cessation programmes offer ways for the individual to reduce this dependency. For
example, nicotine fading procedures encourage smokers to gradually switch to brands of
low nicotine cigarettes and gradually to smoke fewer cigarettes. It is believed that when
the smoker is ready to completely quit, their addiction to nicotine will be small enough to
minimize any withdrawal symptoms. Although there is no evidence to support the
effectiveness of nicotine fading on its own, it has been shown to be useful alongside other
methods such as relapse prevention (for example, Brown et al. 1984).
Nicotine replacement procedures also emphasize an individual’s addiction and depend-
ency on nicotine. For example, nicotine chewing gum is available over the counter and
is used as a way of reducing the withdrawal symptoms experienced following sudden
cessation. The chewing gum has been shown to be a useful addition to other behavioural
methods, particularly in preventing short-term relapse (Killen et al. 1990). However, it
tastes unpleasant and takes time to be absorbed into the bloodstream. More recently,
nicotine patches have become available, which only need to be applied once a day in
order to provide a steady supply of nicotine into the bloodstream. They do not need to be
tasted, although it could be argued that chewing gum satisfies the oral component of
smoking. However, whether nicotine replacement procedures are actually compensating
for a physiological addiction or whether they are offering a placebo effect via expecting
not to need cigarettes is unclear. Treating excessive drinking from a disease perspective
involves aiming for total abstinence as there is no suitable substitute for alcohol.
Social learning perspectives on cessation Social learning theory emphasizes
learning an addictive behaviour through processes such as operant conditioning
(rewards and punishments), classical conditioning (associations with internal/external
cues), observational learning and cognitions. Therefore, cessation procedures emphasize
these processes in attempts to help smokers and excessive drinkers stop their behaviour.
These cessation procedures include: aversion therapies, contingency contracting, cue
exposure, self-management techniques and multi-perspective cessation clinics:
1 Aversion therapies aim to punish smoking and drinking rather than rewarding it.
Early methodologies used crude techniques such as electric shocks whereby each time
the individual smoked a puff of a cigarette or drank some alcohol they would receive
a mild electric shock. However, this approach was found to be ineffective for both
smoking and drinking (e.g. Wilson 1978), the main reason being that it is difficult to
transfer behaviours that have been learnt in the laboratory to the real world. In an
attempt to transfer this approach to the real world alcoholics are sometimes given a
drug called Antabuse, which induces vomiting whenever alcohol is consumed. This
therefore encourages the alcoholic to associate drinking with being sick. This has
been shown to be more effective than electric shocks (Lang and Marlatt 1982), but
requires the individual to take the drug and also ignores the multitude of reasons
behind their drink problem. Imaginal aversion techniques have been used for smokers
and encourage the smoker to imagine the negative consequence of smoking, such as
being sick (rather than actually experiencing them). However, imaginal techniques
seem to add nothing to other behavioural treatments (Lichtenstein and Brown 1983).
Rapid smoking is a more successful form of aversion therapy (Danaher 1977) and
SMOKING AND ALCOHOL USE 117