Monday, March 4, 2013
Interview with a Smoker
The young woman interviewed for this discussion initiated smoking behavior in high school and has continued for a little more than ten years. She is 27 years old, and has tried to quit smoking three times, but during each attempt, her success was limited to temporarily lowering the number of cigarettes she smoked per day. She has never tried smoking cessation products, group support, or counseling. She believes when she becomes pregnant, she will have a strong enough impetus to stop smoking. She does not like or condone her smoking behavior and wishes she had never started. She believes she has a lack of will power to stop and that she may be addicted to nicotine. Her health issues are being significantly overweight and she has suffered from depression and anxiety from approximately age 17. An additional concern for her is the possibility of gaining weight when she tries to quit smoking. She has had alcoholic tendencies and has alcoholism in her family, although at this time, she refrains from alcohol consumption. She is well aware of the health implications of smoking and wants to quit before she reaches her 30th birthday.
She has the typical co-morbidity of depression. Yun, Shin, Kweon, Ryu & Rhee (2012) found a strong association between smoking behavior and depression, especially among females. Additional research suggests a significant number of smokers have psychological dysfunctions such as substance abuse, mood, and anxiety disorders that predispose them to cessation failure (Leventhal et al., 2012). She is typical of females who smoke and have depressive tendencies. These findings suggest she may have a more positive outcome for smoking cessation if her strategy includes depression prevention (Yun, Shin, Kweon, Ryu & Rhee, 2012). Additionally, she, like many smokers, is aware of the risk factors associated with smoking, but this knowledge is not enough to support her in an attempt to stop (Bize, 2012).
A well known association exists between smoking and alcohol consumption (Cook et al., 2012; Falk, Yi, & Hiller-Sturmhofel, 2006). Smokers drink alcohol more often than non-smokers, and when they drink, they consume more alcohol than their non-smoking counterparts (Cook et al., 2006). Additionally, research has identified alcohol use disorders and smoking dependence as coexisting medical conditions (Falk et al., 2006). Alcohol consumption increases the urge to smoke during quit attempts (Businelle et al., 2013). Because she has had difficulty controlling alcohol consumption in the past, she is typical according to these research findings. However, since she no longer consumes alcohol, her chances for successful smoking cessation increase (Businelle et al., 2013; Cook et al., 2012).
Her concern for weight gain during smoking cessation is founded on ample research (Levine, Cheng, Kalarchian, Perkins & Marcus, 2012), although similar research suggests the weight gain is temporary (McBride, French, Pirie, & Jeffery, 1996). Further, research suggests that female smokers with concern about weight gain during smoking cessation might benefit from additional dietary support or weight management interventions (Levine et al., 2012). She may receive an additional benefit from better depression management and prevention.
For the best health outcome, and to create the most effective smoking cessation treatment plan for her, the intervention must include a weight management program, but more importantly a plan for the effective mitigation of her depressive symptoms, and any other psychological dysfunctions (Leventhal et al., 2012). In her best interest, a regular counseling program might be implemented several months prior to her attempt to change or cease her smoking behavior. Leventhal et al. (2012) reported a high incidence of smoking cessation failure because underlying psychological dysfunctions and personality-related issues fail to be identified and resolved prior to undertaking smoking cessation.
Bize, R. (2012). Biomedical risk assessment as an aid for smoking cessation. Cochrane Database Of Systematic Reviews, (12).
Businelle, M. S., Lam, C. Y., Kendzor, D. E., Cofta-Woerpel, L., McClure, J. B., Cinciripini, P. M., & Wetter, D. W. (2013). Alcohol consumption and urges to smoke among women during a smoking cessation attempt. Experimental And Clinical Psychopharmacology, 21(1), 29-37. doi:10.1037/a0031009
Cook, J. W., Fucito, L. M., Piasecki, T. M., Piper, M. E., Schlam, T. R., Berg, K. M., & Baker, T. B. (2012). Relations of alcohol consumption with smoking cessation milestones and tobacco dependence. Journal Of Consulting And Clinical Psychology, 80(6), 1075-1085. doi:10.1037/a0029931
Falk, D. E., Yi, H. Y., & Hiller-Sturmhofel, S. (2006). An epidemiologic analysis of co- occurring alcohol and tobacco use and disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health, 29(3), 162–171.
Leventhal, A. M., Japuntich, S. J., Piper, M. E., Jorenby, D. E., Schlam, T. R., & Baker, T. B. (2012). Isolating the role of psychological dysfunction in smoking cessation: Relations of personality and psychopathology to attaining cessation milestones. Psychology Of Addictive Behaviors, 26(4), 838-849. doi:10.1037/a0028449
Levine, M. D., Cheng, Y., Kalarchian, M. A., Perkins, K. A., & Marcus, M. D. (2012). Dietary intake after smoking cessation among weight-concerned women smokers. Psychology Of Addictive Behaviors, 26(4), 969-973. doi:10.1037/a0028948
McBride, C. M., French, S. A., Pirie, P. L., & Jeffery, R. W. (1996). Changes over time in weight concerns among women smokers engage in the cessation process. Annals of Behavioral Medicine, 18, 273–278. doi:10.1007/BF02895289
Yun, W., Shin, M., Kweon, S., Ryu, S., & Rhee, J. (2012). Association of smoking status, cumulative smoking, duration of smoking cessation, age of starting smoking, and depression in Korean adults. BMC Public Health, 12724. doi:10.1186/1471-2458-12-724