Health Psychology of smoking and alcohol use

1
Health Psychology of smoking and alcohol use
(Worldwide, alcohol and tobacco are the most
widely used drugs.)
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Models of Addiction

• Biomedical Models
• Dependence chronic brain disease
• Concordance studies of MZ and DZ twins suggest
  that genes play a role in physical dependence

3
Reward Models

• Addiction is motivated by pleasure seeking (via
  dopamine pathways)
• Support
• lab studies -gt
• Multi-substance dependence (e.g., smokers are 10
  to 14 times more likely to abuse alcohol than
  nonsmokers)

4
Social Learning Models

• Addiction is behavior -- shaped by learning as
  well as by social and cognitive factors
• Through conditioning, smokers learn to smoke in
  a variety of situations (which are triggers or
  DS)
• A persons identification (Im a drinker) plays
  a key role in the initiation and maintenance of
  an addiction (social cognition)

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Tobacco Use

• Peaked in the US in the early 1960s (half of
  adult men and one-third of women smoked)
• Today, 22.5 of adults smoke
• State with highest percentage? Lowest?
• Kentucky Utah
• Most of the decrease occurred among upper-SES
  groups and men (Nearly 33 percent of adults
  living below the poverty level smoke, compared to
  22 percent of those above the poverty level. )
• Decrease rate wont meet objectives of lt12 by
  2010

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Smoking by Education and Sex
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Smoking Among U.S. High School Students
http//www.tobaccofreekids.org
36.4 in 97 -- 21.9 in 03
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Physical Effects of Smoking

• Cigarette smoking is the single most preventable
  cause of illness, disability, and premature death
  in much of the world
• Cigarette smoking is the single most preventable
  cause of illness, disability, and premature death
  in much of the world
• In the US, men and women who smoke have their
  lives cut short by 13.2 and 14.5 years,
  respectively (CDC, 2004).

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Physical Effects of Smoking

• Half of all deaths due to cardiovascular disease,
  lung cancer, and chronic obstructive pulmonary
  disease are smoking-related

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Pathophysiology of Smoking

• Components of the smoke
• Known carcinogens (e.g., benzenes)
• As many as 2500 compounds created in smoke
  (arsenic, radioactive compounds, lead)
• CO ? ? CVD
• Nicotine
• cholesterol increase
• disturbances in heart rhythm

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Environmental Tobacco Smoke (ETS)

• contains an even higher concentration of many
  carcinogens
• Nonsmokers who are regularly exposed to ETS are
  2070 more likely to die from cardiovascular
  disease

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Stages of Smoking (see fig 5.4)

• I. Initiation
• initial use for most is unpleasant, so how does
  it start?
• Factors in teens who start smoking (pairs
  exercise)

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II. Maintenance

• Use BPS model
• Biological -- Reinforcing properties of smoking
• Seven seconds
• Nicotine stimulates the sympathetic nervous
  system, causes the release of catecholamines and
  serotonin, stimulates dopamine release in the
  brains reward system, and induces relaxation.
• Negative reinforcement (smoking takes away
  withdrawal)
• Nicotine-titration (maintaining a steady level)

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Maintenance

• Psychological
• Affect Management Model -- smokers strive to
  regulate their emotional states (stress, positive
  moods) and performance (e.g., concentration)
• Behavioral conditioning
• 73,000 trials for a 1 ppd smoker
• Associated with coffee, ETOH
• Social
• Social cues (e.g., friends, settings) and peer
  pressure
• Parental beliefs and behavior
• Societal norms and laws

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III. Cessation

• Motivation to quit (including persistence
  despite withdrawal symptoms)
• Level of physical dependence on nicotine
• Barriers to or supports in remaining smoke-free

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Other factors in cessation

• Previous quit attempts
• Stages of change model (precontemplation)
  (next slide)

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Percentage of Abstinent Former Smokers by Stage
of Quitting
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IV. Maintenance or relapse

• The relapse process (see Fig 5.6)
• Lapse vs. Relapse and The abstinence violation
  effect (dissonance and attributions)

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Health Psychologys approach to smoking

• Individual Treatment
• Public Health initiatives (including prevention)

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Individual treatment

• Addiction Model Treatments
• Nicotine gum, transdermal patches, and inhalers
  moderately successful as a stand-alone treatment
• Cognitive-Behavioral Treatments
• Which of the methods that we have discussed might
  be particularly effective?
• Use of multi-modal treatments (e.g.,
  multi-perspective cessation clinics -- p.119)

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Public Health Initiatives

• Docs advice (small, but significant effect)
• Worksite interventions (see Focus on Research
  5.2)
• Community-based programs
• e.g., Inoculation Programs (e.g., with
  adolescents)
• are tailored to developmental needs (rather than
  being based on adult programs)
• provide social supports
• teach adolescents practical skills in resisting
  social pressures to smoke

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Public Health Initiatives

• Government interventions
• Advertising restrictions
• Increase the aversive consequences of smoking
  (increasing cigarette tax increasing the
  punishment associated with underage smoking)
• Banning of smoking in public areas (e.g., NYC)