# Motivation and emotion/Book/2014/Quit smoking cigarettes motivation

* Multimedia presentation (5 min)

## Overview

Have you smoked cigarettes? Do you feel that it has impacted on your physical and mental health? Have you told yourself you would quit, but never found the motivation to achieve it? If you answered yes, this chapter could be very useful in helping you to understand addiction to cigarettes, the negative effects of smoking, relevant motivational theories, the importance of quitting smoking and the positive effects that follow. Once you have read this page we [who?] recommend that you implement a method to quit smoking that we have provided you with, leading to a healthier and happier lifestyle.
You will find that the role of motivation plays a major part in every aspect of quitting smoking. Your motivation needs to come from intrinsic desires to improve your health and well-being. Setting specific, proximal and challenging goals will increase your motivation of succeeding in the cessation of this behaviour.
According to research conducted by the Australian Bureau of Statistics (2013), smoking is a serious issue in Australia and the rest of the world with approximately 3.1 million Australians over the age of 18 years being current smokers, with 90% of that sample smoking every day (Australian Bureau of Statistics, 2013). In addition, cigarettes are the largest cause of preventable illness and death in Australia (Healey, 2011) with approximately 19,000 smoking-related deaths in Australia per year (Australian Bureau of Statistics, 2013). These statistics show just how deadly this addiction is.
While reading this wiki, it will be useful to reflect on the type of smoker you are in order to kickstart your motivation to becoming a non-smoker. Tolonen, Wolf, Jakovljevic & Kuulasmaa (2002) have defined 4 types of smokers:
* A daily smoker is generally someone who smokes 1 or more cigarettes per day.
* An occasional smoker is someone who smokes but has never smoked every day, yet has smoked 100 or more cigarettes in their lifetime.
* A reducer is someone who used to be a daily smoker, but now smokes from time to time.
* An experimenter is someone who doesn't smoke often and has smoked less than 100 cigarettes in their lifetime.
* A non-smoker is someone who has never smoked a cigarette.
Now that you have identified what type of smoker you are, we suggest you take this questionnaire to find out your level of dependancy: If you found your score to be anywhere between medium and very high dependancy in the questionnaire, you will find the pharmacological options suggested to be very helpful.

## Addiction
### What is addiction?

Addiction is defined by the National Institute of Drug Abuse (2012) as a primary chronic disease of brain reward, motivation and memory that is categorised by compulsive drug seeking and use, despite harmful consequences.
According to the DSM-5, you have a substance use problem if you display two of these symptoms over a twelve month period (American Psychiatric Association, 2013):
* There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
* A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
* Craving, or a strong desire or urge to use the substance.
* Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
* Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
* Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
Addiction has three factors that contribute to it:
* The neurotransmittions within the reward structures of the brain are influenced by addiction, resulting in a change of actions that had previously motivated you. These actions replace previous healthy, self care behaviours with the substance[factual?].
* Genetic factors of addictive behaviours contribute significantly predisposition to develop an addictive behaviour[factual?].
* Environmental factors such as parenting and social groups can interact with your genetics changing your chances of establishing an addiction[factual?].

### Why is Smoking Addictive

A cigarette is made from the dried out leaves of the tobacco plant and contains many harmful chemicals, including the poisonous substance nicotine (Healey, 2011). With highly addictive physical and psychological qualities, nicotine causes changes in the brain that makes regular and long-term smoking extremely difficult to quit (Healey, 2011). To put into perspective, it is even more addictive than heroin and cocaine (Healey, 2011).
According to research by Healey (2011), nicotine triggers the release of the neurotransmitter dopamine, which promotes pleasurable and positive feelings of being calm and at the same time more alert. He states that your brain will eventually adapt to the feeling of dopamine release and begins to depend on a cigarette to achieve this stimulating sensation. The more frequently you smoke, the more your body will crave nicotine in order to feel 'normal' (Healey, 2011).
If your cravings for this boost are not met, you may experience withdrawal symptoms, even after a few hours. Your symptoms may include headaches, anxiety, anger, sleeping difficulty and all round lowered mood (Healey, 2011). This video by the National Institute of Drug Abuse (2012) explains addiction, and why addition is so hard to quit. |}

## Health Effects
### Negative

When smoking a cigarette, it is important to consider what you’re actually breathing into your body (Healey, 2011). Cigarettes contain up to 4000 harmful chemical compounds, with forty-three of these chemicals being active carcinogens that have the potential to trigger fatal physiological changes (Healey, 2011). This toxic mix of chemicals including tar, carbon monoxide, hydrogen cyanide, metals, free radicals and radioactive compounds is linked to numerous negative effects on our physiological functioning (Healey, 2011).
The primary short and long-term preventable effects include (Healey, 2011):
Table 1. Short and long term effects.
| Short Term Effects | Long Term Effects |
| Diminished sense of smell and taste. | Increased risk of cardiovascular disease. |
| Shortness of breath. | Increased risk of stroke . |
| Poor lung function. | Increased risk of emphysema. |
| Struggle doing physical activity | Increased risk of cancer in the mouth, larynx, pharynx, esophagus, lungs, pancreas, cervix, uterus and bladder |
| Premature ageing | Increased risk of peripheral vascular disease (due to decreased blood flow to body extremities). |
| Bad breath | Decreased levels of fatality in both men and women. |
According to research by the Centres for Disease Control and Prevention (2004), the leading cause of cancer death is lung cancer which has a high correlation with smoking cigarettes. Researchers compared non-smokers to smokers, [grammar?] finding that men who smoke are around 23 times more likely to develop lung cancer during their life and women are around 13 times more likely.

### Positives Following Quitting

The centres for Disease Control and Prevention stated that 70 percent of smokers want to quit, but don't. However, it is never too late to quit. Even after smoking for years, once you quit the health risks are immediately reduced and will continue to reduce as long as abstinence is maintained (Williams, Gagne, Ryan & Deci, 2002).
According to Centres for Disease Control and Prevention (2004), there are many surprise benefits of quitting smoking. Even as soon as 20 minutes after your last cigarette, your body will start the recovery process, so why not start today?
Here are the key physiological milestones (Centres for Disease Control and Prevention, 2004):
Table 2. Physiological milestones[explain?][factual?].
| Time | Recovery Process |
| 20 Minutes | Your heart rate will drop back towards normal levels. |
| 24 Hours | Your carbon monoxide levels decrease and your blood oxygen levels will increase towards normal, and your risk for heart attack begins to decrease. |
| 3 Days | Nicotine will be completely out of your body, but unfortunately this is the stage where symptoms of nicotine withdrawal will be at it's highest. This is when should consider using pharmacological treatments in your recovery. It is important to remind yourself that withdrawal symptoms generally last a week for most people, but can last up to a month of two for heavy smokers (Healey, 2011). |
| 2-3 Weeks | You'll be able to exercise without feeling winded due to a number of regenerative processes that begin such as improvements in circulation and lung function. Your risk for heart attack will drop significantly. |
| 2-9 Months | Your lungs will begin to repair and function properly. Your coughing and shortness of breath will continue to decrease dramatically during this time. |
| 1 Year | Your risk for heart disease is lowered by 50 percent compared to when you were still smoking. |
| 5-15 Years | Your risk of stroke, heart disease and dying from lung cancer will steadily decline and eventually go back to the same level as someone who doesn't smoke. Your risk of cancer in the mouth, throat, esophagus, bladder, kidney, and pancreas also decreases. |
You can cope with the withdrawal symptoms by knowing what to expect and finding other ways to handle cravings before you quit (Healey, 2011). Withdrawal symptoms are a sign that your body is healing, they won't last forever (Healey, 2011). As a further motivational factor, by quitting smoking it is possible to gain up to 10 years of life expectancy. Hence, if smokers quit by the age of thirty the risk of mortality caused by smoking can almost be reduced to zero. (Healey, 2011)

## The Role of Motivation

Motivation is defined as the internal and external drive factors that stimulate the desire and energy to initiate, guide and maintain goal-orientated behaviours (Curry, Wagner & Grothaus, 1990). According to Deci & Ryan (2000), there are three different types of motivation:
* Amotivation means without motivation, when a person is neither intrinsically nor extrinsically motivated. For example a dropout student or disillusioned athlete.
* Intrinsic motivation is defined as the undertaking of an activity for its implicit satisfaction rather than an external pressure or reward. Some have defined intrinsic motivation in terms an individual being interested in a task, and others have defined it as as reaping a personal satisfaction or gain from participating in a task/activity.
* Extrinsic motivation contrasts intrinsic motivation and is defined as the engagement of an activity with the goal of attaining some sort of external outcome.

### Goal Setting Theory

Locke and Latham (2002) developed the goal setting theory (GST) on the basis that people are more likely to achieve on specific and challenging tasks as opposed to non-specific and simple tasks. The motivation of goal setting is strongly influenced 5 conditions, refer to table 3 to find out how they will benefit you as a smoking quitting cigarettes.
Table 3. Conditions of Goal Setting
| Condition | Action | Example |
| Goal Acceptance and Commitment | Goal acceptance is a person’s decision to either accept or decline the goal and if accepted it will evoke motivation (Reeve, 2009). Goal commitment is the process by which a person is determined and set to achieve the accepted goal (Reeve, 2009). | You will need to accept the goal of quitting smoking and commit to achieve it. |
| Proximal Goals | Lead to higher motivation than distant goal (Schunk, 1990) | If you currently smoke around fifteen cigarettes per day, you might start by setting a date each week (proximal) that you will gradually reduce your intake with the overall goal (distance) of quitting smoking completely within a month. |
| Goal Specificity | When a goal is clear and concise, it reduces uncertainty and maximises the effort of specific behaviours that lead to its achievement (Reeve, 2009) | In conjunction with proximal goal setting example, you need to identify a clear start and end date in order to stay motivated and achieve this specific goal. |
| Goal Difficulty | The difficulty of a goal results in increased effort and performance of it's attainment (Reeve, 2009) | Quitting smoking is one of the most difficult goals to achieve. If you have the intrinsic motivation achieve this, your effort and performance will be at its highest. |
| Goal Feedback | Evokes motivation and increases performance by giving timely feedback of progress towards the goal (Locke, Shaw, Saari & Latham, 1981) | As a smoker in the process of quitting cigarettes, by having positive feedback and encouragement from family and friends your motivation and performance towards the goal will increase significantly. |

### Theory of Reasoned Action/ Theory of Planned Behaviour

The theory of reasoned action was formulated by Fishbein & Ajzen (1975) to explain how actions are influenced by beliefs and attitudes. This theory suggested that behaviour is determined by your intention to perform it, stating that intention is therefore a function of your attitude toward the behaviour and your subjective norms. Fishbein & Aizen (1975) defined intention as the cognitive representation of a person's readiness to perform an action.
Intention is the primary predictor and precursor of behaviour and is determined by three factors (Fishbein & Ajzen 1975):
* An individuals attitude toward the specific behaviour
* An individuals subjective norms
* An individuals perceived behavioural control.
Generally, the more favourable an individuals attitude and subjective norms, the greater perceived control they possess over the wanted behaviour and the stronger their intentions are in performing it.
* Example
* According to research, the theory of reasoned action is implemented to a smoker who wishes to quit cigarettes by using a nicotine replacement every time they would usually smoke in order to become a non-smoker (Fishbein & Ajzen 1975). Fishbein & Ajzen (1975) suggested in their study, that this person must believe that the plan will be effective, must intrinsically want to become a non smoker and also have their social network believe that this strategy will work in quitting.
Ajzen's (1985) later research found that the theory of reasoned action did not fully know about an individuals control over their behaviour. The findings of this research predicted that changes in attitudes, subjective norms and perceived behavioural control would produce changes in behavioural intentions (Ajzen, 1985). Attitudes, subjective norms and perceived behavioural control are factors that are based on a corresponding set of beliefs. Therefore behavioural intentions must try to change the beliefs that ultimately guide an individuals behaviour, however this function is only related to beliefs that are accessible in memory (Ajzen, 1985). Additional research is required to identify accessible behavioral, normative, and control beliefs (Ajzen, 1985). In a questionnaire developed by Ajzen (1985), participants were given a description of the behaviour of interest with relevance to target, action, context and time elements. For example, we could define smoking behaviour as follows: Smoking once a day, on the hour, for the next month. After the participants where allocated the behaviour in context, they were asked a series of questions to evoke accesible beliefs. The responses were used to identify the unique beliefs of each participant or the most commonly held beliefs of the sample population.
Once the accessible beliefs had been defined, they could then conduct the second stage of developmental research and administer the standard theory of planned behaviour questionnaire. It includes direct measures of attitudes, subjective norms, perceptions of behavioral control, intentions, and actual behaviour. By using a measure of statistics, the study showed that attitudes, subjective norms, and perceptions of behavioural control contribute to the prediction of intentions and that the predictions of intentions contribute to the perceptions of control and prediction of behaviour (Ajzen, 1985). The results of the questionnaire revealed the behaviour of the participants to not be 100% voluntary and under control. An extension of the theory was added and this is how the Theory of Planned behaviour came about (Ajzen, 1985).
The theory of planned behaviour Predicts deliberate behaviour (Ajzen, 1991).
* Example
* The theory of planned behaviour's implemented to a smoker quitting [grammar?] [Rewrite to improve clarity] (Topa & Moriano, 2010):
* Smoking behaviour was related to smoking intentions
* Intentions were based on attitudes and subjective norms
* Perceived behavioural control was related to smoking intentions and behaviours, therefore contributing significantly to your desire to quit smoking.

### Self Determination Theory

According to Ryan & Deci (2000), the self-determination theory (SDT) focuses on the extent to which behaviours are relatively autonomous (from within ones self) versus relatively controlled (from external pressures). Ryan & Deci (2000) state that an individual must satisfy three innate psychological needs with emphasis on the role of social context in order to achieve optimal motivation.
* Autonomy
* Competence
* Relatedness
By addressing these psychological needs, a situation where intrinsic motivation can flourish is created. The degree to which any of these needs are not met in social context will have a negative impact on an individuals motivation, health and wellbeing (Ryan & Deci, 2000).
This theory proposes that amotivation, intrinsic motivation and extrinsic motivation are organised along a continuum of self-determination or perceived locus of causality. To distinguish between these different types of motivation, read on and refer to Figure 5.
Table 3. Types of motivation
| Type of motivation | Explanation |
| Intrinsic | Located on the far right hand side of the continuum and reflects one's complete autonomy, competence and sense of relatedness. This motivation arises when you are driven by internal desires. |
| Extrinsic | This motivation arises because of rewards and consequences. The four extrinsic motivational states lie in the middle of the continuum and can be differentiated by their degree of autonomy: External regulation (not at all autonomous), Introjected regulation (somewhat autonomous), Identified regulation (mostly autonomous), Integrated regulation (fully autonomous). |
| Amotivation | Located on the far left side of the continuum and refers to being neither intrinsically or extrinsically motivated. |
The amount of autonomy within a motivational state has significant impacts on how you feel, think and act (Reeve, 2009). The more autonomous your level of motivation, the more effort you will exert into an activity and in turn the more you will achieve (Reeve, 2009). The self-determination theory can be applied to any current or previous smoker. For example, your motivation for quitting refers to your reasons why and the strength of your desire to do so. In addition, if you have a high level of intrinsic motivation to quit then you are much more likely to succeed in that behaviour (Curry, Wagner & Grothaus, 1990).
On the other hand, if there are external pressures telling you to quit such as parents and television advertisements, then you are more likely to be unsuccessful in your attempts (Curry, Wagner & Grothaus, 1990). Many readers may find that they are currently extrinsically motivated in their attempts to quit, the aim of this wiki is to plant the seed of autonomy and lead them to becoming intrinsically motivated.
This theory has proved that you have to actually want to quit for intrinsic reasons such as personal growth and satisfaction (Ryan & Deci, 2000).

## Methods to quit

Once you have psychologically and physically accepted your goal to quit smoking cigarettes, it is important to develop a clear and concise plan tailed to suit your individual needs (Reeve, 2009). Before you commence your road to improving your health and well being, it will be essential to inform your family and your friends to receive timely feedback and encouragement (Reeve, 2009). There are particular methods to suit different individual's, all concluding with the same aim to be completely cigarette free.
* The most successful methods according to ICanQuit are:
* Cold Turkey
* Cut-down
* Nicotine Replacement
Cold Turkey Cold turkey is defined as giving up smoking suddenly, without using any forms of medication. In undertaking this method, you must be intrinsically motivated to quit cigarettes to improve your health and well-being (Reeve, 2009) This method is successful if you consider yourself a light smoker, however if you have ingrained smoking habits, this might not be the most successful method, especially if you associate cigarettes with particular situation for example socialising, having a coffee or drinking alcohol. Although the cold turkey method originally does not involve other therapies, when in conjunction with nicotine replacement therapies or subscribed medications it will be most successful.
Cut-down method
The cut-down method involves setting a start date to begin reducing the amount of cigarettes you smoke per day, and a end date when you will be 100% cigarette free. This plan must attain all 5 conditions of the goal setting theory to give yourself a greater sense of motivation and focus to achieve the task (Reeve, 2009).
For example:
How many cigarettes do you smoke per day on average?
I smoke 15 cigarettes per day
Reduce this number 1/4 each week.
Set a start date: 25th of October Week 1: 12 cigarettes per day
Week 2: 9 cigarettes per day Week 3: 6 cigarettes per day Week 4: 3 cigarettes per day
100% cigarette free date: 25th of November
Some individuals experience quitting fatigue before achieving the goal of being completely cigarette free while implementing the cut-down method.
Nicotine Replacement Therapy Is the use nicotine products to reduce your withdrawal symptoms such as cravings and anxiety. These will usually be strongest after three days of being 100% cigarette free, as the nicotine will be completely out of your body (Healey, 2011). These products also come in varying forms according to your nicotine dependancy. Chewing gum is usually used for social, situational and lighter smokers. Nicotine patches are usually for heavy smokers as the nicotine is released over time.

## Examples of Quit Smoking Campaigns

Quit line is a phone number you can call to speak to an advisor. Around 40% callers who used quit line, sucessfully quit smoking. This video created by quit line, explains how there adviors can help an individual to achieve the goal of quitting cigarettes.
Quit line: 13 78 48
The following four links are Australian campaign websites that aim to aid and motivate current smokers in quitting cigarettes as this will ensure they live a healthier life:
Nailquitting Icanquit
Quitnow The Australian National Preventive Health Agency
The two following brands focus on using nicotine replacement therapy to ease your withdrawals: Nicabate Nicorette

## Conclusion

This chapter has provided you with tools and information that can be used break an addiction to cigarettes. We are all aware of the harmful effects, but this has proven to be ineffective in motivating people to quit as the Australian Bureau of Statistics (2012) last recorded that 2.8 million Australians are still currently smoking on a daily basis. This is why we have presented the positive effects that follow quitting as we want you to realise that it is never too late to improve your life. By becoming intrinsically motivated and setting proximal, specific and challenging goals, you will maximise the motivation of quitting this deadly behaviour. In addition to these factors, if you want to succeed it is essential that you maintain positive attitudes, beliefs and perceived behavioural control over quitting, in combination with encouraging and supporting networks that provide timely feedback. This chapter hopes to have inspired you to make a change to living a longer and healthier cigarette-free life. You don't want to become another statistic of smoking related illness and death.