professional guidance. Such procedures involve self-monitoring (keeping a record of
own smoking/drinking behaviour), becoming aware of the causes of smoking/
drinking (What makes me smoke? Where do I smoke? Where do I drink?), and
becoming aware of the consequences of smoking/drinking (Does it make me feel
better? What do I expect from smoking/drinking?). However, used on their own, self-
management techniques do not appear to be more successful than other interventions
(Hall et al. 1990).5 Multi-perspective cessation clinics represent an integration of all the above
clinical approaches to smoking and drinking cessation and use a combination of
aversion therapies, contingency contracting, cue exposure and self-management. In
addition, for smoking cessation this multi-perspective approach often incorporates
disease model based interventions such as nicotine replacement. Lando (1977)
developed an integrated model of smoking cessation, which has served as a model for
subsequent clinics. His approach included the following procedures:
six sessions of rapid smoking for 25 minutes for one week;
doubled daily smoking rate outside the clinic for one week;
onset of smoking cessation;
identifying problems encountered when attempting to stop smoking;
developing ways to deal with these problems;
self-reward contracts for cessation success (e.g. buying something new);
self-punishment contracts for smoking (e.g. give money to a friend/therapist).
Lando’s model has been evaluated and research suggested a 76 per cent abstinence
rate at six months (Lando 1977) and 46 per cent at twelve months (Lando and
McGovern 1982), which was higher than the control group’s abstinence rates. Killen
et al. (1984) developed Lando’s approach but used smoke holding rather than rapid
smoking, and added nicotine chewing gum into the programme. Their results showed
similarly high abstinence rates to the study by Lando.
Multi-perspective approaches have also been developed for the treatment of
alcohol use. These include an integration of the above approaches and also an
emphasis on drinking as a coping strategy. Drinking is therefore not simply seen as
an unwanted behaviour that should stop but as a behaviour which serves a function
in the alcoholic’s life. Such approaches include:
Assessing the drinking behaviour both in terms of the degree of the problem (e.g.
frequency and amount drank) and the factors that determine the drinking
(e.g. What function does the drinking serve? When does the urge to drink increase/
decrease? What is the motivation to change? Do the individual’s family/friends
support their desire to change?).
Self-monitoring (e.g. When do I drink?).
Developing new coping strategies (e.g. relaxation, stress management).
Cue exposure (e.g. learning to cope with high-risk situations).
Multi-perspective approaches are often regarded as skills training approaches as they
encourage individuals to develop the relevant skills needed to change their behaviour.
SMOKING AND ALCOHOL USE 119