Smoking Cessation: Most Effective Dietary Supplements

Smoking is a major public health problem leading to high morbidity and mortality worldwide. Indeed, according to WHO estimates, tobacco is responsible for over six million deaths annually, with a majority due to cardiovascular diseases, cancers, and respiratory conditions. In France, despite numerous awareness campaigns and health policies aimed at reducing consumption, a significant proportion of the population remains tobacco-dependent. Quitting smoking poses a major challenge for smokers due to the physical and psychological dependence induced by nicotine.

Mechanisms of Dependency

Tobacco dependence results from several psycho-behavioral and pharmacological factors, primarily linked to nicotine, an alkaloid present in cigarette smoke. When a person smokes, nicotine quickly crosses the barrier between the lungs and the blood (alveolar-capillary barrier) and reaches the brain in less than ten seconds. Once in the brain, it binds to specific receptors (the α4β2 receptors), which are part of the "hedonic system," also known as the "reward circuit." This activation triggers a release of dopamine, creating a sense of pleasure and reward, thus reinforcing the consumption behavior. Dependence manifests through positive reinforcement (the pleasurable effects of nicotine) and negative reinforcement (the reduction of withdrawal symptoms such as irritability or anxiety).

Classification of Smokers

Smokers can be classified into several categories based on their level of consumption and dependence. Notably, we distinguish: 22 Light smokers: they consume less than five cigarettes per day, without evident signs of dependence. 22 Intermittent smokers: they alternate between periods of consumption and abstinence. 22 Heavy dependent smokers: they consume more than 15 cigarettes per day with a high score in the Fagerström test, indicating strong dependence.. 22 Irreducible smokers: these smokers, representing about 5 to 10% of all smokers, are strongly dependent and show low motivation to quit, often due to low awareness of health risks.

Management Strategies

Management strategies for smoking cessation can include various pharmacological, behavioral, and psychological approaches to help smokers overcome their nicotine dependence and prevent relapses. The "5 A's" model is often recommended in smoking cessation management: 22 Ask: systematically inquire about patients' smoking status. 22 Advise: clearly and personally advise stopping smoking. 22 Assess: evaluate the patient's motivation to quit smoking. 22 Assist: propose a treatment and set a quit date. 22 Arrange: plan follow-up to prevent relapse and adjust treatment if necessary.. Nicotine replacement therapy is one of the most commonly used pharmacological methods. It involves administering nicotine by means less harmful than cigarettes, such as patches, chewing gums, inhalers, sprays, or lozenges. This helps reduce withdrawal symptoms while gradually reducing dependence.. Varenicline (Champix®) is a partial agonist of nicotinic receptors designed to reduce withdrawal symptoms and attenuate the pleasure associated with smoking, thus easing cessation. Bupropion (Zyban®) acts as a dopamine and norepinephrine reuptake inhibitor. It is used as an alternative to nicotine substitutes, especially for those who cannot use them, offering an effective therapeutic option to quit smoking. Finally, CBT aims to modify behaviors and cognitive patterns associated with tobacco dependence. These therapies can be used during preparation, cessation, and relapse prevention phases. They enable patients to acquire strategies to manage high-risk situations and overcome cravings. A combination of pharmacological treatment and CBT is often more effective..