Couple Dynamics of Change‐Resistant Smoking: Toward a Family Consultation Model*

Abstract

Smoking is North America's leading cause of preventable morbidity and mortality. Although effective cessation treatments exist, their overall effect is modest, and they rarely reach the high-risk, health-compromised smokers who need them most. Surprisingly, despite evidence that marital relationship variables predict the success of cessation efforts, family systems ideas have had little impact on current intervention research. We review and critique the cessation literature from a systemic viewpoint, illustrate two couple-interaction patterns relevant to the maintenance of highrisk smoking, and outline a family-consultation (FAMCON) intervention for couples in which at least one partner continues to smoke despite having heart or lung disease. Taking into account ironic processes and symptom-system fit, FAMCON focuses on the immediate social context of smoking, aiming to interrupt well-intentioned "solutions" that ironically feed back to keep smoking going, and to help clients realign important relationships in ways not organized around tobacco usage. Currently in its pilot-testing phase, FAMCON is an adjunctive, complementary approach designed to include collaboration with primary-care physicians and to make smokers more amenable to other, evidencebased cessation strategies.Smoking, the leading cause of preventable morbidity and mortality in the US, is a proven risk factor for a variety of health problems involving not only the smoker but also those with whom he or she interacts (Wetter, Fiore, Gritz, et al., 1998). Nevertheless, nearly a quarter of the adult population continues to smoke despite major societal efforts to discourage their doing so (CDC, 1996). Although effective cessation interventions exist, their overall effect is modest, and they often do not reach the high-risk, health-compromised smokers who need them most (Compas, Haage, Keefe, et al., 1998;Fiore, Bailey, Cohen, et al., 1996).

Symptom-system fit in couples: Emotion regulation when one or both partners smoke.

“…For example, if partners can anticipate relational difficulties likely to accompany cessation attempts, they can practice exposing themselves to such situations before attempting to quit and can work toward establishing substitute rituals and activities that do not involve smoking-in other words, they can begin to make nonsmoking fit the system. Working with SSF in this way is central to a new family consultation intervention for healthcompromised smokers (Rohrbaugh et al, 2001). In a recent treatment-development project with 20 of the couples who participated in the present study, the family consultation approach helped smokers who had continued to smoke in the face of heart or lung disease achieve a 50% rate of stable abstinence over at least 6 months (Shoham et al, 2006).…”

“…Participants were 26 couples recruited from community-based medical clinics and via newspaper advertisements to receive a couple-level smoking-cessation intervention (Rohrbaugh et al, 2001;Shoham, Rohrbaugh, Trost, & Muramoto, 2006). One partner in each couple (the primary smoker) had either a diagnosed heart or lung problem aggravated by smoking or at least two other documented risk factors for coronary artery disease.…”

“…Although rarely invoked in the smoking literature, family systems theory provides a useful perspective on how close relationships might both maintain and be maintained by changeresistant smoking (Rohrbaugh et al, 2001). Doherty and Whitehead (1986), for example, suggested that smoking can serve important communication functions in close relationships, particularly in regulating emotional closeness.…”

Morbidade, suporte do parceiro e representações do tabaco em fumantes e abstinentes

“…Ao nível da predição do suporte do parceiro foi efetuada uma regressão linear (método enter). MURAMOTO, CATE, LEISCHOW, 2001). A relação negativa entre e a morbidade psicológica e a duração e o controle do tratamento pode indicar que os sintomas de morbidade diminuem à medida que o consumo de tabaco dura mais ou que o tratamento para deixar de fumar é considerado como podendo não ser eficaz.…”

Papel mediador das representações do tabaco e do suporte do parceiro em fumantes e ex-fumantes

“…Deste modo, a literatura realça a importância do suporte do parceiro na mudança do comportamento tabágico (Afonso, 2008;Mermelstein et al, 1983). Ao nível do ajustamento de casal Rohrbaugh, Shoham e Dempsey (2009) e Rohrbaugh et al (2001) também referem a importância do parceiro no comportamento de fumar. Estudos enfatizaram a comunicação e a regulação de emoções entre o casal, no processo de deixar de fumar, como forma de aproximação ou distanciamento (Wenner, Rohrbaugh, Shoham, & Trost, 2004).…”