This page is specifically for Health Professionals who may work with smokers. It should also be of interest to smokers who wish to quit.

The Physiology of Smoking

Most health professionals have a background in the health sciences rather than psychology. A knowledge of the physiological effects of tobacco use is important when counseling patients/clients.

We know that the use of tobacco products, particularly cigarette smoking, is the most preventable cause of death, and a major cause of preventable disease in our society. Use of tobacco results in more deaths than; drug abuse, alcohol, suicide, homicide, AIDS, fire and motor vehicles accidents combined.

You are probably aware of the physiological effects of the use of tobacco products. Sites such as the Tobacco Control Super Site would be an appropriate place to start finding additional information if required. Here I shall just summarise some of the major effects:

• cardiovascular disease - including ischaemic heart disease, stroke and peripheral vascular disease;
• lung cancer
• cancer of the oral cavity, oesophagus and larynx;
• cancer of the stomach;
• cancer of the pancreas and kidneys;
• cancer of the uterus, cervix and vulvar;
• cancer of the bladder and colon;
• cancer of the penis and anus;
• cancer of the liver;
• cancer of the blood [leukaemia and multiple myeloma];
• chronic bronchitis;
• emphysema
• destruction of elastic fibres in the lungs;
• gastric ulcer;
• osteoporosis;
• blindness - via macular degeneration

Some of the short term effects include: nicotine constricting the terminal bronchioles, carbon monoxide in smoke with its affinity for haemoglobin reducing the blood’s oxygen carrying capacity, irritants in smoke causing increased mucosa secretions and inhibiting the movement of cilia in the respiratory system, smoking promotes free radicals that destroy proteins and DNA.

Smoking is also associated with an increase in: impotence, accidents, tooth loss and gum disease, cataracts and urinary incontinence, colds and asthma.

The Psychology of smoking cessation - Changing Behaviour

A danger of being a Health Professional is that we do have relevant knowledge about Health Issues. We do have expertise, we do know best!

“Preaching” to the patient or client, telling them about heart disease, the many cancers, peripheral vascular disease and other dangers associated with tobacco use, may work for some practitioners with some clients. But chances are it will not be the most successful strategy for most clients to stop smoking and to STAY STOPPED.

There is a substantial body of knowledge now available on how and why people change behaviours. Unfortunately, practice does not always follow the theory.

We Health Professionals all tend to think that everyone should stop smoking because of the dangers associated with the activity, and that all smokers should think the same way too.

When I first started working with groups of people who wanted to quit, I was surprised  to find that better health, or prevention of disease, were not always the primary reasons for quitting.

From the point of view of someone changing their behaviour, or we as Health Professionals assisting others to change behaviours, it does not really matter what the reasons are for making the behavioural changes. What does matter is that there are reasons. Also, those reasons need to be IMPORTANT for the client making the behavioural change, and the client will need to have CONFIDENCE that they are able to make the change.

The Health Professional can be helpful working with the client on these aspects of “IMPORTANCE” and “CONFIDENCE”, and in helping the client get READY to make the behavioural change.

MOTIVATIONAL INTERVIEWING
Motivational Interviewing is a treatment developed within the addictions field which has gained widespread acceptance because of its applicability to any client who is ambivalent about change.

“Motivational Interviewing” was first published by Miller and Rollnick in 1991. (My copy is the second edition dated 2002). The techniques used in Motivational Interviewing take into account the “Stages of Change” model of behaviour change espoused by Prochaska and DiClemente and discussed on the previous page of this site.

Although the initial work done by Miller and Rollnick was with users of hard drugs, the successful techniques they use can be applicable to any one at all wishing to make behaviour changes, and to make those changes permanent.

Unfortunately, many Health Professionals do not have the time for the long consultations that Miller and Rollnick spent with their patients. A discussion on behaviour change could be a brief part of a consultation on some other issue with a General Practitioner for example.

“Health Behaviour Change” by Rollnick, Mason and Butler was published in 1999 to address these needs. It is a paperback publication which I would highly recommend to any one working with clients who would like to, and/or who need to change behaviours. After checking local bookstores and not being able to obtain the book, I ordered and purchased my copy some years ago through a University Bookstore. I had to wait a few weeks for it, and it was not inexpensive when it finally arrived. I have since completed a search for it on the net, and found that both Amazon® in the USA, and Amazon® in the UK, have the publication. I have placed links to both these sources below.The price listed by the way is way below half the price that I paid for my copy.

Practitioners skilled in Motivational Interviewing, will use open questioning techniques regarding certain behaviours with their clients to elicit appropriate responses. Many of these responses will be decisions made by the client regarding certain aspects of the behavour(s) being discussed.

So, the process does not involve an “expert” telling someone what they should do. Rather it is a skilled facilitator obtaining “logical” and “rational” answers to questions. Because these answers (decisions), have been made by the client. The client is much more likely to take ownership of the decisions and act upon them, than if they were being told what they should do by a Health Professional.

A decision made by the client to move even through just one of the stages of change is success. For example, if after a Motivational Interviewing session with a client who was ambivalent about making any behavioural changes, that client decided to start thinking about, “perhaps it may be a good idea to think about making a decision to stop smoking”, then the client has successfully moved from the “Pre-contemplation” stage to the “Contemplation” stage.

The next challenge would be to work with the client through to the next stages of change.

Behaviours are very difficult to change. So, even a small step towards the desired behavioural change is great progress.

A smoker for example may have had the habit for twenty or more years. Patience is required is the attempts to try to permanently change that behaviour. There generally will be setbacks.

If you are working with a client who has successfully worked through the first five stages in the Stages of Change model, and they relapsed back to their smoking behaviour, it is important to reassure the client and not let them think that they have “blown it”. They have not “stuffed up” at all, They merely have had a temporary setback.

Statistically we know that the more often people work through the stages of change, the more likely they are to be successful. The Stages of Change Model is cyclic. People will generally go through the cycle several times before permanent exit from the cycle and the new behaviour is embedded.

The client has in fact gone one step closer to obtaining the behavioural change desired. They were in fact successful

The client will now need to work on the “IMPORTANCE” of their making the behavioural change, and they will need to build up their “CONFIDENCE” in being able to make that behavioural change.

There are many strategies listed on this Web Site that will help with those two aspects. As “IMPORTANCE” of making the change is increased in the client’s mind, and the client has gained increased “CONFIDENCE” about being able to make the change, “AMBIVALENCE” about the change should be markedly reduced in the client’s mind. “RESISTANCE” to making the necessary changes will also be reduced.

As the client becomes increasingly “READY” to make the change, the actually timing of the change should be carefully considered. A time should be chosen when the client believes that they have the best chance of success.

I have discussed on a previous page Prochaska’s and DiClemente’s six stage theory of behaviour change.

The stages are: pre-contemplation, contemplation, preparation, action and maintenance. Remember the stages of change model is cyclical. We make progress, and we relapse.

This is the cycle that we go through when we change any sort of behaviour. The average number of times around this cycle for smokers who stop and stay stopped is at least six. Some studies will claim it is up to ten times.

You may be accessing this site from anywhere in the world. But, I am an Aussie, and I am going to give a few Aussie statistics. Around 1.7 million Australians make an attempt to quit each year. Around two thirds of people attempting to quit relapse within days. About ten percent are still not smoking a year later.

It is important for smokers to realise that if they attempt to ‘quit’ and they start smoking again, they have not failed, but merely have a temporary set-back. They have in fact become one step closer to becoming a non-smoker. The reinforcing of this mental attitude is vitally important, and the health professional can be of great help here.

DO’s and DON’Ts for Health Professionals

On the next page I discuss the different types of smokers.

Web Design Ian McKenzie

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