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DOI: 10.1055/s-2001-19379
© Georg Thieme Verlag Stuttgart · New York
Tabakabhängigkeit und Möglichkeiten der medikamentösen Behandlung
Tobacco Dependence and Possibilities of Smoking Cessation TherapyPublication History
Publication Date:
02 January 2002 (online)
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Zusammenfassung
Die Tabakabhängigkeit ist aufgrund der steigenden Raucherzahlen in allen Industrieländern als wachsende Bedrohung für den Gesundheitszustand der Bevölkerung anzusehen. Dabei ist die mit Alkohol und Heroin vergleichbare abhängigkeitserzeugende Wirkung für den jahrzehntelangen Tabakkonsum verantwortlich. Die Abhängigkeit wird exogen ausgelöst, jedoch kommt aufgrund der bisherigen Daten auch eine genetische Komponente in Betracht, wobei Parallelen zur Alkoholabhängigkeit gegeben sind. Für die Behandlung der Tabakabhängigkeit werden verschiedene verhaltenstherapeutische Verfahren empfohlen, die jedoch vom Raucher weniger akzeptiert werden als die medikamentösen Verfahren, unter denen die vorübergehende Nikotinbehandlung die derzeitig erfolgreichste Methode darstellt. Des Weiteren wird die Behandlung mit Bupropion abgehandelt, die jedoch aufgrund der bisher international beschriebenen unerwünschten Wirkungen eine weniger günstige Nutzen-Risiko-Relation als die zeitweilige Nikotinsubstitution darstellt.
Tobacco Dependence and Possibilities of Smoking Cessation Therapy
Due to increasing smoker numbers in all industrial countries the tobacco dependence can be seen as growing threat for the state of health to the population. The dependence producing effect of nicotine is comparable with those of alcohol and heroin and, furthermore the alkaloid is responsible for decades of tobacco consumption of each subject. Nicotine dependence is triggered exogenously, a genetic component is also considered. On the basis of the present data parallels exist to the alcohol dependence. For smoking cessation various behavior therapy programs are used which, however, are accepted by the smoker to a smaller degree than nicotine replacement therapy (NRT). NRT represents the most successful method at time. Bupropion therapy possesses a less favorable use-risk relation than NRT because of its side-effects.
Schlüsselwörter
Tabakabhängigkeit - Nikotin - Nikotinabhängigkeit - Diagnostik - Medikamentöse Therapie - Nikotinersatzprodukte - Bupropion
Key words
Tobacco Dependence - Nicotine - Nicotine Addiction - Diagnostics - Nicotine Replacement Therapy - Bupropion
Literatur
- 1 Statistisches Bundesamt . Voraussichtliche Straßenverkehrsunfallentwicklung 2000: 3 % weniger Getötete und 4 % weniger Verletzte. Pressemitteilung. 21.12.2000;
- 2 Haustein K O. Tabakabhängigkeit: Gesundheitliche Schäden durch das Rauchen. Deutscher Ärzte-Verlag Köln; Dezember/2001
- 3 Peto R, Lopez A D, Boreham J, Thun M, Heath C, Doll R. Mortality from smoking worldwide. Br Med Bull. 1996; 52 12-21 (1)
- 4 Haustein K O. Rauchen: Gesundheitswesen und Politik im Wechselspiel. Z ärztl Fortbild Qual sich. 1999; 93 355-361
- 5 Benowitz N L, Jaffe J H. Drug addiction an drug abuse: Nicotine and tobacco. Gilman AG, Goodman AS, Rall TW, Murrad Goodman and Gilman’s The Pharmacological Basis of Therapeutics New York; Macmillan 1985 4: 554-558
- 6 Fagerstrom K O, Kunze M, Schoberberger R, Breslau N, Hughes J R, Hurt R D. et al . Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers. Tob Control. 1996; 5 52-56 (1)
- 7 DSM-IV. American psychiatric association: Diagnostic and Statistical manual of Mental Disorder, ed. 4th. Washington; American Psychatric Association 1994
- 8 Clarke P B. Tobacco smoking, genes, and dopamine. Lancet. 1998; 352 84-85 (9122)
- 9 Clarke P B. Dopaminergic mechanisms in the locomotor stimulant effects of nicotine. Biochem Pharmacol. 1990; 40 1427-1432 (7)
- 10 Benwell M E, Balfour D J, Lucchi H M. Influence of tetrodotoxin and calcium on changes in extracellular dopamine levels evoked by systemic nicotine. Psychopharmacology (Berl). 1993; 112 467-474 (4)
- 11 Nisell M, Nomikos G G, Svensson T H. Systemic nicotine-induced dopamine release in the rat nucleus accumbens is regulated by nicotinic receptors in the ventral tegmental area. Synapse. 1994; 16 36-44 (1)
- 12 Balfour D J, Birrell C E, Moran R J, Benwell M E. Effects of acute D-CPPene on mesoaccumbens dopamine responses to nicotine in the rat. Eur J Pharmacol. 1996; 316 153-156 (2-3)
- 13 Shoaib M, Benwell M E, Akbar M T, Stolerman I P, Balfour D J. Behavioural and neurochemical adaptations to nicotine in rats: influence of NMDA antagonists. Br J Pharmacol. 1994; 111 1073-1080 (4)
- 14 Wise R A, Bozarth M A. A psychomotor stimulant theory of addiction. Psychol Rev. 1987; 94 469-492 (4)
- 15 Wonnacott S, Irons J, Rapier C, Thorne B, Lunt G G. Presynaptic modulation of transmitter release by nicotinic receptors. Prog Brain Res. 1989; 79 157-163
- 16 Benwell M E, Balfour D J. Regional variation in the effects of nicotine on catecholamine overflow in rat brain. Eur J Pharmacol. 1997; 325 13-20 (1)
- 17 Benwell M E, Balfour D JK. Effects of nicotine administration and its withdrawal an plasma corticosterone and brain 5-hydroxinidoles. Psachopharmacology. 1979; 4 7-11
- 18 Benwell M E, Balfour D JK. The effects of nicotine administration and 5-HT uptake and biosynthesis in rat brain. Eur J Pharmacol. 1982; 6 71-77
- 19 Brioni J D, O’Neill A B, Kim D J, Buckley M J, Decker M W, Arneric S P. Anxiolytic-like effects of the novel cholinergic channel activator ABT-418. J Pharmacol Exp Ther. 1994; 271 353-361 (1)
- 20 Costall B, Kelly M E, Naylor R J, Onaivi E S. The actions of nicotine and cocaine in a mouse model of anxiety. Pharmacol Biochem Behav. 1989; 33 197-203 (1)
- 21 Breslau N, Kilbey M M, Andreski P. Nicotine dependence and major depression. New evidence from a prospective investigation. Arch Gen Psychiatry. 1993; 50 31-35 (1)
- 22 Bailey S L, Ennett S T, Ringwalt C L. Potential mediators, moderators, or independent effects in the relationship between parents’ former and current cigarette use and their children’s cigarette use. Addict Behav. 1993; 18 601-621 (6)
- 23 Koopmans J R, van Doornen L J, Boomsma D I. Association between alcohol use and smoking in adolescent and young adult twins: a bivariate genetic analysis. Alcohol Clin Exp Res. 1997; 21 537-546 (3)
- 24 Hannah M C, Hopper J L, Mathews J D. Twin concordance for a binary trait. II. Nested analysis of ever-smoking and ex-smoking traits and unnested analysis of a „committed-smoking” trait. Am J Hum Genet. 1985; 37 153-165 (1)
- 25 Heath A C, Madden P A, Slutske W S, Martin N G. Personality and the inheritance of smoking behavior: a genetic perspective. Behav Genet. 1995; 25 103-117 (2)
- 26 Pianezza M L, Sellers E M, Tyndale R F. Nicotine metabolism defect reduces smoking. Nature. 1998; 393 750 (6687)
- 27 Oscarson M, Gullsten H, Rautio A, Bernal M L, Sinues B, Dahl M L. et al . Genotyping of human cytochrome P450 2A6 (CYP2A6), a nicotine C-oxidase. FEBS Lett. 1998; 438 201-205 (3)
- 28 Spitz M R, Shi H, Yang F, Hudmon K S, Jiang H, Chamberlain R M. et al . Case-control study of the D2 dopamine receptor gene and smoking status in lung cancer patients. J Natl Cancer Inst. 1998; 90 358-363 (5)
- 29 Blum K, Noble E P, Sheridan P J, Montgomery A, Ritchie T, Jagadeeswaran P. et al . Allelic association of human dopamine D2 receptor gene in alcoholism. JAMA. 1990; 263 2055-2060 (15)
- 30 Blum K, Noble E P, Sheridan P J, Montgomery A, Ritchie T, Ozkaragoz T. et al . Genetic predisposition in alcoholism: association of the D2 dopamine receptor TaqI B1 RFLP with severe alcoholics. Alcohol. 1993; 10 59-67 (1)
- 31 Noble E P. The D2 dopamine receptor gene: a review of association studies in alcoholism. Behav Genet. 1993; 23 119-129 (2)
- 32 Noble E P, Blum K, Khalsa M E, Ritchie T, Montgomery A, Wood R C. et al . Allelic association of the D2 dopamine receptor gene with cocaine dependence. Drug Alcohol Depend. 1993; 33 271-285 (3)
- 33 Comings D E, Ferry L, Bradshaw-Robinson S, Burchette R, Chiu C, Muhleman D. The dopamine D2 receptor (DRD2) gene: a genetic risk factor in smoking. Pharmacogenetics. 1996; 6 73-79 (1)
- 34 Lerman C, Caporaso N E, Audrain J, Main D, Bowman E D, Lockshin B. et al . Evidence suggesting the role of specific genetic factors in cigarette smoking. Health Psychol. 1999; 18 14-20 (1)
- 35 True W R, Xian H, Scherrer J F, Madden P A, Bucholz K K, Heath A C. et al . Common genetic vulnerability for nicotine and alcohol dependence in men. Arch Gen Psychiatry. 1999; 56 655-661 (7)
- 36 Yates W R, Cadoret R J, Troughton E P, Stewart M, Giunta T S. Effect of fetal alcohol exposure on adult symptoms of nicotine, alcohol, and drug dependence. Alcohol Clin Exp Res. 1998; 22 914-920 (4)
- 37 West R, Hajek P. What happens to anxiety levels on giving up smoking?. Am J Psychiatry. 1997; 154 1589-1592 (11)
- 38 Haustein K O. Tabakabhängigkeit - Erfahrungen aus dem Raucherberatungszentrum. Zerdick J Vol. 5: Suchtmedizin im Dialog, Deutsche Gesellschaft für Suchtmedizin Berlin; Verlag für Wissenschaft und Bildung Dezember/2001: 221-231
- 39 Haustein K O. Pharmacotherapy of nicotine dependence. Int J Clin Pharmacol Ther. 2000; 38 273-290 (6)
- 40 Schoberberger R KM. Nikotinabhängigkeit: Diagnostik und Therapie. Wien, New York; Springer-Verlag 1999
- 41 Fiore M C, Smith S S, Jorenby D E, Baker T B. The effectiveness of the nicotine patch for smoking cessation. A meta-analysis. JAMA. 1994; 271 1940-1947 (24)
- 42 Silagy C, Mant D, Fowler G, Lodge M. Meta-analysis on efficacy of nicotine replacement therapies in smoking cessation. Lancet. 1994; 343 139-142 (8890)
- 43 Tang J L, Law M, Wald N. How effective is nicotine replacement therapy in helping people to stop smoking?. BMJ. 1994; 308 21-26 (6920)
- 44 Silagy C, Mant D, Fowler G, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2000; CD000146 (3)
- 45 Herrera N, Franco R, Herrera L, Partidas A, Rolando R, Fagerstrom K O. Nicotine gum, 2 and 4 mg, for nicotine dependence. A double-blind placebo-controlled trial within a behavior modification support program. Chest. 1995; 108 447-451 (2)
- 46 Kornitzer M, Kittel F, Dramaix M, Bourdoux P. A double blind study of 2 mg versus 4 mg nicotine-gum in an industrial setting. J Psychosom Res. 1987; 31 171-176 (2)
- 47 Tonnesen P, Fryd V, Hansen M, Helsted J, Gunnersen A B, Forchammer H. et al . Two and four mg nicotine chewing gum and group counselling in smoking cessation: an open, randomized, controlled trial with a 22 month follow-up. Addict Behav. 1988; 13 17-27 (1)
- 48 Tonnesen P, Fryd V, Hansen M, Helsted J, Gunnersen A B, Forchammer H. et al . Effect of nicotine chewing gum in combination with group counseling on the cessation of smoking. N Engl J Med. 1988; 318 15-18 (1)
- 49 Blondal T, Gudmundsson L J, Olafsdottir I, Gustavsson G, Westin A. Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up. BMJ. 1999; 318 285-288 (7179)
- 50 Bohadana A, Nilsson F, Rasmussen T, Martinet Y. Nicotine inhaler and nicotine patch as a combination therapy for smoking cessation: a randomized, double-blind, placebo-controlled trial. Arch Intern Med. 2000; 160 3128-3134 (20)
- 51 Kornitzer M, Boutsen M, Dramaix M, Thijs J, Gustavsson G. Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial. Prev Med. 1995; 24 41-47 (1)
- 52 Puska P K. Combined use of nicotine patch and gum compared with gum alone in smoking cessation: a clinical trial in North Karelia. Tobacco Control. 1995; 4 231-235
- 53 Tonnesen P, Paoletti P, Gustavsson G, Russell M A, Saracci R, Gulsvik A. et al . Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Collaborative European Anti-Smoking Evaluation. European Respiratory Society. Eur Respir J. 1999; 13 238-246 (2)
- 54 Daughton D M, Heatley S A, Prendergast J J, Causey D, Knowles M, Rolf C N. et al . Effect of transdermal nicotine delivery as an adjunct to low-intervention smoking cessation therapy. A randomized, placebo-controlled, double-blind study. Arch Intern Med. 1991; 151 749-752 (4)
- 55 Daughton D M, Fortmann S P, Glover E D, Hatsukami D K, Heatley S A, Lichtenstein E. et al . The smoking cessation efficacy of varying doses of nicotine patch delivery systems 4 to 5 years post-quit day. Prev Med. 1999; 28 113-118 (2)
- 56 Blondal T. Controlled trial of nicotine polacrilex gum with supportive measures. Arch Intern Med. 1989; 149 1818-1821 (8)
- 57 Transdermal nicotine for smoking cessation . Six-month results from two multicenter controlled clinical trials. Transdermal Nicotine Study Group. JAMA. 1991; 266 3133-3138 (22)
- 58 Joseph A M, Antonnucio D O. Lack of efficacy of transdermal nicotine in smoking cessation. N Engl J Med. 1999; 341 1157-1158 (15)
- 59 Batra A, Schupp P E, Buchkremer G. Die Behandlung von schwerabhängigen Rauchern mit Nikotinpflaster und Nikotinnasenspray. Haustein KO Rauchen und Nikotin - Aktuelle Beiträge zur Raucherentwöhnung Nürnberg; Verlag Perfusion GmbH 1998: 49-58
- 60 Blondal T, Franzon M, Westin A. A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation. Eur Respir J. 1997; 10 1585-1590 (7)
- 61 Zevin S, Benowitz N L. Drug interactions with tobacco smoking. An update. Clin Pharmacokinet. 1999; 36 425-438 (6)
- 62 Miller L G. Recent developments in the study of the effects of cigarette smoking on clinical pharmacokinetics and clinical pharmacodynamics. Clin Pharmacokinet. 1989; 17 90-108 (2)
- 63 Skogh E, Bengtsson F, Nordin C. Could discontinuing smoking be hazardous for patients administered clozapine medication? A case report. Ther Drug Monit. 1999; 21 580-582 (5)
- 64 Haustein K O. Smoking tobacco, microcirculatory changes and the role of nicotine. Int J Clin Pharmacol Ther. 1999; 37 76-85 (2)
- 65 Haustein K O. Cigarette smoking, nicotine and pregnancy. Int J Clin Pharmacol Ther. 1999; 37 417-427 (9)
- 66 Hurt R D, Offord K P, Croghan I T, Gomez-Dahl L, Kottke T E, Morse R M. et al . Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort. JAMA. 1996; 275 1097-1103 (14)
- 67 Ferry L H BR. Efficacy of bupropion for smoking cessation in non depressed smokers [Abstract]. Addict Dis. 1994; 13 249
- 68 Ferry L H. RASP . Enhancement of smoking cessation using the antidepressant bupropion hydrochloride [Abstract 2670]. Circulation. 1992; 86 I-671 (Suppl 1)
- 69 Hurt R D, Sachs D P, Glover E D, Offord K P, Johnston J A, Dale L C. et al . A comparison of sustained-release bupropion and placebo for smoking cessation. N Engl J Med. 1997; 337 1195-1202 (17)
- 70 Jorenby D E, Leischow S J, Nides M A, Rennard S I, Johnston J A, Hughes A R. et al . A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999; 340 685-691 (9)
- 71 Hughes J R, Stead L F, Lancaster T. Anxiolytics and antidepressants for smoking cessation (Cochrane Review). The Cochrane Library, editor. Oxford; Issue 3, 2000 2000
- 72 Hayford K E, Patten C A, Rummans T A, Schroeder D R, Offord K P, Croghan I T. et al . Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism. Br J Psychiatry. 1999; 174 173-178
- 73 Haustein K O. Antidepressivum kontra Nicotin: Neue Methoden der Raucherentwöhnung. Münch med Wschr/Fortschr Med. 2000; 142 988-990
- 74 Goldstein M G. Bupropion sustained release and smoking cessation. J Clin Psychiatry. 1998; 59 Suppl 4 66-72
- 75 anonym. Bupropion: update. Canad ADR Newsletter. 2000; 10 3-7
- 76 anonym . Fachinformation zu Zyban R: Darstellung der Eigenschaften von Bupropion (Glaxo-Wellcome), Stand Juni 2000. 2000. 30.6.2000.
- 77 Dunner D L, Zisook S, Billow A A, Batey S R, Johnston J A, Ascher J A. A prospective safety surveillance study for bupropion sustained-release in the treatment of depression. J Clin Psychiatry. 1998; 59 366-373 (7)
- 78 Tang J L, Law M, Wald N. How effective is nicotine replacement therapy in helping people to stop smoking?. BMJ. 1994; 308 21-26 (6920)
Prof. Dr. med. Knut-Olaf Haustein
Institut für Nikotinforschung und
Raucherentwöhnung
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99084 Erfurt
Email: haustein@inr-online.de