The Quest to Quit: an Exploration of the Cessation - Relapse Cycle of Cigarette Smoking
The smoker's perspective is seldom sought in cessation research. Consequently, cessation approaches may be less effective because they are not based on assumptions and interpretations shared by those who smoke. Understanding how chronic relapsing smokers interpret their predicament could enhance cessation approaches, improving the chances for complete, permanent cessation. To generate such an understanding, five participants were recruited who had attempted to quit smoking several times. Aiming for depth rather than breadth, multiple interviews were conducted with each participant, who also kept an event diary, recording current smoking, nicotine withdrawal, lapsing and relapsing. Narratology, a biographical method of symbolic interactionism drawing on thematic, structural, and dialogic analysis, was used to elicit the participants' points of view from interview and diary data. The findings show that participants make sense of their chronic relapsing through a master narrative of 'willpower versus weakness'. Meanwhile, the tobacco control domain is largely driven by 'cost', and subsidised treatments are driven by the 'addiction' master narrative. This gap between ways of making sense of smoking and relapse can cause self-stigma, reducing the likelihood that quitting will be attempted and that quit attempts will succeed. Changes are proposed to mitigate the negative effects on self-efficacy brought about through the present approach to tobacco control. Ways to improve the effectiveness of existing treatments are suggested. Finally, the value of the narrative method is highlighted, with suggestions for its use in research where elucidating the insider point of view may improve treatment outcomes.