Nicotine dependence treatment Bydgoszcz

In the brain, nicotine binds to nicotinic receptors. These are sites on nerve cells that normally receive signals carried by acetylcholine, one of the messengers of the nervous system. In someone who smokes every day, nicotine stimulates these receptors for most of the day, and the brain adapts, partly by increasing their number. After the last cigarette, this change does not disappear straight away.

A 2009 US study looked at how long it lasts. In 19 people who had stopped smoking, the number of available nicotinic receptors was measured with brain imaging, in some of them several times over the following weeks. The results were compared with those of 20 non-smokers of similar age. A week after the last cigarette, there were clearly more receptors than in non-smokers. According to the authors, this difference lasted for up to about a month, and after 6 to 12 weeks the number of receptors was the same as in non-smokers. Participants who, after 4 weeks, had more receptors in one of the brain areas studied had stronger cravings.

The study involved few people, so its results need to be confirmed. It does suggest, however, that the changes in the brain do not reverse within a few days. Nicotine withdrawal symptoms, such as irritability, anxiety and difficulty concentrating, are strongest in the first week without cigarettes. A stop-smoking medicine eases them during exactly this period, and an addiction therapist helps the patient plan the first weeks without smoking.

Smoking increases the risk of cataracts, a clouding of the lens of the eye that is treated with surgery. A Swedish study followed 44,371 men aged 45 to 79 for 12 years. Men who smoked more than 15 cigarettes a day had cataract surgery 42 percent more often than men who had never smoked. The more someone smoked, the higher the risk.

In men who quit smoking, the risk of cataract surgery fell over the years. Even more than 20 years after the last cigarette, however, it was still higher than in non-smokers. In former smokers who used to smoke more than 15 cigarettes a day it was 21 percent higher, and in those who had smoked no more than 15 cigarettes a day 13 percent higher. In lighter smokers, the risk started to fall sooner.

Age-related macular degeneration damages the central part of the retina, which lets us see detail, such as letters when reading. A UK study compared 435 people with the advanced form of this disease with 280 people without it. The risk rose with the number of cigarettes smoked. In people who had smoked as many cigarettes in their lifetime as a pack a day for more than 40 years, it was almost three times higher than in non-smokers. In people who had not smoked for more than 20 years, the risk was similar to that of people who had never smoked.

Smoking increases the risk of bone fractures. In a summary of 10 studies involving 59,232 people from several countries, smokers had a 25 percent higher risk of breaking any bone than non-smokers. Their risk of hip fracture was 84 percent higher. In a US study of 116,229 nurses followed for up to 12 years, the risk of hip fracture in women who quit smoking fell only after 10 years. By then it was about 30 percent lower than in women who kept smoking. This effect takes years to appear, so the earlier someone quits, the better.

Patients in Bydgoszcz receive support from the doctor and the app, and those who choose the Anti-Nicotine Treatment Plan also work with an addiction therapist. The doctor selects the medicine and checks whether the patient tolerates it well. In the treatment plan, the therapist helps patients practise what to do when cravings return, while the app reminds them when to take their medicine. If the medicine causes symptoms or cravings do not ease, patients do not have to wait for their scheduled appointment. They can arrange an earlier visit at ul. Cieszkowskiego 5 or a video consultation in the app, any day of the week.

No referral is needed for the first medical appointment. Nasz Gabinet in Bydgoszcz at ul. Augusta Cieszkowskiego 5 is open every day from 8:00 to 20:00. Patients can see a doctor at the clinic or by video in the Nasz Gabinet app. Video consultations also allow people in Toruń, Inowrocław, Świecie and Nakło nad Notecią to receive treatment without travelling.

The doctor finds out from the patient how long they have smoked, how many cigarettes they smoke a day, what conditions they are being treated for and what medicines they take regularly. Based on this, the doctor diagnoses nicotine dependence, also called nicotine addiction, and decides whether the patient needs a stop-smoking medicine. If so, the doctor chooses the medicine and sets the dosage. Together with the patient, the doctor sets the quit date and the date of the next appointment.

Patients in Bydgoszcz choose one of two treatment options in the Nasz Gabinet app. The Anti-Nicotine Course costs PLN 350 and includes a medical consultation with an e-prescription for the medicine selected by the doctor. The Anti-Nicotine Treatment Plan costs PLN 2499 and includes a consultation, prescriptions for 3 months of medication and 10 sessions with an addiction therapist. Patients pay for the medicine separately at the pharmacy.

After a puff of smoke, the nicotine level in the blood rises sharply. Nicotine medicines raise it more slowly and to a lower level, and cytisine contains no nicotine at all. Cytisine and all forms of nicotine, that is, patches, chewing gum, mouth spray and lozenges, are available in pharmacies without a prescription. Cochrane is an international network of researchers who gather the results of clinical trials and check how reliable they are. In the network's 2023 review, stop-smoking medicines were compared on the basis of 319 studies.

The Cochrane review assessed how well medicines worked by looking at how many patients were not smoking after at least six months. The differences shown compare treatment with placebo or no medicine.

How does cytisine work?

Desmoxan, Tabex and Recigar contain cytisine, an alkaloid of plant origin. Cytisine attaches to nicotinic receptors and stimulates them more weakly than nicotine, which eases withdrawal symptoms. By occupying these receptors, it also weakens the effect of nicotine from a cigarette smoked during treatment. After a tablet is swallowed, cytisine reaches its highest blood level in just under an hour on average, and its half-life, the time it takes the body to clear half of the medicine, is about 4 hours.

On days 1 to 3, the patient swallows a tablet every 2 hours, up to 6 a day in total. The intervals between tablets then get longer, and in the last days of the 25-day course 1 or 2 tablets a day are enough. The patient stops smoking by day 5 at the latest. With cytisine, 7 more people in every 100 treated quit smoking than with placebo or no medicine. In September 2026, a full course of cytisine cost about PLN 40 to 78. Women who are pregnant or breastfeeding must not take cytisine. The doctor will also not choose it if the patient has recently had a heart attack or stroke, or has unstable angina or significant heart rhythm disorders.

How does a nicotine patch work?

A patch releases nicotine through the skin slowly and without sharp rises in level. With the NiQuitin Przezroczysty 21 mg per day patch, the blood nicotine level settles after the second patch is applied. It is then less than half the average level during half an hour of smoking cigarettes. The patient wears the Nicorette Invisipatch from waking up until going to bed, and the nicotine level in the blood is highest about 9 hours after it is applied.

That is why a patch eases withdrawal symptoms throughout the day, but will not help within minutes when a sudden urge to smoke comes. With a patch alone, 2 more people in every 100 quit smoking than without medication. In September 2026, NiQuitin patches for a whole ten-week course meant spending about PLN 606 to 930.

How do gum, spray and lozenges work?

From gum, spray and lozenges, nicotine is absorbed through the lining of the mouth, so it works faster than from a patch. After a 2 mg dose of Nicorette Spray, the nicotine level in the blood is highest after about 13 minutes. A NiQuitin MINI lozenge usually dissolves in the mouth within 10 minutes. With Nicorette Classic Gum, the highest nicotine level comes 5 to 10 minutes after chewing stops. The patient reaches for these medicines when the urge to smoke comes.

For fast-acting forms of nicotine, the combined result was about 3 more non-smokers in 100 compared with placebo or no medicine. The doctor may also combine a patch with gum, spray or lozenges. In the review, this combination proved only slightly less effective than cytisine, but the authors could not be sure the difference was not due to chance. In September 2026, 4 mg gum in packs of 105 cost PLN 78 to 100. A spray with 150 doses cost less, PLN 62 to 85.

Are varenicline and bupropion available in Poland?

Champix contains varenicline, which, like cytisine, acts on nicotinic receptors. Zyban contains bupropion, an antidepressant. In the review, 8 more people in 100 quit smoking with varenicline and 3 more with bupropion. Both medicines are available only on prescription. In September 2026, Champix was not available in any of the pharmacies we checked, and Zyban has had no valid marketing authorisation since December 2023. So the doctor in Bydgoszcz usually chooses between cytisine and nicotine medicines.

The Anti-Nicotine Treatment Plan includes 10 sessions with an addiction therapist, held by video in the Nasz Gabinet app. If a patient also has an addiction to alcohol or another substance, we treat both addictions alongside each other through addiction therapy in Bydgoszcz.

The first sessions take place before the quit date agreed with the doctor. Patients describe when and why they smoke and work with the therapist to identify the situations in which they most often reach for a cigarette. They also discuss their own reasons for wanting to stop and any doubts still holding them back. Motivational interviewing is one way of having this conversation. The quit date marks the start of complete abstinence from smoking, so patients prepare a plan for cravings beforehand: what they will do instead of smoking. The date must fit the medication schedule; with cytisine, it must be no later than day 5 of treatment.

After the quit date, the therapist helps patients change daily routines associated with cigarettes and find other ways to manage stress and emotions. Sessions can also address concerns about weight gain and lifestyle changes. Later sessions focus on maintaining new habits and becoming comfortable with being a non-smoker. Patients also make a plan for a lapse, so that one cigarette does not lead to a return to smoking. Meanwhile, the doctor assesses nicotine withdrawal symptoms and checks how well the patient tolerates cytisine or nicotine replacement therapy. Medical support is particularly important during the quitting period, and follow-up appointments are arranged individually.

In the Nasz Gabinet app, we record the treatment plan agreed with the doctor: the name of the medicine, the doses and the times to take them. The app sends a notification for every cytisine tablet and for putting on a patch. The patient records a video of themselves taking one dose a day, chosen at random by the app. They mark the other doses as taken with a single tap.

The patient uses gum, spray and lozenges when the urge to smoke comes, so they have no fixed times. The patient marks each use in the app, without recording a video. The app adds them up over the day and shows the number next to the daily limit from the treatment plan, for example 15 pieces of gum a day. Medical staff can see in the app which doses the patient has taken and how many times they reached for gum or spray.

The app itself is free. Patients purchase a course or treatment plan within it; either option gives access to the stop-smoking programme. Visit us at ul. Cieszkowskiego 5 or call the clinic. We can help install the app and make the purchase, then enter the doctor's recommendations in it straight away.

• We do not use aversion therapy. It links smoking with something unpleasant to put people off cigarettes, and its most studied form is rapid smoking, inhaling smoke quickly until smoking becomes unpleasant. A review of 25 studies of such methods found that most of them had serious flaws. The only study in which not smoking was confirmed by a laboratory test showed no benefit. The authors of the review concluded that the evidence does not allow the effectiveness of rapid smoking to be assessed, and that milder aversive methods did not prove effective.
• We do not recommend products containing lobeline, an alkaloid from the lobelia plant that acts on nicotinic receptors. A 2012 review of studies did not find a single study that checked whether people taking lobeline were not smoking after at least six months. A large study with a short follow-up period did not show that lobeline helped people quit.