DÄ internationalArchive4/2010High Potential for Addiction
LNSLNS Whether smoking is a lifestyle habit or an addiction (1) is the subject of much controversial sociopolitical discussion, mostly of a highly emotional nature and often influenced by financial/economic considerations. In such debates, it is often forgotten that tobacco smoke, much as any other psychoactive substances, is not an “either/or” phenomenon but an “as well as” one. In Germany, on the one hand there are millions of non-dependent (lifestyle) smokers who determine their own smoking behavior, and on the other hand, there are millions of persons who are physically and psychologically dependent on smoking, and who are not able to control their smoking behavior individually. Tobacco smoke can therefore not be unequivocally categorized as an addictive substance, but it has a high addictive potential: nicotine dependency, as measured by the Fagerström test, in 356 smokers aged 15–64 years in Berlin reached an average of 37.2% (2).

According to the ICD-10, F17 (mental and behavioral disorders due to use of tobacco), tobacco dependence is a disorder. Extrapolated to the total population, some 7.2 million persons in Germany are affected by this disorder, mostly without being aware of the fact. Tobacco dependence is thus not only the main cause of epidemics such as chronic obstructive pulmonary disease, coronary heart disease, and cancers, but constitutes the very epidemic that is likely to be most severely underrated. The subcategorization into non-dependent and dependent smokers is not only statistically relevant but also has therapeutic and health -economic implications. In the first group, low threshold services to prevent addition may often be sufficient, whereas dependent smokers should be offered guideline oriented addiction therapy delivered by specially trained psychologists and doctors.
DOI: 10.3238/arztebl.2010.0059a

Dr. med. Karl-Heinz Bauer
Köhnholz 17c, 25336 Elmshorn, Germany
kaba.elmshorn@t-online.de
1.
Kraus L, Rösner S, Baumeister SE, et al.: Epidemiologischer Suchtsurvey 2006. Repräsentativerhebung zum Gebrauch und Missbrauch psychoaktiver Substanzen bei Jugendlichen und Erwachsenen in Berlin. IFT-Bericht Bd.167, München 2008.
2.
Breitling L, Rothenbacher D, Stegmaier C, Raum E, Brenner H: Older smokers’ motivation and attempts to quit smoking: Epidemiological insight into the question of lifestyle versus addiction [Aufhörversuche und -wille bei älteren Rauchern – Epidemiologische Beiträge zur Diskussion um „Lifestyle“ versus „Sucht“]. Dtsch Arztebl Int 2009; 106(27): 451–5 VOLLTEXT
1. Kraus L, Rösner S, Baumeister SE, et al.: Epidemiologischer Suchtsurvey 2006. Repräsentativerhebung zum Gebrauch und Missbrauch psychoaktiver Substanzen bei Jugendlichen und Erwachsenen in Berlin. IFT-Bericht Bd.167, München 2008.
2. Breitling L, Rothenbacher D, Stegmaier C, Raum E, Brenner H: Older smokers’ motivation and attempts to quit smoking: Epidemiological insight into the question of lifestyle versus addiction [Aufhörversuche und -wille bei älteren Rauchern – Epidemiologische Beiträge zur Diskussion um „Lifestyle“ versus „Sucht“]. Dtsch Arztebl Int 2009; 106(27): 451–5 VOLLTEXT