Reaching for a cigarette is no longer cool – and certainly not healthy. The road to sobriety is difficult, but at least the withdrawal symptoms can be alleviated.

Tobacco use is one of the leading causes of preventable death, leading to countless premature deaths and many preventable chronic diseases. However, millions of people in Germany are unable to stop suicidal behavior. Smoking is an addiction. Addiction occurs at both physical and psychological levels and is defined in the ICD-10 as “mental health and behavioral disorders caused by tobacco” (F17.2). Patients feel a strong craving for the addictive substance and have only limited control over consumption. They take bodily harm for it.

When smokers quit smoking, physical withdrawal syndrome occurs. It is characterized by irritability, difficulty concentrating, increased appetite, restlessness, depressed mood and insomnia. In order to combat unpleasant feelings, many people want to reach for the next cigarette quickly. In the guide S3 "Smoking and tobacco addiction: examination, diagnosis and treatment", experts have drawn up recommendations on how to help people break tobacco addiction.

Hypnotherapy: only by professionals
The current standard for smoking cessation is a combined psychological and drug therapy. Many people do not like the term "psychotherapeutic interventions". It can be confirmed as confirmation that treatment aimed at permanent smoking cessation does not have to be complex psychotherapy. Psychotherapeutic interventions include, for example, hypnotherapy. The inhibition threshold to try this method is probably lower than with other psychotherapeutic interventions. However, its effectiveness is unclear. In a 2019 Cochrane review, the authors found no clear superiority of hypnotherapy over other smoking cessation methods. Anders Tahiri et al. (2012): They found evidence for the effectiveness of hydrotherapy in smoking cessation, but suggested further research and larger studies. Patients interested in hypnotherapy should consult a medical or psychological hypnotherapist trained in clinical hypnosis. Because of the risks involved, treatment with hypnotics should be discontinued.
If you want to go back to the tried and true, cognitive behavioral therapy is the way to go. The therapist supports the decision to quit smoking. Karskus is committed to not smoking and is learning to deal with critical situations.

Relieves withdrawal symptoms
Tobacco addiction does not end with the mind. The body speaks for itself. Quitting smoking leads to withdrawal symptoms and food cravings. Stress side effects such as weight gain may occur. The good news is that medication can provide relief. The Cochrane Group on Tobacco Dependence uses meta-analysis to determine the effectiveness of individual active ingredients.
Nicotine replacement products are over-the-counter medications that are always in demand in pharmacies. Nicotine Replacement Therapy (NRT) provides smokers with lower doses of nicotine without the accompanying pollutants of tobacco smoke. Individual dosage forms differ in the kinetics of nicotine release. The dose should be reduced slowly over 8-12 weeks. Which nicotine replacement product is suitable depends on the patient and their individual needs and preferences. The authors of the guide do not recommend using NET smoking cessation devices (chewing tobacco, snuff and snuff).
Some drugs such as vareniline, cytisine, dianicline or lobeline act as partial nicotine agonists. In most studies, a daily dose of 2 x 1 mg vareniline was used after a one-week dosing phase. Should side effects such as dizziness and nausea occur, the same results can be achieved by halving the daily dose. There is evidence from a meta-analysis by Smith et al. (2017) that varenicline may be superior to bupropion or nicotine patches in women. Cytisine may be an alternative to vareniline when other approved treatments have failed.

Smoking: mild sedative
Nicotine and possibly other components of tobacco have a weak antidepressant effect. To a certain extent, smokers can manage their depressive symptoms themselves. This amplifies the uncomfortable feelings that come with quitting smoking. Possible depressive symptoms appear (weaken).
 
Antidepressants can help some smokers quit smoking. The use of nortriptyline and bupropion is evidence-based. Both substances can also reduce appetite. It should be noted that in Germany only bupropion is currently approved for smoking cessation. But this drug is not critical. There was evidence of an increased risk of suicide, but this is not yet sufficiently confirmed to be able to reassess the risk-benefit balance. It is unclear whether bupropion can induce psychotic symptoms in certain subpopulations. The inhibitory effect on the cytochrome P450 system and the resulting high potential for interaction must also be taken into account.

Success through technology?
The term "e-cigarette" encompasses a variety of products that burn and vaporize nicotine-containing and nicotine-free liquids. Liquids consist primarily of propylene glycol, glycerin, and flavorings. Tests on animals and cells have shown that e-cigarette aerosol has pro-inflammatory effects, increases oxidative stress, weakens cell function and damages genetic material. In human studies, e-cigarettes reduced lung function and respiratory protection, and increased blood pressure and heart rate. However, the risks are likely to be lower than with smoking. However, no long-term data are available yet.

Quality smoking cessation programs via computers, the internet, and smartphones may be worth a try for some people. However, as with e-cigarettes, there is not enough information to make recommendations. Research is also going in other directions. It would certainly be interesting for many smokers if they could stop their craving for nicotine through vaccinations. With nicotine vaccination, the body is supposed to bind nicotine into larger complexes through an antigen-antibody reaction, so that it can no longer cross the blood-brain barrier and thus no longer trigger any psychotropic effects. A 2022 meta-analysis found that vaccinated groups were 50 times more likely to develop specific antibodies than unvaccinated groups. However, it is still unclear whether vaccination can help with abstinence. No nicotine vaccine has yet been approved.

Advise and encourage
The success of quitting depends on how strong the decision to quit is. In the beginning, it helps many smokers to articulate their "why." their reasons for quitting. Those who know their "why" and are constantly reminded of it often find it easier to keep track of things than those who rely on external motivation.

There are always moments along the way that tempt you to renew yourself. Anyone who prepares for this and, for example, considers alternative activities during the phase of intense desire, has an advantage. A common fear is weight gain from smoking cessation. You can counteract this with the help of a professional nutritionist. However, weight may not be the only thing that changes with weaning. It can also affect the effectiveness of some long-term medications.
 
The reason for the interaction between cigarettes and drugs are polycyclic aromatic hydrocarbons (PAHs). They arise from incomplete combustion of tobacco and induce clinically important CYP isoenzymes. Enzyme substrates are broken down faster. Examples of active drugs include psychoactive substances such as many neuroleptics (clozapine, olanzapine, risperidone, haloperidol, chlorpromazine), antidepressants (amitriptyline, escitalopram, mirtazapine), and benzodiazepines. Doctors and pharmacists should also monitor blood thinners (warfarin), asthma medications (theophylline, inhaled glucocorticoids), and certain cancer drugs (erlotinib, cyclophosphamide). As a rule, a significant interaction can already occur with seven to twelve cigarettes a day. E-cigarettes do not contain any PAH compounds. Therefore, vaping is less hassle-free, at least in this regard.