Envision your future – an approach to quitting smoking

Individuals with substance use problems, such as excessive smoking, tend to prefer instant gratification rather than delayed gratification (1). They are aware of the ill effects but find it challenging to quit.

For example, Rick is a heavy smoker who wants to quit for his respiratory health. Yet, in a moment of craving, the immediate reward of smoking seems more appealing in comparison to the long-term reward of healthier lungs, with the latter requiring more self-control. I will now explain this more technically; bear with me.

Delay discounting is the process by which the perceived value of a reward reduces as a function of time to its receipt; that is, the later we are to receive a reward, the less we tend to value it (2). To illustrate, if I offer you EUR 10 today or EUR 100 in 3 months, which would you choose? Probably the second. Next, if I offer you EUR 10 today or EUR 20 in 3 months, you might wonder if it’s worth the wait. In both cases, the delayed reward was greater than the immediate reward and offered against the same immediate reward. Yet, how much greater the reward is (to us) makes a difference.

Typically, we each attach a subjective value to the immediate and delayed reward, and this value determines our choice. The option evaluated more highly in that moment and context is the one we choose. Naturally, everyone is different in their evaluation of these rewards. Therefore, we each have our own tipping point – the point when the immediate and delayed rewards are evaluated equally and the choice shifts in favour of the immediate reward, like in the second option above. In people with addiction, this tipping point is reached sooner. Logically, one approach to helping people wanting to quit substance use is reducing their tendency to discount delays and exert more self-control to work toward delayed rewards.

Researchers have been developing and testing methods to reduce delay discounting in people with substance use problems and poor eating behaviours with the intention of priming them to think about their future. For example, people are encouraged to visualize their future in terms of events they are looking forward to, like a summer holiday to Paris or running a marathon in 6 months (episodic future prime; EFP) (3, 4, 5). It helps people pre-experience something they are working toward and, in turn, reduces delay discounting and exerts more self-control when contemplating smoking in a weak moment. This way, they can save money for Paris tickets or improve their lung capacity for the marathon.

Similarly, in another intervention, people are asked to spend more time thinking about their future through a writing task (future thinking prime; FTP) (6). Participants are given specific words using which they write a paragraph about themselves. The word list is designed such that they write about their ideas for their future self and thus, spend time thinking about their ideal future. In summary, re-orienting to stay reminded of the better version of ourselves we are working toward can do us some good.

Both EFP and FTP reduce delay discounting, and more so in people with substance use problems (7). There are also some indications that improvements in delay discounting can help reduce smoking (3, 4) through indirect measurements of smoking in hypothetical situations. Unfortunately, evidence for the direct link to successfully quitting is still missing. In the future, delay discounting interventions should measure the effect on smoking through abstinence rates or weekly smoking post-intervention. Such evidence can back the intervention strongly and guide the use of future-oriented thinking for smoking cessation in therapeutic settings as well.

  This blog was written by Suhaavi Kochhar (PhD candidate, Radboud University) for RAD-blog, the blog about smoking, alcohol, drugs and diet.

  References

1. Barlow, P., McKee, M., Reeves, A., Galea, G., & Stuckler, D. (2016). Time-discounting and tobacco smoking: a systematic review and network analysis. International Journal of Epidemiology, 46(3), dyw233. https://doi.org/10.1093/ije/dyw233
2. Da Matta, A., Gonçalves, F. L., & Bizarro, L. (2012). Delay discounting: Concepts and measures. Psychology & Neuroscience, 5(2), 135–146. https://doi.org/10.3922/j.psns.2012.2.03
3. Chiou, W. B., & Wu, W. H. (2017). Episodic Future Thinking Involving the Nonsmoking Self Can Induce Lower Discounting and Cigarette Consumption. Journal of Studies on Alcohol and Drugs, 78(1), 106–112. https://doi.org/10.15288/jsad.2017.78.106
4. Stein, J. S., Wilson, A. G., Koffarnus, M. N., Daniel, T. O., Epstein, L. H., & Bickel, W. K. (2016). Unstuck in time: episodic future thinking reduces delay discounting and cigarette smoking. Psychopharmacology, 233(21–22), 3771–3778. https://doi.org/10.1007/s00213-016-4410-y
5. Stein, J. S., Tegge, A. N., Turner, J. K., & Bickel, W. K. (2017). Episodic future thinking reduces delay discounting and cigarette demand: an investigation of the good-subject effect. Journal of Behavioral Medicine, 41(2), 269–276. https://doi.org/10.1007/s10865-017-9908-1
6. Shevorykin, A., Pittman, J. C., Bickel, W. K., O’connor, R. J., Malhotra, R., Prashad, N., & Sheffer, C. E. (2019). Primed for Health: Future Thinking Priming Decreases Delay Discounting. Health Behavior and Policy Review, 6(4), 363–377. https://doi.org/10.14485/hbpr.6.4.5
7. Shevorykin, A., Bickel, W. K., Carl, E., & Sheffer, C. E. (2021). Future Thinking Priming Especially Effective at Modifying Delay Discounting Rates among Cigarette Smokers. International Journal of Environmental Research and Public Health, 18(16), 8717. https://doi.org/10.3390/ijerph18168717