The Brief Addiction Science Information Source (BASIS)

Addiction & the Humanities, Vol. 7(1) – “It’s for your own good!” A look into smoking bans worldwide

New York City made headlines this week when its City Council approved a controversial law banning smoking in all parks, beaches, and many public plazas; including, iconic Times Square (Katz, 2011). Smoking bans are common around the world; however, the scope of the New York City ban is especially broad. Today’s Addiction & the Humanities explores the rise and proliferation of smoking bans worldwide, and briefly discusses some of the science related to their efficacy.

The Proliferation of Smoking Bans

Smoking bans are not a US invention. Cities such as Paris, Berlin, and Vienna had smoke-free streets as early as the 1800s (Levin, 2004). Smoking bans in the US did not begin to emerge until the 1950s, when research detailing the dangers of smoking and second-hand smoke, in particular, became available (Wydner & Graham, 1950). Minnesota became the first US state to enact a comprehensive smoking ban during 1975, barring smoking in many public venues (Levin, 2004; Minnesota Department of Health, 1975). Since then, smoking bans have spread across the United States and around the world in both quantity and severity. Figure 1 below shows the areas around the world that had complete indoor smoking bans prior to 2007. For more specific information about worldwide smoking bans, please check this BBC series on worldwide smoking bans.

Figure 1. Countries with full indoor smoking bans. Note less stringent bans
are not depicted. Adapted from Koh, Joossens and Connolly (2007).

New York City has been active in the attempt to reduce a variety of risks to the public health (see Addiction & the Humanities 6(10) for a brief introduction to NYC’s anti-obesity campaigns). This smoking ban enhances the original New York State smoking ban by banning smoking in almost all outdoor venues (Levin, 2004). New York is not the only US city working towards such comprehensive bans. Cambridge, MA and Raleigh, NC have formed committees to study smoking bans around public parks (Martin, 2011; Parker, 2011). Smoking bans have steadily become more common and stricter in the previous 60 years; this NYC ban is one more step in that direction.

Are Smoking Bans Effective?

A number of researchers have examined the effectiveness of smoking bans. For instance, Hauri et al. (2010) performed a hypothetical analysis of the public health benefits of a Swiss indoor smoking ban. Their analyses attributed 32,000 preventable days in hospitals to environmental tobacco smoke exposure, costing 330 million Swiss francs, or approximately 350 million US dollars in health care costs. They argued that instituting a smoking ban would yield savings of this financial magnitude. Similarly, Juster et al. (2007) determined that there were 3813 (8%) fewer hospital admissions for acute myocardial infarction after the initial smoking ban in New York State, saving $56 million in direct health care costs. This estimate is lower than predicted by Hauri et al. perhaps because it does not account for other deleterious health effects of smoking, such as cancer and respiratory diseases. Furthermore, research indicates that workplace smoking bans help reduce average consumption of cigarettes by an average of 3.1 cigarettes per person per day, a 29% reduction (Fichtenberg & Glantz, 2002). These three studies are just some of many extolling the virtues of smoking bans. Further research is required, however, whether these benefits are applicable to outdoor smoking bans, such as the new NYC ban.  

Are Smoking Bans Worth it?

After the predictions, readers might wonder what we actually know about the impact of smoking bans. Initially, many economists predicted that smoking bans might decrease the business of bars, restaurants, and hotels. However, some studies have shown that there is no tangible decrease in revenue caused by smoking bans (Glantz & Charlesworth, 1999; Hyland, Cummings, & Nauenberg, 1999). In contrast, others have suggested that smoking bans have decreased state revenue from taxes on cigarettes (Levin, 2004); however, this likely is offset by decreased hospital costs and improved public health. People also chide the new NYC law for being an outdoor ban. Outdoor bans are relatively rare, and research on their efficacy is scant. One such study in Australia found that exposure to second-hand smoke at an uncovered outdoor café was quite variable, but elevated over no-smoking environments (Cameron et al., 2010). Whether this level of elevated exposure represents a significant health risk is unclear.

Does the new NYC smoking ban overstep its bounds?

The most egregious complaint about smoking bans, however, is that by introducing smoking bans, the government effectively is curtailing civil liberties. Two considerations to keep in mind: First, outdoor smoking already is prohibited near playgrounds in cities like Toronto and within a radius of many buildings (CBC News, 2009); there is precedent. Second, many societies already have the right to remove nuisances from public spaces, such as loud noises and those drunk in public. Is the new NYC law overly strict? Our position is that smoking bans support public health. The question that remains is whether smoking bans are worth the restricted liberty. Culture certainly will influence how different people answer this question. However, this is an issue everyone and every jurisdiction must decide on their own.

-Daniel Tao

What do you think? Please use the comment link below to provide feedback on this article.

References

Cameron, M., Brennan, E., Durkin, S., Borland, R., Travers, M. J., Hyland, A., . . . Wakefield, M. A. (2010). Secondhand smoke exposure (PM_2.5) in outdoor dining areas and its correlates. Tobacco Control, 19, 19-23. doi: 10.1136/tc.2009.030544

CBC News. (2009, Jan 28). Toronto bans smoking near playgrounds, wading pools. CBC News  Retrieved Feb 3, 2011, from http://www.cbc.ca/health/story/2009/01/28/tto-smoking.html

Fichtenberg, C. M., & Glantz, S. A. (2002). Effect of smoke-free workplaces on smoking behaviour: Systematic review. British Medical Journal, 325, 188-195. doi: bmj.com 2002;325:188

Glantz, S. A., & Charlesworth, A. (1999). Tourism and hotel revenues before and after passage of smoke-free restaurant ordiances. Journal of the American Medical Association, 281, 1911-1918. doi: 10.1001/jama.281.20.1911

Hauri, D. D., Lieb, C. M., Rajkumar, S., Kooijman, C., Sommer, H. L., & Röösli, M. (2010). Direct health costs of environmental tobacco smoke exposure and indirect health benefits due to smoking ban introduction. European Journal of Public Health, Advance Access. doi: 10.1093/eurpub/ckq142

Hyland, A., Cummings, K. M., & Nauenberg, E. (1999). Analysis of taxable sales receipts: Was New York City's Smoke-Free Air Act bad for restaurant business? Journal of Public Health Management Practice, 5(1), 14-21.

Juster, H. R., Loomis, B. R., Hinman, T. M., Farrelly, M. C., Hyland, A., Bauer, U. E., & Birkland, G. S. (2007). Declines in hospital admissions for acute myocardial infarction in New York State after implementation of a comprehensive smoking ban. American Journal of Public Health, 97, 2035-2039. doi: 10.2105/AJPH.2006.099994

Katz, B. (2011). New York City Council votes to ban smoking in parks. Reuters  Retrieved Feb. 3, 2011, from http://www.reuters.com/article/2011/02/02/us-newyork-smoking-idUSTRE71198V20110202

Koh, H. K., Joossens, L. X., & Connolly, G. N. (2007). Making smoking history worldwide. New England Journal of Medicine, 365(15), 1496-1498. doi: 10.1056/NEJMp068279

Levin, J. C. (2004). Protect us or leave us alone: The New York Smoking Ban. Albany Law Review, 68, 183-206.

Martin, R. (2011, Jan. 19). Raleigh moves closer to parks smoking ban. The News & Observer  Retrieved Feb. 3, 2011, from http://www.newsobserver.com/2011/01/19/929130/raleigh-moves-closer-to-parks.html

Minnesota Department of Health. Clean Indoor Air Act § 144 (1975).

Parker, B. (2011). Cambridge forming group to explore smoking ban for public parks. The Boston Globe  Retrieved Feb 3, 2011, from http://www.boston.com/yourtown/news/cambridge/2011/01/cambridge_forming_group_to_exp.html

Wydner, E. L., & Graham, E. A. (1950). Tobacco smoking as a possible etiologic factor in brachiogenic carcinoma: A study of six hundred and eight-four proved cases. Journal of the American Medical Association, 253(20), 329-336. 

 

Addiction & the Humanities, Vol. 6(11) – 'Tis the season for winter sports and spirits

Earlier this month, there were an unusual number of arrests during the National Football League’s New England Patriots versus New York Jets game in Foxboro, Massachusetts. Foxboro and State Police arrested 117 people, compared to 75 arrests during last year’s matchup; approximately 83-87% of the arrests reportedly involved public intoxication (Kent 2010; Naughton 2010). This week’s Addiction & the Humanities discusses the apparent association between cold weather sports and alcohol-related arrests. 

Disorderly intoxication is not limited to professional football events. This problem extends to collegiate football and other sports. For instance, a study at the University of Florida reported an average of 70.3 (SD = 35.4) arrests during days with home football games compared to 12.3 (SD = 8.8) arrests during control days (i.e., Saturdays without home football games) (Merlo, Hong et al. 2010). These findings are suggestive but not definitive; it is possible that more arrests occur on home game days because inebriated students might be easier to find aggregated within a stadium than distributed across many dorm rooms. Similarly, a recent Montreal Canadiens’ win against the Pittsburgh Penguins hockey game was followed by 41 arrests. It is unclear how many of these arrests were alcohol-related, but one newspaper reported that people were joyous and drunk, with at least six people being arrested before 11pm for public intoxication (Solyom 2010). Click here for photographs from the riots that ensued. Those photos show some people holding beer cans (or what appear to be beer cans). Click here for photographs of others robbing a liquor store. More damaging riots also occurred in Montreal during 2008 after another Canadiens win. Pierre-Paul Pichette of the Montreal police speculated, at the time, that small groups trigger the violence and others follow suit because of the alcohol they have consumed (Hamilton 2008). 

Arrests during warm and cold weather sports
Cold weather might play a role in sports-related drinking behavior. Compared to football, baseball, which primarily takes place during warmer weather, appears to have significantly fewer alcohol-related arrests. Fox News reporters researched baseball fan arrests in or near Cellular Field and Wrigley Field at Chicago from 2005 to 2008; there were 80 and 63 arrests respectively, although they did not specifically report how many of these arrests were alcohol-related (Zoso 2009). If we assume alcohol was involved in all of the baseball arrests, more people were arrested for public intoxication at one football event (i.e., 2010 Patriots vs. Jets at Foxboro) compared to four years of baseball at Cellular and Wrigley Fields. However, the relationship between sports and season is confounded, making this comparison difficult to interpret. Football is a violent contact sport and baseball is a non-contact sport; this characteristic likely is a factor in attracting more disorderly behavior.

Nevertheless, people often speculate that cold weather contributes to alcohol consumption because people falsely believe that hard liquor will warm them up. For instance, Foxboro Police Chief Edward O’Leary suggested that people probably were severely intoxicated because, rather than drinking beer, a typical beverage of choice while tailgating, people were drinking beverages with a higher alcohol content (Police found a large number of empty peppermint Schnapps bottles around Gillette Stadium following the game) (2010; Kent 2010; Naughton 2010).

What can we conclude?
Although anecdotal stories seem to suggest that cold weather might play a role in alcohol-related arrests at sports events, ultimately this remains an empirical question. Cross-sport comparisons confound sport, violence, and season; therefore, it is impossible to say with certainty whether a particular sport or a particular season contribute to causing disorderly behavior. However, there is evidence (e.g., literature showing that violent sports stimulate disorderly conduct and violence among fans (Young 2000). Further, to establish some evidence that will clarify whether temperature is associated with disorderly behavior and alcohol consumption across sports, researchers could compare football and baseball events that were played at the same temperature. To assess the causal relationship between temperature and disorderly conduct among fans, researchers would need to randomize fans to conditions (e.g., sporting events at particular times of year), and then examine their subsequent drinking behavior.

References

(2010). "112 arrests at Monday's Pats game." WPRI. Retrieved December 15, 2010, from http://www.wpri.com/dpp/news/massachusetts/foxboro-112-arrests-at-mondays-patriots-game.

Hamilton, G. (2008). "Riots a black eye for Montreal." National Post. Retrieved December 15, 2010, from http://www.nationalpost.com/news/story.html?id=464332.

Kent, A. (2010). "Patriots fans run up arrest reports like team ran up points on Monday vs. Jets." FanHouse. Retrieved December 15, 2010, from http://nfl.fanhouse.com/2010/12/09/patriots-fans-run-up-arrest-reports-like-team-ran-up-points-on-m/.

Merlo, L. J., J. Hong, et al. (2010). "The association between alcohol-related arrests and college football game days." Drug and Alcohol Dependence, 106(1), 69-71.

Naughton, M. (2010). "Pats win ends in jail time." Metro Boston. Retrieved December 15, 2010, from http://www.metro.us/boston/local/article/714530--pats-win-ends-in-jail-time.

Solyom, C. (2010). "Post-game celebration goes 'well' despite looting, arrests." The Vancouver Sun. Retrieved December 15, 2010, from http://www.vancouversun.com/sports/Montreal+fans+loot+stores+after+Game/3019684/story.html.

Young, K. (2000). Sport and violence. In J. Coakley & E. Dunning (Eds.), Handbook of sports studies (pp. 382-407). London: SAGE Publications Ltd.

Zoso (2009). "Breaking down fan arrests at Chicago baseball games." Redlasso: Fox News Chicago. Retrieved December 15, 2010, from http://www.redlasso.com/ClipPlayer.aspx?id=4f55eed6-7fe3-4c57-a5ce-c7620007c5fc#.

Addiction & the Humanities, Vol. 6(10) - A punch in the throat: Anti-smoking advertisements as a case study for the ‘sensationalization’ of anti-vice advertisements

Note: Certain images contained below may be disturbing to some. Please use discretion.

The news is abuzz with discussion related to the FDA’s proposed graphic warninglabels for cigarette packs. The new labels are much larger than the previous generation and feature a series of new images. These new images are a source of controversy with some people stating that the images are unnecessarily disturbing, and others doubting the efficacy of the change (Harris, 2010). This FDA effort, however, is by no means the first to employ sensationalistic and potentially disturbing anti-vice warnings and advertisings. Last year, the City of New York ran a campaign called Pouring on the Pounds targeting soda consumption with images of fat being poured out of soda bottles (New York City Department of Health and Mental Hygiene, 2009). In the UK, the city of Gwent released an anti-text-while-driving ad that shows a car full of teenagers involved in a horrific accident, including over 20 seconds focusing on the crash and the chilling aftermath. The ad went viral and has almost one million views on Youtube (link). Today’s Addiction and the Humanities discusses whether such ads are effective and justified. 

    
Whereas the United States was the first to mandate cigarette warning labels, the labels themselves have changed little since their introduction (Harris, 2010). Canada and Australia already mandate package warnings with pictures similar to those proposed by the FDA (Borland et al., 2009). Borland and colleagues (2009) showed that Canadian and Australian graphic warnings resounded emotionally with research participants more than text-based American and British warnings. Participants also rated such images as more salient. O’Hegarty et al. (2006) exposed an American sample to American (text-based) and Canadian (image-based) warnings and asked participants to rate the effectiveness of the warnings as a deterrent and motivator of change. Participants consistently rated the Canadian ads as a more effective deterrent. Smokers and former smokers also rated the Canadian ads as more likely to help them quit or stay abstinent. It is possible that these findings were influenced by the novelty of the Canadian warnings, compared to the more familiar American warnings. A similar study by Davis, Nonnemaker, Farrelly and Niederdeppe (in press) explored the effectiveness of anti-smoking print ads based on message content. Participants rated advertisements that provided reasons to quit (e.g. cancer) higher in perceived effectiveness. Of these ads, those providing graphic reasons were rated as more effective than those containing testimonials.

Where does this leave us? Three studies suggest that graphic ads might be more effective at motivating smokers to quit and helping former smokers maintain their abstinence than text-based ads. This is perhaps not surprising considering the dual-process model of persuasion. The elaboration likelihood model of persuasion posits that there are two routes to persuasion: the central route, a logic- and reason-based system engaged when people are motivated to take in information, and the peripheral route, activated when people are unable or unwilling to learn (Petty, Cacioppo, & Goldman, 1981). The peripheral route relies on emotion and unconscious processing, exactly the target of graphic ads. Unless people are motivated to read and process text-based ads and warnings, they are unlikely to be effective. Thus, for the general population, an emotionally laden ad might produce better results (i.e., quitting). There is some support for this: Davis et al. (in press) found a significant correlation between perceived effectiveness of text-based advertisements and intention to quit. These studies did not explore the effect of graphic ads on new smokers. It is therefore unclear whether they are more effective at deterring first-time smokers than textual ads.

Although graphic ads might be more effective, that does not mean they are justified. There are other methods of engaging the peripheral system; anyone who has ever seen a television commercial is well acquainted with the loud sounds and bright colors used to convince us to buy dog food. A previous Addiction & The Humanities (Vol. 6(1)) described the new anti-drug campaign that carries a strong social message against drug use, rather than levying fear. Are we unnecessarily scaring the public? Will these ads retain their effectiveness as people become more familiar with them? 

- Daniel Tao

What do you think? Please use the comment link below to provide feedback on this article.

References

Borland, R., Wilson, N., Fong, G. T., Hammond, D., Cummings, K. M., Yong, H.-H., . . . McNeill, A. (2009). Impact of graphic and text warnings on cigarette packs: findings from four countries over five years. Tobacco Control, 18, 358-364.

Davis, K. C., Nonnemaker, J. M., Farrelly, M. C., & Niederdeppe, J. (in press). Exploring differences in smokers’ perceptions of the effectiveness of cessation media messages. Tobacco Control.

Harris, G. (2010, Nov 10, 2010). F.D.A. Unveils Proposed Graphic Warning Labels for Cigarette Packs. New York Times  Retrieved November 16, 2010, from http://www.nytimes.com/2010/11/11/health/policy/11tobacco.html

New York City Department of Health and Mental Hygiene. (2009, Aug 31). New Campaign Asks New Yorkers if They’re “Pouring On the Pounds”  Retrieved November 17, 2010, from http://www.nyc.gov/html/doh/html/pr2009/pr057-09.shtml

O'Hegarty, M., Pederson, L. L., Nelson, D. E., Mowery, P., Gable, J. M., & Wortley, P. (2006). Reactions of Young Adult Smokers to Warning Labels on Cigarette Packages. American Journal of Preventative Medicine, 30(6), 467-473.

Petty, R. E., Cacioppo, J. T., & Goldman, R. (1981). Personal involvement as a determinant of argument-based persuasion. Journal of Personality and Social Psychology, 41, 847-855.

Addiction & the Humanities, Vol. 6(9): Selling the Dream: Trends in the Commercial Advertising of Lottery Gambling

In a previous Addiction & the Humanities, we explored the design features of a major alcohol media campaign and the potential connection between these design features and risky alcohol use. The scientific literature focusing on gambling advertising is less well developed; comparatively few studies have examined how governments and advertising agencies use message design and content to promote gambling behavior. This week’s Addiction & the Humanities represents an early step towards a psychology of lottery advertising.

McMullan and Miller (2009) analyzed a sample of 920 radio, print, television, and point-of-purchase lottery ads available in Atlantic Canada from January 2005 to January 2006. The authors used content analysis to identify the persuasion techniques of these ads. In this content analysis, the authors attempted to describe the design and content features of the ads by independently coding the ads along a number of dimensions, such as intended audience, color scheme, and theme. The authors report that they agreed 100% of the time on several of the variables and resolved discrepancies for the remaining variables by viewing and discussing the ads several times until they reached a consensus.

Here, we review the study’s findings with regard to a selected number of the coded dimensions.

Intended Audience. Most people depicted in the television and print ads were men, but the reverse was true for print ads. The overwhelming majority of people in all types of ads were Caucasian. In radio and television ads that included dialog, the speakers often used an informal and conversational language style (e.g., “People are gonna be winnin’ everyday.”). Patterns in the ads’ intended audience are consistent with two trends in epidemiological data. First, similar proportions of Canadian men and women participate in the lottery (Marshall & Wynne, 2004). Second, adults of lower income and education levels are more likely to participate in lottery activities (as reviewed by LaPlante, Gray, Bosworth, & Shaffer, 2010). Advertisers were likely attempting to reach out to typical lottery consumers—Caucasian men and women of relatively low income and education levels—and reinforce the notion that that the lottery, and its prizes, are geared to them. Advertisers commonly bolstered this strategy by highlighting “real winners”—ordinary people whose lives were transformed by the simple act of buying lottery tickets.

 

The “real winners” persuasive technique is illustrated here, part of the Massachusetts State Lottery’s website that highlights recent winners and their prizes.  Reprinted with permission from the Massachusetts State Lottery.

Color Scheme. All of the television ads, and most of the print ads, used vibrant shades of red, yellow, green and blue. By contrast, the ads were nearly devoid of dark or muted hues. This tendency likely was not coincidental; advertisers have long used color to shape consumer behavior by changing consumers’ moods and shaping their mental associations. For instance, compared with dark or muted hues, highly intense colors make people feel excited and happy (Cimbalo, Beck, & Sendziak, 1978; Gorn, Chattopadhyay, Tracey, & Dahl, 1997). Whereas people associate darker colors like grey with richness and value, they link brighter colors, particularly red, with cheaper prices (Aslam, 2006). Interestingly, the colors often used in lottery ads—red, yellow, green, and blue— often are associated with toys (Aslam, 2006). In sum, it seems the lottery advertisers used color to communicate the prospect of excitement, happiness, and recreation, all at a cheap price.

Theme. Perhaps not surprisingly, the most common theme was the possibility of winning. The medium often was participatory fantasy; ads encouraged consumers to imagine what they would do with their lottery winnings. Typical slogans were “What if?” and “What would you do?” Some ads encouraged the fantasy of winning by offering concrete examples of elaborate spending scenarios. Another common theme was familial acts of generosity; rather than squander their winnings, fictional lottery winners demonstrated their love and kindness by providing for the well being of their friends and family members . One ad effectively combined the two themes of fantasy and familial generosity. Here, a middle-aged married couple buys a new cottage overlooking a scenic lake. Their adult children, in admiration, promise that they will visit every weekend. Suddenly the children are handed keys to their own beautiful cottages. The parents, children, and grandchildren all embrace in celebration of their family’s dream fulfillment.

Discussion

To summarize, lottery advertisers crafted their messages to appeal to consumers who fit the demographic profile of lottery players, and they manipulated the ads’ color scheme in order to make lottery purchases seem exciting and fun. The central theme of many lottery ads was that a small bet can turn into a life-transforming prize, allowing winners to provide a carefree, luxurious existence for their loved ones and themselves. Paradoxically, the ads’ theme of familial generosity contrasts with popular notions of how actual lottery winners have spent their winnings, notions that often involve  frivolous spending sprees, squandered fortunes, family discord, and eventual bankruptcy (Binde, 2007). Potential lottery players appear to resolve the inconsistency between their fantasies of being rich and generous and their beliefs about actual winners being greedy and lonely by making self-serving judgments (Nelson & Beggan, 2004). In other words, potential consumers think “other people who win the lottery will squander their winnings and alienate their families, but I’ll be loving and philanthropic.” The lottery ads are perfectly crafted to appeal to this impulse.

-Heather Gray

What do you think? Please use the comment link below to provide feedback on this article.

References

Aslam, M. M. (2006). Are You Selling the Right Colour? A Cross-cultural Review of Colour as a Marketing Cue. Journal of Marketing Communications, 12(1), 15-30.

Binde, P. (2007). The good, the bad and the unhappy: The cultural meanings of newspaper reporting on jackpot winners. International Gambling Studies, 7(2), 213-232.

Cimbalo, R. S., Beck, K. L., & Sendziak, D. S. (1978). Emotionally toned pictures and color selection for children and college students. The Journal of Genetic Psychology: Research and Theory on Human Development, 133(2), 303-304.

Gorn, G. J., Chattopadhyay, A., Tracey, Y., & Dahl, D. W. (1997). Effects of color as an executional cue in advertising: They're in the shade. Management Science, 43(10), 1387-1400.

LaPlante, D. A., Gray, H. M., Bosworth, L., & Shaffer, H. J. (2010). Thirty years of lottery public health research: Methodological strategies and trends. Journal of Gambling Studies, 26(2), 301-329.

Marshall, K., & Wynne, H. (2004). Against the odds: A profile of at-risk and problem gamblers.   Retrieved October 14, 2010, from http://www.statcan.gc.ca/pub/11-008-x/2004001/article/6879-eng.pdf

McMullan, J. L., & Miller, D. (2009). Wins, winning and winners: The commercial advertising of lottery gambling. Journal of Gambling Studies, 25(3), 273-295.

Nelson, J. E., & Beggan, J. K. (2004). Self-Serving Judgments About Winning the Lottery. Journal of Psychology: Interdisciplinary and Applied, 138(3), 253-264.

Addiction & the Humanities, Vol. 6(8): Cash for Good Grades…or Bad Grades – Motivation to Succeed?

Ultrinsic, “ULTerior motivation that produces intRINSIC love of knowledge” ("Ultrinsic," 2010), is a company that allows college students to bet on the grades they will receive during the semester. Students who get their predicted grade, or better, win back their wager, plus a reward from the company. Those who do not get the grade lose their wager. Ultrinsic claims that their monetary incentives motivate students to improve their grades and succeed academically. However, motivation research (Ryan & Deci, 2000) suggests that Ultrinsic’s monetary awards could backfire in the end (see http://www.psych.rochester.edu/SDT/theory.php for a summary of Ryan & Deci’s self-determination theory).

Currently, Ultrinsic is available to students at, but not affiliated with, 36 US colleges and universities (e.g., Harvard University). Undergraduate students who do not already have a 4.0 grade point average (GPA) can open an account by providing to Ultrinsic the school they are attending, their course schedule, and academic history. Ultrinsic verifies grades through official transcripts or online school accounts before depositing cash rewards into accounts. Students can use the rewards to place future bets or request a check.

Ultrinsic determines students’ rewards (see Figure 1) using an algorithm based on the amount wagered, the student’s GPA or academic history and the difficulty of the class. Although Ultrinsic allows users to see how much money they can win before they place a bet, students who typically get A’s and bet the same amount for the same grade as students who typically get C’s will win less money.

Figure 1: Ultrinsic’s Betting Activity Types & Hypothetical Contributions (adapted from Ultrinsic.com’s online demo) 
*Incentives and Insurance are shown separately since most students would not bet on good and bad grades for the same course.

Although Ultrinsic claims its service promotes good scholarship, research suggests that this might not be the case over time. Studies show, for example, that individuals who receive financial external rewards for tasks experience less intrinsic motivation (i.e., motivation that is generated internally, such as interest or curiosity) to complete those tasks (Deci, 1971). Similarly, compared to extrinsic goals (i.e., goals that focus on external consequences outside of the task alone), intrinsic goals (i.e., goals that are self-satisfying independent of external factors) are more likely to lead to short and long-term persistence and a more comprehensive understanding of academic material (Vansteenkiste, Lens, & Deci, 2006). Furthermore, extrinsic goals can also predict several negative outcomes, including cheating (Anderman, Griesinger, & Westerfield, 1998). It is important to note that extrinsic motivation might enhance intrinsic motivation if individuals identify with and internalize extrinsic motivators (e.g., striving to receive a good grade [the extrinsic motivator] because one understands and values the importance of doing well in school for future quality of life). However, reward, punishment or deadline-driven extrinsic motivators are less likely to be internalized (Ryan & Deci, 2000).

Ultrinsic’s stated goal is to motivate students to achieve by giving them an opportunity to bet on their grades and receive a cash reward if they succeed. Motivation research suggests that Ultrinsic might compromise this goal. The company is providing an external reward that is not closely tied to intrinsic motivation. Also recall that Ultrinsic offers rewards for bad grades. If students do not possess intrinsic motivation to succeed academically, they could potentially use the site only for its pay-offs – slacking one semester and then doing really well the next to obtain the most money possible. Future empirical research is needed to determine how this company’s goal affects today’s students.

-Tasha Chandler

What do you think? Please use the comment link below to provide feedback on this article.

References

Anderman, E. M., Griesinger, T., & Westerfield, G. (1998). Motivation and cheating during early adolescence. Journal of Educational Psychology, 90, 84-93.

Deci, E. L. (1971). Effects of externally mediated rewards on intrinsic motivation. Journal of Personality and Social Psychology, 18(1), 105-115.

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development and well-being. American Psychologist, 55(1), 68-78.

Ultrinsic. (2010). Retrieved September 2, 2010, from http://www.ultrinsic.com/

University of Rochester. Self-Determination Theory: An Approach to Human Motivation & Personality. Retrieved September 2, 2010, from http://www.psych.rochester.edu/SDT/theory.php

Vansteenkiste, M., Lens, W., & Deci, E. L. (2006). Intrinsic versus extrinsic goal contents in Self-Determination Theory: Another look at the quality of academic motivation. Educational Psychologist, 41(1), 19-31.

Addiction & the Humanities Vol. 6(7) – The Force of Intervention

Ethically, healthcare professionals are bound to respect participants’ addiction treatment-seeking decisions, and therefore cannot force treatment onto unwilling participants unless they represent a threat to themselves or others. But, what would happen if such a restriction did not exist? A previous Humanities review (Vol 5-8) of A&E’s “The Cleaner” revealed the inaccuracies in the show’s depiction of addiction recovery following an intervention. Similarly, this week’s Addiction & the Humanities examines another A&E show related to addiction recovery, “Intervention.” Within the context of the show, we discuss the efficacy and ethical ramifications of intervention as an attempt to change the substance using patterns of a loved one.

Initially, family members and close friends nominate a candidate for “Intervention” based on his/her risky substance use or addiction-related behavior. The “Intervention” team then invites the candidate to contribute to a documentary series on addiction through a series of interviews. The invitation, in part, is a ruse. The true intention of “Intervention” is to force the candidate into treatment. The candidates, who agree to contribute, do not know that the “Intervention” team trains members of the candidate’s family about intervention tactics while searching for an ideal rehabilitation clinic for the candidate to undergo a 90-day treatment. The show content primary consists of interviews of the candidate and family members, who share their perspectives on the effects of addiction. In each episode, the interventionist typically explains to the family how their own inaction translates into an acceptance of the candidate’s addiction. At the end of the show, the family conducts the surprise intervention, and television cameras capture the candidate’s response in real time. In most cases, the candidate agrees to treatment after the intervention.

Intervention and A&E logos are owned by A&E.

If the episode “Amber” is representative of “Intervention”, it suggests that intervention indeed coerces candidates’ decision to agree to rehabilitation. For example, Amber’s father tells her that she can no longer live in his house if she refuses rehabilitation, while her ex-husband promises to seek sole custody of their daughter if her addiction continues. Facing these threats, Amber seems to have no choice other than to accept treatment, including the condition that her family attends a family clinic with her. Two months into treatment, Amber admits that she is having trouble with recovery and that she is disappointed that her family has not attended the family clinic. The show claims that Amber is sober today, but again, the program does not report its follow-up methods.
 
Amber’s case illustrates the coercive tactics that are characteristic of interventions. Her initial response to confrontation is to leave the intervention and escape the clutches of her family. Eventually she submits to social pressure and undergoes treatment. This separation between personal motivation and rehabilitation entry is a distinct flaw of “Intervention.” For example, several studies have suggested the importance of the association between internal desire to reduce or change addictive behavior and long-term recovery (Shaffer 1992; Laudet, Magura, Vogel, & Knight, 2003; Laudet & White, 2008).

“Intervention” also extends ethical boundaries: the candidate is approached only when family members submit a nomination, when the candidate is subjectively deemed to be “at a point of personal crisis and estranged from their friends and loved ones” (http://www.aetv.com/intervention/about/). The candidate remains unaware of the selection process and the true intentions of the show until the family members conduct the intervention, thereby raising ethical questions regarding these methods of treatment introduction.
 
“Intervention” claims that 71% of the candidates who have appeared on the show and entered a rehabilitation clinic have remained sober. Strangely, it cites 131/161 as the exact number of sober candidates, which actually represents a sober rate of 81%. The Division on Addictions attempted to contact Candy Finnigan, one of the show’s interventionists, to determine how follow-up interviews were structured and to explore this statistical discrepancy, but she has not responded. 

Dramatic portrayals of addiction recovery remain surprisingly popular. One possible appeal of shows such as “Intervention” could be the drama of forcing candidates into treatment against their will. This formula essentially simplifies the complexities of addiction and the recovery process. However, such a portrayal can be detrimental to a more comprehensive and accurate understanding of addiction. Regardless of the results of this television show, as a technique, intervention remains a coercive method of persuasion. Considering that the follow-up methods of “Intervention” are presently unknown, the purported rate of recovery seems exceedingly, if not mistakenly high – particularly compared to the rates of relapse and recovery established by treatment outcome research. Furthermore, there is little research focusing on the efficacy and adverse consequences associated with interventions. Consequently, it is premature to consider intervention as an effective treatment, despite shows’ claims; perhaps just as important, there are important questions about intervention as an ethical component of treatment. Alternatively, motivational enhancement techniques may likely result in more successful recoveries with fewer negative effects. These new resistance reduction approaches (Shaffer, 2001) can diminish the need for “interventions” as portrayed on television.

-Aaron Lim

What do you think?  Please use the comment link below to provide feedback on this article.

References

Intervention: About the show. Retrieved from http://www.aetv.com/intervention/about/

Johnson, V. E. (1980). I'll quit tomorrow (Revised ed.). New York: Harper & Row.

Johnson, V. E. (1986). Intervention: How to help someone who doesn't want help. Minneapolis: Johnson Institute Books.

Laudet, A. B., Magura, S., Vogel, H. S., & Knight, E. L. (2003). Participation in 12-Step-Based Fellowships Among Dually-Diagnosed Persons. Alcohol Treat Q, 21(3), 19-39.

Laudet, A. B., & White, W. L. (2008). Recovery capital as prospective predictor of sustained recovery, life satisfaction, and stress among former poly-substance users. Subst Use Misuse, 43(1), 27-54.

Shaffer, H. J. (1992). The psychology of stage change: The transition from addiction to recovery. In J. H. Lowinson, P. Ruiz, R. B. Millman & J. G. Langrod (Eds.), Substance abuse: a comprehensive textbook (Second ed., pp. 100-105). Baltimore: Williams & Wilkins.

Shaffer, H. J., & Simoneau, G. (2001). Reducing resistance and denial by exercising ambivalence during the treatment of addiction. Journal of Substance Abuse Treatment, 20(1), 99-105.

Vargas-Cooper, N. (2010). The rehab show that works. The Daily Beast. Retrieved from http://www.thedailybeast.com/blogs-and-stories/2010-07-21/the-new-ae-reality-show-intervention-with-jeff-vanvonderen-and-candy-finnigan/.

Addiction & the Humanities Vol 6(6) – I Wish I Said That

The Oxford English Dictionary (OED) defines “aphorism” (second definition) as “Any principle or precept expressed in few words; a short pithy sentence containing a truth of general import; a maxim.” Arguably, much of peoples’ attitudes and knowledge are reflected in and derive from such aphorisms. However, such sayings might gain broad recognition and acceptance without containing a truth. This week, Addiction and Humanities reviews several selections from The Quotable Gambler (Paul Lyons, 1999) to determine how they map onto current knowledge and practices related to gambling.  

The more it changes…

Gambling promises the poor what property performs for the rich: something for nothing.- George Bernard Shaw

Mr. Shaw would not be surprised by the number of states that earmark some casino fees and revenues for reducing property taxes.

Something for nothing

A dollar picked up in the road is more satisfaction to us than the 99 which we had to work for, and the money won at Faro or in the stock market snuggles into our hearts in the same way. ~ Mark Twain

In contrast, Aronson & Mills (1959) found that people tend to attribute a greater value to things they put effort into acquiring or achieving. They labeled the effect “effort justification.” Perhaps gamblers cognitively distort winning as a result of their efforts.

Controlling chance

You cannot beat a roulette table unless you steal money from it. ~ Albert Einstein

A gambler is nothing but a man who makes his living out of hope. ~William Bolitho

Despite Einstein’s admonition, some research demonstrates that people diagnosed with an a gambling disorder have higher than usual belief in their ability to control chance (de Stadelhofen, Aufrère, Besson, & Rossier, 2009).

Maybe it’s not about the money

There are two great pleasures in gambling: that of winning and that of losing.  ~ Old French Saying

The subject of gambling is all encompassing.  It combines man's natural play instinct with his desire to know about his fate and his future. ~ Franz Rosenthal

Gambling satisfies the need for stimulation and the discharge of impulses. It also distracts from stress (Clarke et al, 2007). Research has demonstrated that gambling provoked by excitement-seeking is associated with other psychological problems (Pantalon, Maciejewski, Desai, & Potenza, 2008).

But it is a slippery slope

They start gambling for fun, continue for greed, and finally the game becomes a passion.  ~ Francois-Paul Brueys D'Aigalliers

The first steps on the slope

One of the worst things that can happen to you in life is to win a bet on a horse at an early age. ~ Danny Mcgoorty

Clinicians identify early wins as a risk factor for developing gambling-related addiction problems. More work needs to be done to determine whether there is much truth to Mcgoorty’s claim.

With untoward consequences

All the world loves the game, and most sensible people willingly resign themselves to it until they see violence, deception, confusion, loss of money and time paired with it; until they understand that they can spend all their life for it. ~ Montesquieu.

Words of advice

If you must play, decide upon three things at the start: the rules of the game, the stakes, and the quitting time.  Chinese Proverb

It would appear that suggestions for responsible gambling have been around for many years.  

Conclusion

Perhaps you have employed quotes from others or constructed your own aphorisms about the recognition and remediation of addiction. Please forward those sayings with a description of their utility to the BASIS so that we can compile them into an issue for the benefit of our readers. 

-Julia Braverman

Please use the comment link below to provide feedback on this article.

References

Aronson, E., & Mills, J. (1959) The effect of severity of initiation on liking for a group. Journal of Abnormal and Social Psychology, 59, 177-181

Clarke, D., Tse, S., Abbott, M., Townsend, S., Kingi, P., & Manaia, W. (2007). Reasons for starting and continuing gambling in a mixed ethnic community sample of pathological and non-problem gamblers. International Gambling Studies, 7(3), 299-313.

de Stadelhofen, F., Aufrère, L., Besson, J., & Rossier, J. (2009). Somewhere between illusion of control and powerlessness: Trying to situate the pathological gambler's locus of control. International Journal of Clinical and Health Psychology, 9(1), 117-126.

Lyons, P. (1999). The Quotable Gambler. New York, New York, The Lyons Press.

Pantalon, M., Maciejewski, P., Desai, R., & Potenza, M. (2008). Excitement-seeking gambling in a nationally representative sample of recreational gamblers. Journal of Gambling Studies, 24(1), 63-78.

Addiction & the Humanities, Vol. 6(5) - Exposure to Drug-related Music Lyrics

Many researchers suspect that exposure to public health toxins, such as gambling, alcohol, and tobacco, can lead to changes in engagement with those toxins (LaPlante & Shaffer, 2007; Shaffer, LaBrie, & LaPlante, 2004). Consistent with this perspective, many studies have examined the health effects of toxin-related imagery in movies, music, literature, and the like (Addiction and the Humanities, Vol. 6(3); 3(2); and 1(11). This week, for Addiction and the Humanities we review a study that examined the association between adolescents’ exposure to cannabis in popular music, and their cannabis use (Primack et al., 2009).

Methods

• The researchers examined the baseline survey data of an anti-smoking clinical trial involving all students (N=959; 80% of those eligible) enrolled in 9th grade health classes at three large Pittsburgh, PA high schools.
• The baseline survey included socio-demographic, parenting style, sensation seeking, rebelliousness, and alcohol-use scales and variables.  
• The study estimated students’ cannabis lyric exposure in two ways:
• First, by asking students the number of hours per day they listen to music and their favorite musician. The researchers used this information, in combination with the results of a separate content analysis of musicians’ songs (Primack, et al., 2008), to determine each student’s unique exposure to cannabis lyrics (i.e., the product of students’ hours per week listening to music by the number of cannabis references per hour in their favorite artist’s songs).  
• The researchers categorized students’ exposure scores into tertiles: low, medium, and high.   
• Second, by determining students’ favorite artist’s number of songs that contained cannabis lyrics (i.e., 0 songs, 1-2 songs, or 3 or more songs with cannabis lyrics).  
• The primary outcome variables of interest were: (1) ever cannabis use, even a puff (yes or no) and (2) past 30 day cannabis use, even a puff (yes or no).

Table 1: Odds Ratios (95% Confidence Intervals) for Cannabis Use/Exposure Relationship

**p<.05; multivariate regression analyses controlling for all covariates (i.e., socio-demographic, parenting style, sensation seeking, and rebelliousness scales and variables)

Results

• As displayed in Table 1, multivariate logistic regressions, controlling for all covariates (i.e., socio-demographic, parenting style, sensation seeking, and rebelliousness scales and variables), showed that compared to those with the lowest exposure to cannabis lyrics, those with the highest exposure had higher odds of past 30 day cannabis use.
• Regression analyses also showed that compared to those with the lowest song exposure, those with the highest exposure had higher odds of past 30 day cannabis use and ever cannabis use.

Limitations

• The study relied on self-reported data without corroboration; therefore, this study is subject to the problems commonly associated with self-report.
• The study does not consider the role of individual resiliency factors (e.g., positive social networks), which might influence exposure processes.
• The measures of exposure assume that students’ favorite artist also is their most played artist, which might not be the case.
• The study design is cross-sectional; therefore, it cannot establish whether the cannabis exposure and engagement relationship is causal.

Discussion

The study supports research that suggests that exposure to specific public health toxins is associated with increased engagement with those toxins. It is the first study to illustrate this phenomenon with cannabis, using exposure estimation calculations. Future research in the area might consider the role of resiliency factors, which might change the nature and shape of the relationship between exposure and engagement. Also, research on exposure effects for other public health toxins suggests that exposure effects often are attenuated over time, through adaptation processes (LaPlante & Shaffer, 2007; Shaffer et al., 2004). Researchers and others should consider whether such processes might apply here, and/or how to facilitate such processes and minimize prototypical exposure effects.

-Debi LaPlante

What do you think? Please use the comment link below to provide feedback on this article.

References

LaPlante, DA & Shaffer, H. J. (2007). Understanding the influence of gambling opportunities: Expanding exposure models to include adaptation. American Journal of Orthopsychiatry, 77, 616-623.

Primack, B. A., Dalton, M.A., Carroll, M. V. Agarwal., A. A. Fine, M. J. Content analysis of tobacco, alcohol and other drugs in popular music. Archives of Pediatric Adolescent Medicine, 162, 169-175.

Primack, B. A., Douglas, E. L., & Kraemer, K. L. (2009). Exposure to cannabis in popular music and cannabis use among adolescents. Addiction, 105, 515-523.

Shaffer, H.J., LaBrie, R.A., LaPlante, D.A. (2004). Laying the foundation for quantifying regional exposure to social phenomena: Considering the case of legalized gambling as a public health toxin. Psychology of Addictive Behaviors, 18(1), 40–48.

Addiction & the Humanities, Vol. 6(4) - A diary of morphine-addiction

Although evidence suggests that that natural history of addiction is similar across people and expressions of addiction (Shaffer et al., 2004), personal stories about the development of addiction remain compelling and informative. This week’s Addiction and the Humanities presents annotated excerpts from an intensely gripping story about the gradual metamorphosis of the psychological state, thoughts, and emotions of a physician who became addicted to morphine. The fictional story,Morphine, is based on the real experiences of the author, a famous Russian writer Michael Bulgakov*, who became morphine addicted early in his life.

 Background: The story is set in Russia, during January 1917. This is a period involving the Russian Revolution and the First World War. The protagonist, a young doctor Polyakov, not being eligible for active military service after graduation from a medical school in St Petersburg, is beginning an assignment to practice medicine in a remote country village. Below we present annotated excerpts from his diary, as described in, Morphine. The excerpts are unmodified quotes from the book; we give the annotations in italic. 

Jan. 20. 1917. Perpetual blizzards… I’m sick of it. Alone every evening. <…>

Social isolation could have protective or risk-related implications for addiction. Here, social isolation does not appear to provide protection from exposure to potential objects of addiction and leaves the person with no social support. The diary portraits a lonely and distressed person.

Feb. 15.  Last night an interesting thing happened. I was just going to bed, when I suddenly felt pain in the region of my stomach. And what pain! Groaning, I reached the kitchen, and called Anna K., the nurse. She came to my room and had to give me a morphine injection. <…> I must give due praise to the man who first extracted morphine from poppyheads. The pain stopped seven minutes after the injection. It would be a good thing if a doctor were able to test many more drugs on himself. He would then have a completely different understanding of their effect. After the injection I slept soundly and well for the first time in months – and I forgot completely about the woman who deceived me.

The first experience of morphine injection is extremely rewarding. It relieves not only physical pain, but also emotional distress.

Feb 16. I am alone in my quarters. Fearing a recurrence of yesterday’s pain attack, I injected myself in the thigh with .01 gram. The pain cease almost instantaneously. A good thing Anna K. left the phial behind.

Being alone, previous rewarding experience and availability of drug - all become factors in the addiction progress.

Feb 18. Four injections. No harm in that.

Tolerance is evident as he increases the dose to reach the same effect previously obtained at a lower dose.  

Feb 21. Anna K. is behaving very oddly – just as though I weren’t a doctor at all! 1.5 syringes = .0.015 grammas morph.? Yes. It is two weeks now since I last thought about the woman who deceived me. I am very proud of that. I am a man.

Morphine injection “protects” against condemnation of other people. The character feels pride rather than shame.

            For the first minute there is a sensation of being touched on my neck. The touch grows warmer and spreads. In the second minute there is a sudden surge of cold in the pit of my stomach, after which I start to think with unusual clarity and experience a burst of mental energy. If I had not been spoiled by my medical training, I would say that a man can only work normally after an injection of morphine. <…> Anna K. is frightened. Calmed her, saying that since childhood I have been remarkable for having tremendous will power.

Exposure to morphine can produce extremely rewarding psychological states that are accompanied by misleading feelings of self-confidence. Medical training and knowledge about consequences are not enough to protect the person from continuing morphine use.

March 2 I shall go to bed very early <…> And my sleep will be sweet.

Morphine is a central nervous system depressant, often leading to deep relaxation and sleep.

March 19. Last night I had a quarrel with Anna K. “I’m not going to make up the solution any more. ‘ It was then that I first discovered in myself a nasty tendency to lose my temper and, worse, to shout at people when I am in the wrong. <…> And I snatched the keys out of her hand.

Personality change and episodes of violent mood swings can be symptoms of addiction. This often leads to deterioration of interpersonal relationship with other people (e.g., his nurse, who also became Dr. Polyakov’s mistress at that time).

April 9. The devil is in this phial! This is its effect: on injecting one syringe of a 2% solution, you feel almost immediately a state of calm, which quickly grows into a delightful euphoria. This lasts for only a minute or two, and then it vanishes without a trace as though it had never been. Then comes pain, horror, darkness.

This is a common description of euphoria and withdrawal effects. Increasingly shorter periods of euphoria are followed by longer periods of physical suffering. 

May 6. Two syringes of a 3% solution. My previous notes must sound somewhat hysterical. In fact there is nothing particularly unusual or alarming about my condition. It does not in the least affect my capacity to work. On the contrary….

People with addiction often deceive themselves by suggesting that the drug injection may even improve their work ability.

May 18. A book is open in front of me… “.. morbid anxiety, a nervous depressed condition” <...> “Depressed condition” indeed! The body which moves, agonises and suffers is a corpse. It wants nothing, can think of nothing but morphine. The feeling must be something like that of a man buried alive, groaning and writhing as the first tongues of flame lick at his feet. Death. That is what lurks behind that clinical, academic phrase “a depressed condition’. I can’t hold out. I have just had injected myself. Three syringes of a 3% solution. That will last me until midnight.  .. Nonsense. That last entry was nonsense. It’s not as bad as that. Sooner or later I’ll give it up…but now I need sleep, sleep.

Dr. Polyakov experiences mood swing episodes. The dysphoria and physical discomfort associated with withdrawal are accompanied by denial; Another symptom of addiction is irregular sleeping patterns that encourage tiredness and physical distress.

 <…The pages in between describe Dr. Polyakov’ attempts to be treated in a clinic in Moscow that ended by his running away and stealing morphine from the hospital, his coming back to the country, the relationship with the nurse, gradual increase of the injection dose, and his descent into madness…>

Nov 18. <…> I may be in a state of moral decay, but I am nevertheless making an effort to arrest it. This morning, for instance, I did not have an injection.

Attempts of self-cure are difficult and made even more difficult in almost complete social isolation.

Jan. 17. 1918. During abstinence I am terrified by the slightest sound and I find people detestable. I am afraid of them. In the euphoric phase I love everyone, although I prefer solitude.

People with opioid addiction often experience fear and tension during the withdrawal periods. To reduce the discomfort of sounds, lights, and people, one sign of addiction is seeking isolation or trips to an isolated place like the bathroom or bedroom.

Feb. 13. 1918 <…> I have decided against treatment. It’s hopeless. And I don’t want to torment myself any longer. NO ONE IS TO BE BLAMED FOR MY DEATH.

Dr. Polyakov commits suicide and leaves his notebook as a “pathological history” to “warn others.”

Discussion

In 1927, Medical Worker (Medicinsky rabotnik) journal first published this story as an impressive and sincere description of addiction. As described in the annotations, the story contains the initial rewarding experience associated with morphine use, the progression of increasing doses, later self-excuses for using, additional need to increase the dose (tolerance), a switch between self-confidence and disparity, and finally, the agonizing suffering and complete destruction of life. This story raises questions about the role of personality and social settting in addiction. Which is the “devil” here: The person, the environment, or morphine itself? The tale is based on the real experience of the author, who was a physician in a rural area, who developed an addiction to morphine despite his medical training and knowledge. This is a bright illustration of how knowledge itself does not prevent or limit addiction. Unlike his character, Bulgakov managed to overcome his addiction after coming back to Kiev (a big city) from the province and getting support from his family and friends.

-- Julia Braverman

What do you think?  Please use the comment link below to provide feedback on this article.

References cited

M. Bulgakov (1975). A country doctor’s notebook. Morphine. pp.114 – 144. London : Collins, 1975.

Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A. N., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.

The tale is a part of a book of stories that is available on Amazon, ebay, and LibraryThing

The pictures are taken from the story-based movie Morphia (2008) presented at Cannes fest, 2009.

---

^* M.Bulgakov is the author of  a novel “Master and Margarita” that critiques often name among the 100 best books of 20^th century..

Addiction & the Humanities, Vol. 6(3) - Movies, Urges, and Smoking Cues

The Motion Picture Association of America (MPAA) administers a well-known movie ratings system based, in part, on movie characters’ smoking behavior. Specifically, the MPAA’s rating system currently considers three primary questions for movies that contain smoking: (1) Is the smoking pervasive; (2) Does the film glamorize smoking; and (3) Is there an historic or other mitigating context? Movies with affirmative answers to the first two questions, but not the third, receive a higher warning rating than other movies. Do smoking cues in movies warrant higher warnings? This week, Addiction and the Humanities reviews recent research examining how static and dynamic smoking images from movies relate to smokers’ urges to smoke and actual smoking behavior (Lochbuehler, Engels, & Scholte, 2009).

Methods

• The authors conducted two convenience sample studies:

1. a counterbalanced within-subjects (i.e., all participants received both conditions) comparison of 31 adult smokers’ (12 male; 19 female) cravings following exposure to photographs (i.e., static cues) in which smoking is depicted and photographs in which smoking is not depicted;
2. a randomized between-subjects (i.e., participants were randomly assigned to receive one condition or the other) comparison of 65 adult smokers’ (22 male; 43 female) cravings and smoking behavior following exposure to movie clips (i.e., dynamic cues) in which smoking was either depicted or not.

• For both studies, the authors assessed urges using a visual analogue scale (VAS).ⁱ
• For the static study, the authors also assessed urges using a 4-item Questionnaire of Smoking Urges (QSU; e.g., “I crave a cigarette.”).
• For the dynamic study, the authors also called participants one hour after the experiment and asked how many cigarettes they smoked during the previous hour.

Results

• Table 1 shows that the static cue results indicated an effect of smoking cues on two measures of smoking urges, the QSU and the VAS: (1) QSU (t(30)=3.61, p<.01); and (2) VAS (t(30)=3.24 p<.01).
• The dynamic cue results indicated that, movie clip cues had no effect on cravings (F(1,61)=0.25, p>.05) or in the number of cigarettes smoked during the hour following the experiment (F(1,55)=0.12, p>.05), after adjusting for baseline smoking cravings.

Table 1. Mean (standard deviations) Craving Scores by Study Condition
  Note. *=p<.01

Limitations

• Some aspects of the experimental design, including the small sample sizes and the university-based convenience samples, limit the generalizability of the study findings.
• The authors created the study cue materials from a single media source: the movie Atonement. The use of alternative and/or additional media sources could provoke different findings.

Discussion
The results of this study were mixed (i.e., smoking cue effects influenced craving for static, but not dynamic cues). Other research suggests that smoking cues in movies have a variety of predictable effects on individuals’ smoking related behaviors and cognitions (see, A&H Vol. 3(2) for a discussion). Randomized experiments that utilize more representative and larger samples of participants will help elucidate the conditions under which smoking cues in movies affect viewers. Additional research also should pursue a direct comparison of the effects of static versus dynamic smoking cues. More generally, smoking in movies is an ongoing hot topic for public health advocates, movie viewers, and those in the movie industry, and remains worthy of additional research attention.

References
Lochbuehler, K. Engels, R. C. M. E., Scholte, R. H. J. (2009). Influence of smoking cues in movies on craving among smokers. Addiction, 104, 2102-2109.

ⁱParticipants mark a line anchored by two descriptive words at the point that they feel represents their current state.