Book Review

Drug Policy and Substance Abuse

Nicotine Addiction: Principles and Management

N Engl J Med 1994; 331:751September 15, 1994

Article

Nicotine Addiction: Principles and Management
Edited by C. Tracy Orleans and John Slade. 435 pp. New York, Oxford University Press, 1993. $55. ISBN: 0-19-506441-0

Smoking is the greatest preventable cause of mortality and morbidity in the United States. Yet most medical libraries have a limited number of works, if any, on the treatment of smoking. This deficiency has been due, in part, to the absence of a well-written textbook, a lack that Nicotine Addiction clearly corrects.

Specific chapters in the book will be of interest to clinicians (chapter 8, on stepped-care models of treatment, for example), behavioral scientists (chapter 4, on the determinants of the initiation and cessation of smoking), public health workers (chapter 21, on community interventions), and health care administrators (chapter 3, on the economics of smoking). Clinicians will find the sections on management especially helpful. There are also sections on how to set up an office to screen for and treat smoking, how to give brief advice, how to use self-help groups and written materials, new and promising pharmacotherapies, treatment of the use of smokeless tobacco, and the special needs of smokers with other dependencies or psychiatric problems. Helpful sample questionnaires and telephone numbers to call to obtain resource materials and advice are listed.

Many medical books do not clearly distinguish recommendations based on empirical data from those based on opinion. The recommendations in the management sections of Nicotine Addiction are based on empirical data. Thus, one major strength of this book is that clinicians can easily find data-based answers to most of their questions. Another asset is that most sections are clearly written and not overly technical. Clinicians will find the public health and behavioral-science sections easy to understand.

My one minor criticism concerns the absence of information on how physicians can become advocates in smoking prevention and treatment. In my opinion, physicians must begin to see themselves as protectors of the health of a population of patients. In this vein, support for measures such as price increases on tobacco and bans on vending machines is among the most important preventive health activities a physician can undertake.

In summary, I know of no other well-done textbook on smoking. If clinicians, behavioral scientists, public health workers, health care administrators, and legislators want to know more about smoking than they will learn by reading a single review chapter, or if they want a reference book on the topic, then this is the book to purchase.

John R. Hughes, M.D.
University of Vermont, Burlington, VT 05401-1419