Nicotine dependence treatment Wrocław

Nicotine from cigarette smoke passes through the lungs into the blood and reaches the brain within a few seconds. There it binds to nicotinic receptors and increases the release of dopamine, a substance linked to feelings of pleasure and reward. This rapid effect after every puff reinforces the habit of reaching for a cigarette. The World Health Organization recognises nicotine dependence, also called nicotine addiction, as a disease and describes it in the ICD-10 classification under code F17.2 and in ICD-11 under code 6C4A.2.

In someone who smokes every day, the brain adapts to the constant presence of nicotine, and the number of nicotinic receptors grows. When the nicotine level drops, irritability, anxiety, low mood and cravings appear, and the next cigarette relieves them for a while. According to a review published in the New England Journal of Medicine, this relief of withdrawal symptoms is probably the main reason smokers feel calmer and concentrate better after a cigarette.

Withdrawal symptoms ease after a few weeks, but the urge to smoke can return for much longer. After years of smoking with coffee, after meals, with alcohol or among friends who smoke, these situations alone can trigger cravings, as can the smell of smoke or holding a cigarette. That is why the Anti-Nicotine Treatment Plan combines medication, if recommended by the doctor, with sessions in which an addiction therapist helps the patient prepare for these situations.

In a review of prospective studies, smoking increased the risk of periodontitis, a disease of the gums and the tissues that hold the teeth in place, by 85 percent. In long-term studies, smokers had a more than two and a half times higher risk of losing teeth than people who had never smoked. According to the World Health Organization, smoking also causes brown or black stains on the teeth, a changed sense of taste and bad breath.

After quitting, these risks go down. In former smokers, the risk of periodontitis did not differ significantly from that of people who had never smoked, and the risk of tooth loss was close to that of people who had never smoked. These were observational studies. Smoking also gets in the way of dental treatment: in an analysis of 32 studies involving more than 14,000 patients, smokers were twice as likely as non-smokers to have an early dental implant failure.

A patient who is planning dental implants or being treated for gum disease should tell their dentist that they smoke and are starting treatment to quit.

The first changes in the body come quickly. According to the WHO, after 12 hours without a cigarette the carbon monoxide level in the blood returns to normal, and after a year the risk of coronary heart disease is about half that of someone who keeps smoking. In a large US study, smokers lived more than 10 years less than people who had never smoked, and people who quit between the ages of 35 and 44 gained about 9 years of life.

Quitting smoking also improves how people feel. In a summary of 26 studies, people who stopped smoking had fewer symptoms of anxiety, depression and stress at the next measurement, taken 7 weeks to 9 years later, than people who kept smoking. There is money left over too. At the average price of a pack of cigarettes in 2025, PLN 21.61, a person who smokes a pack a day spends about PLN 7,900 a year.

Patients do not have to face quitting alone. If the first few weeks are difficult, they can request an earlier medical appointment and, with the treatment plan, an earlier session in the app. No referral is needed for the first appointment at ul. Dworcowa 11b or by video.

The doctor asks how many cigarettes the patient smokes a day and how soon after waking up they light the first one. These two answers determine, among other things, the dose of nicotine gum or lozenges. We also talk about previous attempts to quit: which medicine the patient used, how long they took it and in what situation they went back to cigarettes. We ask about e-cigarettes, heated tobacco and nicotine pouches as well, because nicotine from any of these sources keeps the dependence going.

Before choosing a medicine, we check what conditions the patient has and what medicines they take, because some conditions and medicines change the treatment plan. Cytisine is not used after a recent heart attack or stroke, in unstable angina, or during pregnancy and breastfeeding, among other situations. A person who takes clozapine, olanzapine or theophylline, for example, should tell the doctor who prescribed these medicines before quitting, because without tobacco smoke their blood levels rise.

The first appointment at Nasz Gabinet in Wrocław takes place at the clinic at ul. Dworcowa 11b or by video in the Nasz Gabinet app. It is included in one of two treatment options purchased in the app. The Anti-Nicotine Course costs PLN 350 and covers a consultation with an e-prescription for the selected medicine. The Anti-Nicotine Treatment Plan costs PLN 2499 and includes a medical consultation with prescriptions for 3 months of medication and 10 sessions with an addiction therapist. No referral is needed. You do not need to stop smoking before the appointment, as the quit day is set after the medicine has been chosen. Treatment is provided by Dr Bogdan Bas, a physician specialising in addiction treatment, together with addiction therapists.

What should you bring to the first appointment?

• a list of all the medicines you take, with doses, including those bought without a prescription;
• your hospital discharge summary, if you have been treated for a heart attack, stroke or heart rhythm disorder;
• the names of the medicines you used in previous attempts to quit, and how long it was before you went back to cigarettes;
• information about which e-cigarettes, heated tobacco products or nicotine pouches you use and how often.

Most cytisine products and all forms of nicotine replacement therapy are sold in Poland without a prescription. At the appointment, the doctor assesses what the patient cannot judge from the leaflet alone: whether cytisine is safe with their conditions and medicines, whether a patch combined with gum or a lozenge would work better, and what dose to start with.

Of people who quit without any help, only 3 to 5 per cent are still not smoking after six months or a year. In studies, people who received support from a therapist alongside medication were more likely to quit than those taking medication alone. Therapists in these studies usually provided 4 to 8 sessions. This is why Nasz Gabinet in Wrocław offers a treatment plan combining a medical consultation with sessions with an addiction therapist.

How do we choose a stop-smoking medicine for people with heart disease and during pregnancy?

We do not offer cytisine to people who have recently had a heart attack or stroke or who have unstable angina. Manufacturers of nicotine patches, gum and lozenges advise caution in these patients, and combining a patch with gum or a lozenge needs a doctor's assessment. A woman who is pregnant or breastfeeding does not take cytisine, and if she cannot quit without medication, the doctor may recommend nicotine patches, gum or lozenges.

In September 2026, varenicline and bupropion were not available in the pharmacies we checked, so in practice the choice today comes down to cytisine and nicotine replacement therapy.

The effectiveness column shows the percentage of people who were not smoking after at least six months. In groups that tried to quit without medication, this was 6 percent on average, and among people taking cytisine, for example, 13 percent. The results come from an analysis of 319 studies prepared by Cochrane, an independent international organisation of researchers who gather and compare the results of studies on a given topic. The table lists example brand names, not every product.

Based on online pharmacy prices in September 2026, a full course of cytisine costs about PLN 40 to 78, and a 10-week course of 24-hour patches about PLN 606 to 930. The 16-hour 25 mg patch costs PLN 57 to 112 for 7 patches, 4 mg gum PLN 78 to 100 for 105 pieces, and the spray PLN 62 to 85 for 150 sprays. None of these medicines is reimbursed by Poland's National Health Fund (NFZ).

An addiction therapist helps the patient recognise the situations in which they reach for a cigarette and work out how to get through each of them without smoking. Some people smoke with coffee or out of boredom, others under stress or with friends who smoke, so each patient builds their own plan for dealing with cravings. In the following sessions, the patient checks which parts of the plan worked and talks through the moments when they came close to lighting up.

Work with the therapist also includes:

• discussing why the patient wants to stop smoking, including through motivational interviewing, in which the therapist helps them explore their own reasons for quitting and any doubts they have,
• preparing for quit day, the first day completely without cigarettes, whose date is agreed with the doctor because it depends on the medicine,
• developing new daily routines to replace smoking, managing stress and emotions, and making lifestyle changes, including discussing worries about weight gain,
• later in therapy, making new habits last, developing a sense of oneself as a non-smoker and deciding what to do after a lapse to avoid a return to daily smoking.

Who provides the sessions, and how many are there?

The Anti-Nicotine Treatment Plan includes 10 sessions. They are provided by Dr Agata Niezabitowska, a certified addiction therapist, and Aleksandra Szypowska, MA, a psychologist and certified addiction psychotherapy specialist who also uses a cognitive behavioural approach. Patients meet their therapist by video in the Nasz Gabinet app.

The doctor manages medication. They assess nicotine withdrawal symptoms and change the dose or medicine if needed. Their support is particularly important during the weeks when the patient is quitting. The doctor and patient agree the timing of the next follow-up individually.

The Nasz Gabinet app mainly helps patients take their stop-smoking medicine regularly and at the right times. The doctor sets the medicine, doses and times at the appointment, and the app sends a reminder for every dose in the treatment plan. With cytisine it reminds you about each tablet, and with a patch it reminds you to put on a new patch in the morning.

The home screen shows the current day of treatment, the time of the next dose, the number of smoke-free days and the money saved on cigarettes. If the doctor has set quit day later than the first day of treatment, the app also shows how many days remain. The treatment programme, either the Anti-Nicotine Course or the Anti-Nicotine Treatment Plan, is purchased in the Nasz Gabinet app. Contact the clinic if you need help with purchasing or installation.

• We do not use acupuncture or laser therapy. Cochrane gathered the results of 38 studies and found no reliable evidence that acupuncture, acupressure or laser therapy help people stay off cigarettes for six months or longer.
• We do not use electrostimulation. In the same review of studies, electrostimulation proved ineffective.

Yes. We treat people who want to stop using e-cigarettes, including those who switched to them from cigarettes. Switching to an e-cigarette does not end nicotine dependence, because the body is still getting nicotine.

At the appointment, we find out how much nicotine the patient takes in: the strength of the liquid and how many millilitres they use a day, or how many nicotine pouches they put under their lip each day. The manufacturer's instructions for the 24-hour nicotine patch also cover people who want to stop using e-cigarettes or nicotine pouches. However, most studies of stop-smoking medicines were carried out in cigarette smokers, so less is known about treating people who use only e-cigarettes.

Sessions with a therapist work much as they do for cigarette smokers: the patient looks for ways to cope with the situations in which they reach for their e-cigarette.

We set the quit date together with the patient, depending on the medicine chosen. The patient starts a course of cytisine while still smoking and smokes the last cigarette no later than the fifth day of taking the tablets. The first 24-hour patch is usually put on the day the patient stops smoking.

Nicotine withdrawal symptoms are strongest in the first week and usually last 2 to 4 weeks, and among people who quit without help, most relapses happen within the first 8 days. In a session with an addiction therapist, the patient decides what they will do when a craving hits in the car, after a meal or when drinking alcohol.

Anyone who smokes a cigarette in the first few days can ask for an earlier appointment or session. At the appointment, we look at the situation in which the patient smoked, and the doctor decides whether to continue the course.

First, we find out why the patient went back to smoking: whether they took the medicine according to the schedule, whether the patch or gum dose was high enough, and in what situation they smoked the first cigarette. These answers determine what we change in the next attempt.

A course of cytisine can be repeated after 2 to 3 months. If one form of nicotine replacement therapy did not help, the doctor may suggest a patch combined with gum or a lozenge: pooled study results found this combination more effective than a single form. If the previous attempt did not include a therapist, we suggest a treatment plan with 10 sessions with an addiction therapist for the next attempt.