How to get rid of tobacco addiction | Psychological and physical dependence on smoking: how to get rid

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Tobacco addiction is a real drug addiction disease; it causes psychological and physical dependence on the active substance of tobacco - nicotine. Like any drug, nicotine first causes psychological dependence, then with regular use a person develops a physical dependence on smoking, that is, on the intake of nicotine in the body.

With regular use of nicotine, it poisons the entire human body, negatively affecting all its internal organs.

How does nicotine withdrawal manifest itself?

Nicotine withdrawal begins in a smoker within a few hours after smoking the last cigarette. Its symptoms are quite clearly manifested, it is difficult not to recognize them:

A smoker develops a cough that cannot be relieved by any medications.
A person experiences shortness of breath, a feeling as if there is not enough air.
The patient experiences a state of weakness and severe fatigue.
Increased appetite may occur.
Nausea appears.
There are sharp changes in blood pressure.
Tachycardia.
The mental state of a person is irritated, depressed.
Sleep patterns are disrupted, and insomnia may even occur.
The patient has tremors of the limbs and convulsions.
Problems arise with the gastrointestinal tract, most often constipation.
A person is tormented by a strong desire to smoke.

These symptoms do not necessarily appear all at once; they may appear periodically. However, you have a choice whether to tolerate them yourself or use the coding method for nicotine addiction.

Nicotine gum

The gum contains from 2 to 4 g of nicotine bound to the resin at pH, ensuring maximum absorption through the mucous membranes of the mouth. Due to the fact that 85-90% of the nicotine that has been stuck in the mucous membranes of the oral cavity is metabolized when it first enters the liver, this method is ineffective without using the correct chewing style (chew-pause-chew-pause).

When used correctly, the level of nicotine in the blood serum reaches 30-60% of the level when smoking cigarettes. In addition, chewing gum, if necessary, can replace smoking in cases of emergency (for example, in a stressful situation) and in ordinary situations. Unfortunately, treatment with nicotine gum is complicated by the need to chew them in large quantities, which negatively affects the digestive system. This method helps achieve remission in 27% of patients within six months.

How long does nicotine withdrawal last?

It is almost impossible to say exactly how long nicotine withdrawal will last, because this period depends on a number of factors:

Experience of addiction.
Smoking mode.
General health of the smoker.

Nicotine withdrawal can last from two weeks to two months. The intensity of symptoms when quitting smoking can also vary. Everyone will have to find out from their own experience how long nicotine withdrawal lasts.

We can say for sure that around the 3rd-4th day the desire to smoke reaches its peak. These days, the smoker is tormented by only one thought - maybe he should smoke? At these moments, it is better to approach the person; he is what is called “on edge.” The smoker is irritated throughout the entire period of nicotine withdrawal, but these days he can even be aggressive, unrestrained and hot-tempered.

How to get rid of psychological addiction to smoking? I really need it, help! :(

2 years of experience. I tried to quit smoking many times already. But it lasted for a maximum of 2 weeks. But the point is not that I broke down because I wanted to smoke, but that when I overcame the physical addiction, it changed to psychological and I couldn’t do anything about it It was pressing from all sides. Constantly 24/7 there was only smoking in my head about how wonderful it was, as if another person’s brain had been installed. And when I broke down and lit a cigarette I didn’t feel pleasure, but it was already too late since the nicotine had already entered the blood anyway (I had to start all over again) I smoked 2 cigarettes about 2 hours ago. Now I’m craving it, but not much. What should I do? How to get rid of this psychological pressure? Please tell me! I’ll have 2 years of experience again.

Causes of nicotine withdrawal

Symptoms of quitting cigarettes are observed throughout the entire period of time while the body is being adjusted to a new way of working, working without nicotine. This is the cause of physiological discomfort.

But there is also psychological discomfort when quitting smoking, and if someone has quit smoking, then most likely they will confirm that this is a more disturbing feeling. After all, a person has already developed numerous conditioned reflexes, he is used to smoking in the morning with a cup of coffee, in the car or before getting behind the wheel, he is used to discussing something with a cigarette in his hand during lunch with colleagues. Everyone had their own little rituals, but all smokers always have them. And a person feels very uncomfortable in all these familiar situations without smoking.

Many people already in advance, before quitting smoking, begin to inspire themselves with all the horrors that await them, thereby further increasing psychological discomfort and tension.

Smokers have certain attitudes regarding smoking; they may not correspond to the facts at all, but for a person it is all very real. Most often, people are sure that cigarettes calm them down, or, on the contrary, activate their mental activity, making them more intelligent and active. Cigarettes are not a sedative, they are toxic poisons. And what smokers think is peace of mind from smoking is actually the normal state of a person, which he lost in the process of nicotine addiction. And nicotine withdrawal is a concern.

Why does a smoker want to smoke during times of stress? At this time, the human body is already having a hard time, so he tries not to increase stress by adding smoking cessation syndrome to it. This is how the body protects itself.

HOW TO GET RID OF PSYCHOLOGICAL DEPENDENCE TO SMOKE A CIGARETTE

Resisting the temptation to smoke throughout your life is the biggest challenge for every ex-smoker. Understanding the risks of smoking and making the decision to quit are the most positive and powerful steps a smoker can take. However, once you have made this decision, you must not smoke. Knowing how nicotine addiction works and how to prevent setbacks will allow you to combat the inevitable cravings that follow the decision to quit smoking. The first days and weeks without cigarettes are the hardest, but over time it gets easier. Therefore, a smoker who wants to get rid of this habit forever must solve two problems:

Overcome nicotine withdrawal symptoms. Resist the temptation to smoke a cigarette for a few days/weeks once he achieves freedom from cigarettes, despite a strong desire to not smoke for life

Typically, sources offering quick and easy ways to get rid of nicotine addiction pay attention only to the first task, ignoring the second, which is more important and difficult. Therefore, many smokers who have managed to cope without cigarettes for several months or years begin to smoke again and again.

WHERE DEPENDENCE COME FROM

The reasons why people decide to smoke are innumerable, but the only reason they become addicted is nicotine. Nicotine causes changes in brain function and encourages you to smoke again and again. In most cases, people start smoking in their teens or twenties. The main reason for adopting this habit is social pressure.

People watch their friends, relatives, media representatives, etc. do it. They start imitating them and get hooked on a deadly habit. Others see smoking as a way to cope with stress and psychological anxiety. The human mind is very powerful; he is highly motivated to deal with anxiety and will do whatever is necessary.

HOW TO DETERMINE THAT A PERSON IS PSYCHOLOGICALLY DEPENDENT ON SMOKING

Having decided to quit smoking, a person begins to select the most suitable day for this, preferably after many holidays and birthdays, when the desire to smoke under the influence of society and the atmosphere increases.
The presence of “nicotine rituals”, when you are used to smoking before/after/during certain activities (after a meal, with a cup of coffee, etc.).
Smoking is a means of dealing with stress.
Smoking is a cure for boredom.

DO YOU REALLY WANT TO QUIT SMOKING?

Nicotine is incredibly addictive and it takes determination to quit smoking. Ask yourself whether a life without smoking is more attractive than continuing to live as a smoker. If the answer is yes, have a clear reason for wanting to quit. Thus, when abstinence becomes difficult, you should address the important reasons why you decided to quit smoking. Identify your reasons for quitting smoking.

Quitting smoking is difficult. You can take on the challenge, but it will help if you keep your goals in mind. Review your mental list as you get closer to your quit date. This is a simple statement that allows you to overcome your bad emotions with tough intelligence. Weighing the pros and cons reminds you that every action has its benefits and consequences. Writing it down helps validate why you started this journey and what you need to do to succeed. However, you need to keep in mind that cigarettes are very effective at delivering nicotine throughout the body.

When you quit smoking, you may experience increased cravings, anxiety, depression, headaches, feelings of tension or restlessness, increased appetite and weight gain, and trouble concentrating. Sometimes it may take more than one attempt to quit smoking. Reason is the only way to quit smoking. Self-motivation is truly beneficial when it comes to overcoming any addiction. Commitment will be a great way to break the habit and start a healthy lifestyle. When you decide that you want to quit smoking, program your whole body to make an effort and apply the following tips to help you quit smoking completely:

GET RID OF EVERYTHING SMOKING RELATED

The mind is influenced by the senses. Nothing you see, smell, touch, hear or taste should remind you of smoking. Therefore, it is wise to dispose of all tobacco products, no matter how expensive they are, and avoid places where you might find these products or smokers.

CONTROL YOUR THOUGHTS

Teach yourself to distract yourself from thoughts about smoking and related activities, as you may get caught up in your thoughts and feel like your cravings are getting worse. To distract yourself from such thoughts, find something else you enjoy doing, something as simple as a hobby.

REPROGRAM YOUR MIND

Smoking is a habit that is learned by association. This means that smokers associate the "feel good" effect of nicotine with the habit of smoking - thus making smoking an activity. If you teach yourself that smoking is harmful, you will find that you hate the habit and will eventually quit. For example, you can try something like adding hot pepper to your tongue every time you feel the urge to smoke.

DETOXIFICATION

Smoking leaves nasty toxins in your body, not just nicotine. If you have been addicted for a long time, it means that toxin levels are high and therefore you need to work hard to complete the detoxification process. First, drink plenty of water to cleanse your blood. Orange juice and grape juice are also highly recommended as they reduce smoking cravings and also help in detoxification. Maintain a balanced diet to restore health.

MAKE ADJUSTMENTS TO YOUR ACTIVITIES

It's difficult, but necessary. When you feel the urge to smoke, switch your attention to a walk, a book, or whatever you enjoy. After eating, take a piece of candy or chewing gum with you instead of a cigarette. Since many people tend to trade tobacco with food items, be sure to bring healthy snacks with you. Grab a large bag of baby carrots and pretzels (low sodium, of course) or fresh or canned fruit.

DISCUSS YOUR ADDICTION WITH SOMEONE

Many smokers know how to stop cravings for cigarettes, the only problem is that they do it incorrectly and cannot cope with the painful symptoms. One way to overcome the consequences is to seek help from family, friends and professionals. By telling people, you are making a commitment not only to yourself, but to others as well. Tell them your end goal and how you want them to help you. Also find someone who understands your feelings. Someone who has successfully quit smoking will be of great help as they know what you are going through.

Cigarettes are a deadly weapon not only against your own body, but also against the health of others. Smoking is considered one of the deadliest addictions, second only to alcoholism. However, when drinking alcohol, you at least ensure that when you take it, you are the only one taking that dose. When smoking, you and everyone around you will take a sip of the drug. Finding the right approach may take some time. Keep in mind that there are times when you may need to make a couple of attempts to succeed in your quit attempt. You'll be surprised how easy it is to breathe, not to mention how youthful you'll look without smoking.

Smoking among teenagers

Of course, compared to the other most serious addictions, cigarette addiction seems like a child’s prank. Today we see children injecting drugs, should we be concerned about cigarettes? In fact, it’s worth it, because nicotine addiction becomes the door to the world of psychotropic drugs for many teenagers. It is easier for a teenager who smokes to decide to drink alcohol or smoke weed.

In addition, we should not forget that nicotine addiction is exactly the same as drug addiction; poisons poison the entire human body, which is especially harmful at the stage of final adulthood, when the formation of the body’s hormonal and reproductive systems is completed. Smoking in adolescence causes the most severe damage to the body, which will affect later life.

At the same time, a teenager has a much higher risk of starting smoking than a mature adult. A young man is more susceptible to outside influence, a teenager explores everything new, and with the help of smoking he tries to look more mature and cooler.

Unfortunately, the surrounding social situation is not conducive to smoking prevention. Although many innovations have formally appeared: smoking is prohibited in public places, cigarettes are sold from closed storefronts, even films have captions that warn that there will be scenes of smoking. But a child or teenager can always meet a person smoking on the street.

Symptoms

The normal functioning of the human body, including all organs and the functions they perform, completely returns to normal without nicotine. Therefore, it is believed that nicotine addiction is not fixed at the physiological level, but not at the mental level. A person can no longer perceive his normal state properly until he lights a cigarette. And then, it seems to him, he feels better. Most smokers feel the need to smoke in certain places where they had to smoke before.

To date, three stages of nicotine addiction have been identified:

first stage. Appears two to three years after the start of smoking. It begins with rare (from one to ten) use of cigarettes in everyday life, with pronounced intoxication. While smoking, a person coughs, feels dizzy and slightly nauseous. Then the person begins to smoke about five cigarettes a day for two to three years. Gradually the number of cigarettes increases to twenty. Psychological dependence is strengthened. When smoking, intoxication is not observed. A person can live like this for about seven years;
second stage. A person can live at this stage for about twenty years, which is characterized by a constant cough and signs of hypertension. The body’s physical reactions to nicotine seem natural; a person cannot even imagine his life without cigarettes;
third stage. Receptors do not work well, the body’s reactions to nicotine lead to a depressed state. The process of smoking takes first place, not the consumption of nicotine. The addict smokes at night (wakes up to smoke). The nervous system is irritated if a person has not smoked even for a short time. The normal functioning of the body and all processes are disrupted.

How does nicotine addiction occur?

When a person smokes, adrenaline enters the blood; in addition, the production of joy hormones and endorphins increases. The smoker enjoys this state; while smoking, he experiences a better mood than usual. Therefore, a person smokes again, then again, and this is how addiction is born. True, the pleasant impressions will soon go away, and only the desire to relieve nicotine withdrawal will remain.

Withdrawal when quitting cigarettes leads the smoker to become particularly irritable. This withdrawal symptom becomes more intense with a long history of addiction. Nicotine has been affecting the body's nerve endings for so long that they can no longer adequately respond to stimuli, especially when quitting smoking.

Four stages of tobacco addiction from smoking cigarettes

It is hardly possible to draw a clear line between these stages. This classification, adopted by the Allen Carr Center, is rather arbitrary, but still reflects the real picture.

First stage. At this stage are those who are just starting out or smoke once or twice a month. They take shallow drags, don’t know how to blow beautiful smoke rings, and for them every cigarette is like their first. Since they rarely smoke, they have no physical dependence on smoking, as well as addiction. Such people are convinced that they have everything under control.

Second stage. This includes people who have already formed an addiction, but are not yet aware of it. They have good health and strong character, they are confident that they can give up cigarettes at any time, but do not yet see the need for this. The path from stage one to stage two is short, and it gets shorter every year because tobacco companies are constantly developing new technologies to speed up addiction. This stage can last from several months to 20–30 years. At this time, they may not even think about how to get rid of smoking addiction, because they think that they can easily overcome this craving.

Third stage. Long-term smokers who already have a pronounced dependence on smoking. They have already experienced the negative aspects of smoking. They constantly feel nicotine starvation, but they explain it to themselves and others as a habit.

Fourth stage. People who have received a diagnosis related to smoking. They have no illusions about the “harmlessness” of cigarettes, but even such an understanding does not guarantee that they will be able to overcome the psychological dependence on smoking.

Treatment for tobacco smoking

Most smokers, before finally quitting, make several attempts that do not bring results. Therefore, the best thing you can do is to immediately contact a specialist and carry out effective addiction treatment.

It's best to see a doctor before quitting so that he or she has a more realistic picture of your addiction. The specialist collects an anamnesis of the disease:

At what age did you start smoking?
Causes of addiction.
Number of cigarettes smoked per day.

This information will help the doctor choose the necessary treatment that will be suitable specifically for your clinical case.

An integrated approach to the treatment of tobacco smoking and nicotine addiction

It is now generally accepted that tobacco smoking (TS) is one of the preventable risk factors for the development and premature death from socially significant diseases: diseases of the circulatory system, respiratory organs and malignant neoplasms. The prevalence of smoking in the Russian Federation is one of the highest among all countries: about 65% of men and 14% of women smoke [4]. More than 300 thousand Russians die from smoking every year [2]. Nicotine addiction should be considered as a disease that needs to be diagnosed and treated, so quitting smoking and treating tobacco addiction is a very urgent task to prolong life and maintain its satisfactory quality.

Before moving on to a discussion of issues related to the treatment of TC, it is necessary to consider the mechanism of formation of nicotine addiction. The main role among the pathological factors of TC belongs to nicotine. Nicotine is a colorless and odorless alkaloid found in plants of the nightshade family, mainly tobacco. The name “nicotine” comes from the Latin nicotina tabacum, which in turn received its name from the name of the French ambassador Jean Nicot, who brought tobacco seeds and leaves from Portugal to France in the mid-16th century [3]. Nicotine is one of the most dangerous poisons of plant origin. A person dies instantly if a dose of nicotine from one smoking pipe is injected into the body intravenously. At the moment of inhaling, the temperature at the tip of the cigarette reaches 900 °C. When smoking, dry distillation of tobacco occurs, resulting in the formation of toxic substances (approximately 4000 components), over 200 of which are dangerous to the body. In addition to nicotine, these are essential oils, carbon monoxide (carbon monoxide), carbon dioxide, ammonia, tobacco tar, radioactive substances, lead, bismuth, arsenic, potassium, as well as butyric, acetic, formic, valeric and hydrocyanic acids, hydrogen sulfide, formaldehyde, nitrogen, hydrogen, argon, methane, hydrogen cyanide, etc. More than 40 of them are carcinogens. The radioactive isotope polonium-210 is especially dangerous, most of which accumulates in the body and contributes to the development of cancer cells. Nicotine quickly penetrates the cerebrovascular barrier and distributes throughout the brain tissue with high concentrations in the hypothalamus, thalamus, midbrain, brainstem and cortex. It interacts with nicotinic cholinergic receptors of the brain, autonomic ganglia, and neuromuscular synapses. Activation of nicotinic receptors causes the release of catecholamines, including acetylcholine, norepinephrine, dopamine, serotonin, beta-endorphin and glutamate, which a person experiences as pleasure, increased performance, decreased anxiety, and decreased hunger. Nicotine addiction is largely due to the release of dopamine. Quite quickly, the smoker develops tolerance to nicotine, and its central toxic effects - nausea, dizziness, weakness - disappear. However, the stimulating effect of nicotine does not last long. With the development of tolerance, persistent depression of central nervous system functions begins, and increasing amounts of nicotine are required to maintain them at the usual level. In this regard, a smoking person increases the number of cigarettes he smokes in order to obtain the same effect or enhance it, i.e., he begins to receive more harmful substances. Thus, nicotine addiction that develops as a result of smoking cigarettes contributes to the constantly increasing intake of a large number of harmful substances into the body. Nicotine has all the properties of an ideal drug. When it stops entering the body, withdrawal symptoms develop, which reach their maximum 48 hours after withdrawal and last 3-4 weeks. Signs of withdrawal include restlessness, irritability, low mood, increased appetite, difficulty concentrating, and a craving to smoke. Smoking is currently considered not as a bad habit, but as a chronic disease, prone to relapse even long after quitting tobacco. Treatment of nicotine addiction, or at least its reduction, will lead to a decrease in the impact of active harmful substances on human health.

Tobacco addiction is considered one of the most invincible. World experience shows that treatment of TC must be comprehensive, since addiction to nicotine manifests itself at several levels: mental and physical. There are: TC with a mental component of addiction - obsessive thoughts about a cigarette, nervousness, habitual actions when lighting a cigarette; TC with a physical component of dependence - a pronounced craving for smoking. This type of TC is characterized by the presence of withdrawal syndrome. If a person has not yet developed a physical dependence on TC (smoker with little experience), but only has a psychological dependence, then the main treatment is psychotherapy. One of the methods of psychotherapy is hypnotherapy. Psychotherapeutic treatment is aimed at eliminating the pathological reflex to TC and reducing strong cravings for cigarettes. In addition to psychotherapeutic treatment methods, reflexology methods (acupuncture) and drug therapy are used. Treatment of TC in a person with extensive experience is mainly carried out using reflexology methods. The main method of reflexology is acupuncture. The essence of this method of treatment is the use of acupuncture needles that affect biologically active points of the body. At the same time, the craving for smoking is significantly reduced, and the symptoms of withdrawal syndrome are weakened. Additional methods of treatment in this case will be psychotherapy and drug therapy.

Treatment of TC should be carried out not only comprehensively, but also individually for each individual person. A positive result from treatment can only be achieved if a person makes a conscious decision to quit smoking. Quitting smoking is not easy. Nicotine dependence is a disease classified in the International Classification of Diseases as a mental and behavioral disorder associated with tobacco use. It ranks higher on the scale of physical and mental dependence than alcohol, amphetamines and hashish. Severe tobacco addiction, which is impossible to get rid of without treatment, is registered in 30–60% of smokers. Its development depends on the age at which a person started smoking, the length of time and intensity of smoking, as well as on the constitutional and personal characteristics of the person. Repeated desire to take nicotine from tobacco smoke develops due to its effect on certain neurotransmitters, including dopamine, released in response to nicotine stimulation of central nicotinic acetylcholine receptors. In addition, nicotine withdrawal leads to the development of a complex of physiological and physical symptoms (irritability, anxiety, headache and others), leading to the desire to smoke, which also maintains constant nicotine intake. Many people who smoke try to quit smoking on their own, but only 5% of them succeed.

The first step in treating tobacco dependence is to identify smokers, assess smoking as a risk factor for developing diseases, and determine the degree of tobacco dependence. Smoking as a risk factor for developing diseases is assessed using the smoking index (SI). It is calculated from the number of cigarettes smoked per day, which must be multiplied by 12 (the number of months in a year). IC > 140 indicates a high risk of developing diseases in a smoker. The development of an individual program of cessation and medical assistance for a smoker should include a differentiated approach taking into account the degree of nicotine addiction, since the effectiveness of smoking cessation methods is inversely proportional to the initial severity of nicotine addiction. To determine the degree of nicotine addiction, a questionnaire developed by the Swedish physician Carl Fagerström is most often used (table), which determines the relationship between an individual score and the severity of withdrawal symptoms, that is, the higher the score, the stronger the withdrawal will be and the more difficult it will be to quit smoking without outside help.

The degree of nicotine addiction is assessed in points. The result is the sum of the points: 0–2 - very weak dependence; 3–4 - weak dependence; 5—average dependence; 6–7 – high dependence; 8–10 – very high dependence [6]. In the absence or mild degree of nicotine dependence (0 or less than 4 points on the Fagerström test), psychotherapy is recommended to begin treatment; with a high degree of withdrawal syndrome, it is necessary to evaluate the need for nicotine replacement pharmacotherapy. Prescribing different forms of drugs from the same group at the same time (for example, a patch and an inhaler or a patch and a nasal spray) can reduce the likelihood of side effects of each drug form and increase the effectiveness of therapy. For moderate (5–7 points according to the Fagerström test) and severe (8 points or more) degree of nicotine addiction, in addition to psychotherapy, nicotine replacement or nicotine-free anti-nicotine therapy (varenicline) is recommended. Varying degrees of nicotine addiction explain why some people quit smoking more easily, while others face insurmountable difficulties. If you know how strong the addiction is, it is easier to find the best ways to overcome it. If the doctor does not have the questionnaire developed by Fagerström, and to quickly determine the degree of addiction, the doctor can ask the patient three questions, to which he must answer “yes” or “no.”

Do you smoke more than 20 cigarettes a day?
Do you smoke within the first half hour after waking up?
Did you experience severe cravings or withdrawal symptoms during a previous attempt to quit smoking?

A patient's positive answer to all three questions indicates a high degree of dependence on nicotine. Smoking within 5 minutes of sleep is also a reflection of a high degree of nicotine addiction, and its exceptionally high level is characterized by an irresistible desire to smoke at night. Drug therapy for nicotine addiction should be carried out by all smokers who want to give up TC, which significantly reduces the risk of resuming smoking: according to V.K. Smirnov [5], within 5 weeks up to 80% of those who quit smoking return to TC.

According to the provisions of evidence-based medicine, the effectiveness and safety of a treatment method must be confirmed by the results of clinical studies (the highest evidence comes from randomized controlled trials and meta-analyses of such studies). Hypnosis and psychological conversations do not have a sufficient evidence base, although this does not completely deny the effectiveness of such types of influence. The largest evidence base has currently been accumulated for a number of medications used in the drug therapy of nicotine addiction. These medications include nicotine replacement therapy (NRT) (chewing gum, nasal spray, inhaler, lozenges, Nicorette patch); cytisine (Tabex), varenicline (Champix), and bupropion (the antidepressant Zyban).

NRT is the cornerstone of the modern approach to treating patients with nicotine addiction. The method was developed more than 40 years ago in Sweden on the basis of numerous scientific studies. NRT is based on the idea of supporting willpower during the quitting process by alleviating withdrawal symptoms. Nicorette became the first NRT drug that embodied a new approach to the treatment of tobacco addiction: for the first time, not only the psychological, but also the physiological factor was taken into account. When using Nicorette preparations, the body receives the minimum required dose of pure therapeutic nicotine (less than in a cigarette), but sufficient to relieve nicotine withdrawal. There are several dosage forms of the drug: chewing gum containing 2 and 4 mg of nicotine; sublingual tablets at a dose of 2 mg; inhalation solution containing 10 mg of nicotine in one dose; adhesive patch (a transdermal therapeutic system that provides gradual release of nicotine into the blood at dosages of 5 mg/16 hours, 10 mg/16 hours and 25 mg/16 hours). According to a study conducted by P. Tonnessen et al. [10], using a nicotine replacement inhaler for a year increases the rate of successful smoking cessation by 2–3 times compared with placebo.

In the eighties of the 20th century, nicotine patches appeared and became popular. The mechanism of their action is as follows: the nicotine they contain enters the body through the skin, relieving the withdrawal state. The maximum concentration of nicotine in the blood appears after 6–10 hours. Nicotine is excreted through the liver (with feces), kidneys (with urine) and lungs (with exhaled air). The course of treatment is individual, but usually lasts at least three months. Typically, treatment begins with the highest dose (a patch containing 15 mg of nicotine), after which they move on to 10 mg and 5 mg patches. According to research by European scientists, nicotine activates ion channels in skin cells, which provokes inflammation and itching.

Recently, nicotine chewing gum has become a fairly popular means of stopping smoking among smokers, thanks to which nicotine enters the body through the lining of the oral cavity. Studies have shown that people trying to quit smoking and chewing gum have twice the results of those who try to quit smoking without it. To use nicotine gum correctly, you need to put a piece in your mouth and bite lightly until a strange taste appears. Then press the chewing gum between your cheek and gum. The procedure must be repeated every few minutes. A piece of gum should last about 30 minutes. Rapid chewing and swallowing of saliva does not activate the effects of nicotine and may cause nausea. Nicotine chewing gum is used when the need to smoke arises. To begin with, you may need 10 to 12 pieces of gum per day, gradually decreasing this amount each week. Nicotine from chewing gum is absorbed into the blood more slowly, and the amount of nicotine consumed is difficult to control. Some people believe that chewing nicotine gum is harmless. In fact, if you use it uncontrollably, the dose of nicotine absorbed by the body may be much greater than when smoking. Chewing gum with nicotine only helps to get rid of the habit of smoking (holding a cigarette in your hand), and nicotine consumption remains the same.

Sublingual tablets and lozenges may contain 2 and 4 mg of nicotine. Nicotine lozenges release less nicotine, while lozenges release 25–27% more nicotine than chewing gum. If the patient continues to smoke or chew tobacco, the lozenges should not be used. When using sublingual tablets, up to 80 mg of the drug can be used daily. It is recommended to use 7-8 lozenges per day, and the maximum dose is 25 lozenges daily.

Nicotine spray is currently not a very common remedy in the fight against nicotine addiction. There are sprays for the nose and mouth. The most commonly used are nasal sprays. The nicotine spray is injected into both nostrils, where it is absorbed by the nasal membranes and enters the veins, which then lead to the heart and brain. This nicotine delivery system works a little faster than patches and gum, although not as fast as a cigarette. Dose: 1 mg in each nostril. Treatment begins with one to two doses per hour, the minimum is 8 doses per day, and the maximum is 40 doses per day. For most users, treatment with sprays should be reduced to 6-8 weeks. Undesirable side effects: short-term irritation of the nose, throat, sneezing, lacrimation, nasal discharge. These symptoms usually disappear after 5–7 days.

A nicotine inhaler contains a cartridge with a solution whose nicotine concentration is 10 mg. Each inhaler holds approximately 300 doses. Since nicotine is absorbed primarily by the oral mucosa, its entry into the bloodstream begins after about 20 minutes. The dosage is selected individually, taking into account the severity of the patient’s nicotine addiction. One cartridge replaces 4 cigarettes. If the patient smoked 20 cigarettes per day, 6 cartridges per day should be used. The first selected dose should be used for 3–6 weeks. At this time, you can use up to 12–16 cartridges per day. The selected dose is gradually reduced over 3 months, reducing it by 25% per month.

The dose of drugs for NRT is selected individually and depends on a number of factors (age, anthropometric data, severity of nicotine addiction, severity of nicotine withdrawal symptoms). Treatment consists of two stages: in the first stage, continuous (basic) therapy with nicotine replacement drugs is carried out for 1-2 weeks of quitting smoking. The goal of therapy at the first stage is to create a constant concentration of nicotine in the blood, preventing the development of withdrawal syndrome. At this stage, the most convenient form of adhesive plaster is that it provides a constant, long-lasting release of nicotine into the blood, since with severe nicotine addiction, taking medications may be required every hour, and in some cases more often. Then a gradual reduction in the dose of nicotine is carried out until the basic NRT is completely discontinued (the duration of treatment is individual). At this stage, it is possible to use any dosage forms of nicotine-containing drugs. The total duration of treatment is 3–6 months, the dose of the drug is reduced until it is completely discontinued within 2–3 months. Due to its high effectiveness and the possibility of a flexible approach to the treatment of tobacco dependence, NRT is now included in the set of priority measures that WHO recommends to governments to successfully combat TC.

Medicines that do not contain nicotine. The herbal drug Tabex is intended for the treatment of chronic nicotineism, that is, it helps those who want or are forced to quit smoking. Its therapeutic effect is based on the fact that, against the background of smoking, it creates unpleasant symptoms of nicotine overdose, which stimulates you to reduce the number of cigarettes you smoke or quit smoking altogether. 1 tablet contains 1.5 mg of the active substance cytisine, obtained from the plant Cytisus laburnum (creeping broom). For the entire course (25 days), approximately 100 tablets are recommended. However, it must be taken into account that the dosages recommended by the manufacturer are designed for heavy smokers, and the individual dosage must be selected individually. As a rule, for people with low smoking intensity (up to ten cigarettes per day), the individual dosage is significantly lower than the recommended one, and you can select it based on your own well-being.

The famous Austrian company made a breakthrough in the field of pharmacological drugs for smoking by releasing Zyban tablets, a remedy for nicotine addiction that does not contain nicotine. The mechanism of action of the drug is simple: when quitting smoking, the main active ingredient, bupropion, prevents the neutralization of dopamine, the “pleasure hormone,” in the smoker’s body. The action of the substance bupropion is based on its antidepressant properties, which gives the quitter psychological comfort, which is an important factor in the process of quitting smoking. Thus, treatment with Zyban is fundamentally different from nicotine replacement methods, which are designed to maintain the usual level of nicotine in the blood in case of quitting smoking. Zyban acts directly on those areas of the brain that control the level of dopamine in the blood.

Varenicline (Champix) is a partial nicotinic receptor agonist. The manufacturers of this drug claim that in 50% of cases the drug allows smokers to quit tobacco within 7 weeks [7]. Today it is the most effective drug for the treatment of nicotine addiction [1]. Varenicline is available in tablets for oral administration. The drug dosage regimen is as follows: in the first 3 days varenicline is taken at a dose of 0.5 mg 1 time per day, in the next 4 days the dose is increased to 1 mg / day (0.5 mg 2 times a day), from the second week of treatment the drug take 1 mg 2 times a day. The treatment period is 12 weeks. If side effects occur, the dose of the drug can be reduced to 1 mg/day while still taking it twice a day. The most common side effect of the drug is mild or moderate nausea, which does not require its discontinuation. Varenicline is rapidly absorbed, reaching maximum concentration 3–4 hours after administration, and easily penetrates tissues, including the central nervous system. Its combination with NRT drugs is not recommended due to the accumulation and enhancement of side effects of therapy [8, 9].

Thus, today it is possible to choose drugs for the treatment of TC and nicotine addiction that are effective from the standpoint of evidence-based medicine. Apparently, only complex therapy, including methods of reflexology and psychotherapy plus drug treatment, will allow you to get rid of this type of substance abuse. The method of complex therapy presupposes a serious attitude of the patient himself and his motivated desire to quit smoking, therefore the main condition for successful treatment of TC and sustainable remission is the patient’s serious attitude towards treatment, his active cooperation with the doctor and careful implementation of all recommendations.

Literature

Kukes V.G., Marinin V.F., Gavrisyuk E.V. Varenicline - a new generation drug for the treatment of tobacco addiction // Klin. pharmacology and therapy. 2009, 18 (3), 1–5.
Maslennikova G. Ya., Oganov R. G. The influence of smoking on the health of the population: Russia’s place in Europe // Prof. sick and health promotion. 2002; 6: 17–20.
Martsevich S. Yu., Lukina Yu. V. The problem of tobacco smoking in Russia. Drug therapy for nicotine addiction: new and old drugs from the perspective of evidence-based medicine.
Oganov R. G., Tkachenko G. B. Current problems of preventing the prevalence of tobacco smoking. Proceedings of the conference “The situation related to tobacco smoking in Russia.” M., 2001; 21–22.
Smirnov V.K., Ermolova O.I., Speranskaya O.I. Current issues in the treatment of tobacco addiction // Narcology. 2010, 6, 36–39.
Chuchalin A.G., Sakharova G.M., Novikov K.Yu. Practical guide to the treatment of tobacco addiction // Russian. honey. magazine. 2001, 21, 2–19.
Ebbert JO, Sood A, Hays JT et al. Treating tobacco dependence; review of the best and latest treatment options // J. Thor.Oncol. 2007; 2: 249–256.
Foulds J. The neurobiological basis for partial agonist treatment of nicotine dependence: Vareniclin // Int. J Clin Pract. 2006; 60:571–576.
Obach R., Reed-Hagen A., Krueger S. et al. Metabolism and disposition of varenicline, a selective acetylholine receptor partial agonist, in vivo and in vitro // Drug Metab Dis. 2006; 34: 121–130.
Tonnesen P., Nurregard J., Mikkelsen K. et al. A double-blind trial of a nicotine inhaler for smoking cessation // JAMA. 1993; 269:1268–1271.

I. V. Andryushchenko, Candidate of Medical Sciences E. V. Malinina

State Educational Institution of Higher Professional Education VSMU Ministry of Health and Social Development of Russia, JSC Russian Railways National Health Institution Departmental Hospital, Vladivostok

Contact information for authors for correspondence

Smoking code

The symptoms of nicotine withdrawal are quite painful, which often leads people to a breakdown. But they will have to be endured for as long as nicotine withdrawal lasts, and the craving for smoking does not leave a person during this period. In order for an addict to still be able to quit smoking and give up cigarettes, despite the fact that addiction causes withdrawal symptoms, numerous nicotine coding methods have been created. Using coding allows you to ease the path to freedom from smoking, bypass the problem of withdrawal and give yourself the opportunity to live without nicotine addiction.

The most optimal solution for getting rid of nicotine addiction is to use both coding and psychotherapeutic assistance from a specialist.

No to depression, no to smoking!

The new drugs also include the antidepressant bupropion, known under the brand name Ziban. “Zyban”, and like any antidepressant, has an effect primarily on the mental component of tobacco addiction. The second active principle is the direct antidepressant effect of Zyban, which allows you to avoid withdrawal symptoms. The effectiveness of the method is 2.7-3.1 times higher than when taking placebo.

What are the methods of drug coding for smoking cessation?

Tablets, sprays, mouthwashes that reduce or eliminate the desire to smoke.
Drugs and anti-nicotine patches that simulate the entry of nicotine into the body.

You need to select an anti-nicotine patch under the supervision of a doctor, because an incorrectly selected patch that cannot imitate your smoking regimen will be useless. The problem with tablets and sprays is that compliance with their use becomes the complete responsibility of the patient. Violation of the medication regimen can lead to breakdowns.

Nicotine patch

The nicotine patch is a transdermal system that releases nicotine and maintains a constant serum level for 16-24 hours. This method ensures effective absorption of nicotine, a short half-life and a constant level in the blood serum, which significantly reduces the desire to smoke associated with withdrawal. Therapy lasting at least 8 weeks is recommended. Patients need to change the patch daily.

This therapy can be used for patients with damage to the coronary arteries and pregnant women (that is, in cases where they have to quit smoking for health reasons). Among the side effects of the nicotine patch, skin irritation should be noted, which requires constantly changing the place where it is applied. There are cases of sleep disturbance when using the patch, in which case it is recommended to use it only during the day, which in turn reduces the effectiveness of the effect. It has been found that 27% of people using this method stop smoking before the end of the treatment period, and another 22% have a remission lasting 6 months or more. 16 and 24 hour patches are equally effective.

Freedom from nicotine is possible

The most difficult will be the first month of quitting smoking, during this period you really want to smoke, you are constantly reminded of those moments and situations in which you usually smoked. But after about a month, the irritability goes away, the desire to smoke appears less and less, general health improves, and the cough goes away. The body is cleansed of nicotine and returns to its natural rhythm of work.

There are, of course, unpleasant moments: sweating, phlegm and an unpleasant taste in the mouth in the morning. During this period, the immune system weakens slightly, and there is a possibility of catching some kind of infection. But all these are small things compared to freedom from nicotine.

However, regardless of whether you endured this time without cigarettes yourself or with the help of drug coding, it is worth remembering that the internal psychological causes of the disease still remain. Therefore, in order to eliminate the risk of relapse, it is necessary to undergo a course of psychotherapy and get rid of psychological dependence on nicotine.

In our consulting room, we can select for you the full range of treatment for nicotine addiction, including initial examination and diagnosis, as well as drug coding and psychotherapeutic treatment. This will allow you to forever forget about the unpleasant and painful addiction, about the fruitless attempts to leave it, which you made alone. Take advantage of the experience of specialists. You can get a telephone consultation on the treatment of nicotine addiction right now by contacting our hotline, you will see its number on the website page.

Treatment and prognosis

There are various ways to treat nicotine addiction, most of which can be done by a person on their own. One of these is the method of replacing cigarettes with other products containing nicotine. Provided that a person wants to quit addiction and consciously goes to replace tobacco products with patches, tablets, plasters, etc., this method will be effective.

To eliminate psychological symptoms, antidepressants may be required (Bupropion, Nortriptyline, etc.). Pharmacological drugs that are antagonists of nicotinic receptors can also help. The most popular are:

"Cytisine";
"Varenicline";
"Mecamylamine."

These are effective smoking cessation products that make a person feel aversion to cigarettes. These drugs are part of the drug coding system. Other means aimed at preventing relapse can be used - mouthwash solutions based on silver nitrate or copper sulfate. No less effective are injections of apomorphine hydrochloride, which block the effect of the drug used.

Complete relief from physical dependence is observed after 10-14 days.

Treatment and prognosis are individual due to the characteristics of psychological attraction. To find motivation for a healthy lifestyle, many people turn to psychotherapists. Using individual or group therapy methods, you can support a person's desire to fight the habit and save him from relapse.

Hypnotic treatment methods are no less common. Aversion to nicotine, the danger of consequences, etc. is instilled.