Abstract

            Smoking is a dangerous and deadly habit. People light and inhale tobacco, which enters their bloodstream releasing nicotine. Nicotine is addictive and smoking cigarettes is harmful to the body. Smoking habits creates a negative impact on prolonging a healthier lifestyle and presents risk of death. Despite knowing the risks, millions of people smoke. Since 1964, over 20 million people have died because of smoking (Alberg & Carpenter, 2012). Attempting to quit is difficult, and many smokers fail. The research will examine approaches to quitting smoking to develop information on the use of behavioral contracts supporting healthier regimes to enhance successful cessation.

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Introduction

            The dangers of cigarette smoking were identified in the 1960’s (Alberg & Carpenter, 2012). Since the Surgeon General released a warning about the negative health effects of smoking, 55% of smokers have quit (Alberg & Carpenter, 2012). Despite positive change, there is still a high number of smokers in the United States. One in every five Americans smoke cigarettes (Alberg & Carpenter, 2012). Smoking causes a broad spectrum of diseases. Many are deadly. One-third of cancers are caused by smoking (Alberg & Carpenter, 2012). Smoking cessation is the only solution for reducing the negative health consequences associated with this dangerous habit.

            Research indicates several approaches could be valid for smoking cessation. According to Alberg & Carpenter (2012, p. 260), “telephone quit-lines, smoking cessation pharmacotherapies, nicotine replacement therapy (NRT), and non-nicotine therapies such as bupropion and varenicline” are effective for quitting smoking. A comprehensive approach is required to address the physical and behavioral factors associated with the addiction. According to Hughes (2003), smokers will make repeated attempts to quit smoking, but they do not employ the use of treatment.  

In 2005, more smokers attempted to quit than in 2010 and 2015 (CDC, 2016). In 2015, more smokers relied on cessation assistance from a health professional increasing the number of smokers who successfully quit. In 2010 and 2015, fewer smokers attempted to quit with 68% and 67% respectively.  The following chart depicts attempts to quit, smokers who quit, and smokers who received assistance to quit.

Smoking is complex and will require a complex response. Behavioral and support therapies boost the likelihood of the smoker ceasing to smoke. Clinicians can have a powerful influence on smoking behavior. Through therapy, the smoker can learn how to change their behavior. The creation of behavioral contracts will support the client’s efforts to quit as well as provide guidance and direction in achieving goals.

            According to research by Pervin & Yatco (1965) linked cognitive dissonance to smoking behaviors. People will smoke even when they understand the risks to their health. When a smoker is confronted with the information that smoking is harmful, “dissonance is created between this cognition and the cognition that allows the person to smoke even knowing the risks” (Pervin & Yatco, 1965, p. 30). Rather than terminating the dangerous behavior, the smoker will ignore the facts involving lung cancer.

            Behavioral contracts are tools used to assist the smoker in changing their behavior. The behavioral contract provides a step by step process for changing behavior.  The behavior contract spells out in detail the expectations of the smoker to assist in the creation of a carefully planned intervention. Employing this positive-reinforcement intervention will increase the likelihood of cessation. Through the behavioral contract, a plan can be made to change the how the smoker thinks. The contract addresses the behavior that is needed to change in a step by step process for the desired outcome.

 

Method

            In a study conducted by the Community Health Center, commitment contracts were examined for their effective in helping smokers quit. The research examined a population of smokers who signed commitment contracts to assess their abstinence. The sample was surveyed at the 2-month, 6-month, and 12-month mark after attending mandatory counseling and taking medications (Community Health Center, 2015). The research indicated compliance with behavioral contracts (commitment contracts) support smoking cessation when paired with medication and psychotherapy.

            A behavioral contract for smoking cessation begins with identifying the behavior being changed and establishing the goals of the behavioral change. For the smoker, the goal is to quit smoking to lead a healthier lifestyle. In the behavioral contract, the smoker can decide to slowly reduce their smoking behavior or decide to quit all at one time., if the smoker quit gradually, they will outline the steps and provide specific dates for cutting down cigarettes as well as select a final quit day. The behavioral contract outlines the steps smokers will use to quit smoking.

            The smokers needed the support strategies to successfully quit smoking. They also learned to identify behaviors linked to smoking to make positive changes. Behavioral therapy supports efforts to condition new behaviors to replace the old. Smokers require support and behavioral intervention to support successful cessation.

 

Results/Discussion

            The self-management approach employed in the research involved the development of a behavioral contract, including self-management cessation strategies, and a schedule-reduced smoking (Cole & Bonem, 2000). The sample was treated with four weekly behavioral therapy sessions of a one-month period. Therapy sessions lasted 45 minutes (Cole & Bonem, 2000). For the sample, there was a 60% to 70% reduction of smoking behaviors.

Each year 40% of smokers make attempts at cessation. Out of the smokers who attempt to quit between four and six percent will be successful (Hughes, 2003, p. 1053). Many smokers believe the only way to quit is cold turkey; they do not understand the complex interplay between their addiction and behavior. 

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