Nicotine dependence treatment Gdańsk

In nicotine dependence, the brain links cigarettes with the places, people, times of day and moods that have accompanied smoking for years. After quitting, any of these cues, such as the sight of a pack, the smell of smoke or a work break in the usual spot, can trigger a strong urge to smoke.

Researchers at Purdue University pooled 41 experiments in which people dependent on nicotine, alcohol, cocaine or heroin were shown objects or pictures related to their substance, as well as neutral stimuli. In all groups, exposure to these cues clearly increased participants' desire to use the substance. Their heart rate also rose slightly and they sweated more. In smokers, the urge increased more than in people dependent on alcohol.

A team at the University of Pittsburgh looked at how such situations lead to the first cigarette after quitting. Participants carried handheld computers and recorded every moment of temptation and the first cigarette they smoked as it happened, and the device also asked them for entries at random times of day. Compared with situations in which participants only felt tempted, they were more likely to light their first cigarette when in a bad mood, in places where smoking was allowed, when cigarettes were at hand and in the company of smokers. Temptations that did not end in smoking were more often linked with moving from one activity to another. During such a temptation, participants were 12 times more likely to try to cope in some way than before smoking. However, only coping strategies that involved changing their thoughts, such as reminding themselves of their reasons for quitting, protected them from lighting up, while simply doing something else did not offer such protection in this study.

The addiction therapist asks where, with whom, at what time and in what mood the patient used to smoke. Together, they decide what the patient will change in their surroundings in each situation and what they will tell themselves when cravings return.

Yes. In smokers, the disease develops more often, flares up more often and comes back more often after surgery. Crohn's disease is a chronic inflammation that can affect any part of the digestive tract, most often the last section of the small intestine. It causes diarrhoea, abdominal pain and weight loss, and flare-ups alternate with periods when symptoms ease or disappear.

According to a pooled analysis of 9 studies, smokers developed it about 76 percent more often than non-smokers. At a hospital in Paris, doctors encouraged 474 consecutive patients who smoked to quit and made it easier for them to join a dependence treatment programme. A total of 59 people, or 12 percent, stayed off cigarettes for more than a year. They were then followed for about 29 months. Flare-ups occurred as rarely in them as in patients who had never smoked, and less often than in people who kept smoking. They needed steroids and immunosuppressive medicines as often as non-smokers. The risk of surgery did not differ significantly between the groups.

A pooled analysis of 16 studies, in turn, included 2962 patients who had had surgery for the disease. In smokers, symptoms came back about twice as often as in non-smokers, and within 10 years they needed another operation about 2.5 times as often. Former smokers did not differ significantly from people who did not smoke.

A bowel disease does not rule out treatment for nicotine dependence. The manufacturer of the NiQuitin patch does not describe any clinically confirmed interactions between the nicotine in the patch and other medicines. Cytisine very commonly causes dry mouth, diarrhoea and nausea, so in a patient during a flare-up, the doctor takes this into account when choosing a medicine.

The risk of stroke starts to fall soon after quitting smoking. In large studies, the difference between former and current smokers was clear after just a few years.

In an American study, 117,006 nurses aged 30 to 55 were followed for 12 years. Among women who smoked, there were roughly 2.6 times as many strokes as among women who had never smoked, and among former smokers 1.3 times as many. In former smokers, the excess risk largely disappeared 2 to 4 years after quitting, regardless of how many cigarettes they had smoked before and the age at which they had started.

In a British study, 7735 men aged 40 to 59 were followed for almost 13 years. Smokers had a stroke about 3.7 times as often as men who had never smoked. The benefit of quitting appeared within 5 years. In men who had smoked fewer than 20 cigarettes a day, the risk of stroke fell to the level seen in non-smokers. In those who had smoked more, it remained more than twice as high. In absolute terms, men with high blood pressure gained the most.

We support Gdańsk residents in quitting through the Nasz Gabinet app or at our Gdynia clinic. During video consultations, the doctor asks about medication side effects and the strength of cravings, and adjusts treatment when needed. In the treatment plan, the addiction therapist holds video sessions with the patient, while medical staff can see in the app whether doses are being taken.

We do not have a clinic in Gdańsk. Residents can start treatment with a video consultation in the Nasz Gabinet app or an appointment at our Gdynia clinic at ul. Franciszka Sokoła 28. Neither type of consultation requires a referral, and appointments are available every day of the week between 8:00 and 20:00. Patients can connect with the doctor from home, work or any quiet place.

The doctor asks about smoking, health conditions and current medicines, then recommends medication and agrees a quit date with the patient. An e-prescription is issued for the recommended medicine and can be filled at a nearby pharmacy in Gdańsk. A cytisine course lasts 25 days, while nicotine patches are usually used for several weeks. Follow-up consultations can also take place by video in the app.

In a study from the US state of Kansas, counselling by video gave results similar to counselling by phone. It involved 566 smokers from rural areas, each of whom had 4 sessions with a counsellor. Half talked to the counsellor by video at their local clinic, and half by phone from home. After a year, test-confirmed abstinence was found in 9.8 percent of the first group and 12 percent of the second, and the analysis could not rule out that the difference was due to chance. People who talked by video, however, were more likely to use stop-smoking medicines, 56 percent of them compared with 46 percent in the phone group, and were more willing to recommend the programme to family and friends.

Only partly, and not all to the same degree. A nicotine patch eases cravings that build up from a lack of nicotine, but in laboratory studies it did not suppress the sudden urge triggered by the sight of a cigarette. Nicotine gum reduced this urge after around a quarter of an hour. Data on the effectiveness of medicines come from a review of 319 studies published in 2023 by Cochrane, an independent scientific organisation that gathers the results of clinical trials and assesses how far they can be trusted. Prices are from September 2026.

The review assessed how well medicines worked by the proportion of people who were not smoking after at least six months. The differences shown compare treatment with placebo or no medicine.

When does a nicotine patch ease cravings, and when is it not enough?

In one experiment, 61 smokers went without smoking for 6 hours while wearing a patch with 21 mg of nicotine or a nicotine-free patch. Before and after this break, they were shown cigarettes and other objects. The nicotine patch reduced cravings and the low mood caused by the break from smoking itself, but the urge triggered by the sight of cigarettes rose just as much as in people wearing the nicotine-free patch.

A similar result came from a study of 158 people on their first day of quitting, who were randomly given a patch with 35 mg of nicotine, stronger than pharmacy patches, or a nicotine-free patch. The nicotine patch lowered the overall level of craving but did not limit the sudden rise in the urge after exposure to cigarettes. In people treated with nicotine, a stronger rise in this urge was linked with a higher chance of going back to smoking.

In Poland, the patches available are NiQuitin Przezroczysty, which releases nicotine around the clock, or Nicorette Invisipatch, worn for 16 hours and removed at night. A new patch is applied every day, and its strength is reduced gradually through the stages of treatment. Without other medicines, a patch helped about 2 more people per 100 treated to quit. A ten-week course of NiQuitin patches cost from PLN 606 to PLN 930 in pharmacies.

Which medicine helps with a sudden urge to smoke?

In a multicentre study, 296 people quit smoking with nicotine gum or nicotine-free gum. On the third day without cigarettes, they were exposed to a smoking-related cue in a research laboratory and then chewed their gum. At first, the urge fell in both groups, but after 15 minutes it fell clearly more in people chewing nicotine gum.

The forms used when a sudden urge strikes include Nicorette Classic Gum, NiQuitin MINI lozenges and Nicorette Spray mouth spray. Nicotine is absorbed from them through the lining of the mouth. The patient uses no more than 15 pieces of gum or 15 lozenges a day. With the spray, no more than 2 sprays can be used for one craving episode, 4 within an hour and 64 within 24 hours. For fast-acting forms of nicotine, the combined result was about 3 extra non-smokers per 100 compared with placebo or no medicine. The doctor can combine one of these forms of nicotine with a patch. Prices ranged from PLN 62 to PLN 85 for a 150-dose spray and from PLN 78 to PLN 100 for 105 pieces of 4 mg gum.

How do cytisine and varenicline affect the urge to smoke?

Cytisine, contained in Desmoxan, Tabex and Recigar tablets at 1.5 mg each, is a plant alkaloid that binds to the same brain receptors as nicotine but stimulates them more weakly. As a result, it eases withdrawal symptoms, and a cigarette smoked during treatment gives less pleasure. The number of tablets falls from 6 a day on days 1 to 3 down to 1 or 2 towards the end of the course, which lasts 25 days. Smoking must stop by day 5 of treatment. Cytisine helped about 7 more people per 100 to stop smoking, and a pack of 100 tablets for the whole course cost from PLN 40 to PLN 78. We found no study results on its effect on the urge triggered by the sight of a cigarette, only the description of a planned study using virtual reality.

Varenicline, the active substance in Champix, also stimulates nicotine receptors more weakly. In studies, it helped about 8 more people per 100 to quit. With bupropion, the active substance in Zyban, about 3 more people per 100 quit. In an experiment involving 40 smokers, varenicline reduced overall cravings and the urge triggered by the sight of a cigarette, but not when participants had been put under stress before seeing the cigarette. Both medicines are prescription-only. In December 2023, Zyban's marketing authorisation in Poland expired. When we looked for Champix in September 2026, none of the pharmacies we checked had it.

In studies, no medicine completely removed the urge triggered by surroundings, which is why the doctor chooses the medicine and the patient prepares with an addiction therapist for situations in which the urge returns.

The doctor and addiction therapist have different roles. The doctor assesses nicotine withdrawal symptoms and selects treatment: nicotine replacement therapy or cytisine. Medical support is particularly important while the patient is quitting, and follow-up appointments are planned individually. The therapist addresses areas where medication alone is not enough: motivation, habits and situations that trigger cravings. Therapy is included only in the Anti-Nicotine Treatment Plan, costing PLN 2499. It combines a medical consultation and prescriptions for 3 months of medication with 10 sessions that Gdańsk residents attend by video in the Nasz Gabinet app. The Anti-Nicotine Course costs PLN 350 and includes a medical consultation and e-prescription, but no therapy sessions. Both options are purchased in the app; medicines are paid for at the pharmacy. Our page on addiction therapy in Gdańsk explains the therapist's approach.

The early sessions focus on motivation. The therapist helps patients identify their own reasons for quitting, using approaches such as motivational interviewing. Recalling these reasons during temptation was one of the strategies associated with avoiding a cigarette in the Pittsburgh study described below. Patients also learn about their own dependence: why they reach for a cigarette and in which situations. Before the quit date, from which they stop smoking completely, they prepare a plan for cravings. They agree the date with the doctor to fit the medication schedule; with cytisine, smoking must stop by day 5 at the latest.

After quitting, patients discuss daily habits, managing stress and emotions, and lifestyle changes with the therapist. They can also discuss concerns about weight gain if they have them. Later in therapy, patients maintain new habits and increasingly see themselves as non-smokers. They also decide with the therapist what to do if they smoke again, so that a single lapse does not lead to a return to smoking.

The Nasz Gabinet app sends a notification when each dose in the doctor's plan is due, which with cytisine means 6 reminders a day at first and 1 or 2 towards the end of treatment. After swallowing a tablet or applying a patch, the patient just taps a button on the screen. Every day, the patient takes one randomly chosen dose in front of the phone camera, and the video is reviewed by medical staff. The patient does not record gum, spray or lozenges, because they use these when the urge to smoke strikes.

The recording can also be made on the phone without internet access, for example in a place with no signal. The app then saves the video in the phone's memory and sends it together with the dose confirmation once the phone reconnects to the network, even if the app has been closed in the meantime.

The app is free to download. Patients purchase a course or treatment plan, including access to the stop-smoking programme, within the app itself, so Gdańsk residents do not need to travel. If you have questions about purchasing or installation, just call us.

• We do not provide treatment with psilocybin, a substance found in hallucinogenic mushrooms. In a small study at Johns Hopkins University, 82 smokers without mental illness were randomly given a single high dose of psilocybin or a nicotine patch, and both groups received cognitive behavioural therapy for 13 weeks. After six months, test-confirmed abstinence was found in 40.5 percent of people given psilocybin and 10 percent of those given the patch. However, participants and researchers knew who had received what, and the authors themselves called the study a pilot. In Poland, psilocybin is classified as a psychotropic substance that may only be used in scientific research.
• We do not use transcranial magnetic stimulation, which stimulates selected areas of the brain with a magnetic field from a coil placed against the head. In a multicentre study, 262 smokers who had tried unsuccessfully to quit at least once received real or sham treatment, first every day for 3 weeks and then once a week for another 3 weeks. Before each session, an urge to smoke was triggered in them. During follow-up up to week 18 of the study, at least four consecutive weeks without smoking were recorded in 19.4 percent of people who had real sessions and 8.7 percent of those who had sham sessions, and the US Food and Drug Administration later cleared the device for this use. However, the method requires a special device and daily visits to a clinic, and its effectiveness rests on a single large study, whereas cytisine and nicotine medicines have been tested in many clinical trials.