ESCAPE FROM NICOTRAZ

Angaleena Presley

Seven years ago, on a dark back hollow road, I placed a cigarette into my mouth and sealed my fate as prisoner of the smoking habit. At first, I liked the tingly feeling I would get in my legs as each puff filled my lungs. Then, I found myself becoming used to the smell, the taste, and the habit of holding them in my hand. First thing in the morning, after breakfast, on the way to class, between classes, after lunch, after dinner, during homework, talking on the phone, before bed, a ritual began and now I don’t know how to change it. Trying several methods, I have attempted to quit three times. After reading an article on behavior modification I began smoking in designated areas such as the bathroom. I figured that if I only smoked in places that were uncomfortable I could create an aversion. Wrong. Next, I tried to go cold turkey. During Christmas break I asked my parents to lock me into a room and not to set me free until I didn’t want to smoke anymore. They complied and catered to my every need for the three days I spent on lockdown. This method was quite effective and I did not smoke for approximately four months, until finals week sent me back to the other side. Most recently, I attended a hypnosis seminar and I am struggling to remain a non-smoker but it is a battle that seems to have no end. Thus, I have chosen an article deals with yet another experimental procedure attempting to aid in the non-smoking effort.

            Wilson, Wallston, and King conducted an experiment on the effects of contract framing, motivation to quit, and self-efficacy on smoking reduction. Initially defining terms, Wilson et al says that self-efficacy refers to how a person views his or her ability to accurately achieve certain goals. Previous studies have found significant differences in self-efficacy and motivation to quit and actually quitting. Most found that people who have high levels of both generally smoke fewer cigarettes that those with lower levels. The purpose of the present study was to further research into the examination of how self-efficacy and motivation to quit effect the smoking habit. Wilson et al expanded their study to include contingency contracting, which acted as a behavioral treatment. Two questions were addressed in the study. How did cognitive processes change over course of treatment and how did motivation, self-efficacy, and contract framing interact with these changes.

            Methodologically, subjects were 70 cardiovascular patients who were told that stopping smoking was not a requirement of the study. Participants were involved in a 12-month treatment program where they interacted with researchers through phone and mail response forms. Framing contracts were negotiated over the phone and were different for each individual based on his or her perceived ability. Also, a $3.00 reward was offered for the successful completion of each contract.

            Variables measured were type of contract, self-efficacy, motivation to quit, and smoking behavior. First, researchers developed two types of contracts including gain and gain/loss. In the gain condition, participants were simply told that they would receive a reward if they completed their contract. In the gain/loss condition participants were told not only that they would receive an award for completing but also that they would lose the reward if they did not complete their contract. To measure self-efficacy, researchers questioned subjects about their confidence levels concerning quitting, relapse, and effort. Measuring motivation, researchers asked subjects to report their desire to quit using a scale from 0, no desire, to 100, strong desire. Finally, asking subjects how much they smoked tested smoking behavior and accuracy of response. Their responses were checked through collaterals and saliva cotinine assays.

            Resulting in some significant differences, the study’s extraneous variables had to be considered before causal relationships could be determined. Subject attrition was surveyed to see if the drop out rate effected the size of each contract-framing group. Groups were also examined for differences in initial motivation and pre-experimental differences. One significant difference was found in the gain/loss group because they had a greater number of smokers to report a heavier number of cigarettes smoked in their past. There were no significant differences found in treatment and counseling variables for average performance on phone calls, receiving awards, completing contracts, etc. Finally, the subjects’ responses were validated by saliva collateral contacts and saliva cotinine assays.

            There were various significant relationships found in the study. With contract framing acting as the independent variable, there was a significant main effect for time on self-efficacy beliefs. In other words, subjects’ attitudes toward believing that they could quit increased over the first three months of the study then leveled off throughout the end. Similarly, motivation also significantly increased over the first three months then leveled off as well.

            A 2x2x3 analysis of variance was conducted for framing, motivation to quit, and self-efficacy to test the predicted hypothesis of cognitive beliefs and their effect on stopping smoking. There was no significant relationship among the three-way analysis. However, at the three-month mark, where most of the cognition seemed to have occurred, there were significant relationships among framing condition, motivation, and self-efficacy. Subjects exposed to the gain/loss condition reported higher motivation and self-efficacy resulting in smoking fewer cigarettes.

            Discussing their work, researchers reported that their initial prediction concerning beliefs about smoking was partly supported.   At the three-month point, subjects under continued treatment and the condition of the gain/loss contracting frame did experience increased cognitions about stopping and decreased number of cigarettes smoked. The cause could have been that participants were in more detailed contact with counselors during the first three months of the experiment.  Predictions not supported were the expectation that the gain/loss frame would produce overall increased self-efficacy and motivation to quit and also a three-way interaction among self-efficacy, motivation, and frame contracting. However, at the three-month mark, subjects who reported low motivation did better under the gain/loss. Possible explanations included that subjects low in motivation became aware of risk, and the “loss” wording made them more afraid of failure.

            Finally, researchers presented the limitations to the study. The gain/loss contract frame was not valid therefore relationships that occurred under this condition should be studied further. Perhaps the gain/loss frame was more effective because the idea of loss was salient to participants. Similarly, the gain/loss frame might have been better because there were more than just one statement about rewards.

            After reading the study I began to think about my own motivation and self-efficacy. My motivation is quite high but my perceptions about my ability to quit could use a lot of work. I am totally convinced that there will never be a day in my life that I don’t at least think about or want to smoke. It seemed that actually writing things down and agreeing to certain behaviors seemed to help the participants of this study. Maybe, by becoming more aware and familiar with their habit, they gained more control over their behaviors. Also, the thought of receiving and especially losing rewards seemed to help as well. When I tried behavior modification, I wrote down times and places when I have the greatest desire to smoke then I tried to make sure I didn’t smoke during those particular instances. However, when I was successful, I did not receive or lose any type of reward. Rather, I regretted having made the decision to stop because my urges increased daily.

            So, there were some aspects of the study that I liked and will probably institute in my own stop smoking plan. First, I totally agree with the idea of a reward system. Nicotine is one of the most addictive drugs on the market and when I turn it down, a reward for my efforts would be nice. I do not know how I could give my own self rewards but it is really something to consider. I suppose it would be the same principal behind cheating in a game of solitaire. Even though I would be in complete control, I would have to let the cards, in this case rewards for not smoking, play themselves out. Another aspect of the study that I really liked was the length of the treatment program. My mother often says that if you want to do something then you just have to do it. Smoking is not something that a person can just quit. Cigarettes have been with me through every fun, stressful, sad, scary, boring, etc., time I have had in the past seven years; really, since the beginning of my adulthood. Like losing a best friend, quitting smoking takes time and patience.

            There were also things I did not like about the study. First of all, the subjects were all cardiovascular patients. It seems that smokers with heart conditions would have different reactions to behavior modifications than the general smoking population. I would like to see this same study conducted on healthy, college students like myself. Also, I did not agree with the way they formed the contracts. According to Milgrim’s studies, people are more prone to authority if they are facing it directly rather than just hearing it. Perhaps if the contracts were arranged in person and subjects had to report their progress directly to that same person, results might have been more significant.

            Regardless of what I did not like about this study, I feel that any research on stopping smoking is extremely important. People who have never been captive to the smoking habit cannot fathom how hard it is to quit. With all the disease, stench, money loss, and trouble in general that smoking causes, I feel that greater efforts should be taken to help rid the world of it. We have centers for weight loss, alcoholism, drug abuse, and even gambling but I have never heard of a hospital dedicated specifically to smoking. If I ever get the qualifications, time, and money, I plan to open such a facility. I envision a place where desperados like me can go to seek a wide variety of treatments that work best for them. The concepts used in the Wilson, Wallston, and King study would be one of many methods offered. For now, I suppose I will cling to the fleeting effects of my recent hypnosis and imagine that “smoking is something I used to do but now it has no control over me.” Yeah, right. Somebody give me a CIG!