Tobacco consumption is the only most easily eliminated cause of death throughout the world, through which about half of all persons smoke for a long time.
As the general director of Dr. Grle Bruntland in an international meeting stated in 2008: “A cigarette is a softened name for a skillfully made product that supplies exactly the amount of nicotine that is necessary in order to cause a lifetime dependence in a person and, in the end, to kill him.”
What makes a person smoking in the face with hundreds of deaths and warnings about them to continue to smoke, quit and return to smoking again?
The answer is simple: all tobacco products contain nicotine, a substance that causes heavy, insurmountable with no “strong will”, lifelong dependence.
According to the researcher of Filip Morris, which is one of the largest manufacturers of tobacco products around the world: “cigarette should not be considered as a product, but as a packaging. The product is nicotine. Think about a pack of cigarettes as a container for storing a daily dose of nicotine. Think of a cigarette as a dose of nicotine. Think of puffing with smoke as a means of introducing nicotine. ”
It is the dependence on nicotine that makes the smoker who we see him: a person with a “weak will”, having a “bad habit”, and not deciding to abandon the last pleasure of “smoke” even when everything is said about the diagnosis of “cancer”.
Why, according to the 2003 survey, only 1 out of 7 who have ever smoked was able to abandon this “bad habit” and only 6% of those who smoked daily successfully did this? The answer is simple: tobacco smoking causes nicotine dependence.
Manifestation and assessment of nicotine dependence
Nicotine is a component of tobacco that causes dependence. Nicotine affects the central nervous system, acting as an agonist of the nicotine subtype of receptors to the neurotransmitter of the central nervous system acetylcholin. Approximately 25% of nicotine, which enters the body during smoking, enters the bloodstream and after 15 seconds reaches the brain. Thus, by the speed of action on the brain, nicotine is comparable to drugs administered intravenously. One of the features that determine the addiction to tobacco is its rapid destruction in the body (50% in 2 hours), and the rapid occurrence of the desire to smoke again, which supports the formation of dependence.
Nicotine, like other drugs, causes dependence by acting on the dopamine structures of the brain, as a result of which the perception of a “positive” effect is fixed, and the desire to repeat this effect. Dopamine is a substance involved in the formation of behavior motivation, i.e. What a person will do and how he will behave. Dopamine also regulates the emotions of a person, for example, “rewards” him when achieving something. The activating effect of nicotine on the central nervous system is also associated with an increase in the concentration of adrenaline and norepinephrine (“stress hormones), other hormones (ACTH, cortisol). The effect of nicotine resembles a state of stress, and therefore, at the physiological level, “relieve stress” can not actually “relieve stress”. It creates a perception of a sensation of “reducing the level of stress”, by increasing the release of endogenous opiata - endorphine in the cerebral cortex. This is perceived as “removal of stress” with smoking people, but to maintain the effect you will have to smoke any more cigarette. And then continue to smoke already relieving stress from the consequences of smoking.
Even before the development of nicotine dependence, the use of any type of tobacco (cigarettes, cigars, cigarettes), over the past 12 months, causes harmful consequences for health both in physical (cough) and in the mental (irritability) spheres. Smoking is often criticized by others, and, especially in adolescents, is associated with various negative social consequences, but this is not a sign of the harm of use. At the smoking stage with harm to health, a person is still able to independently and easily stop smoking, since physical dependence on nicotine has not yet been formed at this stage.
Continuing smoking leads to the formation of dependence on nicotine in about 90%, and many psychological dependence arises very early.
Nicotine causes strong physical dependence comparable to the drug. The return to smoking of cigarettes after the abstinence period leads to a faster appearance of dependence, since the dependence remains even without active smoking.
The diagnosis of dependence on tobacco can be established after repeated, prolonged smoking of a large amount of it in the presence of 3 or more signs that arose over the past year. Firstly, it is a strong need (desire) or a feeling of difficult to crash smoking. Secondly, a reduced ability to control smoking. It is manifested by the use of cigarettes in large quantities and over a period of time more than intended. The main manifestation of the inability to control the smoker attributed to the “weak will” is unsuccessful attempts to “throw”, a constant desire to reduce or control the use of tobacco. Thirdly, with a decrease or termination of the use of nicotine, a state of nicotine cancel or withdrawal syndrome develops. The resumption of smoking helps to relieve or prevent the symptoms of cancellation. The state of the abolition of nicotine is one of the main manifestations of physical dependence on this substance.
Nicotine cancellation syndrome manifests itself already 3-4 hours after the cessation of smoking. Its manifestations reach a peak within 24-28 hours. Upon termination of smoking, there are: passionate desire to smoke, restlessness; feeling of malaise or weakness; dysphoria; irritability and intolerance, a sense of anxiety or anxiety; insomnia; increased appetite; strong cough; Head of pain difficulties in concentration. The severity of these symptoms usually decreases after 2-3 weeks, but increased appetite and difficulty in concentration of attention can remain for several months. Since nicotine is a substance that causes addiction, smoking when reducing the number of smoked cigarettes or transition to the so -called The “light” cigarettes can change the smoking manner for maximum nicotine absorption in the body, for example, delaying deeperly.
There is also an increase in tolerance to the effects of nicotine, which consists in the need to increase the dose to achieve the desired state or in the fact that taking the same amount of cigarettes leads to a clearly weakened effect. The absorption of smoking is also revealed, which is manifested in the fact that for the sake of smoking a person completely or partially abandon other important forms of pleasure and interests, or that much time is spent on smoking. And, finally, with dependence on nicotine, smoking continues contrary to signs of harmful consequences and understanding of nature and the degree of harm from smoking.
The desire to smoke, a violation of smoking control and ignoring the consequences of smoking in their opinion, in our opinion, are the reasons that the smokers acquired, which they do not know about, and not the “bad habit”, which they are constantly informed, cannot follow the advice of the doctor or the call of the poster and simply abandon the dependence.
To determine the degree of nicotine dependence in clinical practice, the Fagerstrom questionnaire may be used, based on the assessment of the severity of its manifestations. If a person smokes more than 25 cigarettes per day and lights the first cigarette in the first 30 minutes. After waking up, its dependence on nicotine is severe.
The degree of nicotine dependence is estimated by the sum of the questionnaire points. In the presence of 0-2 points - the dependence is very weak; 3-4 - weak addiction; 5 -dependence of medium degree; 6-7-severe dependence; 8-10 points - a very difficult dependence.
In the presence of less than 4 points, according to the fagherstrom questionnaire, the dependence on nicotine is characterized by a weak physical component, for starting treatment, psychotherapy is recommended, with a high degree of cancellation, it is necessary to evaluate the need for pharmacotherapy. In the presence of 4 -6 points, nicotine dependence is manifested by a temperate physical component, a combination of psychotherapy and pharmacotherapy is necessary for treatment. In the presence of 4 -6 points, physical dependence on nicotine is expressed, and pharmacotherapy should be a mandatory addition to psychotherapy.
Nicotine dependence in its intensity exceeds alcohol or narcotic dependencies: the dependent smoke many times over the day, daily over the years of life, sometimes even during pregnancy and breastfeeding, often with the development of severe consequences of smoking - heart attack, stroke, lung cancer, etc.
Tabacian treatment methods
Tobacco dependence is a chronic recurrent disease that in most cases of long -term supporting re -treatment. Persons with nicotine dependence cannot stop smoking on their own even when they consciously make this decision. It is shown that the frequency of independent refusal of smoking among dependent persons does not exceed 5%. They need the help of a doctor and pharmacological therapy aimed at reducing the manifestations of cancellation syndrome.
About 90% of adult smokers are trying to stop smoking on their own. At the same time, about 70% of those who stop smoking resume smoking within 3 months. After 3 unsuccessful independent attempts to stop smoking, it is recommended to seek psychotherapeutic and drug treatment of dependence on nicotine.
Non -changing treatment includes cognitive and behavioral psychotherapy. Behavioral therapy includes “self -government”: the patient learns “self -control”, recording the conditions under which the desire to smoke is enhanced. The patient also carries out “control over stimuli”, in which incentives prone to smoking are excluded from the environment. Other methods include the “nicotine attenuation” method, the patient’s training can do without cigarettes, the prevention of a return to smoking and the formation of a sense of aversion to tobacco (obverse therapy).
Cognitive therapy includes: a) a detailed analysis of the thoughts, feelings and behavior of the smoker, b) an analysis of the motivation for the refusal of smoking and its change; c) the conclusion of the therapeutic agreement with the distribution of liability between the therapist and the patient; d) keeping a diary of thoughts, feelings and behavior, as well as incentives and ways to overcome the “traction”; e) restructuring the lifestyle and the acquisition of new classes.
