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.)

2. 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 -> • 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 person’s identification (“I’m a drinker”) plays a key role in the initiation and maintenance of an addiction (social cognition)

5. 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

6. Smoking by Education and Sex

7. Smoking Among U.S. High School Students http://www.tobaccofreekids.org 36.4% in ’97 -- 21.9% in ‘03

8. 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).

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

10. 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

11. 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

12. 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)

13. 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)

14. 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

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

16. Other factors in cessation • Previous quit attempts • Stages of change model (precontemplation…) (next slide)

17. Percentage of Abstinent Former Smokers by Stage of Quitting

18. IV. Maintenance or relapse • The relapse process (see Fig 5.6) • Lapse vs. Relapse and “The abstinence violation effect” (dissonance and attributions)

19. Health Psychology’s approach to smoking • Individual Treatment • Public Health initiatives (including prevention)

20. 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)

21. 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

22. 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)