Evidence based methods in tobacco dependence treatment

Smoking is the leading cause of preventable death. Every year, more than 71600 of Poles and 36600 Romanians are killed by tobacco-caused disease. In whole European Union 1 400 000 people die due to tobacco smoking. Tobacco smoking causes many diseases like cardiovascular diseases, pulmonary diseases, cancer and others, however tobacco dependence is a disease itself. Tobacco dependence syndrome (F 17.2.- ICD X revision) is a chronic disease caused by nicotine dependence. The criteria to diagnose tobacco dependence are very similar to those recognized in drug and alcohol addiction. Tobacco dependence is a chronic condition that is treatable, however due to its nature often requires repeated intervention for success and good plan for treatment provided by specialist (doctor, nurse, health counsellor, therapist etc). The effective treatment exists and include pharmacotherapy and behavioural support. Both methods are effective itself but according to Cochrane library reviews the most effective is combing both medicines and psychological support. Evidence-based guidelines recommend nicotine replacement therapy, bupropion SR, and varenicline as effective in smoking cessation therapy, especially when combined with behavioral interventions. There is as well effective and safe herbal drug - cytisine, however not available in all European countries. The success rate is at least doubled by using evidence based methods in tobacco dependence treatment. The effects of alternative methods like hypnotherapy in smoking cessation in uncontrolled studies were not confirmed by analysis of randomized controlled trials. Electrostimulation is not effective for smoking cessation. Well‐designed research of acupuncture, acupressure and laser stimulation could be needed since these are very popular among smokers, though these interventions alone are likely to be less effective than evidence‐based interventions. There is an evidence from few trials that electronic cigarettes effectiveness in smoking cessation may be equal to nicotine patches or higher, when both products were accompanied by behavioral support