aims to make the actual process of smoking unpleasant. Smokers are required to sit in
a closed room and take a puff every 6 seconds until it becomes so unpleasant they
cannot smoke any more. Although there is some evidence to support rapid smoking
as a smoking cessation technique, it has obvious side effects, including increased
blood carbon monoxide levels and heart rates. Other aversion therapies include
focused smoking, which involves smokers concentrating on all the negative experi-
ences of smoking and smoke-holding, which involves smokers holding smoke in their
mouths for a period of time and again thinking about the unpleasant sensations.
Smoke-holding has been shown to be more successful at promoting cessation than
focused smoking and it does not have the side effects of rapid smoking (Walker and
Franzini 1985).
2 Contingency contracting procedures also aim to punish smoking and drinking and
to reward abstinence. Smokers and drinkers are asked to make a contract with either
a therapist, a friend or partner and to establish a set of rewards/punishments, which
are contingent on their smoking/drinking cessation. For example, money may be
deposited with the therapist and only returned when they have stopped smoking/
drinking for a given period of time. They are therefore rewarding abstinence.
Schwartz (1987) analysed a series of contingency contracting studies for smoking
cessation from 1967 to 1985 and concluded that this procedure seems to be success-
ful in promoting initial cessation, but once the contract was finished, or the money
returned, relapse was high. In a study of alcoholics, 20 severe alcoholics who had
been arrested for drunkenness were offered employment, health care, counselling,
food and clothing if they remained sober (Miller 1975). The results showed that those
with the contracts were arrested less, employed more, and were more often sober
according to unannounced blood alcohol checks than those who were given these
‘rewards’ non-contingently. However, whether such changes in behaviour would per-
sist over time is unclear. In addition, this perspective is reminiscent of a more punitive
moral model of addictions.
3 Cue exposure procedures focus on the environmental factors that have become
associated with smoking and drinking. For example, if an individual always smokes
when they drink alcohol, alcohol will become a strong external cue to smoke and vice
versa. Cue exposure techniques gradually expose the individual to different cues and
encourage them to develop coping strategies to deal with them. This procedure aims
to extinguish the response to the cues over time and is opposite to cue avoidance
procedures, which encourage individuals not to go to the places where they may feel
the urge to smoke or drink. Cue exposure highlights some of the problem with in-
patient detoxification approaches to alcoholism whereby the alcoholic is hospitalized
for a length of time until they have reduced the alcohol from their system. Such an
approach aims to reduce the alcoholic’s physiological need for alcohol by keeping
them away from alcohol during their withdrawal symptoms. However, being in
hospital does not teach the alcoholic how to deal with the cues to drink. It means that
they avoid these cues, rather than being exposed to them.
4 Self-management procedures use a variety of behavioural techniques to pro-
mote smoking and drinking cessation in individuals and may be carried out under118 HEALTH PSYCHOLOGY