Download Introduction to Psychology

Health Psychology of
smoking and alcohol use
(Worldwide, alcohol and
tobacco are the most widely
used drugs.)
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
Reward Models
Addiction is motivated by
pleasure seeking (via
dopamine pathways)
Support:
lab studies ->
Multi-substance
dependence (e.g., smokers
are 10 to 14 times more
likely to abuse alcohol
than nonsmokers)
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 person’s identification (“I’m a drinker”) plays a
key role in the initiation and maintenance of an
addiction (social cognition)
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 won’t meet objectives of
<12% by 2010
Smoking by
Education and Sex
Smoking Among U.S. High
School Students
http://www.tobaccofreekids.org
36.4% in ’97 -- 21.9% in ‘03
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).
Physical Effects of Smoking
Half of all deaths due to cardiovascular
disease, lung cancer, and chronic
obstructive pulmonary disease are
smoking-related
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
Environmental Tobacco
Smoke (ETS)
contains an even higher concentration of
many carcinogens
Nonsmokers who are regularly exposed to
ETS are 20–70% more likely to die from
cardiovascular disease
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)
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 brain’s reward system, and induces relaxation.
Negative reinforcement (smoking takes away
withdrawal)
Nicotine-titration (maintaining a steady level)
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
III. Cessation
 Motivation to quit
(including persistence
despite withdrawal
symptoms)
 Level of physical
dependence on
nicotine
 Barriers to or
supports in remaining
smoke-free
Other factors
in cessation
Previous quit attempts
 Stages of change model
(precontemplation…) (next slide)
Percentage of Abstinent Former
Smokers by Stage of Quitting
IV. Maintenance or relapse
• The
relapse process (see Fig 5.6)
• Lapse vs. Relapse and “The abstinence
violation effect” (dissonance and attributions)
Health Psychology’s
approach to smoking
Individual Treatment
Public Health initiatives (including
prevention)
Individual treatment
Addiction Model Treatments
Nicotine gum, transdermal patches, and
inhalers — moderately successful as a standalone treatment
Cognitive-Behavioral Treatments
Which of the methods that we have
discussed might be particularly effective?
Use of multi-modal treatments (e.g., multiperspective cessation clinics -- p.119)
Public Health Initiatives
Doc’s 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
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)