# Motivation and emotion/Book/2013/Nicotine and motivation

* Multimedia presentation (5 min)

## Overview

The legal and easy accessibility to Nicotine has made it one of the worlds most used stimulants. The use and abuse of nicotine is largely tied to an individual's internal and external driving forces. Nicotine is believed to alter Motivation in many ways and depending on the situation can increase motivation, decrease motivation and completely re-direct motivation.
* Case study: Tracey
* Tracey is 35 years old and has been smoking for 15 years. Tracey now smokes an average of 30 cigarettes per day. Tracey has attempted to quit before but has been unsuccessful in her attempts. Recently she has been thinking about trying to quit again, in order to improve her health, but hasn't managed to take the first step.
* What motivated Tracey to smoke?
* What motivated Tracey to want to quit?
* What motivational forces are preventing Tracey from quitting successfully?
* What motivational techniques can be used to further Tracey's quitting attempts in the future?
* what motivational changes have occurred in Tracey as a result of smoking?

## Nicotine
### What is it?

* Nicotine is a powerful Para sympathomimetic alkaloid found in the Tobacco plant.
* Nicotine is a highly addictive stimulant which is a naturally occurring colourless liquid which turns brown when heat is applied.
* Nicotine is absorbed through the skin, the mucosal membranes in the nose and mouth and through the lungs.
* As nicotine is largely used through cigarettes and pipes it is predominately absorbed through the lungs, causing seriously damaging health effects.

### History

The tobacco plant is native to the Americas and its use as a stimulant and a medicine has been traced back thousands of years. The ancient Native American and Mayan cave drawings tell the stories of the indigenous peoples enjoying the spoils of the tobacco plant. These cultures would burn tobacco in ritualistic ceremonies to gain access to the spirit world. By the early 1600’s tobacco had spread to the American colonies, England, Europe, the Middle East and Africa creating a booming worldwide industry largely contributing to local economies. Initially tobacco was consumed through raw chewing until the first hand made cigarette was developed in Spain in 1614 (Lah, 2011). The growth of the tobacco industry continued to expand steadily until it exploded in 1881 when the world’s first commercial cigarette rolling machine was invented by James Bonsack. Bonsack’s machine could produce 120,000 cigarettes in 10 hours which completely revolutionised the cigarette industry. Nicotine has been used an insecticide due to in anti-herbivore characteristics However, today nicotine is predominately used in cigarettes and chewing tobacco for recreational uses.

### Statistics

* The World Health Organisation (2013) estimates that there are currently 1.1 billion people around the world who regularly smoke.
* The Australian Bureau of Statistics (2013) found that 36.7% of Australians aged 18 years and over currently smoke, with 91% of those people smoking daily.
* The Australian Institute of Health and Welfare (2013) found that 30% of teenagers aged between 14 and 19 smoked daily.
* There are 19,000 smoking related deaths annually in Australia.
* Worldwide, cigarette consumption is increasing especially in low income countries however; cigarette use is decreasing in middle and high income countries.
* 35 million people seriously attempt to quit each year.

### Biological factors

Nicotine is absorbed very rapidly and it reaches the brain and infiltrates the bloodstream in just 7-10 seconds of inhalation or consumption (Krueger, 2013). For example: a typical smoker will consume 30 cigarettes every day, taking ten puffs on each cigarette. Each inhalation of smoke provides the user with a hit of nicotine, therefore providing a pack per day smoker with 300 hits of nicotine every single day. Nicotine provides users with a balance of both stimulant and depressant effects and depending on the dose can either increase or decrease heart rate. Nicotine activates the centres of the brain that controls pleasure and motivation and through stimulation of the adrenal glands increases the levels of dopamine in the brain (Mergel, 2010).

## Motivation

Motivation is the inner drive that prompts individuals to work towards something they desire. For example, a person may be motivated to run every morning at 6.00 am in order to lose weight.

### Intrinsic and extrinsic motivation

Motivation is believed to stem internally from within an individual or externally from outside an individual.
Intrinsic motivation refers to the motivation that arises from within an individual. The motivation arises from the sense of satisfaction the individual gets from completing a task (Bainbridge, 2013). For example, an intrinsically motivated individual may work on a painting for hours because they get a sense of pleasure from working on their art. There is nothing else that an individual would gain from painting other than being internally satisfied.
Extrinsic motivation refers to the motivation that arises from motivating factors that are external to the individual. An extrinsically motivated individual would be motivated by some kind of reward (Bainbridge, 2013). For example, an individual’s would only work on a painting for hours if it meant that they would receive a reward, such as money, in return. The individual still may enjoy paining however, this enjoyment alone is not enough to motivate the individual to keep working on the painting.
Koenig and Masters (1965) suggest that the motivation to use and continue to use nicotine is largely motivated by intrinsic factors, however the desire to decrease one's nicotine dependence is more balanced; as there are extrinsic and intrinsic motivational factors involved.

### Incentive theory of motivation

A theory of motivation that ties into an individual’s natural intrinsic and extrinsic motivation is the concept known as Incentive theory of motivation. Cherry (2013) describes incentive theory as the model of motivation that suggests that individuals are motivated to behave in specific ways in order to gain some type of reward or positive reinforcement for behaving that way. The reward may be tangible or intangible, obvious or subtle but is always received directly after the occurrence of a particular behaviour. The motivational effect increases when the reward is immediately received and decreases when the reward is delayed as the association made in the individuals mind is weakened.
Incentive theory largely emerged from the work of B.F Skinner and was created by behaviourists to investigate why an individual’s behaviour changes due to the internal and external rewards that they receive for acting in specific ways.
Incentive theory differs from other theories of motivation as its main focus is with the rewards or positive punishment that individuals receive. As compared with other theories which look at the negative reinforcer's, incentive theory emphasises the actions and behaviours that individuals will display in order to gain something and they are incentivised to keep expressing this certain behavioural action.
Incentive theory of motivation is a concept which can widely explain the correlation between nicotine use and motivation. As the incentive theory states that an individual will partake in and continue to behave in a certain way in order to receive some kind of reward for that behaviour, smoking becomes the rewarded behaviour.
Nicotine takes between 7 and 10 seconds to reach the brain and provides an individual with a hit almost immediately after the action of smoking. This immediate reward for smoking is something that is reinforced with every inhale and every cigarette. Smokers are associating smoking with the positive effects that the nicotine supplies. This repetitive combination of action and direct reward largely leads to the continuation of nicotine use and addictive behaviour.

### Drive theory of motivation

Drive theory of motivation suggests that individuals are driven to act out certain behaviours in an attempt to reduce the internal tension that arises from internal needs not having been met (Cherry, 2012). The theory suggests that individuals are born with a set of psychological needs and attempt to satisfy these needs in order to remain in a relaxed state. For example, a nicotine addicted individual has an internal need for nicotine and will be motivated to fulfill this need by obtaining nicotine in order to return to a relaxed state of being. This internal drive can make it extremely difficult for an individual to abstain from nicotine use and motivational effort is directed towards finding nicotine rather than quitting it.

## Nicotine and motivation

* Nicotine's positive effects on motivation
* While smoking nicotine cigarettes is considered an extremely unhealthy behaviour with an abundance of negative health risks, nicotine in itself has been found to produce some positive motivational effects. Morrison (1974) conducted a study which investigated the motivational changes in rats exposed to nicotine. Researchers injected rats with nicotine over a period of time and then measure their motivation changes towards tasks they would normally avoid. The study found that the rats injected with nicotine were far more likely to attempt a task they had previously avoided. Morrison (1974) concluded that the nicotine injected rats had an increased level of motivation to attempt and complete difficult tasks.
* In a similar study Cortright, Sampedro, Neugebauer and Vezina (2012) completed research looking at the effects that certain drugs, including nicotine, had on rats. The study found that nicotine could enhance the incentive motivational effects within the rats and the rats that had been administered with nicotine had a significant increase in attempting actions that they otherwise would not have the motivation to do.
* Due to this research on rodents, Gamaleddin, Wertheim, Zhu, Coen, Vemuri, Makryannis, Goldberg and Le Foll (2012) completed a similar experiment on humans. The human study also found that individuals had an increased level of motivation once exposed to nicotine. In comparison to the rodent studies, the human study found that motivational increases were highly associated with addictive behaviours and higher levels of motivation were found in individuals whom responded to the nicotine with addict like characterstics.
* Further research is required to completely understand the behaviour between nicotine and motivation however, experiments have found a correlation between increased motivation and nicotine consumption which suggests that there are some positive motivational effects associated with nicotine.
* Nicotine's negative effects on motivation
* Although studies have provided findings that suggest there are positive effects of nicotine on motivation, It is still widely considered to have a negative effect on motivation. Studies have found that nicotine can decrease and have extended negative effects on motivation and mental health. The mental health foundation (2013) found that depressed individuals are twice as likely to use nicotine products compared to their non-depressed counterparts. Nicotine stimulates the release of dopamine which may be why depressed individuals attempt to temporarily increase these levels by smoking. However, in the long term smoking encourages the brain to cease making these levels of dopamine which subsequently can increase depression levels. These findings suggest that nicotine use has a profound effect on ones emotional state which in turn can effect motivation to change that state.
* Baker, Brandon and Chassin (2004) conducted a study which investigated the motivation of individuals at different stages of their addiction and compared them to individuals not using nicotine. The study found that those participants who had been using nicotine for a long period of time had a major decrease in motivation levels compared to individuals who had used nicotine for a shorter time and those individuals who did not use nicotine products. This study provides support to the idea that while nicotine initially creates a stimulant effect which can temporarily increase arousal and motivation levels in the long term motivation levels decrease.
* Bizzaro and Stolerman (2003) conducted a study looking into the effects of nicotine and other drugs on attention, accuracy and motivation to find food. The rats exposed to nicotine were found to have an initial increase in arousal which slightly increased their accuracy for tasks. However, general motivation was decreased; particularly in those rats who had repeated exposure to nicotine. This finding again provides support to the idea that nicotine decreases motivation in humans and rodents when it is used repeatedly.
* The negative effect of nicotine on motivation is an area of research which is currently generating new studies which continue to support these negative effects. Nicotine is extremely addictive and many individuals indulge in nicotine use over a long period of their lives which in turn decreases and continues to decrease their motivation levels every time they use nicotine products. Further in depth research is needed in order to completely understand the long term and short term effects of nicotine on motivational levels.

## Motivation to quit

There is a vast amount of research on the motivation associated with quitting the use of nicotine. If we take incentive theory into account, one could be motivated to quit through the application of some type of reward whether it may be monetary or just the simple attractions of the improved health. However, an individual’s personal levels of intrinsic and extrinsic motivations would have an influence on what reward needed to be applied in order to produce the motivation to quit.
An individual’s motivation to quit smoking is largely related to the successfulness of their attempt. Smit, Fidler and West (2011) completed research into the quitting attempts of people through three different motivational aspects; desire (wanting to quit), duty (believing one ought to quit) and intention to quit soon. The study found that participants who had a strong motivational desire and intention to quit had significantly higher levels of smoking cessation compared to those individuals who were quitting out of duty. These findings suggest that intrinsic motivation is extremely important in the initial motivation to quit and while extrinsic motivations or incentives can help at a later stage an individual must internally want to quit.
Once an individual has made the decision to quit nicotine use there are many ways to increase their motivation in order to successfully quit. Williams, Herzog and Simmons (2011) note that reminding individuals of the extremely bad health effects associated with smoking and the benefits of improved health that quitting will provide to motivate an individual to continue on their path to quitting.
Curry, Wagner and Grothaus (1991) completed in depth study on motivation to quit smoking and found that in order to produce successful quitting behaviour there must be a balance of intrinsic and extrinsic motivational factors. Curry et al. researched the effects of participants in either a financial incentive or personalised feedback groups. The study found that participants who received financial incentives had increased intentions to quit but the financial reward did not increase cessation rates at a 6 month follow up however; the group that received personalised feedback had a significant level of successful quitting rates. As it has been found that intention to quit can be translated into quitting success it is important to note the role that financial reward had on this increase in intention. Both financial reward and personal reward did manage to create some kind of effect to move participants closer to successfully quitting.

## Motivation to seek nicotine

Nicotine’s addictive qualities make it a difficult substance to stop using and research is being conducted to understand the nicotine seeking motivation factors that drive people to nicotine particularly when attempting to quit. Shaham, Adamson, Grocki and Corrigal (1997) conducted an experiment on nicotine addicted laboratory rats in which the rats were provided with option of easily accessible food or nicotine which they could only get to by completing an exhaustive obstacle course. The study found that the majority of the rats chose to endure the tough obstacle course in order to get to the nicotine, clearly providing support to the idea that the desire for nicotine has a rather immense impact on motivation particularly when using this motivation to seek nicotine.
As previously stated nicotine encourages the release of dopamine which provides the user with a happy feeling that positively reinforces the use of nicotine and provides the incentive to seek the release again and again. Emotional factors such as depression and anxiety are believed to influence ones motivation to seek and use nicotine (Cohen,Kodas & Griebel, 2011).
Nicotine’s addictive, calming and satisfying qualities all influence an individual’s desire to use the product. Research suggests that individual’s motivation to seek nicotine is increased in ways that would not otherwise be present and subjects are motivated to endure certain situations if the reward is nicotine.

## Motivation changes during nicotine withdrawals

It is important to note that even though an individual may be receiving incentives or some kind of motivational reward to cease smoking, the focus of their motivation can quickly change; particularly when having to endure withdrawal symptoms (See Table 1). Watkins, Stinus, Koob and Markou (2000) conducted research into the changes in motivation that occurs throughout the entire quitting process. The researchers suggested that while rewards and reinforcers can motivate individuals to quit smoking in the initial stages once an individual reaches the stage of withdrawal their behaviour can revert. As the drive theory dictates an individuals motivation to quit will be lowered and replaced with a high motivation to find and use nicotine. The hit of nicotine that they will receive becomes the key motivational focus which entirely changes an individual’s motivational direction and behaviours (Watkins & Stinus, 2000).
Table 1: Nicotine Withdrawal Symptoms (Kaiser Foundation, 2008)
| Nicotine Withdrawal Symptoms | Duration |
| Nicotine cravings | 3-8 weeks |
| Dizziness | 3 days |
| Insomnia | 1-2 weeks |
| Migraines | 1-2 weeks |
| Chest pain | 1-2 weeks |
| Irritability | 2-4 weeks |
| Fatigue | 2-4 weeks |
| Lack of concentration | 3 weeks |

## Conclusion

The vast majority of research has shown that nicotine use has an altering effect on motivation. Motivation has been found to increase immediately after nicotine consumption as the nicotine hit provides a direct positive reinforcement to the nicotine-using behaviour. In comparison, nicotine has also been found to decrease motivation when used over a long period of time, which is compounded when teamed with the negative health effects. Through the use of nicotine motivation levels are increased and decreased and changes to the motivational focus occur. Motivation is also largely changed when an individual is seeking nicotine or has an intense desire to quit using it. Rewards or reinforcements are often successfully used to curb a nicotine addiction and can rapidly change the focus of one’s motivation. Nicotine has been shown to completely alter ones motivational state and create actual behavior change to align with this motivational state.
* Case Study: Tracey - Revisited
* Tracey was directly rewarded by the immediate hit of nicotine from her first cigarette which motivated her to continue to smoke. She also could have been motivated to smoke to satisfy an internal need for nicotine.
* Tracey was motivated to improve her health.
* During withdrawals the brain is seeking nicotine and can re-direct Traceys motivational focus making her want to smoke.
* Tracey can be given incentives to further her quit attempt such as monetary awards, feeling and looking healthier or any other treats that Tracey desires.
* Tracey initially had increased motivation when she started to smoke at age 20 however, by age 35 her motivation levels have significantly decreased due to prolonged nicotine use.

## How to quit

In order to improve your mental and physical health and well-being it is important to quit smoking. Quitting methods include:
* Nicotine replacements (gum, patch, lozenge).
This method slowly decreases the level of nicotine that one is exposed to which in turn decreases dependence by fulfilling cravings until they are able to cease all nicotine use.
* Cold turkey
This method can be difficult to sustain as cravings can be intense and difficult to endure.
* Medication
Is available to people to assist with smoking cessation
* Rapid smoking
Is used to turn the act of smoking into a negative stimulus therefore reducing the desire to smoke
* Hypnotherapy
This has been found to reduce the desire to smoke
* Acupuncture
This can be used to help an individual relax and deal with the withdrawa symptoms
It is important to get support when attempting to decrease and cease nicotine use and there are many government programs that can assist you in choosing the best way to quit.
For help with quitting, visit the Quit now website or call the Quitline on 137 848

## Test your knowledge

1
Nicotine reaches the brain in approximately?
5 seconds
7-10 seconds
7 minutes
70 seconds
2
The incentive theory of motivation suggests that people are more likely to attempt to quit smoking when provided with a reward.
True
False
3
Extrinsic motivation describes the motivation that arises from within an individual?
True
False
4
When given the option of food and nicotine, rats who were already addicted to nicotine, were more likely to endure an exhaustive obstacle course to attain the:
Nicotine
Food
Water
None of the above
5
Motivation is increased when:
An individual is seeking nicotine
Immediately after nicotine use
An individual has ceased smoking
All of the above :