From cytisine to psychological paths, via drugs and alternative techniques: what really works to quit smoking and why it is easier to do so today
Quitting smoking has never been easy, but today it can be a little less difficult. At the heart of this strategy is a name still little known to the general public: cytisine.
Since March 30, the Italian National Health Service has been reimbursing citisin-based medication, facilitating access to one of the most effective therapies for quitting smoking. This initiative aims to support those suffering from addiction by breaking down economic barriers. To access the benefit, however, it is mandatory to visit a smoke-free centre and to combine medical treatment with ongoing psychological and behavioural support.
"The studies and the first results clearly indicate that the combination of cognitive-behavioural paths and pharmacological treatment is the one that offers the highest probability of success," explains psychologist Silvia Marini, who leads the anti-smoking courses of Lilt Firenze - Lega Italiana per la lotta contro i tumori (source in Italian).
Lilt's new cycle 'Try Freedom, Leave Cigarettes Behind', starting on 10 April, focuses precisely on this mix: eight structured meetings, flanked - when indicated - by customised pharmacological support.
What is cytisine and how does it really work
Citisin is a substance of plant origin that acts directly on the brain's nicotinic receptors. In practice, it 'tricks' the addiction system.
The result? The smoker stops getting satisfaction from the act and, at the same time, suffers less from nicotine withdrawal.
The scientific data are promising: in a study conducted in Italy, 32.1 percent of the participants treated with cytisine stopped smoking after 12 months, compared to just 7.3 per cent of those who had only received psychological support. A figure that speaks volumes about the potential of the drug, especially if it is included in a structured pathway.
The decisive role of behavioural therapy
Beware, however: it is not the drug that does all the work. The real difference is made by the context in which it is used.
The path proposed by Lilt works on daily habits, those most difficult to break. The cigarette after coffee, the one to manage stress, the 'automatic' one without even realising it. This is what cognitive-behavioural work is for: recognising the mechanisms and changing them.
The aim is to carry out programmes that help recognise smoking triggers, manage anxiety, and change ingrained habits. When cytisine is used, the patient is followed by a doctor who assesses suitability and synchronises the therapy with the psychological course.
It is precisely this integration that makes the difference: the drug acts on the body, the therapy on the mind. And together they increase the probability of success.
The numbers of smoking and cancer: why quitting is urgent
Behind all this is not only individual well-being, but a huge public health issue. Smoking remains the main avoidable risk factor for lung cancer.
There are around 45,000 new cases every year in Italy, and this neoplasm continues to be one of the main causes of cancer death. More generally, cancer diagnoses in our country exceed 360 thousand per year.
Globally, the picture is even starker: lung cancer causes around 1.8 million deaths each year. Numbers that explain why every attempt to quit is not just a personal choice, but a concrete investment in one's health.
And although mortality has been falling in recent years thanks to better diagnosis and treatment, the link with smoking remains very strong.
Not only citisin: other smoking cessation drugs
Cytisine is not the only option available. There are several pharmacological tools, often used in combination with psychological support:
Compared to other drugs, cytisine stands out for its lower cost and good efficacy profile, which is why it is also attracting more and more attention in Europe.
Alternative techniques: what really works
Alongside drugs, alternative or complementary approaches have become increasingly popular in recent years, often chosen by those seeking a less medicalised path or wanting to strengthen their motivation.
Among these, mindfulness and meditation are gaining ground: they help recognise the urge to smoke without reacting automatically, working on awareness and stress management, which is one of the main triggers of addiction.Hypnosis is also used in some cases, but with very variable results: it may work well on particularly receptive people, but does not have the same solid evidence as other approaches.
More debated is the role of the electronic cigarette. For some smokers, it represents a useful transitional phase because it maintains the act by reducing, at least in part, exposure to the most harmful substances. However, it is not without risk and is not considered a definitive solution, so much so that its use remains a subject of debate in the scientific community.
Finally, digital solutions are also growing rapidly: apps and online programmes that accompany those who want to quit day by day, with reminders, progress monitoring and motivational support. Useful tools, especially for maintaining consistency and awareness over time.
The point, however, remains the same: none of these techniques alone guarantees results comparable to those of a structured course. The strongest evidence indicates that the real quantum leap comes when several approaches are combined, adapted to the characteristics and needs of the individual person.
DW Russian 
