1. Smoking

2. 1. What is Addiction? Addiction occurs when there is: –a strong desire to engage in a behaviour; –an impaired capacity to control the behaviour; –discomfort / distress when the behaviour is ceased; –persistence of the behaviour despite evidence that it leads to social disapproval / morbidity Chronic disorder precipitated and maintained by various biopsychosocial factors ‘… uncontrolled, compulsive use …’ Smoking: physical and psychological dependency

3. 2. Biopsychosocial Psychological processes lead to smoking Smoking has direct effects on physical health Psychological Processes Behaviour Physical Health Indirect Path Direct Path Indirect Path

4. 3. Core processes  Background factors: SES, parental smoking  Stable factors: explanatory styles, emotional disposition, generalised expectancies  Social factors: social support and peer pressure  Situational factors: appraisal and coping Distal Proximal

5. 4. Theory: Transtheoretical Model PCCPAM Self-Efficacy Temptations Pros Cons Experiential +  Processes of Change  + Behavioural Stages of Change (Prochaska & DiClemente, 1983)

6. 5. Processes: Relapse Abstinence Violation Effect Increased Self-Efficacy Decreased Self-Efficacy Coping Response No Coping Response High Risk Situation (Marlatt & Gordon, 1986) No Relapse Lapse Relapse Vulnerable phase: 6 months for smoking

7. 6. Cognitive dissonance To entertain two or more contradictory thoughts/beliefs at the same time Smokers likely to experience high dissonance: most know smoking is bad and many want to give up, but often continue to smoke. Thoughts are therefore dissonant rather than consonant – leads to feelings of discomfort

8. 7. Practice: Screening Questions: - Level of addiction: strongest factor determining quit after decision to give up Do you smoke ? Number cigarettes per day >15/day How long after waking <30mins Have you thought of giving up ?

9. 8. Practice: FRAMES (motivational interviewing) F eedback regarding personal risk or impairment after assessment of substance use patterns and associated problems R esponsibility for change is placed squarely and explicitly on the patient A dvice about changing (reducing or stopping) substance use is clearly given in a non-judgemental manner M enus of self-directed change options and treatment alternatives are offered to the patient E mpathic counselling is emphasised, e.g. showing warmth, respect, and understanding S elf-efficacy or optimistic empowerment is engendered in the to encourage change

10. 9. Practice: Tailoring Intervention to Patient Stage Patients StageClinicians Task Precontemplation Health advice; harm minimisation, informed choice Contemplation Motivational interviewing; Ideal self imagery; Value clarification Preparation Negotiate change date and preparatory tasks and goals; Enhance commitment Action Support and monitor abstinence; promote self- reinforcements Maintenance Relapse prevention, and ongoing support and input Relapse Damage control - encourage change and learning from past behaviour (strategy)