Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Positionspapier

Politiker könnten Deutschland auf Weltniveau der Tabakentwöhnung bringen

Published Online:February 13, 2015https://doi.org/10.1024/0939-5911.a000347

Abstract

Die Weltgesundheitsorganisation bedauerte 2013, dass der Zugang zu kostenloser Behandlung der Tabakabhängigkeit in nur 21 Staaten der Welt eingerichtet wurde. Deutschland wird durch seine Gesetzgebung daran gehindert, zu den erfolgreichsten Staaten im Umgang mit der Tabakabhängigkeit aufzusteigen, da die Tabakabhängigkeit nicht als behandelbare und zu behandelnde Krankheit wahrgenommen, sondern die Tabakentwöhnung als Präventionsmaßnahme zur Erhöhung der Lebensqualität angesehen wird. In Deutschland rauchen gegenwärtig 29.7% der erwachsenen Bevölkerung, von denen etwa die Hälfte die ICD-10-Kriterien einer Tabakabhängigkeit erfüllen dürften. Ihr Anspruch auf eine kostenfreie – auch medikamentöse – Behandlung kann auf der Basis der derzeitigen Gesetzeslage nicht erfüllt werden, obwohl effektive Behandlungsoptionen existieren und die Behandlungen aufgrund ihrer Kosteneffektivität die zu erwartenden Krankheitskosten in Deutschland senken würden. Wenn sich Deutschland nicht dem Vorwurf einer Diskriminierung einer bedeutsamen Gruppe kranker Menschen aussetzen will, besteht dringender legislativer Handlungsbedarf.


Improving smoking cessation in Germany depends on politics

According to the World Health Organization WHO (2013), only 21 countries presently provide access to cost-covered smoking cessation services. The reason for Germany’s not attaining a high level of achievement lies in the prohibition by the German law of a full financing of clinical cessation interventions by the health insurance companies. This attitude does not take smoking cessation seriously as a treatment form of an addictive disorder, but rather mainly regards it as an intervention toward improving the individual’s quality of life. In Germany, 29.7% of the adult population smoke cigarettes daily or at least occasionally, and about a half of them may be considered dependent according to the ICD-10 criteria for tobacco dependence. Today, around the world tobacco dependence is considered to be a serious disease with even more serious future consequences. However, in Germany tobacco dependency is treated as an unhealthy lifestyle and, unlike other serious diseases, denied medical treatment (including medication) at no charge. There are effective treatment options in Germany which would even lower the costs of the health insurance system in the long-term. In order to avoid discriminating against an important group of chronically ill patients, German legislators should revise the laws forbidding full payment for smoking cessation treatment by health insurance companies.

Literatur

  • Anders, S., Strobel, L., Krampe, H. & Raupach, T. (2013). Wissen Studierende im Praktischen Jahr genug über die Behandlung der Alkohol- und Tabak-Abhängigkeit? Deutsche Medizinische Wochenschrift, 138, 23 – 27. First citation in articleGoogle Scholar

  • Berman, M., Crane, R., Seiber, E. & Munur, M. (2013). Estimating the cost of a smoking employee. Tobacco control, online first: doi:10.1136/tobaccocontrol-2012 – 050888. First citation in articleGoogle Scholar

  • Bolin, K. (2012). Economic evaluation of smoking-cessation therapies. Pharmacoeconomics, 30, 551 – 564. First citation in articleCrossref, Google Scholar

  • Cahill, K., Stevens, S., Perera, R. & Lancaster, T. (2013). Pharmacological interventions for smoking cessation: An overview and network meta-analysis. The Cochrane Library, Issue 5. First citation in articleGoogle Scholar

  • Chapman, S. & MacKenzie, R. (2010). The global research neglect of unassisted smoking cessation: Causes and consequences. PLoS Medicine, 7 (2), Online: doi: 10.1371/journal.pmed.1000216. First citation in articleCrossref, Google Scholar

  • Chevreul, K., Cadier, B., Durand-Zaleski, I., Chan, E. & Thomas, D. (2013). Cost effectiveness of full coverage of the medical management of smoking cessation in France. Tobacco control. Online first: doi:10.1136/tobaccocontrol-2012 – 050520. First citation in articleGoogle Scholar

  • Cook-Shimanek, M., Burns E. K. & Levinson, A. H. (2013). Medicinal nicotine nonuse: Smokers’ rationales for past behavior and intentions to try medicinal nicotine in a future quit attempt. Nicotine & Tobacco Research, 15, 1926 – 1933. First citation in articleCrossref, Google Scholar

  • Datamonitor (2011). Tobacco Industry Profile: Germany. Tobacco Industry Profile: Germany. First citation in articleGoogle Scholar

  • Fiore, M. C., Jaén, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., Curry, S. J. et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U. S. Department of Health and Human Services. First citation in articleGoogle Scholar

  • Freeman, M. K., Sanman, E., Kowling, K., Ng, M., Lopez, A. D., Mokdad, A., Murrac, C. L. & Gakidou, E. (2013). Concentrating risk: a systematic analysis of the global smoking epidemic. The Lancet, 381 (suppl. 2), S52. First citation in articleCrossref, Google Scholar

  • Goodwin, R. D., Pagura, J., Spiwak, J. R., Lemeshow, A. & Sareen, J. (2011). Predictors of persistent nicotine dependence among adults in the United States. Drug and Alcohol Dependence, 118, 127 – 133. First citation in articleCrossref, Google Scholar

  • Grant, B. F., Hasin, D. S., Chou, S. P., Stinson, F. S. & Dawson, D. A. (2004). Nicotine dependence and psychiatric disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 61, 1107 – 1115. First citation in articleCrossref, Google Scholar

  • Hartmann-Boyce, J., Stead, L. F., Cahill, K. & Lancaster, T. (2013). Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews. Addiction, 108, 1711 – 1721. First citation in articleCrossref, Google Scholar

  • Hughes, J. R., Helzer, J. E. & Lindberg, S. A. (2006). Prevalence of DSM/ICD-defined nicotine dependence. Drug and Alcohol Dependence, 85, 91 – 102. First citation in articleCrossref, Google Scholar

  • Lampert, T., von der Lippe, E. & Müters, S. (2013). Verbreitung des Rauchens in der Erwachsenenbevölkerung in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 56, 802 – 808. First citation in articleCrossref, Google Scholar

  • Nutt, J. D., King, L. A. & Phillips, L. D. (2010). Drug harms in the UK: A multicriteria decision analysis. The Lancet, 376, 1558 – 1565. First citation in articleCrossref, Google Scholar

  • Piné-Abata, H., McNeill, A., Murray, R., Bitton, A., Rigotti, N. & Raw, M. (2013). A survey of tobacco dependence treatment services in 121 countries. Addiction, 108, 1476 – 1484. First citation in articleCrossref, Google Scholar

  • Rasch, A. & Greiner, W. (2006). Effekte einer Erstattung der Kosten für Raucherentwöhnungsmaßnahmen durch die Krankenversicherung. Prävention und Gesundheitsförderung, 1, 269 – 277. First citation in articleCrossref, Google Scholar

  • Rasch, A., Klose, K. & Greiner, W. (2010). Verhaltenstherapeutische Raucherentwöhnung in der GKV: Analyse der Angebots- und Erstattungssituation. Prävention und Gesundheitsförderung, 5, 151 – 158. First citation in articleCrossref, Google Scholar

  • Raupach, T., West, R. & Brown, J. (2013). The most ”successful” method for failing to quit smoking is unassisted cessation. Nicotine & Tobacco Research, 15, 748 – 749. First citation in articleCrossref, Google Scholar

  • Raupach, T., Strobel, L., Beard, E., Krampe, H., Anders, S. & West, R. (2013). German medical students’ beliefs about the effectiveness of different methods of stopping smoking. Nicotine & Tobacco Research, 15, 1892 – 1901. First citation in articleCrossref, Google Scholar

  • Reda, A. A., Kotz, D., Evers, S. M. A. A. & van Schayck, C. P. (2012). Healthcare financing systems for increasing the use of tobacco dependence treatment. The Cochrane Library, Issue 6. First citation in articleGoogle Scholar

  • Ruger, J. P. & Lazar, C. M. (2012). Economic evaluation of pharmaco- and behavioral therapies for smoking cessation: A critical and systematic review of empirical research. Annual Review of Public Health, 33, 279 – 305. First citation in articleCrossref, Google Scholar

  • Schnoll, R. A., Goren, A., Annunziata, K. & Suaya, J. A. (2013). The prevalence, predictors, and associated health outcomes of high nicotine dependence using three measures among US smokers. Addiction, 108, 1989 – 2000. First citation in articleCrossref, Google Scholar

  • Stolerman, I. P. & Jarvis, M. J. (1995). The scientific case that nicotine is addictive. Psychopharmacology, 117, 2 – 10. First citation in articleCrossref, Google Scholar

  • Strobel, L., Schneider, N. K., Krampe, H., Beißbarth, T., Pukrop, T., Anders, S., West, R., Aveyard, P. & Raupach, T. (2012). German medical students lack knowledge of how to treat smoking and problem drinking. Addiction, 107, 1878 – 1882. First citation in articleCrossref, Google Scholar

  • The Lancet (2013). Tobacco control: When economics trumps health. The Lancet, 382, 182. First citation in articleGoogle Scholar

  • U.S. Departement of Health and Human Services (2014). The health consequences of smoking – 50 years of progress: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Desease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. First citation in articleGoogle Scholar

  • Vemer, P. & Rutten-van Mölken, M. P. M. H. (2010). Crossing borders: Factors affecting differences in cost-effectiveness of smoking cessation interventions between European countries. Value in Health, 13, 230 – 241. First citation in articleCrossref, Google Scholar

  • Vemer, P., Rutten-van Mölken, M. P. M. H., Kaper, J., Hoogenveen, R. T., Van Schayck, C. P. & Feenstra, T. L. (2010). If you try to stop smoking, should we pay for it? The cost-utility of reimbursing smoking cessation support in the Netherlands. Addiction, 105, 1088 – 1097. First citation in articleCrossref, Google Scholar

  • Willems, R. A., Willemsen, M. C., Smit, E. S., Nagelhout, G. E., Janssen, E. & de Vries, H. (2013). Which smoking cessation aids are proven effective according to smokers who want to quit smoking? A report from the Netherlands. Tobacco control. Online first: doi:10.1136/tobaccocontrol-2013-051076. First citation in articleGoogle Scholar

  • World Health Organization (2011). Assessment of the economic costs of smoking: Economics of tobacco toolkit. Zugriff am 07. 07. 2013. Verfügbar unter whqlibdoc.who.int/publications/2011/9789241501576_eng.pdf First citation in articleGoogle Scholar

  • World Health Organization (2013). WHO Report on the global Tobacco Epidemic, 2013. Enforcing bans on tobacco advertising, promotion and sponsorship. Zugriff am 07. 07. 2013. Verfügbar unter apps.who.int/iris/bitstream/10665/85380/1/ 9789241505871_eng.pdf First citation in articleGoogle Scholar

  • Zhan, W., Dierker, L. C., Rose, J. S., Selya, A. & Mermelstein, R. J. (2012). The natural course of nicotine dependence symptoms among adolescent smokers. Nicotine & Tobacco Research, 14, 1445 – 1452. First citation in articleCrossref, Google Scholar