Control Mastery and Nicotine Addiction...

• Mission Statement by Jessica Broitman, 11/9/96
  • Case Specific by Jessica Broitman, 12/2/96
    • Could this be applied in work w/medical pts? by Ellen Dornelas, Ph.D., 12/10/96
      
      

Hi Ellen and Jessica. I thought I'd throw a few thoughts in here, about the treatment of nicotine addiction in patients with recent cardiac problems. I use control mastery in combination with an addiction medicine perspective, in the treatment of addicts, (Ellen you can get articles I've written about this from our research group office), and nicotine is certainly one of the worst addictions. The first thing I keep primary in my mind in treating an addict is that addicts all want to get better (the addict form of our control mastery assumption that people are driven to health, to recover from their problems), and their immediate plan --sometimes conscious and sometimes unconscious-- is not so "case specific", that is in every case really, its to stop using drugs. And this is certainly the case in the cardiac patient who is smoking, as it is with every other addict in big danger. So I start there, and even when patients tell me they dont want to stop, I let them know that I believe they do, only they may feel unconsciously hopeless about it. They may have tried many times, and failed due to the severity of their addiction (ie the physiological reality), and they feel desperate and hopeless, and then tell themselves they don't want to stop. So I take a strong "you really want to quit" position (ie, you want to get better), which really helps. And a strong "you can stop, recovery is possible" position.ie, provide hope. I also keep in my mind the biomedical basis of addiction. So when an addict relapses, I regard it as first of all, a physiological/brain chemistry event, a response to an overwhelming craving that takes place in the brain. A relapse may be a response to a protracted withdrawal effect in the brain, and may have little to do with a person's psychological problems or pathogenic beliefs. In some cases pathogenic beliefs may contribute to a relapse, or may keep a person using (including smoking) and this may be something like an identification with a using parent ( a parent who smoked all the time for example), or a compliance with a parent who made the patient feel like they were supposed to be the out of control, down and out member of the family. I may try out these kinds of explanations/interpretations, but at the same time I really focus on getting through the immediate craving --ie the part I think of as physiological that looks psychological but really isn't-- by encouraging the person to be involved in 12-step programs, or groups, or therapy, to call a friend, or me, or to exercise, or whatever it takes. So I try to hit it from two vantage points, and it can be quite helpful. I regard nicotine as one of the worst drugs to withdraw from, partly because its subtle and there are recurrances of the withdrawal response, that show up as "craving" for a really long time. I understand that new research is showing that when people have craving --be it to nicotine, or heroin, or alcohol, or pot, or whatever, there is a marked drop in body temperature. I'm sure you know that clonidine (catapres) is helpful in reducing nicotine withdrawal effects. I think that having this perspective helps the patient feel less like its a moral issue, less like they are "bad" or a "failure" for having difficulty with not using their drug. Or even that it means they have deep psychological problems. People tend to think they are so weak for relapsing on nicotine, and its not about that at all. I think a lot can be accomplished in a one-time therapy session with an addict. I worked in a crisis setting for three years, and found that hearing that recovery is possible, that there are successful treatments, that "you want to quit using and get better", and the biomedial basis of addiction and drug craving can really impact a patient and direct them into recovery. And bringing in a discussion of a patients pathogenic beliefs, feelings of loyalty, identifications and compliances, these types of explanations, I find to be additional support for people struggling with addiction. I am fascinated to think about the work you are doing with people in medical situations, and hope you find these ideas useful.

• More on quitting smoking by Ellen Dornelas, 1/16/97
• Why can't they cope? by Jessica Broitman, 1/16/97
  • Negative Affect & Relapse by Ellen Dornelas, 1/24/97
• Guilt could be making your job harder! by Jessica Broitman, 2/6/97
  • How true it is! by Ellen Dornelas, 4/24/97
• ... but you wrote about ''Considerations of Addiction (in general) and of Addiction to Nicotine (specifically'' by Bernard D. Tremblay (Ben), 3/27/98
  • Confused by Jessica, 3/27/98