Cigarette addiction: a psychological perspective

1. Cigarette addiction: a psychological perspective Robert West University College London June 2009

2. Psychology, sociology and biology • Biology • the science of living organisms • Sociology • the study of human social behaviour • Psychology • the science of mind and behaviour

3. The psychological perspective Social and physical environment Behaviour Sensation Cognition Motivation Skill

4. Where does motivation fit in? Information acquisition system Sensation Cognition Mental representation system Motivation Response generation system Skill Response control system

5. Not just ‘reasons’ Brain processes that energise and direct behaviour Relevant concepts: Motivation

6. The psychological perspective • Why do people smoke? • nicotine from cigarettes creates motivation to smoke that is stronger than motivation not to • How do you stop people smoking? • reduce motivation to smoke and/or increase motivation not to • make it too expensive • make it socially unacceptable • limit situations where it can occur • persuade people that it is too harmful • help deal with nicotine dependence • limit and counter efforts from tobacco industry to promote it

7. The structure of human motivation Five interacting subsystems providing varying levels of flexibility and requiring varying levels of mental resources and time p Plans r Responses i Impulses m Motives e Evaluations Higher level subsystems have to act through lower level ones where they compete with direct influences on these

8. Why people smoke: impulse • Much of our behaviour is controlled by ‘habit’ Cue Response Nicotine reinforcement Nicotine hit from each cigarette puff, acts as a positive reinforcer leading to formation of cue-impulse association

9. Why people smoke: wanting a cigarette • Much of our behaviour is controlled by anticipated pleasure or satisfaction (‘wanting’) Cue Response Nicotine fuelled pleasure Nicotine from cigarettes makes the whole experience enjoyable creating pleasurable anticipation of smoking

10. Why people smoke: ‘needing’ a cigarette • Much of our behaviour is controlled by anticipated relief from mental or physical discomfort and drives Discomfort Response Relief Nicotine from cigarettes relieves craving and unpleasant nicotine withdrawal symptoms

11. Why people smoke: functional beliefs • Wanting and needing can be driven by beliefs about functions performed by an activity Experience of pleasure or relief Notice the experience Functional belief Experience of withdrawal relief leads smokers to believe that smoking helps with stress

12. Why people smoke: failure of opposing beliefs • Beliefs can be modified by wants and needs, and do not have any motivational power on their own Belief causes discomfort Need to minimise discomfort Alter or suppress the belief Beliefs that smoking is harmful, too expensive or antisocial leads people to want to stop, but they can be countered or suppressed

13. Why people smoke: failure of plans to stop • Plans can be subverted or abandoned in the face of immediate wants and needs Suspend plan not to smoke Need to smoke Lapse The ‘quit attempt’ is a plan not to smoke which can always be suspended in the face to immediate want or need to smoke

14. Evidence: Nicotine-driven Impulses • Much smoking occurs automatically in response to smoking triggers • Nicotine stimulates brain activity that makes associations between cues and impulses Piper et al, 2008

15. Evidence: Wanting to smoke • 50% of smokers report that they enjoy smoking • Nicotine stimulates brain activity associated with pleasure • Those who report that they enjoy smoking are: • one third as likely to have made a quit attempt 6-months later but are • no less likely to have succeeded if they tried Data from Smoking Toolkit Study

16. Evidence: Needing to smoke • 30% of smokers report moderate to strong urges to smoke when still smoking • Repeated nicotine exposure leads to changes in the brain that result in cravings and withdrawal symptoms • Those who experience moderate to strong urges while smoking are: • no less likely to try to stop but are • half as likely to succeed in stopping if they try at 6-month follow-up Data from Smoking Toolkit Study

17. Evidence: Functional beliefs • Smokers report that smoking: • relieves stress • aids concentration • reduces weight • Belief that smoking helps with stress, and that their life is worse now is associated with relapse • First lapse most commonly occurs in presence of negative mood Yong et al, 2008; Dijkstra et al, 2007; Vangeli 2009

18. Evidence: Suspended plans • The most common pattern for ‘late relapse’ is suspension of plan to stop (Vangeli)

19. Implications • Maintain pressure to quit by: • keeping it salient by repeatedly using • negative imagery associated with smoking • positive imagery associated with making the quit attempt using effective methods • Aid quit attempts by: • actively promoting effective methods of stopping • tackling the need to smoke with medical interventions • countering functional beliefs • promoting a strong ‘not a puff’ rule • reducing exposure to smoking cues • more sophisticated psychological interventions ...

20. To be continued ... • Workshop session will explore psychological principles and evidence relating to smoking cessation counselling