Smoking Addiction: A Descriptive Psychology Conceptualization and Test

Daniel Warsaw Minerva (Ph.D., 1989)

Thesis directed by Professor Peter G. Ossorio

A model of smoking addiction and corresponding treatments were developed based on a Descriptive Psychology formulation. This formulation hypothesized that one or some combination of the following problems are the source of difficulty for most smokers who want to quit smoking but do not: (1) motivation problem (reasons for smoking have more weight than reasons for not smoking); (2) unthinkability problem (smoking cessation seems to be beyond one's control); (3) combination problem (affected by both problems). Specific treatments ("Motivation," "Unthinkability" or "Combination" Treatment) were developed and implemented to address each of the diagnosed problems. Questionnaire items were employed to diagnose each smoker's problem (i.e., primarily a motivation, unthinkability or combination Problem).

Smokers (N = 128) were randomly assigned to one of five groups: Motivation Treatment (N = 22), Unthinkability Treatment (N = 34), Combination Treatment (N = 30), Stress Reduction Treatment Control (N = 22), or No-Treatment Control (N = 20). Each group included Motivation, Unthinkability and Combination Subjects. Forty seven percent attended all six treatment sessions, and 64% attended at least four treatment sessions. Subjects estimated average number of cigarettes they smoked and reported their smoking identity (i.e., smoker, nonsmoker or in transition) at pretreatment, posttreatment and three- and six-month follow-up via a questionnaire.

At posttreatment, Subjects in the Motivation, Unthinkability and Combination Treatments were smoking less than subjects in the Control Group, but not less than subjects in the Stress Reduction Control Group. At three- and six-month follow-up, however, there were no significant differences among groups. Predictions based on matching smokers with a particular smoking problem to a specific treatment designed to reduce that problem were generally not borne out (i.e., Motivation Subjects under the Motivation Treatment, and Unthinkability Subjects under the Unthinkability Treatment). Combination Subjects under the Combination Treatment did, however, reduce smoking more than Combination Subjects in either the Motivation or unthinkability Treatments at three month follow-up.

The discussion underlined: (1) the changing nature of motivation in relationship to treatment, (2) that an unthinkability problem is tied into resistance to change identity and self-concept, and (3) treating a smoker with an unthinkability problem may be comparable to handling identity and self-concept issues in psychotherapy. Suggestions for future treatments and research were offered.