Derek Heim

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Compulsion or choice? A social perspective on
tobacco dependence

• Derek Heim
• School of Psychology
• University of Central Lancashire

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Before I begin...

• Smoking kills and peoples health would be better
  if they didnt smoke.
• There is not necessarily a mechanism for sane and
  rational people continually engaging in
  potentially lethal behaviour.

3
Addiction as an explanation

• Characterises problematic behaviour.
• Focuses on individual-level / pharmacological
  processes.
• This is evidenced in the language we use to
  describe smoking (e.g. Treatment, Craving,
  Withdrawal).
• Medicalises smoking e.g. focus on nicotine.

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Problems with the concept of addiction

• Exclusive focus on addictive properties of
  substances ignores contexts and motives for
  smoking smoking can be enjoyable.
• Controlled smoking chipping (e.g. Presson et
  al., 2002).
• Rat-park studies (e.g. Alexander, 1981).
• Self-reports (e.g. Davies, 1997).

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What vs why? (Davies, 2004)

• Pharmacology of smoking explains what happens to
  peoples brain / body when they smoke.
• Cant explain why people smoke.
• Gender differences.
• Social class.

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Problems with addiction applied to smoking

• Withdrawal symptoms not the strongest predictor
  of cessation outcome (see Russel Davies, in
  press).
• Withdrawal /affective symptoms ease within 3-4
  weeks yet urge to smoke persists.
• Medical treatment not necessary.
• Close to 80 of those who quit do so without
  formal assistance (Zhu et al., 2000).
• Instantanious quitting (West Sohal, 2006).

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Evidence for compulsion is ambiguous

• People (fail to) quit all the time.
• Helpless addicts vs amazing willpower.
• Smokers show much control over their smoking
  behaviour.
• ?It is something people do, not something that
  happens to them.

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Smoking as an addiction implications

• As people learn to smoke, they learn to explain
  their behaviour in terms of addiction (Eiser,
  1977 et seq).
• Belief in addictive properties of nicotine makes
  quitting more difficult (e.g. Katz Singh,
  1986).
• Self-efficacy is undermined.

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Redressing the balance

• Drug, Set and Setting (Zinberg, 1984).
• Smoking is an unhealthy choice.
• Mediated by physiological aspects, personal
  situations and individual factors and social
  contexts.
• (So are all choices).

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Smoking has a sense-giving script

• People smoke and quit for reasons.
• If you ask people why they smoke they will give
  you meaningful answers (e.g. relaxation).
• Personal reason for stopping (e.g. family,
  children and health).
• Smoking is an appealing social identity for some.
  
• Addiction can be part of this script.

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Changing the script

• The script makes sense of smoking and provides
  the framework within which decisions to smoke or
  quit are made.
• To implement a decision to quit necessitates a
  change of the script.
• Reinventing oneself as a non-smoker.
• Addiction need not be a part of the script.
• Young smokers may not see themselves as addicted
  (Amos et al., 2006 Sheffels Shou, 2007).

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Picture by Banana Donuts (www.flickr.com/photos/an
nabananabobaloo/2967658060/)Creative commons
license
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Conclusions

• Its hard enough to stop smoking for
  pharmacological, personal and social reasons.
• Conceptualising smoking in terms of addiction /
  dependence is a barrier we can and should remove.
  

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Final thought

• ...So therapists are right when they say that
  research cant help individuals learn to live
  with suffering, resolve moral dilemmas or make
  sense of their lives. But they must be disabused
  of the notion that their clients stories are
  literally true, or that they have no part in
  shaping them...
• Tavris, 2003 xvii
• In Lilienfeld, S. O., Lynn, S. J., Lohr, J. M.
  (Eds.) (2003). Science and Pseudoscience in
  Clinical Psychology. New York Guilford.