A link between addiction mindset and smoking behavior

From the Bricker Group, Division of Public Health Sciences
Image of broken cigarette
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Cigarette smoking increases the risk of all-cause mortality and is estimated to kill more than seven million people per year worldwide. Thus, an increased understanding of barriers encountered by individuals in their quest to quit smoking has the potential to substantially decrease smoking prevalence and associated morbidity. Psychology studies reveal that one’s mindset about a human attribute, that is, whether the attribute is fixed or malleable, may impact the success of behavioral change. While the concept of a growth (i.e. the behavior is malleable) or fixed (i.e. the behavior is unchangeable) mindset has been assessed in the context of behaviors such as dieting and social interactions, its role in addiction was unexplored until now. Researchers in Dr. Jonathan Bricker’s research group and the Division of Public Health Sciences recently published a paper in the journal Substance Use & Misuse in which they describe the addiction mindset and its associations with smoking cessation.

Because mindset specifically in the addiction domain had not previously been assessed, the authors first created a tool to assess addiction mindset. To do this, 600 participants completed a 22-item questionnaire that included growth and fixed mindset statements. Examples of such statements include “Whether a person is addicted or not is deeply ingrained in that person. It cannot be changed very much” and “With effort, people can get over their addiction.” The participants rated each statement on a scale of one to six, indicating strongly agree to strongly disagree, respectively. Statistical analyses were conducted using the exploratory factor analysis method to first determine whether the responses differed between smokers and nonsmokers; this analysis reduced the number of items to ten. Subsequent analyses further reduced the number of items to a total of six. The authors named this new tool the Addiction Mindset Scale (AMS).

In the next step, the authors investigated relationships between addiction mindset and behaviors related to smoking cessation, including motivation, commitment, and perceived barriers to successful smoking cessation. Dr. Vasundhara Sridharan, former doctoral student in the Bricker research group and lead author of the work, described the rationale for the second part of the study, “Behavior change theories and principles from psychology like that of growth mindset can be powerful tools for understanding human behavior including addiction. This is the first work to our knowledge to apply principles of fixed and growth mindset to understanding smokers' beliefs about addiction. We hope that by first learning the belief systems that underpin addictive behaviors, we can identify the invisible cognitive barriers that may be in the way of cessation and behavior change. This is a first critical step that is necessary to help guide individuals towards healthy behaviors to prevent cancer.” 

The authors recruited 200 current smokers to complete the six-item AMS and additional questionnaires and checklists to assess psychological processes related to quitting smoking. Higher AMS score, indicating a growth mindset, was not associated with number of cigarettes smoked per day, with quit attempts in the previous year, or with intention to quit in the future. However, AMS score was associated with both motivation and commitment to quitting. Consistent with these findings, higher AMS score was also associated with fewer perceived barriers to successful quitting. Participants were also presented with a hypothetical scenario in which they were asked to envision a situation in which they decide to quit smoking but are unsuccessful after one week. Participants then completed a survey to assess why they might have quit. Results from this exercise revealed that individuals with a growth mindset were more likely to explain their failure to quit due to lack of effort while individuals with a fixed mindset were more likely to attribute the failure to lack of ability to quit.

These initial insights into the relationship between addiction mindset and factors involved in smoking cessation provoke several new questions. Dr. Sridharan elaborated, “Is it that having a growth mindset predisposes someone towards greater motivation to quit smoking? Or is it that someone who is more motivated is predisposed to have a growth mindset? Can changing mindset aid in cessation efforts?” In follow-up work, Dr. Sridharan is exploring these questions, “As part of my PhD dissertation, I have been able to start unpacking some of these critical next questions in a pilot randomized trial for a growth mindset intervention for smoking cessation. In conjunction with Dr. Bricker's work in digital interventions, I am testing the feasibility and efficacy of a fully online intervention.” Dr. Sridharan emphasized the potential impact of this work, “If proven effective, it would be a simple, cost-effective and efficacious way using psychology to change behaviors that can cause cancer.”

This work was supported by the National Cancer Institute and a Hutch United Doctoral Fellowship to Dr. Vasundhara Sridharan.

Fred Hutch/UW Cancer Consortium members Drs. Jonathan Bricker and Jaimee Heffner contributed to this research.

Sridharan V,Shoda Y,Heffner JL,Bricker J. 2019. Addiction mindsets and psychological processes of quitting smoking. Substance Use & Misuse. doi: 10.1080/10826084.2018.1555259.