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Section 5
Triggers for Smoking

Question 5 | Answer Booklet | Table of Contents

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In the last section, we discussed the SALES approach to overcoming tobacco dependency.  The SALES approach is a technique that attempts to maximize the effectiveness of a client’s quitting partner.  Clearly, SALES is an acronym for speak, abstain, link, empathize and solve.  We also looked at a three step problem solving process regarding smoking cessation.

In this section, we will discuss smoking triggers.  This section intends to provide practical information and techniques for dealing with four common smoking triggers.  The four smoking triggers we will look at in this secti are places, people, time, and feelings. 

As you listen to this section, you might consider your client and evaluating the techniques in this section to decide if they are applicable to your practice.  You might consider playing this section during your next session with a tobacco dependent client. 

Four Common Smoking Triggers

♦ #1  Places
First, let’s take a look at places that trigger smoking.  I have found that bars and nightclubs are the most obvious of places that trigger smoking.  Clearly, restaurants can also be a high risk place for relapse, where smokers tend to light up after a meal.  For bars, restaurants, and other public places, clients can take a friend who will make relapse less possible, avoid busy hours when there is heavy smoke, or avoid ordering the usual meal.  

As you are aware, many tobacco dependent clients smoke in their homes.  You may give clients who are triggered to smoke at home advice regarding changes at home.  For example, the client can throw away the ashtrays, rearrange the furniture, or sit in a different room. 

Another private place that triggers smoking in clients may be the car.  Janet, age 24, smoked frequently in her car.  During one of Janet’s quit attempts, she tried to avoid smoking by hiding her cigarettes in the trunk.  Janet stated, "Whenever I would go anywhere, I’d promise myself that I wouldn’t smoke.  I’d throw my cigarettes in the trunk, and take off.  One day, I was on the highway and got an awful craving.  I pulled over, got my cigarettes, and lit one right there on the shoulder of the highway.  I was about halfway through my cigarette when a state trooper pulled up to find out what I was doing.  When I explained the situation to him, he just laughed at me.  I felt so stupid!"  Obviously, clients cannot avoid their homes or their cars, but clients who successfully break smoking patterns often do so by avoiding high risk places that may lead to relapse. 

♦ #2  People
Also, clients who successfully break smoking patterns often avoid people that may influence relapse.  For example, Gino, age 32, lived with his girlfriend Donna.  Gino was struggling with overcoming tobacco dependency, but Donna refused to even cut down on her cigarette intake.  Gino was in a tough situation, but I reviewed some options with him. 

First, Gino tried cutting down on the number of cigarettes he smoked to see if Donna’s intake also decreased.  Second, Gino asked for Donna’s support.  At a later session, Gino stated, "I let her know that I was working on quitting.  I asked her for help, but she wasn’t willing to help.  I think she felt like I was pressuring her to quit with me."  Gino had made it clear to Donna that he was not asking her to quit, but instead just wanted her to support him in quitting.  Gino was specific about what he wanted from Donna, but she avoided helping him reach his goals. 

A third option For Gino was trying to spend time with Donna engaged in activities not conducive to smoking.  I stated to Gino, "Maintain the underlying message that you love Donna and want to be with her, but don’t want to spend time with her while she is smoking because you become tempted to smoke." 

At a later session, Gino stated, "Nothing works with this girl.  There is no way I can be with her and quit smoking.  It’s really unfair that I have to choose between our relationship and my health."  I replied, "You might just take a break from each other so you can stop smoking.  In the long run, the relationship might be over, but maybe it will be strengthened and regained."  Gino stated, "Whatever. Either way, I’m doing what I need to do for my own health and well-being."

♦ #3  Time
In addition to places and people, a third common smoking trigger is time.  When does your client smoke most frequently?  A good technique for identifying time as a trigger is self-monitoring smoking habits.  If you recall, Eric from section 3 implemented self-monitoring of his smoking habits to prepare to quit smoking.  If your client has already completed self monitoring sheets, then you might consider using them to identify high risk times for relapse. 

For example, Eric’s self monitoring sheets revealed that he smoked between four and seven cigarettes between 7 a.m. and 10 a.m.  These numbers almost doubled during the weekends.  Clearly, for Eric, having free time in the morning led to frequent smoking.  Do you have a client like Eric?  What could he or she do in the morning to avoid smoking?

♦ #4  Feelings
In addition to places, people, and time, smoking can also be triggered by certain feelings.  Clearly, the type of feeling that might trigger a relapse depends on the individual.  Lane, age 26, was triggered to smoke by almost every feeling he had.  Lane stated, "I get so frustrated sometimes.  Smoking helps me clear my head."  Anger, depression, anxiety, and conflict also made Lane want to smoke. 

However, positive feelings were Lane’s strongest smoking trigger.  Even the satisfaction he felt after sex triggered Lane’s cravings.  Lane stated, "I call myself a happy smoker.  I love to smoke when I feel content and happy."  What feelings lead your client to smoke?  Clearly, Lane was not willing to part with happiness or sex, so we worked out a technique for avoiding relapse during happy or content moments called the "Empty Pack" technique. 

♦ 3-Step "Empty Pack" Technique
I stated, "First, carry an empty pack of cigarettes with you.  Write the date and time of your last cigarette on a small piece of paper and put it inside the pack. 

Second, whenever the urge comes to light up, take out the paper.  Focus on how long it’s been since you last smoked.  Use positive self talk to reassure yourself that if you’ve gone that long, you can keep go longer. 

Finally, smell the inside of the pack.  It’ll smell like stale tobacco and remind you of the way you used to smell."  Lane agreed to try this technique.  Think of your Lane.  Could the "Empty Pack" technique work for your client?  Later in this section, you’ll hear some other techniques that worked for Lane.

♦ Other Triggers
Of course, there are many other triggers that can lead clients to smoke.  Have you found as I have that some clients may experience the following contributing factors to smoking triggers?

• Reminders of the past
• Rejection
• Smoking on TV or in movies
• Hunger
• Inactivity
• Particular activities

Regardless of the smoking triggers your client experiences, here are two general tips that he or she might find useful.  Lane found these two tips productive.

• Compete with smoking.  Certain activities, like running, skiing, or dancing are incompatible with smoking.  Lane looked for activities that could help him smoke less.
• Don’t use cigarettes as a reward.  Lane stated, "Sometimes, I’ll have a day where everything goes my way and I suppress my cravings with little effort.  Then, later in the evening I’ll get a craving and think, ‘I’ve gone all day without a smoke.  Why not have one now as a reward?’  That’s a bad idea!"

Do your clients reward themselves with cigarettes?  Could managing smoking triggers help your client begin to successfully break smoking patterns?

In this section, we have discussed smoking triggers.  This section intended to provide practical information and techniques for dealing with each of the four common smoking triggers.  The four smoking triggers discussed in this section are places, people, time, and feelings.  Do you have a tobacco dependent client that would benefit from listening to this section during your next session?

In the next section, we will discuss relapse.  Because relapse is highly individualized, we will discuss two situations that cause relapse as well as the three rules of relapse.  The two situations that cause relapse are emotional upset and boredom. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Evers-Casey, S., Schnoll, R., Jenssen, B. P., & Leone, F. T. (2019). Implicit attribution of culpability and impact on experience of treating tobacco dependence. Health Psychology, 38(12), 1069–1074.

Minami, H., Tran, L. T., & McCarthy, D. E. (2015). Using ecological measures of smoking trigger exposure to predict smoking cessation milestones. Psychology of Addictive Behaviors, 29(1), 122–128.

Pedersen, E. R., Tucker, J. S., Davis, J. P., Dunbar, M. S., Seelam, R., Rodriguez, A., & D'Amico, E. J. (2020). Tobacco/nicotine and marijuana co-use motives in young adults: Associations with substance use behaviors one year later. Psychology of Addictive Behaviors. Advance online publication.

Piper, M. E., Piasecki, T. M., Federman, E. B., Bolt, D. M., Smith, S. S., Fiore, M. C., & Baker, T. B. (2004). A Multiple Motives Approach to Tobacco Dependence: The Wisconsin Inventory of Smoking Dependence Motives (WISDM-68). Journal of Consulting and Clinical Psychology, 72(2), 139–154.

Robinson, J. D., Li, L., Chen, M., Lerman, C., Tyndale, R. F., Schnoll, R. A., Hawk, L. W., Jr., George, T. P., Benowitz, N. L., & Cinciripini, P. M. (2019). Evaluating the temporal relationships between withdrawal symptoms and smoking relapse. Psychology of Addictive Behaviors, 33(2), 105–116. 

QUESTION 5
What are Four Triggers for smoking? To select and enter your answer go to Answer Booklet.

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