Sektion Suchtmedizin des Universitätsklinikums Tübingen, Tübingen, Germany.
Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim/Lehrstuhl für Suchtforschung, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany.
Eur Addict Res. 2022;28(5):382-400. doi: 10.1159/000525265. Epub 2022 Jun 27.
In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation.
Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online.
In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms.
除了预防烟草消费外，建立和确保高质量的烟草制品有害使用和依赖治疗仍是德国的一项重要健康相关任务。定期更新医学科学协会联合会（AWMF）的 S3 指南“吸烟与烟草依赖：筛查、诊断和治疗”（烟草指南）为戒烟提供了可持续且可靠的知识来源。
在德国精神病学、心理治疗、身心医学和神经病学学会（DGPPN）和德国成瘾研究和成瘾治疗学会（DG-Sucht）的主持下，2019-2020 年，63 名专家在 11 个工作组中修订了烟草指南。通过仔细管理利益冲突，最大限度地减少了利益冲突对指南的不当影响。来自 50 个专业学会的代表讨论了 80 条指南建议，并在线投票。
除了筛查和诊断建议外，烟草指南还对低门槛咨询和支持服务的使用采取了积极的立场。如果由于烟草相关疾病的严重程度，简短咨询、电话咨询或基于互联网或智能手机的方法不够有效，则应采用个体或小组行为疗法，可能与药物联合使用。如果尼古丁替代疗法无效，则应提供伐尼克兰或安非他酮。推荐级别较低的替代策略是催眠疗法、基于正念的治疗或使用烟碱的药物。在青少年和孕妇中，应将药物的使用限于明确规定的例外情况和尼古丁替代。对建议的总体一致性达到 98%。三个临床算法提供了烟草指南治疗建议的概述。
