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No joking on smoking: My top ten tips for giving up smoking this Stoptober

Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol addiction and nicotine addiction (see ‘Further reading’ below). In 2012, I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.

In my previous blog I looked at ways to reduce alcohol intake as part of the ‘Go Sober For October‘ campaign. In today’s blog I provide my advice for giving up smoking as part of the annual ‘Stoptober’ campaign. In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects.

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Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:

  • (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
  • (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
  • (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
  • (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0300 123 1044) or visit the Smokefree website.
  • (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
  • (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
  • (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
  • (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
  • (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
  • (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.

Becoming less of a drag: The Stoptober campaign (revisited)

(The following blog is based on an article I published last year in the Nottingham Post on why I was actively supporting the Stoptober smoking campaign to get people to stop smoking for 28 days during October. I also published a blog last year outlining my 10 top tips for giving up smoking. Since that blog, my ten tips have been slightly changed and adapted in co-operation with the Department of Health running the Stoptober campaign. I make no apologies for repetition between today’s blog and that published last year, as my only aim is to help people give up smoking).

Although most of my academic research is on behavioural addiction, I have published quite a few papers on more traditional addictions such as alcohol and nicotine addiction (see ‘Further reading’ below). Last year I had to watch my mother fight a losing battle with smoking-related lung cancer and chronic obstructive pulmonary disease. She died in September 2012 aged 66 years, and had chain-smoked most of her adult life. This followed the death of my father who also died of smoking-related heart disease, aged just 54.

This October, the Department of Health (DoH) are re-launching the ‘Stoptober’ campaign for the second time, urging as many nicotine smokers as possible to give up smoking for 28 days from October 1. The DoH website claims that “people who stop smoking for 28 days are five times more likely to stay smoke free” compared to those that don’t give up for such a long period. Like last year, those that decide to try and stop for the month will be given a lot of encouragement during the campaign including access to the Smokefree Facebook page and the downloadable Stoptober app. People will also be sent daily emails providing additional encouragement.

In the UK smoking accounts for approximately one in four cancer deaths, and as I said, it’s something I’ve witnessed first-hand. I’m sure most people reading this are aware of the addictive nature of nicotine. As soon as nicotine is ingested via cigarettes, it can pass from lungs to brain within ten seconds and stimulates the release of the neurotransmitter dopamine. The release of dopamine into the body provides reinforcing mood modifying effects. Despite nicotine being a stimulant, many people use cigarettes for both tranquillising and euphoric effects. Most authorities accept that nicotine is one of the most addictive drugs on the planet and that smokers can become hooked quickly. One of the reasons my own parents were never able to give up was because of the prolonged withdrawal effects they experienced whenever they went more than a few hours without smoking. This would lead to intense cravings for a cigarette. Watching both my parents’ die of smoking-related diseases is enough incentive for me to never smoke a cigarette. Hopefully, others can find the incentives they need to help them give up permanently. Here are my top ten tips to help you (or someone you know and love) stop smoking:

  • (1) Develop the motivation to stop smoking: Many smokers say they would like to stop but don’t really want to. When you take stock, make sure you are clear as to why you want to give up. It may be to save money, to improve your health, to prevent yourself getting a smoking-related disease, or to protect your family from passive smoking. (It could of course be all of the above). Really wanting to give up is the best predictor of successful smoking cessation.
  • (2) Get all the emotional support you can: Another good predictor of whether someone will overcome their addiction to nicotine is having a good support network. You need people around you that will support your efforts to quit. Tell as many people that you know that you are trying to quit. It could be the difference between stopping and starting again.
  • (3) Avoid ‘cold turkey’: Although some people can stop through willpower alone, most people will need to reduce their nicotine intake slowly. The best way of doing this is to replace cigarettes with a safe form of nicotine such as those available from the pharmacy, or on prescription from the doctor.
  • (4) Get support from a professional: Even if you are using a safe form of nicotine from your pharmacist or doctor, cutting out cigarettes completely can be hard. Getting support from a trained NHS stop smoking adviser can double your chances of stopping smoking. To find your nearest free NHS stop smoking service (in the UK call 0800-1690169) or visit the smokefree website and click on the ‘ways to quit’ tab.
  • (5) Use non-nicotine cigarette shaped substitutes: Smoking is also a habitual behaviour where the feel of it in your hands may be as important as the nicotine it contains. The use of plastic cigarettes or e-cigarettes will help with the habitual behaviour associated with smoking but contain none of the addictive nicotine.
  • (6) Use relaxation techniques: When cravings strike, use relaxation exercises to help overcome the negative feelings. At the very least take deep breaths. There are dozens of relaxation exercises online. Practice makes perfect.
  • (7) Treat yourself: One of the immediate benefits of stopping smoking will be the amount of money you save. At the start of the cessation process, treat yourself to rewards with the money you save.
  • (8) Focus on the positive: Giving up smoking is one of the hardest things that anyone can do. Write down lists of all the positive things that will be gained by stopping smoking. Constantly remind yourself of what the long-term advantages will be that will outweigh the short-term benefits of smoking a cigarette. In short, focus on the gains of stopping rather than what you will miss about cigarettes.
  • (9) Know the triggers for your smoking: Knowing the situations in which you tend to smoke can help in overcoming the urges. Lighting up a cigarette can sometimes be the result of a classically-conditioned response (e.g. having a cigarette after every meal). These often occur unconsciously so you need to break the automatic response and de-condition the smoking. You need to replace the unhealthy activity with a more positive one and re-condition your behaviour.
  • (10) Fill the void: One of the most difficult things when cigarette craving and withdrawal symptoms strike is not having an activity to fill the void. Some things (like engaging in physical activity) may help you in forgetting about the urge to smoke. Plan out alternative activities and distraction tasks to help fill the hole when the urge to smoke strikes (e.g. chew gum, eat something healthy like a carrot stick, call a friend, occupy your hands, do a word puzzle, etc.). However, avoid filling the void with other potentially addictive substances (e.g. alcohol) or activities (e.g. gambling).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D. (1994). An exploratory study of gambling cross addictions. Journal of Gambling Studies, 10, 371-384.

Griffiths, M.D.  (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Griffiths, M.D. (2012). First person: Highly-addictive drug killed both of my parents. Nottingham Post, October 1, p.13.

Griffiths, M.D., Parke, J. & Wood, R.T.A. (2002). Excessive gambling and substance abuse: Is there a relationship? Journal of Substance Use, 7, 187-190.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2010). Gambling, alcohol consumption, cigarette smoking and health: findings from the 2007 British Gambling Prevalence Survey. Addiction Research and Theory, 18, 208-223.

Griffiths, M.D., Wardle, J., Orford, J., Sproston, K. & Erens, B. (2011). Internet gambling, health. Smoking and alcohol use: Findings from the 2007 British Gambling Prevalence Survey. International Journal of Mental Health and Addiction, 9, 1-11.

Resnick, S. & Griffiths, M.D. (2010). Service quality in alcohol treatment: A qualitative study. International Journal of Mental Health and Addiction, 8, 453-470.

Resnick, S. & Griffiths, M.D. (2011). Service quality in alcohol treatment: A research note. International Journal of Health Care Quality Assurance, 24, 149-163.

Resnick, S. & Griffiths, M.D. (2012). Alcohol treatment: A qualitative comparison of public and private treatment centres. International Journal of Mental Health and Addiction, 10, 185-196.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Umeh, K. & Griffiths, M.D. (2001). Adolescent smoking: Behavioural risk factors and health beliefs. Education and Health, 19, 69-71.

Are Twitter and Facebook more ‘addictive’ than nicotine and alcohol?

Last week I was asked by the British media to comment on the story suggesting that using Twitter and Facebook were more addictive than activities like smoking cigarettes and drinking alcohol. Once again this was a classic example of the media – for instance the Daily Telegraph – going beyond the data and not letting the facts get in the way of a good story.

Before being interviewed for a radio programme, I had read the newspaper reports about the research but these didn’t seem to tell me very much. I wanted to know the aims of the research, the method that had been used to collect the data, and I wanted to know how the researchers had reported their results and what conclusions they had reached. The research was carried out by psychologists Dr Wilhelm Hofmann (University of Chicago), Dr Kathleen Vohs (University of Minnesota), and Dr Roy Baumeister (Florida State University). I emailed Dr Hofmann and told him that I wanted to write about his study in my blog. He immediately sent me a copy of the paper and a very helpful ‘media summary’. So what was the researchers’ aim and what did they actually do?

The first thing to note was that the research was not about addiction but about desire and temptation. The researchers point out that little is known about what types of urges are felt strongly (or only weakly), which urges conflict with other important things that we should be doing, and the extent to which urges can be resisted. The primary aim of the research team was to compare the various desires and the extent to which they are resisted in people’s day-to-day lives. The researchers used an innovative methodology to assess the frequency, intensity, conflict, resistance, and enactment of peoples’ desires.

The data were collected from 205 people (although interestingly, this turned into 250 in many of the press reports I read). They were aged 18 to 55 years and all living in (and around) Würzburg (in Germany). Two-thirds of the participants were female (66%) and three-quarters of the total sample were university students (73%). All of the people taking part in the study were provided with a handheld Blackberry device and carried it around with them for a one-week period. Each day, they were sent seven messages over a 14-hour period asking them for specific data relating to desires and urges. All those taking part were given a small financial incentive at the start the study and were given additional financial incentives if they completed data entry for more than 80% of the messages sent by the research team. On average, over 90% of messages sent by the research team resulted in data being sent back (so there was an excellent response rate).

After each message was sent, those taking part in the study had to indicate whether they were currently experiencing a desire (explained as a craving, urge, or longing to do certain things) or whether (in the previous half an hour) they had just experienced a desire. If they had a desire, they then had to indicate what kind of desire from a list of 15 domains (i.e., food, non-alcoholic drinks, alcohol, coffee, tobacco, other substances, sexual, media, spending, work, social, leisure, sleep, hygiene-related, or other). Additionally, they had to indicate:

(i) The strength of the desire on a scale from ‘0’ (no desire at all) to ‘ (irresistible)

(ii) The degree to which the desire conflicted with other personal goals on a scale from 0 (no conflict at all) to 4 (very high conflict)

(iii) The nature of the conflicting goals from a list of 20 options (such as sleep conflict, social conflict, work conflict, etc.) and whether they attempted to resist the desire (yes or no), and whether they yielded to the behaviour implied by the desire at least to some extent (yes or no).

Up to three desires could be reported any given measurement occasion. In total there were 10,558 responses and a total of 7,827 desires reported during the one-week period. So what did the results show? The main finding – perhaps unsurprisingly – was that the most frequently described desires related to basic bodily needs (e.g., eating, drinking, and sleeping). More specifically, the researchers reported significantly above-average desires for sleep, sex, hygiene (e.g., needing to go to the toilet), sports participation, social contact, and non-alcoholic drinks. The lowest average desire strength were for drinking alcohol and smoking cigarettes (and is where the sensationalist headlines came from).

The study also noted that the participants’ desires to work and use media (e.g., Twitter and Facebook) were especially prone to yielding to their urges. However, the authors rightly note that “resisting the desire to work when it conflicts with other goals such as socializing or leisure activities may be difficult because work can define people’s identities, dictate many aspects of daily life, and invoke penalties if important duties are shirked”. They also speculate that checking emails, surfing the web, texting, and/or watching television might be hard to resist in light of the constant availability, huge appeal, and apparent low costs of these activities. They also assert that “media consumption behaviors might, however, turn into strong habits or forms of pathological media abuse”.

I ought to add that I did ask Dr. Hofmann about the media reports and how the press had sensationalized the study. In an email to me he said:

“Our data can only speak to self-control failure rates in the different domains, not to the ‘addictiveness’ of these desires. To study the development of addiction, we would have to sample desires over longer time spans and see whether they become more frequent and pressing over time. Still, I believe our findings tell us that people have a hard time putting desires for media use of, perhaps because we did not really learn well how to control those (plus, given the constant availability of those gadgets). Whether the consequences of frequent media (over)use outweigh those of more risky things such as alcohol and nicotine consumption is a different ballgame, again”.

I was also interested to read the media summary that Dr Hofmann sent me. It said that:

Our main finding can be summarized in just two words: people want. However, the present data are among the first to paint a clearer picture of what it is people desire, how they feel about it, and how successful they are in dealing with it. Extrapolating our findings to a 16-hour waking day, people on average spend about eight hours desiring things, three hours resisting desire, and a glorious half hour yielding to temptation”

The authors’ claim that based on their findings, their results challenge the stereotype of addiction as driven by irresistibly strong desires. They also claim that the knowledge they have generated can inform understandings about self-control, behavioral change, and addiction. However, there does seem to be one major limitation of the research. I couldn’t find anywhere in the paper that the authors had reported what percentage of the people who took part in the study were either cigarette smokers or drank alcohol. In fact there were no limitations mentioned whatsoever (such as the small non-representative sample – mainly female and mainly university students – from one German locality). If most of the sample were non-smokers/non-drinkers or casual smokers/casual drinkers it wouldn’t be surprising if there were few urges or desires to drink or smoke!

Postscript: Since writing this article, I received a very informative email from Dr Hofmann informing me that 22% of the sample in this study were current smokers (and that a very small minority were ex-smokers). Dr Hofmann informed me that they are doing further analysis on the data set. I look forward to seeing more papers from this interesting research study.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Hofmann, W, Vohs, K.D. & Baumeister, R.F. (2012). What people desire, feel conflicted about, and try to resist in everyday life. Psychological Science, in press.

Griffiths, M.D. (2010). Gaming in social networking sites: A growing concern? World Online Gambling Law Report, 9(5), 12-13.

Griffiths, M.D. & Kuss, D. (2011). Adolescent social networking: Should parents and teachers be worried? Education and Health, 29, 23-25.

Kuss, D.J. & Griffiths, M.D. (2011). Addiction to social networks on the internet: A literature review of empirical research. International Journal of Environmental and Public Health, 8, 3528-3552.

Kuss, D.J. & Griffiths, M.D. (2011). Excessive online social networking: Can adolescents become addicted to Facebook? Education and Health, 29. 63-66.