Smoking cessation: the most effective dietary supplements

Smoking is a major public health problem that causes high morbidity and mortality worldwide. Indeed, according to WHO estimates, tobacco is responsible for more than six million deaths per year, the majority due to cardiovascular diseases, cancers and respiratory diseases. In France, despite numerous awareness campaigns and health policies aimed at reducing consumption, a substantial portion of the population remains dependent on tobacco. Quitting smoking is a major challenge for smokers because of the physical and psychological dependence induced by nicotine.

Mechanisms of dependence

Tobacco dependence results from several psycho-behavioral and pharmacological factors, mainly related to nicotine, an alkaloid present in cigarette smoke. When a person smokes, nicotine rapidly crosses the barrier between the lungs and the blood (alveolo-capillary barrier), then 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 called the "reward circuit". This activation triggers a release of dopamine, creating a sensation of pleasure and reward, which contributes to 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 according to their level of consumption and dependence. These include notably: • Light smokers: they consume fewer than five cigarettes per day, without obvious signs of dependence. • Intermittent smokers: they alternate between periods of smoking and abstinence. • Heavy dependent smokers: they consume more than 15 cigarettes per day with a high score on the Fagerström test, indicating strong dependence. • Irreducible smokers: these smokers, who represent about 5 to 10% of all smokers, are highly dependent and show low motivation to quit, often due to limited awareness of health risks.

Management strategies

The strategies for managing smoking cessation can include various pharmacological, behavioral and psychological approaches to help smokers overcome their nicotine dependence and to prevent relapses. The "5 A" model is often recommended in the management of smoking cessation: • Ask (Ask): systematically inquire about patients' smoking status. • Advise (Advise): advise quitting in a clear and personalized way. • Assess (Assess): evaluate the patient's motivation to stop smoking. • Assist (Assist): offer a treatment and set a quit date. • Arrange (Arrange): plan follow-up to prevent relapse and adjust treatment if necessary. Nicotine replacement is one of the most commonly used pharmacological methods. It consists of administering nicotine by means less harmful than the cigarette, such as patches, chewing gum, inhalers, sprays or lozenges. This reduces withdrawal symptoms while gradually decreasing dependence. Varenicline (Champix©) is a partial agonist of nicotinic receptors, designed to reduce craving symptoms and to attenuate the pleasure associated with smoking, thereby facilitating cessation. Bupropion (Zyban©) acts as an inhibitor of dopamine and norepinephrine reuptake. It is used as an alternative to nicotine substitutes, notably for people 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 the preparation, cessation and relapse prevention phases. They enable patients to acquire strategies to manage high-risk situations and overcome urges to smoke. A combination of pharmacological treatment and CBT is often more effective.