Traitement de la dépendance tabagique

Abstract

Tobacco consumption is one of the major causes of cardiovascular events. Together with hypercholesterolemia and arterial hypertension, smoking is responsible for large artery atherosclerosis, whatever the lesion localization. Therefore, smoking cessation is mandatory in case of any vascular event. In primary and secondary prevention as well, immediate benefit is observed. Despite the existence of such risk and awareness of its seriousness, over 50% of the smokers keep smoking; the reason for such paradox is known: smoking is a behaviour reinforced by an addiction due to the psychoactive properties of nicotine. Addiction is an explanation for all hindrances encountered when fighting tobacco consumption, both at the individual and the general level. For smokers having experienced vascular events, difficulties are important and due to paradoxically insufficient motivation for cessation, to the severity of addiction, and to the frequency of associate anxiousness and depressive disorders. Assistance for smoking cessation is a multiple step procedure that includes: the evaluation and the reinforcement of the basic smoker’s motivation; the implementation of smoking stoppage with prior assessment of the addiction, screening for other psychoactive substances consumption, and detection of anxious and depressive comorbidities; the prevention of relapses, known to be frequent but avoidable with adequate strategies. Only three types of treatment have demonstrated an efficient action: nicotine replacement therapy (patches, chewing gums, …); behavious and cognitive therapies; psychotropic drugs that exert a general activity on the withdrawal syndrome (bupropion), or a specific activity such as the antidepressive agents, particularly the serotonin recapture inhibitors that are utilized in case of anxious and depressive disorders.