Smoking

Individual Differences, Psychopathology, And Emotion

David G. Gilbert

• Publisher: Taylor & Francis
• Year: 2014
• Print ISBN: 9781138996175
• eBook ISBN: 9781317837169
• Topic: Psychologie
• Subtopic: Addiction en psychologie

Personality, psychopathology and emotional factors are intimately related to smoking, yet there are few efforts to integrate relevant findings in these areas. Taking a comprehensive, current and detailed view, this text develops an empirically-based model that reflects the multi-dimensional, individual-difference-related causal paths associated with smoking and its reinforcing and affect-modulating effects.; Starting with a review of models of smoking motivation, this volume then goes on to discuss effect and emotion, and the nature, biological bias and relationships among personality, temperament and psychopathology. Other chapters focus attention on questions of when, in whom and what mechanisms promote and reinforce smoking and tobacco use such as gender differences. Utilising the findings of these chapters, the integrative biopsychosocial STAR Model Of Smoking Effects And Motivation Is Presented And Its Implications are examined.; As the percentage of smokers in the general population decreases, a growing number of those continuing to smoke will be even more difficult to reach. Such individuals will benefit from the individualised and intensive interventions suggested here. This text is intended to be of use to psychologists, psychiatrists, physicians, epidemiologists, sociologists and other health professionals.

 

 

 

 

 

Chapter 1

Introduction and Overview: Smoking’s Relationship to Individual Differences, Psychopathology, and Emotion

 

 

 

 

 

WHY INDIVIDUAL DIFFERENCES, PSYCHOPATHOLOGY, AND EMOTION NOW?

The 1988 Surgeon General’s report (or SGR, U.S. Department of Health and Human Services |USDHHS|, 1988) proclaiming smoking to be an addiction “similar to heroin and cocaine” (p. 9) was followed by an explosion of research on the individual differences, the psychopathology, and emotional processes associated with smoking. The 1988 SGR assessed relationships of smoking with stress, coping, and affect but gave little attention to individual differences in personality and psychopathology associated with smoking and devoted only a few sentences to genetic factors associated with smoking. U.S. congressional hearings on whether smoking is addictive and whether cigarettes should be further regulated received a great deal of press during April 1994. The front cover of the April 18, 1994. Time magazine depicted a smoker with a dozen guns aimed at his head and the caption “Is It All Over for Smokers? The Battle Against Tobacco Is Turning Into a Rout” (Farley, 1994). Members of the House of Representatives attacked tobacco, saying that it was spiked with added nicotine so as to ensure that smokers became hooked. In contrast, tobacco industry executives countered by saying that tobacco can be considered addictive only under a very liberal definition of addiction that includes things such as coffee. James W. Johnson, chairman and CEO of R. J. Reynolds Tobacco Company, told a House subcommittee that nicotine is not addictive and that “the allegation that smoking cigarettes is addictive is part of a growing and disturbing trend that has destroyed the meaning of the term, by characterizing virtually any enjoyable activity as addictive, whether it is eating sweets, drinking coffee, playing video games or watching TV” (Shapiro, 1994, p. A4). These debates have rarely included discussion of individual differences in predisposition to smoke or the mechanisms involved in becoming a highly dependent smoker. Empirical evidence makes it clear that almost all smokers smoke primarily to obtain nicotine; however, many individuals do not become highly dependent on nicotine, and many others exhibit strong dependence on smoking. This book explores these and many other individual differences that make the study of smoking far more interesting than the casual observer might expect.

This book presents evidence indicating that both sides of the tobacco battle are in some respects correct, but they miss the complex nature of the causal processes associated with smoking behavior. Smoking is neither just a habit nor just an addiction. It is both and much more. The reinforcing and dependence-producing effects of smoking result primarily from nicotine, but simple exposure to nicotine does not account for the the large individual differences in smoking effects and prevalence observed across situations and individuals.

The half-dozen years subsequent to the SGR (LJSDHHS, 1988) were characterized by both a wide acceptance of the addictive nature of smoking and a rediscovery of the importance of individual differences in personality, psychopathology, genetics, and environment in determining who becomes a smoker and who quits for how long. Numerous genetic studies have shown high heritability for smoking and common genetic components for smoking, personality, and psychopathology.

The major purpose of this book is to summarize and synthesize the literature on the relationship of smoking and smoking dependence and addiction to individual differences and affective processes. Although it has long been noted that personality and emotional factors are intimately related to each other and to smoking, there is no model or book that integrates relevant findings and models in a comprehensive fashion. This lack of an integrative model stems from the fact that research in this area is scattered across a wide variety of disciplines so as to make integration a formidable challenge. This book reviews and attempts to integrate the numerous complex and interesting biological, psychological, and social mechanisms by which personality, psychopathology, emotion, and smoking influence each other and relate to smoking.

INTO AND BEYOND THE ADDICTION QUESTION

At the same time as the U.S. Surgeon General published his 1988 report (USDHHS, 1988) concluding that smoking is an addiction just like cocaine, others were saying that cocaine use was just like gambling addiction, food addiction, and excessive dependence on members of the opposite sex (Peele, 1988). Yet some were noting that simply labeling smoking as a form of nicotine addiction did very little to explain the smoking process (Ashton & Golding, 1989; O. F. Pomerleau & Pomerleau. 1984, 1989; Warburton, 1989). Almost immediately after the 1988 SGR, a number of well-respected and influential researchers (e.g.. Jaffe. 1990; Warburton, 1990) began to question the degree to which smoking and the effects of nicotine are in fact similar to those of cocaine, heroin, and other “harder” drugs.

These and other motivation-related issues are reviewed in Chapter 2. Chapters 3 and 4 address emotional processes and individual differences in personality and psychopathology. The juxtaposition of smoking motivation, personality, and emotional processes draws attention to common mechanisms underlying these constructs and suggests new syntheses and questions related to individual differences in smoking prevalence, effects, and quitting. These become important in later chapters that address smoking’s relationship to and differential effects on emotional and motivational processes as a function of personality, psychopathology, gender, and situation.

At the same time as the importance of differentiation among drugs has been underscored, other investigators have argued that the psychobiological and psychosocial mechanisms underlying addiction to drugs do not differ from those underlying other forms of compulsive behavior (Bozarth, 1990; Peele, 1985, 1988). The paradoxical result of this conceptual focus is that yes, nicotine is like cocaine, which is like heroin and alcohol, which are all like mother’s milk—or at least like compulsive jogging or adolescents” compulsive crushes (Peele, 1985). To some extern, brain and psychological mechanisms are common across a wide range of reinforcing activities. There are certainly things to be learned by focusing on similarities, just as there are by studying differences. Thus, one of this book’s focuses is this similarity—difference dimension. The similarity-difference dimension is important not only when characterizing different drugs and compulsive or habitual behaviors, but also when characterizing conditions under which users and nonusers differ. To what degree are users and nonusers similar or different, on what variables, in what situations, and why?

What motivates smokers to smoke in spite of continuous health warnings and the belief of the vast majority of smokers that smoking causes cancer and a variety of other serious diseases? Do smokers possess a psychological or psychobiological predisposition to smoke? If so, what might the specific nature of this disposition be? Do some individuals find smoking and nicotine more inherently rewarding than do others? A great deal of progress has been made in understanding the smoking habit during the past 2 decades, especially in the understanding of nicotine’s effects on biological and psychobiological processes. It is now well established that nicotine reinforces the smoking habit (see Chapters 2 and 5). Furthermore, the view that it does so by a number of mechanisms is receiving growing acceptance (Ashton & Golding, 1989; O. F. Pomerleau & Pomerleau. 1989). The complexities of smoking and of nicotine’s effects are demonstrated by evidence indicating that the effects of smoking-sized doses of nicotine are dependent on (a) environmental demands and stress level (see Chapter 5), (b) personality and psychopathology (see Chapter 7), (c) dose and rate of administration (Armitage, Hall, & Sellers, 1969; Gilbert, Meliska, Williams, & Jensen, 1992), and (d) time since previous dose (Goldstein, Beck, & Mundschenk, 1967; Guha & Pradhan, 1976).

The biopsychosocial Situation × Trait adaptive response (STAR) model proposed in Chapter 9 summarizes recent insights and provides a broad structure from which one can obtain fundamental new insights. The model draws attention to the unique Person × Situation transactional nature of smoking motivation and abstinence responses. I propose that each smoker must be viewed as a complex system of multiple traits; interrelated subsystems (temperament, personality, nicotine history, goals, and cognition and affect). The adaptations and transactions of this ever-changing set of subsystems with the environment determines overall systemic behavior, including whether the individual smokes. Evidence presented in Chapters 6, 7 and 8 has indicated that a consideration of biological, psychological, and social and environmental systems and subsystems across time as they influence each other is a necessary requirement and a foundation for any future adequate characterization and theory of smoking and its effects. Evidence provided in these chapters has suggested that interactive perspectives, such as that provided by the STAR model, are more accurate depictions of smoking-related processes and mechanisms than those found in previous models. Thus, I predict that the STAR model will be useful in leading to improvements in intervention approaches designed to achieve long-term abstinence, as well as in prevention efforts.

The question of what cessation interventions are most effective in given subgroups of smokers is drawing increasing attention. This increased focus on treatment matching for particular smoking subgroups is motivated in part by high relapse rates in general smoker populations and in particular by the very high relapse rates in special groups (see Chapter 7) that are constituting an ever-higher percentage of the smoking population (Coambs, Kozlowski, & Ferrence, 1989). Another reason for developing specific interventions for specific subgroups is that empirical evidence has supported the view that the relative balance of mechanisms maintaining smoking and promoting relapse vary systematically as a function of individual traits, including one’s typical work and interpersonal environment. Special high-risk populations include individuals high in characteristics that have always differentiated smokers from nonsmokers: neuroticism and emotional disorders, impulsivity, and antisocial behavior. Personality-, psychopathology-, and situation-specific mechanisms are identified in Chapters 7 and 9 as contributing to the difficulty these groups have in achieving smoking cessation success. These individual differences point to a need for the development, refinement, and efficacy testing of theoretically driven psychosocial interventions for smoking dependence that take into account individual differences.

New cessation and prevention interventions need to be based on the current understanding of the joint and interactive influence of situational and trait factors. Chapter 10 considers potential interventions based on the STAR model reviewed in Chapter 9. Characterization of individual differences in those who are and those who are not successful in quitting permanently is an important first step toward eventually providing smoker-focused individualized interventions with a higher probability of success. More generally, successful interventions must build on empirically based knowledge of the psychological and biological mechanisms mediating the development of smoking initiation and maintenance if trial and treatment error are to be avoided (Leventhal & Cleary, 1980).

Shiffman (1993b) concluded that the lack of clinical innovation during the past decade has resulted in part from the near universal use of multicomponent programs that has ended in all programs looking alike. He suggested that the field is now focused on “tinkering with details of existing programs. … [and that it] has stopped producing innovative approaches to smoking cessation” (p. 719).

Shiffman’s (1993b) articulate observations should be supplemented with the observation that (contrary to superficial appearance) most current interventions are focused on technique rather than on individual smokers and smoking theory. For example, nicotine replacement therapies (nicotine gum and patch) are generally prescribed with minimal or no individualized smoking, situational, or trait-based counseling or therapy. Acupuncture, hypnosis, relaxation training, and coping skill development are also technique-driven interventions that fail to adequately address complex situational, motivational, trait, biological, and learning factors involved at various stages of the cessation process. In addition, minimal or no consideration is given to the very long-term impact of relapsing after using what many smokers believe will be a “magic bullet.”

Finally, Leventhal and Cleary (1980) hypothesized that all effective interventions, regardless of specific technique, must deal with motivation to quit smoking and coping skills to sustain avoidance. Evidence provided in Chapters 9 and 10 shows that situational and trait factors influence and are correlated both with motivation to quit and with coping skills and should be added to the list of important causal factors.

In summary, this book draws together the very large body of basic theory and data into the development of a sound, adequately complex model of smoking behavior. Furthermore, I hope that this model is productive in directing future research, theory development, and effective cessation interventions. The model proposed is in no way intended to be taken as a definitive theory of smoking. It is intended to stand as a general theoretical framework that can guide the observation and analysis of smoking-related processes. I assume that specific aspects of this framework will change as a result of empirical findings. The value of the theoretical framework as a whole is evaluated with reference to its utility for generating productive research and more efficient treatment interventions.

Chapter 2

Smoking Motivation: Models and Issues

The brain systems are so interlinked that their functions cannot be meaningfully separated, and … nicotine and smoking affect simultaneously all the major functional systems governing behavior. … Viewed from this perspective, older models of smoking, such as the addiction model and the arousal modulating model, appear somewhat naive. (Ashton & Golding. 1989. p. 42)

The scientific process is an uneven path of evolution toward more powerful heuristic, predictive, and explanatory formulations. Some aspects of smoking have received more attention at different points along this evolutionary path. There is an ever-present danger that researchers will forget the experiences of earlier generations as they become enamored with the latest Zeitgeist, the new construction of explanatory and theoretical truth. Thus, this chapter provides an overview of past and current thinking and research that is designed to prepare the reader for more critical and in-depth discussions in subsequent chapters. There is a need for examination of why some smokers are more dependent than others and how such differences can be characterized (W...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• Chapter 1 Introduction and Overview: Smoking’s Relationship to Individual Differences, Psychopathology, and Emotion
• Chapter 2 Smoking Motivation: Models and Issues
• Chapter 3 Affect and Emotion
• Chapter 4 Personality, Temperament, and Psychopathology
• Chapter 5 Evidence of Affect Modulation, Performance Enhancement, and Reinforcement by Nicotine
• Chapter 6 Mechanisms Underlying Nicotine’s Reinforcing and Affect-Modulating Effects
• Chapter 7 Personality, Psychopathology, Tobacco Use, and Individual Differences in Effects of Nicotine
• Chapter 8 Gender Differences in Tobacco Use and Effects
• Chapter 9 A Situation × Trait Adaptive Response Model of Smoking
• Chapter 10 Implications of the STAR Model for Smoking Interventions
• References
• Index