1 Why do people smoke when they know it’s bad for them? University College London November 2013 Robert West some

2 The big picture

3 If we allow large corporations to make huge profits from a product that is cheap to make, can be made attractive to young people, addictive and causes it users to get sick and die in middle age or beyond we can expect very large numbers of people to die in middle age or beyond

Tobacco companies make massive profits From paper by Anna Gilmore in

The rise and rise of cigarette sales 5

Tobacco and other drugs Lim et al 2012 Lancet

7 Is smoking really that bad for you?

Death 8 Source: Doll et al (2004) BMJ, 328, 1519.

Difficulty getting about 9 Source: Smoking Toolkit Study, unpublished data

Problems washing and dressing 10 Source: Smoking Toolkit Study, unpublished data

Difficulties with usual activities 11 Source: Smoking Toolkit Study, unpublished data

Pain 12 Source: Smoking Toolkit Study, unpublished data

Anxiety and depression 13 Source: Smoking Toolkit Study, unpublished data

14 Why do any of us do anything?

The constant battle in our heads 15 At every moment we act in pursuit of what we most want or need at that moment

Thinking, feeling and acting 16 Thinking Feeling Acting I should do it I want/need to do it I just did it Triggers

Sources of wants and needs Duty Pleasure Pain Discomfort Imitation Curiosity Drives Boredom Emotions 17

18 Starting to smoke

Curiosity 19 I wonder what would happen if I put my head in

Impulsivity 20

Sensation seeking 21

Social pressure 22

Genes 23 NIDA NOTES, Vol. 15, No. 2, August, 2000

24 Continuing to smoke

25 Addiction to cigarettes Cigarettes deliver nicotine rapidly to the brain via the lungs in a form that is convenient, palatable and for many people socially acceptable

26 Positive reinforcement Nicotine binds to nicotinic acetylcholine receptors in the Ventral Tegmental Area

27 Positive reinforcement This increases firing of neurones in the mesolimbic dopamine pathway

28 Positive reinforcement This increases release of dopamine in the Nucleus Accumbens

29 Positive reinforcement The dopamine release ‘teaches’ the smoker to repeat the action of puffing on a cigarette just like feeding a dog teaches it to sit up and beg

30 Negative reinforcement Withdrawal discomfort, craving Puff on a cigarette Withdrawal relief More puffs

31 Nicotine withdrawal symptoms

32 Addiction to cigarettes I really want to stop smoking: it’s costing me money and it will probably kill me I need a cigarette

Smoking triggers 33 See other people smoke Drinking alcohol Having nothing to do Typical smoking situations Stress

34 How to stop smoking

The secret to stopping smoking Keep rolling the dice Load the dice in your favour 35

Ways of loading the dice Medicines – Champix Nicotine products – patches, gum, electronic cigarettes Professional advice Stop abruptly not gradually Avoid smoking triggers ‘Not a puff – no matter what’ Take on a new identity 36

Helping smokers to help themselves by bring the science of stopping to smokers 37