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Behavioural support: what is the state of the art?
Robert West
Abstract
We use the term 'behavioural support' to encapsulate advice, social support and psychological techniques aimed at helping smokers who are trying to stop smoking. It may be delivered through face-to-face sessions that involve individual smokers or stop-smoking groups. It may also be delivered by telephone, the internet, videos or DVD's, audio tapes or CDs, and books or booklets. In the final analysis, not-smoking involves maintaining the motivation not to smoke above the motivation to smoke at all times. Behavioural support aims to increase the desire to exercise restraint by adding social pressure, reminding smokers of the benefits of cessation, strengthening the 'non-smoker identity', and attempting to generate habits of thought, feeling and action that make smoking unattractive. It seeks to reduce the impulses and desire to smoke by giving advice on ways of avoiding or escaping from smoking cues, telling smokers about and training them in mental and physical actions that can reduce smoking urges, and reshaping the way that smokers think about cigarettes and themselves as 'smokers'. This presentation summarises up-to-date evidence on the effectiveness of different approaches to behavioural support. It delineates approaches that have proven effectiveness, those that show promise, those which appear unlikely to be effective and those for which there is insufficient information to form a view. It also considers the distinction between the theoretical efficacy of different intervention approaches and their effectiveness in practice, which depend critically on how the interventions are implemented. It is proposed that early in a quit attempt the emphasis must be on minimising impulses to smoke and bolstering restraint but long-term success requires a fundamental shift in identity to that of a 'non-smoker' because as long as active restraint is required to keep someone from smoking, sooner or later that will fail.
Biography
Robert West is Director of Tobacco Studies at the Cancer Research UK Health Behaviour Unit, University College London. He started researching tobacco and nicotine use in 1982 under the direction of Michael Russell. His early research focused on the nicotine withdrawal syndrome but since then he has also contributed to clinical trials of behavioural and pharmacological aids to cessation, population surveys and cohort studies of smokers looking at patterns of smoking and smoking cessation, as well as surveys of health professionals examining attitudes, knowledge and behaviours relating to smoking cessation. He has also contributed to the development of clinical practice guidelines on smoking cessation in the UK and elsewhere. He is Editor-in-Chief of the journal, Addiction. He has been an author on more than 250 scientific works and has recently written a book developing a new, comprehensive theory of motivation and its application to addiction. More information can be found at www.rjwest.co.uk
Robert West
Professor of Health Psychology
Department of Epidemiology and Public Health
University College London
London
WC1E 6BT
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