Health Education Research, Vol. 15, No. 1, 118-120,
February 2000
© 2000 Oxford University Press
Book Review |
Helping the Hard-core Smoker: A Clinician's Guide
Public Health Policy Analyst, East Sussex, Brighton and Hove Health Authority, Visiting Research Fellow in Health and Social Psychology, University of Sussex
The foreword to this volume states that it `belongs on the desk of every physician, psychiatrist, nurse practitioner, dentist, psychologist, elementary and secondary school teacher, drug and alcohol counsellor in the nation'. Does it live up to this ambitious claim?
In this book, `hard-core smokers' are defined as people who smoke despite being seriously ill, those who score highly on nicotine dependence scales or who have co-existing psychological morbidity which renders them more likely to smoke (e.g. depression).
The book is arranged in five parts. Part I is a single chapter which is a useful introduction to the nature of pharmacological addiction and how it may be distinguished from habit. It concludes, unsurprisingly, that nicotine is addictive. While the authors suggest that this fact may in some way empower clinicians to discuss smoking in a less victim-blaming way, they fail to consider the converse of this approach: that emphasizing the psychopharmacological properties of nicotine may encourage potential quitters to feel helpless and believe that cessation is outside their grasp. This introductory chapter also fails to tackle issues such as the frequency of relapse in the absence of withdrawal symptoms or the difficulty in cessation experienced by smokers whose nicotine intake is small. In addition, most of the references cited are rather old. As such, this chapter is a somewhat simplistic, unbalanced account of dependency on cigarettes.
Part II describes developments in clinical research. Again, this part is a single chapter concerning nicotine dependency in relation to certain psychiatric disorders. The first part of the chapter reiterates some of the characteristics of addiction, before discussing evidence for the association between smoking and depression, alcoholism, anxiety states and schizophrenia. While these associations are probably already known to most of the intended audience, it is unlikely that reading the 23 pages of (albeit painstakingly gathered) studies will grip the imagination of many dentists or primary teachers. This chapter is more likely to be of passing interest to research students in this specialized field as a source of citations.
Part III is titled `Assessment and Treatment: Special Populations', illustrating the strongly medicalized approach throughout the whole book, especially given that the first offering in this part is concerned with preventing smoking among young people. This brief chapter describes (superficially) some of the approaches taken to smoking prevention in the US, mostly around 15 years ago. No discussion is offered as to the reasons why young people smoke nor is any explanation offered as to why this group is considered `hard-core' given the definition offered in the introduction. This chapter is probably the least useful in the volume and many better reviews of adolescent smoking are readily available. The second chapter focuses on women's smoking. This chapter is very brief and again is superficial in its treatment of important issues, e.g. the section titled `smoking cessation in pregnancy' is limited to a discussion of foetal damage and the question of whether or not pregnant women should take nicotine replacement preparations. The next chapter describes a specific smoking cessation programme aimed at pregnant women in New York. Some its components do not appear to cross the Atlantic too well. Nevertheless, there are useful tips in this chapter for anyone running cessation programmes, although again this information is available in much more digestible form elsewhere. The final chapter in this part concerns interventions aimed at older smokers (defined as people aged 50 and over). There are initial sections about smoking prevalence (in the US), the health consequences of smoking with particular reference to older people and the benefits of quitting, even after many years of smoking. Next, a brief section examines differences in health beliefs between younger and older smokers (up to 74 years of age). Older smokers are less likely to believe that smoking and illness are related (although if a lifetime smoker has reached his or her mid-70s without becoming ill, this observation is neither surprising nor particularly useful). A discussion of the physician's role in helping older smokers quit ensues, but since there is no appreciable difference offered between this role and a physician's role in respect of younger smokers, this chapter is somewhat repetitious of others elsewhere in the book.
The next section is headed `treatment approaches' and considers nicotine replacement, other drug treatments, psychotherapy, hypnosis and psychotherapeutic methods of preventing relapse. The first chapter is on nicotine replacement therapy (NRT), and is a useful (if brief) summary of the evidence for the use of nicotine patches and gum, including information about their use in pregnancy, among adolescents and with people suffering from a range of medical conditions. This section is to be welcomed, particularly in the light of the current widespread enthusiasm for NRT. The remaining chapters may be of academic interest to specialists in the field, but are unlikely to be very helpful to practitioners operating within the British NHS where such methods are uncommon. A chapter about the role of dentists is also included. As much of this chapter describes oral conditions resulting from smoking, it may be helpful to dental students; however, this information is certain to exist in a better format elsewhere. The volume is rounded off by a very short, very general, chapter entitled `a public health perspective'.
In summary, this book's claim to be indispensable to just about everyone in health, education and social services is grandiose and predictably unrealistic. Much of the text is specific to the US and other sections are likely to be of interest only to a limited audience (e.g. research students specifically interested in this field). The majority of contributions are unlikely to be read with interest by practising clinicians in the British NHS or teachers in the UK. Moreover, many of the contributions focus on groups of smokers who are not `hard-core' according to the editors' own definition. While a few of the sections are useful, the same information is available in other books which are of much greater overall value to their intended audience.
Notes
D. F. Seidman and L. S. Covey (eds) Erlbaum, Englewood Cliffs, NJ, 1999 307 pp. ISBN 0-8058-2755-2
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