tolerance may be a disease model concept but it relies upon some degree of social
learning theory for it to operate. Likewise, people might smoke an increasing number
of cigarettes because they have learned that smoking relieves withdrawal symptoms.
However, whilst this form of association is derived from a social learning perspective
it implicitly uses a disease perspective in that it requires the existence of physical with-
drawal symptoms. Therefore, most researchers draw upon both disease and social
learning perspectives. Sometimes, this interaction between the two forms of models
is made explicit and the researchers acknowledge that they believe both sources of
influence are important. However, at times this interaction is only implicit.THE STAGES OF SUBSTANCE USE
Research into addictive behaviours has defined four stages of substance use: (1)
initiation; (2) maintenance; (3) cessation; and (4) relapse. These four stages will now
be examined in detail for smoking and alcohol use and are illustrated in Figure 5.4.STAGES 1 AND 2: INITIATING AND MAINTAINING AN ADDICTIVE BEHAVIOUR
Smoking initiation and maintenance
In 1954, Doll and Hill indicated that smoking was predictive of lung cancer. Fifty years
later, approximately 30 per cent of the adult population still smoke even though most ofFig. 5-4 The stages of substance use110 HEALTH PSYCHOLOGY