Title: Why do people smoke and find it so hard to stop
1Why do people smoke and find it so hard to stop?
Robert West
- University College London
- November 2008
2Outline
- Why do people do anything?
- Why do people smoke?
- What does stopping doing something mean?
- Why is it hard to stop doing anything?
- Why is it hard to stop smoking?
3Why do people do anything?
- We
- act on impulse
- we do it without thinking about the consequences
- want or need something
- we seek a source of pleasure or satisfaction, or
of relief - think it is right or will serve a purpose
- we do what we consider best
- are following a plan
- we act on a prior intention
- And this motivation is stronger than any
competing motivation present at the time
4Example
- Faced with an apparent thief running towards us
on the street - the impulse is to avoid physical contact
(flinch) - there may be anticipation of satisfaction from
catching a criminal - there may be anticipation of harm from being
attacked - there may be a belief that one should be a good
citizen - there may be a prior generalised intention to
fight crime where possible - Conflict between these different types of
motivation will determine what action is taken
in the moment
5The requirement
- To develop a model that describes how different
types of motivation interact and compete to
generate responses in the moment
6A solution
- A motivational system with 5 levels, with higher
levels feeding into lower levels - Responses
- starting, stopping or modifying actions
- Impulses vs inhibition
- Activation of CNS pathways underpinning actions,
and competing pathways inhibiting them (urges) - Motives
- Mental representations of future world states
with feelings of anticipated pleasure or
satisfaction (wants) or relief (needs) - Evaluations
- Beliefs involving sense of what is useful/harmful
(functional), right/wrong (moral),
pleasing/displeasing (aesthetic) - Plans
- Mental representations of future actions
associated with feeling of varying degrees of
commitment (intentions and rules)
7The structure of the motivational system
Five interacting subsystems providing varying
levels of flexibility and requiring varying
levels of mental resources and time
p Plans r Responses i Impulses m Motives e
Evaluations
Higher level subsystems have to act through lower
level ones where they compete with direct
influences on these
8Key points
- Our behaviour is motivated at multiple levels
from impulses, motives and evaluations to plans - Higher level motivations must work through lower
level ones where they may come into conflict with
other motivations at that level - Plans have a vital role to play in organising our
behaviour and protecting our longer term
interests in the face of immediate demands - But implementing them in the face of conflicting
wants, needs and urges is effortful and uses up
mental resources
9Why do people smoke?
- They light up and puff on impulse
- much smoking is habitual, done without thinking
- They want or need to
- they expect to enjoy it they experience a
hunger for a cigarette after a period of not
smoking - They think it serves a purpose
- they expect it to help with stress, weight
control and concentration - They form plans to smoke
- they have a routine of going for a cigarette
during coffee breaks - These motivations are stronger than any competing
motivations including a plan not to smoke
10How does this arise?
- Nicotine hits from each puff of a cigarette
binds to nicotinic acetylcholine receptors in the
brain causing - dopamine release in the nucleus accumbens which
- generates an automatic impulse to smoke in the
presence of smoking cues - provides pleasure and satisfaction associated
with smoking - makes other experiences associated with smoking
more pleasurable - changes the functioning of the brain region
concerned so that when CNS nicotine levels are
depleted there is need to smoke to restore those
levels (nicotine hunger) - other chronic changes to brain chemistry
resulting in - adverse mood and physical symptoms such as anger,
depression and difficulty concentrating generate
an additional need to smoke
11What does stopping doing something mean?
- Self-consciously stopping doing something
typically means - forming a rule (plan) not to do it, or
- forming a rule (plan) that one will try not to
do it - Applying that rule in relevant situations which
generates a want or need not to do it
12Why is it so hard to stop doing anything?
- To stop ourselves doing something that is
habitual or we want or need to do, our rule must
generate more powerful competing wants and needs - This is difficult if
- the impulse, want or need to engage in the
behaviour is at least sometimes strong and/or - our capacity to generate competing wants or needs
when required is weak
13Why is it so hard to stop smoking?
- The impulse to smoke
- Many smokers experience powerful cue-driven
impulses in situations in which they would
normally smoke - The want to smoke
- Many smokers enjoy and get satisfaction from
smoking - The need to smoke
- Nicotine hunger, adverse effects of abstinence
- Positive beliefs about smoking
- Stress relief, aid to concentration, weight
control - The routine of smoking
- Strong over-learned plans to smoke at certain
times
14Rates of attempting to stop smoking
- Rate of attempts to stop decreases with age
- Data from 4374 adults aged 16 who smoked in the
past year in Smoking Toolkit Study, surveyed in
2008
15Success rates of unaided quit attempts
The need to smoke decreases rapidly after the
first week, but can re-emerge months or years
later
16Wanting and needing to smoke
- Wanting to smoke appears to deter attempts to
stop while needing to smoke leads to relapse once
an attempt is made
Data from 1479 smokers in Smoking Toolkit Study,
followed up 6 months after ratings or enjoyment
and urges were made to find out whether had
attempted to stop and if so had relapsed
17Tackling the problem at all levels reducing
motivation to smoke
- Reduce the impulse
- medication during smoking to break the
smoking-reward link - reduce exposure to smoking cues
- Reduce the want and need
- medication during smoking and abstinence to make
smoking less satisfying and reduce nicotine
hunger and adverse symptoms - control exposure to events that provoke wanting
and needing - Change beliefs
- convince smokers that smoking does not confer
benefits - Change plans
- change routines that involve smoking
18Tackling the problem at all levels increasing
motivation not to smoke
- Generate competing impulses
- set up competing habitual responses to smoking
cues - Increase the want and need not smoke
- use extrinsic rewards and punishments (e.g.
social approval, disapproval, vouchers) - maintain salience of negative feelings about
smoking (e.g, disgust, anxiety) - foster intrinsic rewards for not smoking (e.g.
achievement) - Change beliefs
- foster negative beliefs about smoking and
positive non-smoker identity - Establish firm, coherent plans
- Establish clear not a puff rule as part of new
identity - Establish clear if-then rules to minimise wants,
needs and urges
19Conclusions
- Our actions are controlled by multiple levels of
a motivational system (PRIME) with higher levels
(plans) having to work through lower levels
(impulses and inhibitions) - At every moment there may be conflict between
motivations arising from the same or different
levels - Stopping doing something involves forming a rule
(plan) which has to generate sufficiently strong
wants and needs to overpower more immediate
wants, needs and urges rising at a lower level - Stopping smoking is hard because of powerful
urges, wants and needs arising from the actions
of nicotine in the brain - The optimum solution requires attending to all
levels of the motivational system to minimise the
motivation to smoke and maximise the motivation
not to at all times