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Smoking. 1. What is Addiction? Addiction occurs when there is: –a strong desire to engage in a behaviour; –an impaired capacity to control the behaviour;

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Presentation on theme: "Smoking. 1. What is Addiction? Addiction occurs when there is: –a strong desire to engage in a behaviour; –an impaired capacity to control the behaviour;"— Presentation transcript:

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)


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