Therapie der Tabakabhängigkeit

Rauchen ist wegen der hohen Prävalenz gerade bei psychiatrisch Erkrankten von besonderer Bedeutung. Die Entwicklung einer körperlichen und psychischen Abhängigkeit macht es oft schwierig, den Konsum zu beenden. Die aktuelle S3-Leitlinie liefert evidenzbasierte Strategien zur Behandlung dieser Suchterkrankung und zum erfolgreichen Rauchstopp und gibt Empfehlungen für die Besonderheiten psychiatrischer Patienten und deren Medikation.

Abstract

Smoking is a major health risk to the general public and especially to psychiatric patients. Both mental and physical tobacco dependency makes quitting challenging for many smokers. Evidence based cessation support as referred to in the German AWMF-treatment guidelines can make quit approaches successful. Basically, a structured assessment of smoking status combined with advice to quit should be offered to all smokers with or without mental illness. Cessation programs should combine stop-smoking counselling with medication to reduce withdrawal symptoms. Self-help booklets, internet- and app-based programs can support quit approaches easily and effectively. Nicotine replacement, varenicline, bupropion, cytisine and the second line drugs nortriptyline and clonidine help smokers effectively to quit, whereas e-cigarettes were not recommended. Ongoing observations about their long-term use may help to clarify their potential health risks. Nevertheless, e-cigarettes may have a potential for harm reduction approaches in smokers. A stop smoking support for mentally ill smokers should be offered in a period of stable illness, contain specialized counselling to meet the patients’ coping needs and address the fact that the plasma level of several psychiatric drugs could be affected when smoking is stopped. Considering the tremendous health consequences of smoking, we see a need for cost coverage of cessation programs by the health insurance companies to facilitate an increase in the amount of quit approaches in smokers.

Schlüsselwörter

Rauchen - Tabakabhängigkeit - Raucherentwöhnung - psychiatrische Patienten - E-Zigarette

Key words

smoking - tobacco dependency - smoking cessation - mental illness - e-cigarette

Publication History

Article published online:
08 May 2023

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