Updated: Nov 16
Humans are creatures of habit, and our biological drive is to gravitate toward what is familiar, safe, and comfortable to avoid suffering and change. This resistance to change is deeply etched in our biology as our prefrontal cortex is prewired for addiction.
Roughly 21 million Americans struggle with at least one type of addiction, and only 10% willingly seek treatment for it (Addiction Center 2021). Yet still, 34 million US citizens smoke cigarettes, and most perceive smoking as a negative behavior choice, with 22.7 million of the 34 million who smoke claiming they want to quit smoking. And yet, less than one in ten of these individuals will succeed.
To understand the reason for this exorbitant lack of efficacy and autonomy over our choices, we must look deeply into the nature of behavior and the determinants that play a role in our choices.
We have been aware of the negative consequences of smoking for decades. It is no surprise that chronic nicotine intake affects health, whether chewing or smoking tobacco. Most of us are also aware that smoking leads to deleterious outcomes on homeostatic factors within the biological and biochemical mechanisms of the human organism. And yet, we continue to engage.
To refresh you, dear reader- regular and long-term nicotine intake from either inhalation or ingestion of tobacco can lead to the development of cancer, addiction, dental and gum loss, heart disease, COPD, and many other harmful health outcomes. We know smoking is bad, and raising awareness seems like a positive way to affect change, but studies have shown that this is not true.
So, what factors influence a person’s likeliness to start smoking, continue smoking, and possibly quit after becoming addicted? These factors are based on the health model's determinants that give the public health professional a foundation for applying specific behavior modification techniques. These factors are listed below-
Intrapersonal factors include your attitudes, beliefs, volitions, and genetics.
Interpersonal factors include your relationships with family, friends, coworkers, or classmates.
Organizational influences include school and college systems, government, industries, and corporations.
Community factors on this level include social media sites, where you live, and where you congregate, such as the pub or the library.
Public policy consists of political representatives and public health professionals in the community establishing appropriate policies.
Physical Environment factors make up where on earth you live
Culture includes religion, social norms, ethnic influences, politics, etc.
These seven determinants of health influence our behaviors in many ways and on numerous levels. While awareness of these influences does little to change behaviors for most of us, it is helpful to recognize that, on a biochemical level, we all have less autonomy over our choices than we think. In fact, 95% of our choices are executed subconsciously- meaning we only make about 5% of our daily choices consciously.
According to the behavior change theory models of the Theory of Reasoned Action/Theory of Planned Behavior, we tend to act on changing things if we value the outcome, such as prolonging our lives by improving health through smoking cessation. If the behavior results in something we value, we are more likely to engage in it. More still, an individual addicted to nicotine will not quit smoking if their perceived control and volition to quit are low, even when educated on the hazards of smoking. So, while we may value quitting smoking, if we have low levels of self-efficacy (self-esteem?), paired with little volition and intention to change, we will continue with the addictive behavior.
Forgive the redundancy, but to recap- People do not quit an addictive behavior because they do not have positive perceived control nor the volition to change. It is not difficult to realize why so many Americans struggle with unhealthy physiology and psychology. The individual knows the addiction is bad for them. Still, they do not believe they can quit or do not perceive the threat as severe enough to change, so they continue strengthening the addiction instead of changing the behavior.
As a behavior modification specialist, I have studied behavior change models and applications for many types of people in all stages of change and types of addiction for years. What I have found to be the foundational factor influencing change is a person’s perceived level of self-esteem paired with an awareness of the perception of their addiction.
It is unequivocally possible to quit any addiction or harmful habit if the desire and perceived behavior to quit is high. Self-esteem and self-awareness are central constructs in attaining freedom from attachments to addiction, habits, and modalities in life that cause us unhappiness and suffering. The choice to change is up to the individual who desires and values quitting more than continuing to engage in addictive proclivities and also desires autonomy over their choices.
For more information on addiction and behavior change theories, please email me @ firstname.lastname@example.org.