Are smokers attracted to other smokers?

How not smoking becomes a reality

Some people smoke because they want to. Others because they can't make the jump. Smoking is an underestimated addiction with physical and psychological dependence. "It is a tried and tested means of relieving tension or overcoming boredom. It is linked to many pleasant habits," says psychiatrist Anil Batra, head of the addiction research section at Tübingen University Hospital and chairman of the Scientific Committee on Tobacco Weaning (WAT).

Around every fourth adult smokes in Austria. Only in Hungary and Greece is the number even higher. Around a third of smokers in Austria try to quit smoking. According to Batra, around 95 percent of those in Germany who attempt withdrawal alone without an effective smoking cessation method fail. It won't be any different in Austria, because smoking is equally addictive everywhere. "Tobacco is available everywhere and comparatively cheap. At the same time, the withdrawal symptoms such as sleep disorders, irritability and concentration problems in everyday life are very unpleasant," says the psychiatrist. "Then some people think, 'one of them won't be that bad' - and get trapped again."

How should those affected go about quitting smoking?

Anyone who is determined to quit from one day to the next should just give it a try. For example, a smoking cessation program lasting several weeks (six course sessions, 90 minutes each) can help. Scientifically proven tobacco cessation methods such as behavior therapy and nicotine chewing gum improve the chances of quitting smoking. This has also been confirmed by the current study by the German survey on smoking behavior (Debra). Which method is suitable depends on whether the psychological or physical dependency predominates.

How important is behavior therapy?

"Behavioral therapy is very important, especially if you have severe psychological addiction. Its goal is to get people to unlearn how to smoke," says Batra. Behavioral therapy usually includes a phase of self-observation in order to break up automatisms and increase the willingness to rethink. Critical relapse situations as well as possible solutions are simulated in role plays. The success rate for several weeks of behavioral therapy is around 30 percent in group and individual therapy. If behavior therapy includes intensive follow-up care, the success rate can further improve.

Another method is hypnotherapy. It includes, for example, trance states in which the subconscious receives instructions from the therapist. They are intended to increase the desire to be non-smokers. Non-smoking situations are consciously linked to positive feelings, and a new positive imaginary non-smoking identity is created for the individual. Hypnotherapy is not quite as effective as behavior therapy for long-term abstinence. "Hypnotherapy would probably produce better results than it does now if more relapse prevention techniques were built in," Batra said. However, the benefits of hypnotherapy have not been clearly scientifically proven; the study results are contradictory.

Which nicotine-containing products for smoking cessation are there?

Nicotine-containing patches, lozenges and chewing gum as well as nicotine inhalers and mouth sprays are available from pharmacies without a prescription. The nicotine is released slowly and evenly and the nicotine dose is gradually reduced. Nicotine replacement products suppress withdrawal symptoms and reduce the desire to smoke. After six to twelve months, the success rate is 15 to 17 percent. There are hardly any side effects.

What nicotine-free drugs are there and what is their success rate?

There are two prescription-only nicotine-free drugs: one is Zyban, which contains the active ingredient bupropion. It is particularly suitable for heavy smokers and is used in low doses for about three months. "This antidepressant inhibits the re-absorption of the messenger substance dopamine and thus reduces the desire to smoke. It is as effective as nicotine replacement therapy," explains Batra. "If it is combined with behavior therapy, the chances of success increase 1.7 times. However, severe side effects such as sleep disorders, seizures, increased blood pressure and dizziness are possible."

The second non-smoking pill, also requiring a prescription, is called Champix. "The contained active ingredient varenicline occupies the nicotine receptors, which eliminates the kick of smoking," says Batra. Physical withdrawal symptoms and the desire to smoke decrease. Studies have shown a success rate of 20 to 23 percent for Champix after 40 weeks. However, not inconsiderable side effects such as nausea, insomnia, headaches and dizziness are possible here too.

Does it make sense to combine medication and behavior therapy?

The specialist guidelines recommend this option, with the combination of nicotine replacement products and behavior therapy being the first choice. With this combination, there are significantly fewer side effects than with the nicotine-free drugs.

Does the psychological addiction favor a relapse?

Smoking is not only an addiction, but also a cherished "occupation". "The associated memory content fades only gradually after a smoking cessation and is therefore of great importance with regard to a possible relapse," said Batra. The temptation to "just smoke a cigarette" is great. "Most relapses in smoking cessation occur in the first 100 days. Those who survive the first three months have a good chance of remaining smoke-free after a year. After that, only two percent will return to cigarettes by the fifth year", encourages the Tübingen addiction researcher. (Gerlinde Felix, February 26, 2020)