Tashkin, S Rennard, JT Hays et al .: Effects of varenicline on smoking cessation in patients with mild to moderate COPD: a randomized controlled trial. Chest 2011, 139: 591-599.
  16. Jump up ↑ RD Hurt, DP Sachs, ED Glover et al .: A comparison of sustained-release bupropion and placebo for smoking cessation. N engl J Med 1997, 337: pp. 1195-1202.
  17. ↑ DE Jorenby, SJ Leischow, MA Nides et al .: A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med 1999, 340: pp. 685-691.
  18. ↑ Huges, JR, Stead LF, Lancaster T.: Antidepressants for smoking cessation. Cochrane Database Syst Rev 2007: CD000031.
  19. ↑ a b FDA: Public Health Advisory: FDA Requires New Boxed Warnings for the Smoking Cessation Drugs Chantix and Zyban December 30, 2013.
  20. ↑ A. Einarson, S. Riordan: Smoking in pregnancy and lactation: a review of risks and cessation strategies. Eur J Clin Pharmacol, 2009, 65: pp. 325-330.
  21. ↑ K. Fagerström, Ph. D .: Determinants of Tobacco Use and Renaming the FTND to the Fagerström Test for Cigarette Dependence. , Nicotine Tob. Res. (2012), 14 (1): pp. 5-78.
  22. ^ TF Heatherton, LT Kozlowski, RC Frecker, KO Fagerström: The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionaire. Br. J. Addict 1991, 86: pp. 1119-1127.
  23. ^ DTC Lai, K. Cahill Y. Quin, JL Tang: Motivational interviewing for smoking cessation, Cochrane Database of Systematic Reviews. Reviews 2010, No. 1, John Wiley and Sons, Ltd Chichester, UK.
  24. ↑ A. Stefan, A. Rittmeyer, M. Hinterthaner, RM Huber: Smoking cessation in lung cancer feasible and effective. Deutsches Ärzteblatt, vol. 110, issue 43, October 2013.
  25. ↑ JJ Prochaska, JF Hilton: Risc of cardiovascular serious adverse events associated with varenicline use for tobacco cessation: systematic review and meta-analysis. BMJ May 4, 2012, 344: e2856.
  26. ^ NA Rigotti et al .: Efficacy and safety of Verenicline for smoking cessation in patients with cardiovascular disease. A randomized trial. Circulation, 2010, 121: 221-229.
  27. ↑ KH Thomas et al .: Smoking cessation treatment and risk of depression, suicide, and self harm in Clinical Practice Research: prospective cohort study. BMJ 2013, 347: f5704.