Cigarette addiction: a psychological perspective

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Cigarette addiction a psychological perspective
Robert West

• University College London
• June 2009

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Psychology, sociology and biology

• Biology
• the science of living organisms
• Sociology
• the study of human social behaviour
• Psychology
• the science of mind and behaviour

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The psychological perspective
Social and physical environment
Behaviour
Sensation Cognition Motivation Skill
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Where does motivation fit in?
Information acquisition system
Sensation
Cognition
Mental representation system
Motivation
Response generation system
Response control system
Skill
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Motivation

• Not just reasons
• Brain processes that energise and direct
  behaviour
• Relevant concepts

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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

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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Evidence Suspended plans

• The most common pattern for late relapse is
  suspension of plan to stop (Vangeli)

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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 ...

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To be continued ...

• Workshop session will explore psychological
  principles and evidence relating to smoking
  cessation counselling