Tobacco consumption in Switzerland remains high: according to an estimate based on the CoRolAR survey, more than a quarter of the Swiss population aged 15 and over smokes. How can healthcare professionals help address this leading preventable cause of death and help patients quit smoking?
(ag) The main reason for continuous smoking is nicotine dependence. Nicotine binds to nicotinic acetylcholine receptors in the brain. By activating these receptors, it triggers the release of various neurotransmitters, including dopamine, glutamate, serotonin, GABA, and β-endorphin. These in turn influence perception and behavior. They lead to feelings of happiness, contentment, increased cognitive performance and appetite, and reduce anxiety and tension. According to Dr. med. Jürg Barandun of the Hirslanden Lung Center, Zurich, this “rewards” the body for nicotine consumption and at the same time “punishes” it with withdrawal symptoms if the next cigarette does not follow. Some possible nicotine withdrawal symptoms according to ICD-10 and DSM-IV are listed in Table 1.
More deaths
While other drugs such as heroin and cocaine lead to crime and illegality in society and alcohol is mainly responsible for accidents, nicotine has an impact on society as a whole in that it increases the number of secondary deaths and illnesses the most. Although the severity of physical withdrawal is subsequently less pronounced, the difficulty of achieving abstinence can be compared to that of alcohol and heroin.
Smoking as a disease
WHO and the American Psychiatric Association recognize tobacco dependence as a disease. Smoking also has disease value in Switzerland, the expert said. This is crucial if smoking cessation agents (e.g. varenicline) are to be reimbursed by health insurance. A limitatio states that the criteria of the dependence syndrome (according to DSM-IV or ICD) must be fulfilled, furthermore the patient must be motivated and a certain degree of severity must be reached (secondary disease or dependence ≥ 6 according to the Fagerström test). Further, advice and support from a specialist is necessary. The Fagerström test includes time to first cigarette after waking, number of cigarettes smoked per day, and preferred period of smoking.
According to Dr. Barandun, smoking cessation must be accompanied by a change in diet and consistent physical training two to three times a week. The start of these measures is always before smoking cessation.
A chronic disease
Nicotine addiction is not only chronic, but also associated with relapse – many smokers struggle for decades to achieve abstinence. According to Dr. Barandun, it is crucial to look for the reason for relapses in the nature of the addiction and not in the failure of the individual. In fact, statistically, only 3-5% of smokers manage to achieve six months of abstinence if they are inadequately supported. Relapses often occur within the first eight days. “Medical professionals therefore play a critical role in smoking cessation,” Barandun said. “They can encourage and counsel patients on any behavioral and pharmacotherapeutic interventions.”
Source: Media Round Table, June 19, 2014, Zurich
HAUSARZT PRAXIS 2014; 9(8): 10
