Article archive / January 1, 2010
Originally published: . Volume 1, No. 5. Source pages: 1, 3, 12.
Dr. Amy Copeland, Associate Professor at LSU, Director of the LSU Psychological Services Center, and Adjunct Associate Professor at Pennington, leads a team of researchers and clinicians to help people stop smoking. In combination with her research efforts to discover the cues for relapse, she and her team use empirically supported counseling techniques, a combination of behavioral and pharmacological therapies, to produce best possible outcomes. She collaborates with Dr. Bob Matthews and Dr. Sean Lane from the LSU cognitive area, as well as Dr. Paula Geiselman from the biological area, to help identify variables in this dangerous habit.
She said to PT, “Now we know that nicotine is every bit, if not more, addictive as other substances, and how destructive and costly cigarette smoking is.”
Dr. Copeland’s interest in substance use, and her personal goal of public service, crystallized in her early career. While working at the Veterans Administration Medical Center (VAMC) and University of California at San Diego, it impressed her that, “The population who needs treatment the most can’t afford it.” She continued, “And so I knew that I wanted to focus in public service in some way or another.” As an undergraduate, Amy worked for three years in research at VAMC. “We were looking at the relationship between depression, stressful life events, and relapse in alcoholic patients. It all fascinated me…Especially the Viet Nam Vets who had very little, but just seemed to have such resilience, for what they had been through. Their persistence and strong desire to change, to improve their health and lives in general, was so compelling. I wanted to understand more about the process of health behavior change.”
Amy’s team is looking at heavy smokers who are not necessarily interested in quitting smoking. “We are using motivational interviewing strategies by providing health-related feedback on breath carbon monoxide, pulmonary lung functioning and blood pressure. We call it a health screen for smokers.” She explained, “Most smokers want to quit, on some level. If they are not particularly motivated at the time, then the more tailored the information is to their specific needs, as far as health feedback, the more meaningful it is to the patient. Identifying concerns for the smoker can be key to motivating smokers to quit.” One of her current manuscripts addresses this area, “Personalized health feedback to heavy smokers as a brief motivation interviewing strategy.” Amy’s hope is that this type of brief intervention can ultimately be delivered in a primary care setting by health professionals. She explained that the literature indicates that when physicians or psychologists spend just five minutes talking to patients about quitting smoking, it can make a “huge difference.”
“When they are ready, encourage the combination of behavioral counseling, cognitive behavioral, and some sort of pharmacotherapy. These make withdrawal a lot easier for people. It still takes work, but these certainly take the edge off of withdrawal symptoms.” Amy suggested, “It is best for the smoker to set a specific quit date in advance and to prepare cognitively, emotionally, and behaviorally for the day.” Amy stated that there are many resources online, making good information and advice available to smokers who cannot, or opt not to, participate in face-to-face programs. However, she said, “I still think the group setting is best for people. You can see the camaraderie develop among group members as they go through withdrawal together.” She noted that then they can support each other and implement the tools they’ve learned, the cognitive and behavioral coping responses, to get through the urges. “Once people understand the associative nature of urges and cravings, and that laying down new memories and forming new associations will work, it’s going to get a lot easier.”
She remarked on how addictive nicotine is, and how people who have tried to quit many times are discouraged. “As clinicians, we need to address smokers’ level of confidence in successfully quitting. Heavy smokers who have attempted to quit many times and relapsed are discouraged. They have low self-efficacy for cessation. So you really need to emphasize, just like you would with a condition such as depression, that nicotine dependence is a very treatable disorder. There are efficacious therapies and pharmacotherapies, to give the person a lot of support.”
“Let them know also that they are going to go through mood changes, while in withdrawal,” she said. And, “There should be an educational component to it. Then of course, in relapse prevention, make people aware of their high-risk situations.” She explained that when faced with urges, smokers must implement behavioral and/or cognitive skills. She also recommends stress management and rewards. “It’s really important,” she said, “in pure operant terms, that they should reinforce or reward themselves, for making it through even 24 hours without smoking. Don’t think about forever right now, just think about getting through the next few hours without smoking and take it a little bit at a time.”
She also recommends discussing weight. Some of her past research has uncovered that women fear the weight gain associated with quitting, “Even though smoking a pack of cigarettes per day puts more stress on your heart than being one hundred pounds overweight.”
While Amy has published extensively in addiction, cognitive therapy, and health, another primary research interest of hers includes the relationship among weight, eating-related variables and stimulant use (nicotine is a mild stimulant). Amy explained that many women report smoking exclusively to control appetite and weight. While they don’t necessarily suffer from clinically significant eating disorders, they do show high levels of “dietary restraint” or “weight concern,” both associated with cigarette smoking and difficulty with cessation efforts. “I see this in many college women who say to me, ‘But Dr. Copeland, I don’t intend to smoke when I’m your age.’ They don’t realize that nobody does! However, they become nicotine dependent just like anyone else who smokes regularly. Perhaps the most disconcerting is the finding that these attitudes exist in very young children, especially girls. The belief that smoking is related to controlled appetite and weight is predictive of later smoking behavior in adolescents.”
Amy’s research efforts in this area presently focus on college student smokers and whether extreme dieting attitudes associated with smoking can be modified to produce healthier beliefs regarding diet and substance use, including smoking and drinking.
Dr. Copeland can be reached at copelan@lsu.edu for further information about her research, services, and technical questions.
Her lab’s webpage is http://www.lsu.edu/psychology/faculty/DrCopelan d.htm
L to R: Dr. Amy Copeland, Magda Kulesza, Claire Adams, Meredith Terlecki, abd Diana Stewart, viewing the pulmonary lung functioning feedback for smokers. Dr. Amy Copeland’s team at the lab: Left to right: Diana Stewart, M.A., Magdalena Kulesza, M.A.; 2nd row: Megan Apperson, M.A., Claire Adams, M.A., Dr. Copeland, Ning Ding, Meredith Terlecki, M.A., Lauren Baillie, M.A.
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