Helping the Hard-Core Smoker: A Clinician's Guide

Helping the Hard-Core Smoker: A Clinician's Guide

Helping the Hard-Core Smoker: A Clinician's Guide

Helping the Hard-Core Smoker: A Clinician's Guide


This book constitutes a major new resource for professionals working with hard core smokers and their families. It is designed as a practical, clinically useful and up-to-date guide for all those in a position to intervene: mental health professionals, physicians, dentists, nurses, pharmacists and other health care professionals, clergy, human resource and employee assistance program corporate staff, and teachers and guidance counselors.

New research suggests that difficult-to-treat smokers often have emotional problems adjusting to stopping smoking. Some also have psychiatric diagnoses or abuse other substances. These are factors which interfere with their efforts to quit.

Because these difficulties have been poorly understood, hard-core smokers have not been provided with adequate resources and skills to overcome their addiction. These smokers are in need of increasingly comprehensive assessment and treatment.

Despite massive public health education about the dangers of cigarette smoking, rates of smoking among the population are no longer declining in the United States and the success rates of clinical programs for smokers remain low. Helping the Hard-Core Smoker seeks to explain why current approaches are often inadequate and how best to help today's highly nicotine-dependent smokers who are struggling with their addiction quit.


Joseph A. Califano Jr.

In August 1975, on the beach at Gull Pond in Wellfleet, Massachussets, I asked my eleven-year-old son Joe III what he wanted for Christmas. "Your birthday is just after Christmas, so you never get a proper present," I said. "Let me know what you want and we'll get it in September."

"I want you to quit smoking," he responded immediately.

"Seriously, Joe, tell me what you want for your birthday."

"Seriously, Dad," he shot back, "I want you to quit smoking."

With that formidable task ahead, I returned to Washington on Labor Day.

Like the subjects of this book, I was a hard-core smoker. I had begun smoking in 1945 shortly before my 14th birthday. By the time I got to Harvard Law School in 1952, 1 was up to a pack a day, and I hit a whopping four packs daily from 1965 to 1969 while working as Lyndon Johnson's special assistant for domestic affairs.

In 1966, when I recommended to President Johnson that he send to Congress legislation to ban cigarette advertising from television, he looked at the cigarette between the fingers of my right hand and said, "When you stop, I'll send that legislation forward." Already at war with the Southern states over civil rights, his top national priority, LBJ had no intention of opening a second front in tobacco in states like North Carolina, Kentucky, and Virginia. He knew that by setting that condition on my proposal, he had tabled the issue for the duration of his presidency.

Lyndon Johnson himself had been a chain smoker until his massive heart attack in 1954. Though he quit smoking after that, on most days at the White House he would say, "The day I leave here, I'm going to light up a cigarette." Indeed he did -- on the flight back to Texas on the afternoon of January 20 , 1969, shortly after Richard Nixon was sworn in as president. He died of a heart attack 4 years later.

I did not seriously try to quit smoking while serving in the Johnson White House. On returning to law practice, I settled into a two-pack-a-day habit.

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