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Smoking and nicotine dependence are still one of the main reasons for a number of serious and life-shortening somatic diseases. At the same time, they are more prevalent in mentally ill individuals than in the general population. This work, which constitutes the first part of recommendations of the Polish Psychiatric Association, presents the scale of the phenomenon in the general population and among people with psychiatric disorders, diagnostic criteria of nicotine dependence and nicotine withdrawal. It discusses the impact of smoking and exposure to cigarette smoke on the development and course of psychiatric disorders as well as on the treatment of psychiatric disorders, including interactions between nicotine and psychotropic medications. Many psychiatric patients can reduce smoking or achieve complete abstinence if they are offered adequate motivation and therapeutic support. Contrary to popular belief, smoking cessation and nicotine dependence treatment do not negatively affect the symptoms of psychiatric disorders; patients' mental conditions can improve following smoking cessation therapy. The best results in terms of maintaining abstinence are achieved with a treatment approach that combines pharmacotherapy with psychotherapeutic intervention integrated into routine psychiatric care.

The development of treatment methods for nicotine dependence has progressed slowly because people with psychiatric disorders are usually excluded from participating in clinical trials. There are several therapeutic options to support smoking cessation, including psychological and pharmacological interventions, which should be offered to smokers with mental disorders. The first step in helping tobacco smokers and nicotine-dependent individuals is the assessment of smoking intensity and confirmation of nicotine dependence. Currently, we have several methods of treating nicotine dependence - starting from education and psychotherapy, through pharmacotherapy and replacement therapy, and ending up with obtaining gradual progress with the application of harm reduction. Pharmacological treatment options include nicotine replacement therapy, varenicline or bupropion. The effectiveness of such interventions can be improved by providing anti-smoking therapy under psychiatric treatment and promoting harm reduction as an acceptable initial therapeutic goal. The harm reduction strategy is an approach that should be taken into account individually, particularly in the case of individuals unable to stop smoking, patients with limited insight into their illness, patients experiencing an exacerbation of their illness and persistently uncooperative patients. In this paper, recommendations of the Polish Psychiatric Association on the diagnostics and different treatment methods for nicotine dependence in patients with psychiatric disorders are presented.

Tabacco smoking is a major public health problem. The evidence demonstrates that smokers are over-represented among the patients with severe diseases. Smoking in the significant way influence the prognosis related to the outcome of treatment and the length of stay in Intensive Care Units (ICUs). Recent studies confirmed that smoking has an independent dose-related adverse effect on mortality of critically ill patients. This review covers the issues connected with critically ill patients addicted to nicotine emphasizing the problems that could occur during their stay in ICU. Identifying patients at risk of complication at ICU may lead to earlier intervention in routine clinical practice.

Background: Diagnostics in the intensive interventions of tobacco use and dependence should include, among others assessments of nicotine dependence, motivation to quit and readiness to change., Objective: Based on the own research findings critical researcher's assessment of the accuracy of some recommended diagnostic tests and theories such as Fagerström Test for Nicotine Dependence FTND, Schneider Test ST and Transtheoretical Model of Behaviour Changes for clinical practice in Poland., Methods: Data were collected between 2001 and 2007 in the outpatient clinic in Lodz where group-based smoking cessation intensive intervention was provided to smokers. Follow-up study by postal questionnaire and cotinine saliva test was performed in 2008. Some short- and long-term outcomes of the uni- and multivariate analyses with nicotine dependence and motivation to quit variables measured by FTND and ST were included into paper., Results: In the research population that was representative for treatment-seekers in Lodz, both of two variables differentiated the female population only, with FTND score <7 points as one of the predictors of quitting smoking in group-based intervention. Neither FTND nor ST differentiated male population in the research., Conclusions: The conclusion of the paper based on the own research findings supported by subject literature is as following. The state of panel experts' recommendations refers to the nicotine dependence and motivation to quit should be defined in Poland as popularity outstrips evidence. The urgent revision of previous recommendations is needed. It should be provided for the clinical practice new tests. with high sensitivity better reflecting modern concepts of nicotine dependence as well as motivation and readiness to quit. The further research on assessment of diagnostic accuracy of recommended tools is needed.

Smoking tobacco still remains one of the basic health and social-economic issues, both in Poland and around the world. Popularity of smoking, dissemination of this habit, and continually high levels of its social acceptance make physicians feel helpless, and often relieved from the obligation of counteracting the phenomenon. Nonetheless, there are some interesting possibilities of pharmacological assistance using nicotine substitution therapy, not to mention a number of drugs that facilitate quitting smoking. Additionally, a pattern of psychological assistance or intervention actions has been developed which has proved to be extremely successful within a truly short time span, called minimum (anti-nicotine) intervention. The goal of this article is to popularise those methods and invite physicians to become familiar with the new ideas, in view of their future application to working with the patient.

Tobacco-related diseases killed 100 millions people in 20th century and unless urgent action is taken, it is predicted that 1 billion people in total will be killed by smoking in this century. Pharmacists as health-care professionals should support the healthy lifestyle campaign and motivate smokers to quit smoking especially as they have the theoretical basis for such counselling. The aims of the study were: 1. to evaluate the readiness of pharmacists employed in public pharmacies to manage patients who would like to stop smoking; 2. to assess the pharmacists' current knowledge of the harmfulness of smoking and methods of treatment of this addiction. The pharmacists were interviewed for readiness to help addicted people and for knowledge of health promotion problems. A study was carried out do determine pharmacists counselling skills. Investigator (monitor) visited pharmacies passing him(her)self off as a smoker who would like to quit smoking and enquired about methods of the addiction cessation. Next the investigator filled in questionnaires according to the pharmacists' answers. Sixty pharmacists were interviewed. The results showed that pharmacists were willing to help tobacco-addicted patients and although they strongly recommended smoking cessation, their knowledge of methods of tobacco-addiction treatment was restricted. The strongest interest and most extensive knowledge of smoking cessation problems was observed in pharmacists ranging in age from 30 to 50 whereas pharmacists over 50 showed the worst results. The reason of this result was due to imperfect factual knowledge and unawareness of the value of pharmaceutical care in the oldest group of pharmacists. Insufficient education of pharmacists may influence the effectiveness of counseling.

It was estimated that current cigarette smoking will cause about 450 million deaths worldwide in the next fifty years. Reducing current smoking by 50% would avoid 20 to 30 million premature deaths in the first quarter of the century and about 150 million in the second. Preventing young people from starting smoking would cut tobacco-related death but not until after 2050. Quitting by current smokers is therefore the only way in which tobacco-related mortality can be reduced in the medium-term. There is evidence that some form of treatment aids an increasing number of successful quit attempts. European experiences concerning schedules of the fight against the tobacco addiction with the use of the treatment aids were described in the paper.

The methods of tobacco dependency treatment, which are alternative to pharmacological ones, have in recent years increasingly gained popularity. The most popular include: acupuncture, laser therapy, electrostimulation, hypnosis and autohypnosis, bioresonance, as well as herbalism, aromatherapy and homeopathic methods. The above mentioned methods have been shortly characterized in this paper. Their effectiveness and usefulness of application have as well been brought up for discussion on the basis of available specialist literature. The aspects related to safety of particular methods of therapy for the patient have also been presented. The analysis showed that effectiveness of the methods is often disputable and the main advantage of those methods is a support effect to patient who wants to give up smoking. Thus, it seems that alternative methods may be applied in combination with pharmacological ones because they increase the smoker's motivation to stop smoking and at the same time increase the chance to overcome the addiction in general.

The addiction to nicotine has psychical and physical basis. It is estimated that about 3 million people in the world die every year because of illnesses caused by cigarette smoking. It is said that 9 million of the adult population of Poles is addicted to cigarettes. The aim of this paper was to present the characteristics of chronic smokers in different age groups. 905 subjects were examined in the study. They were divided into three age groups; those who were twenty, forty, and sixty years old. Some additional examinations (including spirometrical one) as well as an interview concerned cigarette smoking and doctor's examination were conducted. The most numerous group among 905 subjects examined in the study was the group of chronic smokers aged from 40 to 59. In all age groups the subjects usually smoke 20 cigarettes a day. The average length of smoking was 32 years. Most people with university degree were in group I. In the group of twenty-year old subjects the majority started smoking in a primary school. More than 3/4 of the examined subjects breathe cigarette smoke both at home and/or at work. We still smoke too many cigarettes a day and for too long at least 30 years. It is because, we are accustomed to smoking and we allow others to smoke both at home and at work. What we can do is to educate starting from the very early age, telling people how harmful it is to breathe smoke and encouraging them to take part in special health programs created by primary care doctors.

Tobacco dependence is a chronic, relapsing disease causing an enormous burden of deaths. The aim of the study was a one year evaluation of the efficacy of bupropion SR supported by an educational program in the treatment of nicotine dependence and analysis of the reasons of relapses. 54 smokers were enrolled. The 12-month continuous abstinence rate was 28.3%. The most common cause of relapses in the treatment period was craving for cigarettes, in the post-treatment period stress.

Aim: To evaluate psychological factors influencing the effectiveness of smoking cessation using bupropion and psychological intervention in patients with cardiovascular diseases., Method: A group of 59 patients (26 M, 33 F; mean age 44.2 +/- 10.2 years) identified among smokers admitted to the 1st Cardiac Department between 2000 and 2001 with hypertension (n = 46) and coronary artery disease (n = 13). Entry criteria to participate in a 7-week programme included nicotine dependence and no contraindications to bupropion. Pharmacotherapy was used in parallel with psychological interventions based upon cognitive and behavioural methods. The type and degree of nicotine dependence was measured using Fragerstrom tolerance questionnaire whereas motivation was scored according to the Schneider questionnaire. The severity of depression symptoms was measured by the Beck Depression Inventory., Results: At 2 months and at one year after discontinuation of treatment 74.6% and 40% of the patients respectively maintained abstinence from smoking. Among patients with good therapeutic effects the level of motivation to quit smoking was higher (p < 0.001 vs. p < 0.007). The level of motivation was correlated with the severity of depression symptoms (p < 0.005) but not with nicotine dependence, age and sex. Motivation to stop smoking is related to the depression symptoms (beta = -0.32; p = -.01)., Conclusion: Patients with initially higher motivation benefit more from treatment of nicotine dependence. The level of motivation is adversely affected by the depressive mode of functioning (negative cognitive patterns, learned helplessness). It appears necessary to take into account the assessment of depressive disorders when planning treatment of nicotine dependence in patients with cardiovascular diseases.

Tobacco smoking generally regarded as a form of nicotine dependence. The behavioural effects of nicotine and its relative reinforcing properties, as well as the development of tolerance and withdrawal syndrome indicate that nicotine has addiction liability, which is however not strongly marked. Nicotine replacement therapy, low nicotine smoke aerosol and citric acid aerosol as potential smoking cessation aids are discussed.

The deletorious health effects of smoking are generally known. In spite of that, great numbers of people still smoke tobacco in the whole world. It is primarily due to the addictive properties of nicotine. Cigarette smoking is also dependent on various social and psychologic factors making quitting very difficult. Among various treatment modalities for tobacco dependence we aimed to assess the efficacy of nicotine replacement therapy (NRT) vs group therapy. 325 subjects smoking at least 15 cigarettes/day for more than 3 years were studied. They were allocated to group therapy (neurolinguistic programming) or NRT (gum or patch) at their will. Non-smoking was validated at each of follow-up visits, at 1 and 2 weeks 1, 3, 6, 12 months by measuring CO in expired air. All groups were matched in age, smoking history and nicotine dependence. The best quit rate was observed as a result of group therapy (41% at 1 year, p. < 0.001) as compared to nicotine patch (2%) and nicotine gum (9%).