Charles E. Dodgen.
Nicotine Dependence:
Understanding & Applying the Most Effective Treatment Interventions (2005). American Psychological Association.
For details on ordering this book, please refer to: Click to view
NOV/DEC 2005
Volume 11 - No. 4
SRNT Newsletter
Nov/Dec 2005, Volume 11, Number 4
Book Review
Trying to wade through the voluminous literature on nicotine dependence, or more specifically, smoking cessation techniques, is a daunting task for any busy clinician, so Charles Dodgen in his book, "Nicotine Dependence: Understanding and Applying the Most Effective Treatments" does the swimming for you. This ten chapter book offers a practical, hands on guide geared to clinicians interested in providing smoking cessation treatment for their patients. If you are a nicotine researcher steeped in the literature, you will likely find his cursory treatment of such complex topics such as craving and withdrawal or the pharmacology of nicotine unsatisfying. However, for the clinician who is interested in learning enough about nicotine dependence to get a handle on how to best provide interventions to patients, this book is just what the doctor ordered.
Starting with the negative consequences of smoking, Dodgen clearly and concisely outlines the current state of knowledge about the physical and psychosocial consequences of smoking. However, the one disappointing aspect of his review in this section is that this book must have gone to press prior to the release of the most recent Surgeon General's report on the health consequences of smoking (USDHHS, 2004). Thus he compared the original Surgeon General's report (USDHEW, 1964) to the 1989 Surgeon's General's report (USDHHS, 1989) which makes the coverage of this topic feel a bit dated. However, he does draw on other sources of research to bring it more to the present day knowledge, and the general gist of the information remains true to what is known today about the health consequences of smoking.
The author then examines the psychological processes of smoking including such topics as initiation of smoking and the misperceptions of smokers that help to maintain smoking behavior. No matter what your clinical orientation, Dodgen provides a review of different processes involved in smoking maintenance, including more traditional psychoanalytic theories of denial to the more cognitively focused theories on stress and coping. In two subsequent chapters on the pharmacology of nicotine and nicotine and addiction, he provides the biological basis for nicotine dependence and maintenance of smoking behavior. These broad topics are given just enough depth to provide the clinician with some understanding of the mechanisms that maintain nicotine dependence, without weighing them down with an exhaustive review of the literature or overly complex theories.
The middle three chapters are what most clinicians would consider the "meat" of the book and cover the important topics of assessment, treatment, and treatment efficacy. Dodgen provides an overview of the current assessment materials commonly employed, including the DSM-IV criteria for nicotine dependence and nicotine withdrawal. He reviews the utility of the Fagerstrom Tolerance Questionnaire and the revised form of this instrument, the Fagerstrom Test for Nicotine Dependence. He also discusses the Stage of Change Model and provides the four questions needed to assess current readiness to change. Most assessment instruments are presented in an easy to use table format with scoring and interpretation provided, which increases the utility of this book for clinicians. The author also provides his own assessment instruments or exercises throughout this chapter, as well as case examples utilizing these instruments. While some clinicians may find his assessment exercises useful, they are presented at a fairly high reading level, and patients with less than a high school education may need assistance completing the assessments.
The author divides his review of treatments and treatment efficacy into two different chapters. He broadly covers rarely used techniques such as electric shock and other highly aversive therapies to the more commonly used interventions of stimulus control, social support, and nicotine replacement. Again, rather than exhaustively reviewing the literature for each technique, Dodgen presents one or two representative studies in the area to give a flavor for how the intervention is used. In the treatment efficacy chapter, he provides results from meta-analytic studies in a two tables (counseling and pharmacotherapy) which offer a nice way to quickly scan for the efficacy of a particular intervention. He mentions briefly other relevant topics in nicotine treatment such as harm reduction, fear of weight gain after quitting smoking, and motivating smokers to quit. Obviously, these two chapters cover a lot of ground, but the material is presented in an easily digested format.
Finally, the remaining chapters cover issues of craving and relapse prevention, treatment with special population (e.g., psychiatric and substance abuse patients, gender, and race and ethnicity), and interventions with adolescents. Even though each of these topics could be a book by itself, Dodgen provides a nice overview of the current research. As he points out, while certain populations appear to not respond as well to standard interventions (e.g., women appear to not be as successful using NRT products for quitting smoking compared to men), the state of research is not such that we would recommend dramatically different treatment approaches for these individuals.
This easy to read, succinct overview of the treatment strategies for nicotine dependence will be a welcome reference for clinicians interested in providing smoking cessation treatment to their patients or to the student researcher/clinician new to the field . While the focus of this book is on cigarette smoking, many of the techniques outlined are also appropriate for treatment of other forms tobacco dependence. However, researchers immersed in the field may be irritated by the scant attention paid toward many of the complex topics inherent in nicotine treatment and may be better off traversing through the latest research studies in the literature on their own.
Karen Cropsey is an Assistant Professor in the L. Douglas Wilder School of Government and Public Affairs at Virginia Commonwealth University in Richmond, Virginia. Her interests include smoking cessation and drug abuse treatment research with correctional populations.