Nicotine and nicotine addiction

Mental and behavioral disorders caused by tobacco use (synonyms: tobacco smoking, tobacco addiction, nicotine addiction, nicotinism) are traditionally regarded as tobacco smoking (episodic or systematic) and tobacco addiction in Russian narcology.

[1],

Causes of the nicotine addiction

At the beginning of the XXI century. Smoking remains a fairly common phenomenon among the population of all countries of the world. Currently there are 1.1 billion smokers in the world, which is 1/3 of the world's population over 15 years old. WHO predicts that by 2020, the nicotine addiction epidemic will move to developing countries, which are characterized by a shortage of funds to finance smoking control programs. In Russia, 8 million women and 44 million men smoke, which is 2 times more compared to the developed countries of Western Europe and the United States of America.

It is known that most people are attached to smoking in childhood and adolescence. In countries with a high prevalence of smoking, 50-70% of children try to smoke. In Russia, the problem of child smoking is one of the most acute. Children begin to smoke in grade 5-6. The consequences of an early onset of smoking adversely affect life expectancy: if you start smoking at 15 years old, life expectancy is reduced by 8 years.

Of the social factors, irregular exercise, positive or indifferent attitude to tobacco smoking in the family, lack of information about its harm, frequent conflicts in the family have a significant impact on the prevalence of nicotine addiction among school students. The following educational factors play an important role in the occurrence of nicotine addiction among students: frequent conflicts at the place of study, difficulties in adapting to studies in the upper grades, the presence of complaints about the deterioration of health due to the study load, the number of unloved subjects (more than 7). The most significant biological risk factors for the development of nicotine addiction among schoolchildren are: passive smoking, a symptom of psychosomatic dissociation after the second sample of smoking, frequent alcohol intake, and the absence of an episodic smoking period. If a combination of biological, educational and social factors takes part in the occurrence of nicotine addiction, then the most significant role in the occurrence of tobacco smoking in adolescents is mainly social factors.

In the emergence and development of tobacco smoking and nicotine addiction of schoolchildren, there are three critical periods. The first period is at the age of 11 years, when the number of people with the first experience of smoking increases 2.5 times. The second period corresponds to the age of 13 years, it is characteristic of a significant (2 times) increase in the prevalence of episodic smoking. The third period is the age of 15-16 years, while the prevalence of systematic smoking exceeds the prevalence of episodic, the number of people with nicotine addiction increases 2 times. Factors contributing to smoking in childhood and adolescence include female gender, incomplete family, lack of intent to continue their studies after school, a feeling of alienation from school and its values, frequent use of alcohol, ignorance or misunderstanding of health risks, the presence of at least one smoking parent, permission of parents to smoke, the amount of pocket money, visiting discos.

The formation and formation of nicotine addiction occurs against the background of the action of two main factors - social and biological. The social factor is traced in the form of tobacco smoking traditions, and the biological factor is reflected in the body's initial individual reactivity to inhaling tobacco smoke. The interaction of the “external” and “internal” factors ultimately forms the development of addiction to tobacco smoking. There are risk factors of three ranks. The leading factor of the I rank is a hereditary predisposition to smoking tobacco. At the same time, they find the nepotism of smoking, passive smoking, an indifferent or positive attitude to the smell of tobacco smoke. Risk factors of rank II include a symptom of psychosomatic dissociation, manifested at the stage of the first tobacco smoking tests. Factors III rank include premorbid soil. Tobacco addiction includes all three risk factors for the occurrence of tobacco smoking in the background of a micro-social environment with the traditions of tobacco smoking.

The motivation for smoking in most adolescents is formed as follows: curiosity, the example of adults and friends, the enjoyment, the fear of being outdated, the desire to keep up with peers, to assert themselves, to support the company, “having nothing to do” or “just like that.”

Harm of smoking

Numerous studies have proven that smoking causes irreparable damage to public health. The medical consequences of tobacco use include diseases of the cardiovascular and respiratory systems, the digestive tract, and malignant neoplasms of different localization. Cigarette smoking remains one of the dominant causes of death. From causes related to smoking, in Russia, up to 300 thousand people die prematurely every year. The health consequences of cigarette smoking by the cardiovascular system are characterized by lesions of the coronary arteries (angina, myocardial infarction), aorta (aortic aneurysm), cerebral vessels and peripheral vessels. Nicotine causes systemic vasospasm, increases blood clotting due to platelet activation. Most among tobacco smokers among the diseases of the respiratory system meet chronic bronchitis, a high prevalence of acute and chronic forms of pneumonia, emphysema. Diseases of the digestive tract, considered as consequences of tobacco use, are represented by acute gastritis, gastric ulcer and duodenal ulcer, with frequent relapses. Nicotine acts as an atherogenic factor, leading to the development of malignant neoplasms. According to different researchers, in 70–90% of cases, lung cancer develops as a result of tobacco smoking. The share of deaths from malignant tumors caused by smoking is quite high. It is noteworthy that the mortality rate for women from lung cancer due to tobacco smoking is higher than the development of breast cancer. Among tobacco smokers, a significant proportion of malignant tumors of the oral cavity, pharynx, esophagus, trachea and larynx are recorded. Possible damage to the kidneys, ureters, bladder, cervix. About 25% of gastric and pancreatic cancers are associated with tobacco use. A serious medical consequence of tobacco use is passive smoking. Non-smoking members of smokers' families are at high risk of developing lung cancer, cardiovascular diseases, children under 2 years old are susceptible to respiratory diseases. Data on the dangers of passive smoking, which increases the risk of disease in healthy people, have led to a ban on smoking in public places.

Significant harm is caused by smoking products on the female body. In women who smoke, infertility is noted, vaginal bleeding, circulatory disorders in the area of the placenta, ectopic pregnancy more often develop. The number of spontaneous abortions increases by 5 times compared with non-smoking women. There is a higher risk of premature birth (premature babies), delayed delivery or placental abruption (stillbirth). The consequences of exposure to the fetus include slowing the growth of the fetus (a decrease in height and weight at birth); increased risk of congenital anomalies, the probability of sudden death of a newborn increases 2.5 times; possible consequences affecting the further development of the child (mental retardation, behavioral deviations).

Pathogenesis

One cigarette contains on average 0.5 mg of nicotine (active ingredient of tobacco. Nicotine is a surfactant (psychoactive substance) of a stimulating effect. Possessing narcogenic properties, it is addictive, addictive and addictive. The physiological effects of nicotine include narrowing of peripheral vessels, increasing heart rate and arterial pressure, increased intestinal motility, tremor, increased release of catecholamines (norepinephrine and epinephrine). Overall decrease in metabolism. Nicotine stimulates the hypothalamic center p pleasure, with this is associated with the emergence of addiction to tobacco. The euphoric effect is somewhat similar to the action of cocaine. Following brain stimulation occurs a significant decline, until depression, it causes the desire to increase the dose of nicotine. Such a two-phase mechanism is characteristic of all narcotic stimulants, first stimulating then depressing.

Nicotine is easily absorbed through the skin, mucous membranes and lung surface. In the pulmonary route of administration, the effect on the CNS side appears already after 7 s. Each tightening has a separate reinforcing effect. Thus, if with 10 puffs per cigarette and when smoking one pack of cigarettes per day, the habit of smoking gets about 200 reinforcements per day. A certain time, the situation, the ritual of preparing for smoking when repeating is conditionally-reflexively associated with the effect of nicotine.

Over time, there are signs of tolerance, manifested in the weakening of subjective sensations with repeated use of nicotine. Smokers usually report that the first morning cigarette after nocturnal abstinence has the most pronounced refreshing effect on them. When a person begins to smoke again after a certain period of abstinence, the sensitivity to the action of nicotine is restored, and he may even experience nausea if he immediately returns to the previous dose. First-time smokers may develop nausea even with a low concentration of nicotine in the blood, while experienced smokers experience nausea when the concentration of nicotine exceeds their usual level.

Negative reinforcement is associated with relief that an individual feels in connection with the cessation of an unpleasant feeling. In some cases, nicotine addiction is smoked to avoid withdrawal symptoms, since an imperative need for smoking can occur when the level of nicotine in the blood falls. Some smokers even wake up in the middle of the night to smoke a cigarette, likely to relieve withdrawal symptoms that occur against the background of low levels of nicotine in the blood and interrupt sleep. If the level of nicotine in the blood is artificially maintained by slow intravenous infusion, the number of cigarettes smoked and the number of puffs are reduced. Thus, people can smoke to maintain the nicotine reinforcement effect or to avoid the painful sensations associated with nicotine withdrawal or, more likely, due to a combination of these causes.

Often there is a combination of depressed mood (due to dysthymia or other affective disorder) with nicotine addiction, but it remains unclear whether depression predisposes to the onset of smoking or it occurs as a result of nicotine addiction. According to some reports, adolescents with depressive symptoms often become dependent on nicotine. Depression increases significantly during the period of abstinence from smoking - this is called one of the causes of relapse. The association of smoking with depression is indicated by the ability to inhibit the activity of monoamine oxidase (MAO-B) in the non-nicotine component of tobacco smoke. The degree of inhibition of enzyme activity is less than that of antidepressants - MAO inhibitors, but it may be sufficient to cause an antidepressant (and possibly antiparkinsonian) effect. Thus, smokers with a penchant for depression may feel better when smoking, which makes it difficult to quit.

[2], [3], [4], [5], [6], [7], [8],

Symptoms of the nicotine addiction

[9]

F17. Acute nicotine intoxication

Symptoms arising from nicotine poisoning: nausea, vomiting, excessive salivation and abdominal pain; tachycardia and hypertension (early onset of symptoms); bradycardia and hypotension (late manifestation), tachypnea (an early symptom) or respiratory depression (late manifestation); miosis; confusion and impulse (late manifestation); mydriasis; seizures and coma (later manifestation).

In the process of systematic smoking of tobacco, a disease is gradually formed - tobacco dependence, which has its own clinical features, dynamics of development, stages and complications.

[10], [11], [12], [13], [14]

(F 17.2) Clinical picture of nicotine addiction

It is presented by syndromes of the organism's altered reactivity to the action of nicotine (change in tolerance, disappearance of the protective reactions observed during the first tobacco samples, change in the form of consumption), pathological craving for smoking tobacco, withdrawal syndrome, personality change syndrome.

When the first smoking samples are normal, the toxic effect of tobacco smoke on the body as a whole manifests itself - a psychosomatic reaction develops: a drop in blood pressure, fainting, tachycardia, a feeling of nausea, severe dizziness, agonizing muscular weakness, vomiting, a feeling of insufficiency of breath, melancholy, anxiety, fear of death protective reaction of the body). People who have suffered a similar form of response, as a rule, no longer smoke. In other body reactions, tobacco smoke is split (a symptom of psychosomatic dissociation). They experience a slight dizziness, calm, a sense of mental comfort, simultaneously combined with muscle weakness, nausea and vomiting. The symptom of psychosomatic dissociation, along with the traditions of the micro-social environment, contributes to the smoking of tobacco in such people.

When using tobacco, an increase in tolerance in the dynamics of the disease and its change during the day are observed. After a day of smoking for 6-8 hours, the resistance to the effects of tobacco the next morning disappears. That is why many smokers describe the strong effect of the first cigarette. With each subsequent cigarette smoked tolerance increases.

The core disorder that characterizes tobacco dependence is a pathological attraction to tobacco smoking, while abstaining from smoking causes a complex of psychosomatic disorders. For most people, the syndrome of pathological craving occurs after a few years from the onset of systematic smoking. In other cases, tobacco addiction does not occur in people who systematically smoke, the habit of smoking is formed. The syndrome of the pathological attraction to tobacco smoking is a psychopathological symptom complex, including ideatorial, vegetative-vascular and psychological components.

The presence of a mental, figurative, or mental-figurative memory, a view, a desire to smoke tobacco, perceived by patients, is characteristic of an ideator component. Thoughts of smoking become painfully obsessive, stimulating the search for tobacco products.

The vegetative-vascular component manifests itself in the form of individual transient symptoms: cough, thirst, dry mouth, pain of different localization, dizziness, tremor of the fingers of outstretched hands, hyperhidrosis, instability of blood pressure, gastrointestinal dyskinesias.

The mental component is expressed asthenic and affective disorders. When abstaining from smoking, psychogenic asthenic reactions occur with transient fatigue, exhaustion, restlessness, irritable weakness, sleep disorders, appetite, decreased performance, deterioration of health. Asthenic or anxiety subdepression is characteristic of affective disorders. Patients complain of depression, weakness, tearfulness, irritability, anxiety, anxiety. Expressed manifestations of the syndrome of the pathological craving for smoking tobacco can be represented by illusory and hallucinatory disorders in the form of a sense of taste and smell of tobacco smoke.

Syndrome of the pathological attraction to smoking tobacco in development goes through several stages (initial, formation, final). At the initial stage, lasting up to 1 month, a symptom of psychosomatic dissociation is observed. Formed during the first tests of tobacco smoking and manifested in different directions of mental and somatic forms of response to the toxic effect of tobacco smoke. The stage of formation lasts up to 2-3 years, characterized by the formation of the syndrome of a pathological desire to smoke tobacco with the simultaneous disactualization of the symptom of psychosomatic dissociation. At the final stage, the dominance in the clinical manifestations of the disease of the syndrome of a pathological desire for smoking of tobacco determines the behavior of an individual, aimed at finding a tobacco product and its smoking (occurs on the 3-4th year of systematic smoking).

[15], [16], [17], [18], [19]

(P17.3) Quitting Nicotine Use

It causes the development of withdrawal syndrome (AS, deprivation syndrome), its manifestations reach a peak in 24-28 hours after the last smoking. These include: anxiety, sleep disturbance, irritability, intolerance, overwhelming desire to smoke, impaired concentration, drowsiness, increased appetite and headache. The intensity of the symptoms decreases after 2 weeks. Some symptoms (increased appetite, difficulty concentrating) may remain for several months.

There are two types of flow of nicotine addiction: periodic and permanent. For the periodic type of the course, there are light periods during the day, when patients forget about smoking for 30-40 minutes. The intensity of smoking tobacco with a periodic type of flow - smoking 15 to 30 pieces of tobacco products. The constant type of flow is characterized by the presence of a constant craving for smoking tobacco, despite ongoing activities. With this type of patient smoked during the day from 30 to 60 pieces of tobacco products.

The clinical picture of the syndrome of the pathological craving for tobacco smoking, the types of the course of the disease determine the main forms of nicotine addiction described in the literature: ideatorial, psychosomatic and dissociated.

For the ideator form, a combination of the ideator and vegetative-vascular component in the structure of the syndrome of the pathological craving for tobacco smoking in individuals with schizoid traits in premorbid is characteristic. The ideator form is peculiar: the early age of the first sample of tobacco smoking (10-12 years), the absence of the episodic smoking stage, the rapidly emerging need for systematic smoking, the gradual excess of the initial tolerance by 8-10 times, the late onset of tobacco smoking during the day (after 1 4 hours after awakening), an early awareness of smoking, a periodic type of the disease, the possibility of self-cessation of smoking for a period of 2-3 months to 1 year.

In the psychosomatic form of nicotine addiction, a combination of the ideator, vegetative-vascular and mental component in the structure of the syndrome of a pathological craving for smoking tobacco in people with epileptoid traits and premorbid is noted. This form is characterized by a relatively late age of the first sample of smoking (13-18 years old), the absence of an episodic smoking stage, the late age of the onset of systematic smoking, a rapid increase in tolerance with an excess of the initial 15-25 times, early morning smoking (immediately after waking up, on an empty stomach), a late awareness of smoking, a constant type of the course of the disease, unsuccessful attempts at self-cessation of smoking.

The dissociated form of nicotine addiction is distinguished by the presence in the structure of the syndrome of pathological craving, not perceived at the ideational level, the desire to smoke tobacco. Its manifestation is internal undifferentiated vital vital sensations that appear during long breaks in smoking. They are localized in different areas of the body: in the pancreas, tongue, throat, trachea, lungs, back, shoulder blade, etc. Early initiation of smoking (the first test at 8-9 years), a periodic type of the disease, a short stage of episodic smoking are characteristic of a dissociated form. Smoking on an empty stomach. The peculiarity of this form should be considered "flickering" tolerance. A patient can smoke 2-3 cigarettes in one day without experiencing the need for more, but on other days it smokes 18-20 cigarettes. Compared to other forms of nicotine addiction, the most recent awareness of craving for tobacco, which appears in the structure of withdrawal syndrome, is revealed. In the process of self-cessation of smoking tobacco, remissions can last from 5 days to 2-3 months. The dissociated form is characterized by the presence of a delayed withdrawal syndrome (can be qualified as an actualization of a pathological desire for tobacco).

[20],

Combined addiction

Smoking is very common among people addicted to alcohol, cocaine or heroin. Because nicotine is a legal substance, many addiction treatment programs in the past have ignored nicotine addiction and concentrated mainly on alcohol or illegal drugs. In recent years, hospitals have begun to fight smoking, prompting hospitalized patients to quit smoking with nicotine patches. This measure can be an excellent opportunity to begin treatment of nicotine addiction, even if it requires the simultaneous correction of other forms of addiction. The same principles can be applied to patients undergoing outpatient treatment for dependence on certain substances. Nicotine addiction, which has a destructive effect, should not be ignored. Treatment can be started with the correction of the most acute problems, but patients' attention should be paid to nicotine addiction, correcting it with the help of the above combination of remedies.

Nose Drug Abuse

In recent years, among children and adolescents living in Central Asia, Kazakhstan, in some regions of Russia, the use of nasa has become widespread - mixtures of crushed tobacco leaves, lime and ash in water or vegetable oil. Depending on the technology of preparation, there are three types of nasa: on water from tobacco and ash; on water from tobacco, ash, lime; on the oil of tobacco, ash, lime. We lay in the oral cavity under the tongue or lower lip.

Studies of recent years, conducted by various experts, indicate the toxic effect of us on many human organs and systems. In an experiment on animals, it was established that we are affected by lesions of the stomach and liver, and precancerous changes. Persons consuming us are many times more likely to get cancer than those who do not use it. If among 1000 examined persons who use us, pretumor processes of the oral mucosa were found in 30.2 cases, then among those who do not use us this figure was 7.6.

The most pronounced pathological changes in individuals consuming us are observed in the oral cavity. Mainly in places of laying. If we are laid under the tongue, we are more likely to get cancer of the tongue; among residents of Kazakhstan, where we are laid on the lower lip, the lower gum is most often affected.

In children and adolescents, addiction to nasa as an intoxicating substance usually begins with curiosity, imitation, and the desire to keep up with peers. The particular harm of its use by children and adolescents lies in the fact that they are laying under the tongue secretly from adults, often under unforeseen circumstances, are forced to swallow it, which aggravates the pathological effects of nasa due to its direct effect on the esophagus, stomach, intestines.

The first in the life of laying a nasa causes a pronounced sensation of tingling and tingling under the tongue, enhanced saliva secretion. Mixing with nasom, it accumulates in large quantities, it causes the need to spit it out after 2-3 minutes. A part of nasa is involuntarily swallowed with saliva. The state of acute intoxication is characterized by mild dizziness with increasing intensity, palpitations and sharp muscle relaxation. In children and adolescents, when trying to get up, the surrounding objects begin to spin, “the earth goes out from under their feet.” Against the background of increasing dizziness, nausea occurs, then vomiting, which does not bring relief, about 2 hours you feel unwell: worried about general weakness, dizziness, nausea, this makes it necessary to stay in a horizontal position. Unpleasant memories of this persist for 6-7 days.

Some of the children and adolescents who have the most pronounced manifestations of intoxication during the first use of nasa do not resort to it later. Others, having the information of others about the fact that during subsequent methods of forceful sensations are not observed, but. On the contrary, a pleasant state arises, continue its use. In such cases, after 2-3 doses, the clinical picture of intoxication changes. The disappearance of the protective reaction of the body nausea, vomiting, increased salivation is characteristic. There is a slight euphoria, looseness, a sense of comfort, vigor, a surge of strength. Drunk become talkative, sociable. The described condition continues for 30 minutes. Over the next 2-3 months, the frequency of receiving NASA increases from 2-3 times a week to 7-10 per day. At this stage, the number of nasa used at one time increases, a need appears longer (15-20 minutes) to keep it in the mouth to prolong the state of intoxication.

Systematic reception of NASA contributes to the formation of the syndrome of pathological craving, manifested by a decrease in mood, irritability, irascibility, deterioration of efficiency. Thoughts about Nasa interfere with focus, make it difficult to perform familiar work. 2-3 days after the cessation of nasa use (for various reasons), signs of withdrawal syndrome appear: headache, dizziness, feeling of weakness, sweating, palpitations, loss of appetite, irritability, nastiness, decreased mood, insomnia. The described condition is accompanied by a pronounced attraction to receiving NASA and lasts up to 2-3 days. At this stage, the systematic use of NASA is caused not only by the desire to cause a state of intoxication, but also by the need to stop the withdrawal symptoms described above. The formation of an abstinence state is accompanied by a further increase in the single and daily dose. Persons who use us for a long time can observe a decrease in tolerance to it.

The most noticeable mental disorders in the use of NASA are in children and adolescents who detect signs of cerebral insufficiency (cranial trauma, residual neuroinfection, personality anomalies). They are manifested by a sharp aggravation of their incompatibility, irritability, conflict, aggressiveness. They note a progressive decrease in memory, a weakening of concentration of attention, ingenuity - the reasons for the decline in academic performance, discipline, and hostility in the school team.

The appearance of those who show signs of common substance abuse is quite characteristic: the skin is flabby with an earthy tint, and looks older than his years. They more often observe chronic diseases of the digestive organs.

[21], [22]

Stages

1. (F17.2.1) Initial stage - smoking is systematic, the number of consumed cigarettes is constantly increasing (change in tolerance). Smokers feel increased efficiency, improved well-being, a state of comfort (signs of a pathological attraction). At this stage of the disease, manifestations of psychosomatic dissociation disappear, signs of somatic and mental changes are absent. The duration of the stage varies within 3-5 years.
2. (F17.2.2) Chronic stage - tolerance first continues to grow (up to 30-40 cigarettes per day), then becomes stable. The desire to smoke occurs when any change in the external situation, after a slight physical or intellectual load, when a new interlocutor appears, changing the topic of conversation, etc. The manifestation of the syndrome of a pathological inclination to smoking tobacco is aggravated, symptoms of withdrawal syndrome are formed. The patient is worried about morning cough, unpleasant sensations and areas of the heart, arterial pressure fluctuations, heartburn, nausea, general discomfort, low mood, sleep disturbances, irritability, decreased performance, constant and sustained desire to continue smoking, including at night. The duration of this stage of nicotine addiction is individual, on average from 6 to 15 years or more.
3. (F17.2.3) Late Stage - Smoking becomes automatic, non-stop. Indiscriminate and causeless. The type and variety of cigarettes for the smoker does not play any role. No comfort when smoking. There is a constant heaviness in the head, headache, loss and loss of appetite, memory impairment and performance. At this stage, smokers become lethargic, apathetic, at the same time easily irritated, "lose their temper." The phenomena of somatic and neurological ill-being grow and intensify. The pathology of the respiratory organs, gastrointestinal tract, cardiovascular system, central nervous system is clearly expressed. The skin and visible mucous membranes of the smoker acquire a specific icteric shade.

The stages of nicotine addiction are developed individually and depend on many factors - the time of onset of tobacco use, its type and variety, age, sex, health, resistance to nicotine intoxication.

Every smoker is trying to quit using tobacco on his own. The duration of bright gaps and spontaneous remissions is completely different, depending on many factors. Breakdowns usually occur as a result of various external influences, situational circumstances, mood swings.

Only an insignificant part of patients with nicotine addiction is able to stop smoking on their own, the rest need medical assistance. Short remissions, frequent relapses characteristic of this disease make it difficult to solve the problem of tobacco smoking among the population.

(F17.7) A comparative study of the clinical manifestations of therapeutic and spontaneous remissions in patients with nicotine addiction has shown: the occurrence of remissions goes through three stages - formation, formation and stabilization. Each of the stages has clinical features and a time interval of existence. The main types of remission are asymptomatic, residual with neurosis-like symptoms and hyperthymic, without symptoms of craving for smoking tobacco.

Asymptomatic type of remission - there are no residual symptoms of nicotine addiction. This type is characteristic of spontaneous remissions, as well as the ideator form of nicotine addiction during therapeutic remission. This type is the most resistant to relapses, which are absent in self-cessation of smoking, and in therapeutic remissions observed in patients with an ideator form of nicotine addiction, they are rarely seen against the background of psychogeny.

Residual type of remission is characterized by complete abstinence from smoking tobacco, there is a residual symptomatology of a pathological inclination to smoking tobacco in the form of spontaneous or by association arising mental and figurative memories and ideas about smoking tobacco in the daytime or at night, during sleep, dreams. Residual type among therapeutic remissions is characteristic of the dissociated and psychosomatic form of nicotine addiction. In the dissociated form of nicotine dependence, neurosis-like symptoms in remission are manifested by mentality, distraction, distractibility, fatigue, and mood swings during the day. In case of residual remission with neurosis-like symptoms, its instability is noted. The appearance of a sensitive coloring of experiences is accompanied by an exacerbation of the symptoms of a pathological desire to smoke tobacco. Stressful situations, alcohol intoxication also lead to exacerbation of the symptoms of nicotine addiction. Relapse of smoking resumption in the residual type of remission occurs quite often.

The hyperthymic type of remission is characterized by heightened mood in the absence of craving for nicotine. Note the phasing of affective disorders. This type is characteristic only of the dissociated form of nicotine addiction in therapeutic remissions.

As can be seen, the types of remission are determined by the clinical form of nicotine addiction and premorbid personality traits. The clinical picture of the types of remission prognostic criterion of its duration. The prognostically most favorable (the longest duration and the smallest number of relapses) are asymptomatic. The less favorable is the residual type with neurosis-like symptoms, and the unfavorable type is the hyperthymic type of the course of remission.

In the structure of mental disorders in patients with nicotine addiction, the main place is occupied by general neurotic (asthenic) disorders, which are more pronounced than among non-smokers. Tobacco smoking in the early stages of nicotine addiction development is accompanied by affective disorders, which act as factors contributing to the maintenance and aggravation of nicotine addiction.

Recently, due to the increasing interest of researchers in the problem of comorbid conditions in psychiatry and narcology, the interaction of cynical diseases, tobacco smoking and nicotine addiction has been studied. The main characteristics of tobacco smoking and nicotine addiction are the duration of smoking, the age of the first test and the onset of systematic smoking, motives, degree of nicotine dependence, clinical manifestations of tobacco dependence (differ in patients with mental disorders of different registers depending on the phenomenology of their existing disorders). Affective disorders, comorbid with nicotine addiction, have some clinical features: non-psychotic level of manifestations, low intensity, flickering nature of the course, low progression. For the first time, affective disorders are diagnosed only when requesting medical assistance for cessation of tobacco smoking. These disorders are not considered a consequence of nicotine addiction or its cause, they arise against the background of an already formed nicotine addiction and in the presence of unfavorable premorbid soil. Psychogenic factors usually trigger the development of affective disorders, becoming the determining factor in the cessation motive. Among patients with neurotic pathology, the ideator form of nicotine dependence with a moderate degree of dependence on nicotine prevails, and for patients with schizophrenia, a psychosomatic form with a high degree of dependence is characteristic. The type of accentuation (excitable, cyclothymic, emotive, exalted and demonstrative) is attributed to factors of an increased risk of tobacco smoking and the formation of nicotine addiction in patients with neurotic disorders. The elimination of nicotine addiction improves the course of neurotic disorder, but exacerbates the manifestations of schizophrenia.

[23], [24], [25], [26], [27]

Diagnostics of the nicotine addiction

The following are diagnostic signs of acute intoxication due to tobacco use (acute nicotine intoxication) (F17.0). It must meet the general criteria for acute intoxication (F1 *.0). In the clinical picture, dysfunctional behavior or perception disorders are necessarily fixed. This is evidenced by at least one of the signs: insomnia; fancy dreams; mood imbalance; derealization; violation of personal functioning. In addition, at least one of the following symptoms is detected: nausea or vomiting, sweating, tachycardia, cardiac arrhythmias.

The diagnosis of withdrawal syndrome (F17.3) is based on the following symptoms:

• state compliance with the general criteria for withdrawal syndrome (F1 *.3);
• in the clinical picture, any two of the manifestations are observed: a strong desire to use tobacco (or other nicotine-containing agents); feeling unwell or weak; anxiety; dysphoric mood; irritability or anxiety; insomnia; increased appetite; pronounced cough; ulceration of the oral mucosa; decreased concentration and attention.

[28], [29], [30], [31], [32],

Treatment of the nicotine addiction

The problem of treating nicotine addiction has not lost its relevance to date. More than 120 methods of treating nicotine addiction are known, of which about 40 are widely used. The main methods of treating typical nicotine addiction include various options for reflexotherapy, suggestive forms of psychotherapy, autotraining, behavioral therapy, nicotine replacement therapy (intranasal spray, inhaler, trans dermal patch, chewing gum), etc.

There are no radical methods for treating nicotine addiction. All the methods of treating nicotine addiction in the arsenal of a narcologist are grouped as follows: behavioral therapy; replacement therapy; drug therapy: non-drug therapy.

[33], [34], [35], [36]

Behavioral Therapy for Nicotine Addiction

The behavioral therapy includes activities carried out in some countries to develop behavioral strategies aimed at maintaining a healthy lifestyle (physical education and sports, rational nutrition, optimal alternation of work and rest, elimination of bad habits). Promoting a healthy lifestyle means, first of all, stopping smoking, which is becoming a vital human need. Other work should be done in educational institutions, health care facilities, in print and electronic media. There are many approaches to behavioral therapy. Those who wish to quit smoking should use certain rules.) Reduce daily cigarette consumption according to a certain pattern; increase the interval between cigarettes smoked; start smoking is not like a brand of cigarettes.

Clinical manifestations of nicotine addiction allow us to offer some techniques of behavioral therapy. It is known that actions, usually accompanied by smoking, cause a pronounced desire to smoke. That is why it is necessary to avoid actions related to smoking, to develop replacement habits (using chewing gum, candy, drinking mineral water, juices, etc.). Smoking after eating, as a rule, increases the pleasure. In this regard, it is advisable to choose alternative ways to enjoy (watching your favorite movies, listening to music, reading fiction). Quite often, relapses of smoking occur in high spirits. Smokers need to adjust themselves and think over their behavior in situations that cause positive emotions (pleasant excitement, anticipation of the meeting, waiting), in which they are at increased risk of resuming smoking (evening with friends, colleagues, visiting a cafe, restaurant, fishing trips, hunting and etc.). A strong desire to smoke may appear in a state of psycho-emotional stress. Obviously, relapses occur when smokers experience sadness, sadness, despondency, restless and irritated. In such cases, they should take psychotropic drugs (tranquilizers, antidepressants), and also use behavioral methods to overcome negative emotions (self-hypnosis in a state of relaxation, seeking support from specialists). The increase in body weight observed in abstinence from tobacco use is one of the main reasons for the relapse of smoking. An important role here is assigned to the organization of proper nutrition, exercise, and sports.

[37], [38]

Hypnosistractive Express Method

Among non-pharmacological approaches for treating nicotine addiction, the hypnosisuturgical rapid method is used. In the hypnotic trance spend suggestions with therapeutic settings. They inspire the obligatory occurrence of serious health consequences with further smoking; the possibility of premature smith; the disappearance of the effects of smoking, health promotion in smoking cessation. With the help of suggestion, they remove a pathological attraction to smoking, produce indifference, indifference and aversion to tobacco. Form a stereotype of the patient's behavior in society with the refusal of smoking in any situation, even when exposed to stressful factors that provoke attraction. Strengthen the patient's own installation to quit smoking.

Among the methods of psychotherapy of tobacco smoking, stress psychotherapy according to A.R. Dovzhenko. When exposed to a patient, this therapy includes a system of positive reinforcement as a universal mechanism of self-regulation and self-control of body functions.

Substitution therapy of nicotine addiction

As replacement therapy for nicotine addiction, special preparations containing nicotine are widely used. The effect of nicotine is imitated as a result of using chewing gum with nicotine and nicotine in solution. Chewing gum with nicotine should not be considered as a panacea. Its use gives a certain effect in the complex of medical, social and other measures in the fight against smoking tobacco.

Drugs containing nicotine, cause effects, to achieve which patients resort to smoking: maintaining a good mood and performance, self-control in stressful situations, etc. According to clinical studies, the drug nicorette affects the symptoms of nicotine withdrawal syndrome - evening dysphoria, irritability, anxiety, inability to concentrate. Reduces the number of somatic complaints.

Studies have established that the treatment of nicotine addiction with the use of a nicotine patch is much more effective compared to the treatment of placebo. A high dose of nicotine in the patch (25 mg) is preferable to a low dose (15 mg). The transdermal approach to nicotine addiction replacement therapy is carried out by using a large number of drugs: Habitrol, Nikodermar, Prostep, and three types of nicotrol, containing 7, 14, 21 mg of nicotine, with a duration of absorption for 16 or 24 hours.

Improving the effectiveness of tobacco therapy can be achieved through the combined use of nicotine chewing gum and nicotine-releasing transdermal system, providing a constant and stable flow of nicotine in the body. Chewing gum patient uses occasionally, as needed. Combination therapy is carried out sequentially. In this case, the patient first uses a mini nicotine patch, and then periodically uses chewing gum to maintain long-term remission.

Nicotine aerosol facilitates abstaining from smoking, but only in the first days of its use. Use nicotine inhalers to the form of a plastic tube with a nicotine capsule for intake of nicotine through the mouth. Per day use 4-10 inhalations. Nicotine inhalations are useful for quitting smoking for a short time.

A pronounced need for smoking with withdrawal syndrome is the cause of unsuccessful attempts to quit smoking. That is why an adequate replacement of nicotine during acute withdrawal syndrome allows you to overcome the desire to smoke. To do this, use the above nicotine preparations. The indications for their use are pronounced dependence on nicotine (consuming more than 20 cigarettes daily, smoking the first cigarette within 30 minutes after waking up, unsuccessful attempts to quit smoking: strong attraction to cigarettes in the first week of the syndrome). Nicotine replacement therapy can also be prescribed to patients with sustained smoking cessation motivation. When using replacement therapy, the need for the usual daily amount of cigarettes is reduced, and if you stop smoking at one point, the withdrawal syndrome is alleviated. A long course of substitution therapy (2-3 months) does not solve the problem of tobacco cessation. It should be remembered that with somatic contraindications (myocardial infarction, hypertension, thyroid hyperfunction, diabetes mellitus, renal and hepatic diseases), the administration of nicotine patches and nicotine gum is impractical. Nicotine overdose is not excluded in cases of continued smoking, as well as side effects and complications when combined with pharmacotherapy (weakness, headaches, dizziness, hypersalivation, nausea, vomiting, diarrhea).

To develop a negative conditioned reflex to smoking, emetic preparations are used in combination with smoking. We are talking about apomorphine, emetine, tannin, solutions of silver nitrate, copper sulfate for rinsing the mouth. Their use in smoking tobacco is accompanied by altered sensations in the body: the unusual taste of tobacco smoke, dizziness, dry mouth, nausea and vomiting.

[39], [40], [41], [42]

Weakening of attraction

In 1997, the FDA approved the use of bupropion as a means to reduce craving for nicotine. Registration of a new indication for the use of the drug, which has already been used as an antidepressant, was based on the results of double-blind tests that demonstrated the ability of bupropion to reduce craving and facilitate tolerance to nicotine withdrawal. According to the recommended regimen, bupropion is started one week before the intended cessation of smoking. In the first three days, take 150 mg once a day, then 2 times a day. After the 1st week, a nicotine patch is prescribed in addition to relieve withdrawal symptoms, and bupropion is combined with behavioral therapy to reduce the risk of recurrence. However, studies of the long-term efficacy of this combination therapy has not been conducted.

Studies show that when quitting smoking with a patch or chewing gum with nicotine, confirmed abstinence after 12 months was noted in 20% of cases. These are lower cure rates than with other addiction options. Low efficiency is partly due to the need to achieve full abstinence. If a former smoker “breaks down” and tries to smoke “by a little”, then usually he quickly returns to the previous level of dependence. Thus, the criterion of success can only be complete abstinence. The combined use of behavioral and drug therapy may be the most promising direction.

Reflexology and nicotine addiction

In recent years, reflexotherapy and its modifications (electroreflexotherapy) have been widely used in the treatment of nicotine addiction. These methods are in many ways superior to traditional drug therapy.

Electropuncture method on biologically active points (corporal and auricular) is painless, does not cause skin infection, does not give complications, does not require much time (3-4 procedures per course). During the procedure, patients lose the desire to smoke, are manifestations of nicotine withdrawal. After completing the course of treatment, when trying to smoke, patients develop an aversion to the smell and taste of tobacco, and the craving for it disappears. Patients stop smoking. Auricular reflexology is the most effective method of treating nicotine addiction.

[43], [44]

Combined treatment of nicotine addiction

It has been established that with nicotine addiction, a combination of the following treatment methods is very effective: acupuncture or electropuncture for getting rid of physical dependence; a session (ideally a course) of individual psychotherapy for mental adjustment to a new life, a new solution to problems associated with emotional experiences: the inclusion in the group of mutual support for the formation of a new lifestyle; abstinence from smoking for a sufficient time (prevention of relapse).

A complex technique with the use of acupuncture combined with hypnosuggestia quickly and effectively deactivates the craving for nicotine, this is an important moment for many patients who are set up to get rid of nicotine addiction at one moment. This approach allows you to eliminate the functional symptoms that provoke craving for smoking.

Acupuncture is carried out according to the classical method "Antitabak", developed by the Frenchman Nogier, using n mainly auricular points. The task of the session of verbal hypnotherapy is to achieve a shallow wakeful state. In the formulas used, the suggestion takes into account not only the motivation of the patient to quit smoking, but also his idea of the motives for craving for tobacco. During the session, the duration of which is about 30 minutes, stop the pathological attraction to tobacco. Repeat sessions are carried out every other day with the additional inclusion of the corporal points of impact, which increase the impact of the needles by twisting them.

It is known that the cessation of smoking causes hormone-mediator dissociation, it affects the state of mental and physical comfort of a person. The use of reflex therapy modifications accompanies the normalization of the functional state of the sympathoadrenal system. That is why the use of laser exposure methods with powerful stimulating and normalizing effects contributes to the rapid recovery of hormonal-mediator dysfunction arising in the treatment of nicotine addiction (withdrawal syndrome).

When developing the medical section of the national anti-smoking project, it is necessary to consider:

• treatment of nicotine addiction requires special knowledge and skills and should be concentrated within the framework of the clinical discipline - narcology;
• the implementation of individual sections of therapeutic programs for smoking cessation, drug treatment specialists may attract non-medical specialists (psychologists, sociologists, educators, etc.);
• Treatment of the somatic consequences of smoking is an interdisciplinary problem, its solution must be implemented through integration with the addiction of various clinical specialties (cardiology, oncology, pulmonology, toxicology, etc.);
• the implementation of the medical section of the national project to combat smoking requires the creation of centers for outpatient treatment of nicotine addiction, inpatient beds for the treatment of severe forms of nicotine addiction.

[45], [46]

Forecast

Smokers seeking help turn out to be the most therapeutically resistant. The effectiveness of treatment programs in these cases does not exceed 20%. At the same time, 95% of those who stopped smoking did not receive medical care. Prognostically unfavorable factors consider unsatisfactory social adaptation, female gender, high levels of tobacco use before the start of treatment, and pronounced manifestations of nicotine addiction.

[47], [48]