Families to Loved Ones: Why Won't You Quit Smoking!?

The Stages of Change Theory.

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Changing one’s behavior isn’t easy, particularly when highly addictive substances, like the nicotine in cigarettes, are involved.   Even when  well-intentioned loved ones are doing their best to help or convince friends or family quit smoking, by doing so, their efforts may elicit frustration, anger and resentment.  Avoiding these negative confrontations is critical for successful smoking cessation.

  Rather, fostering a supportive and understanding environment is often a more successful approach.

One way friends and family can help a loved one who is struggling with smoking is to consider the “Stages of Change” theory as it pertains to smoking cessation.  This theory, sometimes called the Trans-theoretical Model, which was described in the 1970’s and 80's by Drs. James Prochaska and Joseph DiClemente, explains that changing behavior is a process consisting of 5 separate “Stages of Change”, rather than an isolated event.  The five stages of change are:

  1. Precontemplation.  This is a stage when individuals are not ready to even think about changing one’s behavior.  In the context of smoking, a sign that a loved one is in the “precontemplative” stage is that they refuse to discuss their smoking habit.  This often manifests as “denial” about the hazards of cigarette smoking or seeming “stubborn” to loved ones.  If a loved one is in the precontemplative stage, it might seem that nothing you say is ‘getting through.’  The health care provider’s role is critical in this stage and counseling should focus on providing education about the dangers of smoking, listing of alternatives and making recommendations regarding the need to quit smoking.
  1. Contemplation.  Patients in the contemplation stage have begun to think about changing behavior, but have not yet taken any discrete steps towards doing so.  Patients in contemplation recognize that quitting smoking is an important health priority.  Positive reinforcement by health care providers, loved ones and other support systems is an important component of supporting individuals in this stage of behavior change.
  1. Preparation.  The preparation stage is heralded by taking specific action towards making a behavior change in the near future (usually within 30 days).  In the context of smoking, patients may set a future quit date, announce to friends and family that they plan on quitting smoking, or come up with plans for alternative strategies to take when cravings set in.
  2. Action.  This is the stage when the individual actively changes their behavior.  During action stage, a patient might clean out the environment of all cigarettes and ashtrays.  They may eliminate factors known to trigger smoking cravings, use nicotine replacement therapies and/or use medications.
  3. Maintenance.  The maintenance stage occurs when the individual sustains the behavior change for six months or more.  Those who reach maintenance phase have successfully changed their behavior.

It is extremely important to realize, however, that for most patients who reach action or maintenance stage, it is common (even likely!) that the will ‘fall out’ of the maintenance stage and re-enter the cycle at an earlier stage (for example, contemplation).

  In fact, one of the best predictors of successfully quitting smoking is having tried to quit, and failed, in the past.  People often progress through stages of change, have a setback and regress to an earlier stage and subsequently readvance along the stages.

For a thorough review of the Trans-Theoretical Model (Stages of Change) click here.

The Bottom Line.  Changing one’s behavior, whether it be in the context of smoking or otherwise, is a hard thing to do and is frequently a cause of tension or conflict between loved ones. Consideration of and being sensitive to where loved ones falls in the Stages of Change continuum may help ease this stress by providing a source of understanding and support for both patients and their families struggling with smoking cessation.

Here are some helpful resources that may help you or a loved one quit smoking:

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