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Book Reviews |
Key Words: Books Reviewed
Despite my great interest in the field of addiction treatment, I approached this volume with some skepticism because monographs that are products of a committee, in my experience, often yield products that can be diffusely conceived and erratically executed. However, the actual reading was a very pleasant surprise, both because of the taut writing style and the broad applicability of the material to psychiatrists and nonphysician clinicians alike, with a nod to legislators.
The philosophical premise here is straightforward: addictions are chronic, relapsing diseases that, incompletely or improperly treated, typically result in lamentable morbidity or premature death. Often co-occurring with mental or medical illness, they are difficult to diagnose and complex to treat. Common additional socioeconomic factors further complicate the picture. Although no single solution is offered, a multifaceted framework is proposed:
1.Take a complete subjective and objective history, incorporating sequential interview samples and varied collateral information.
2.Be attentive to predisposing (genetic) and exacerbating (stressor) risk factors for the patient.
3.Be mindful of countertransference and other systematic biases of the caregiver as well as sensitive to the meanings and boundaries of the doctor-patient relationship.
4.Consider all treatment options and variables (urine drug screens, psychotherapies, medications, self-help, social structures, and support).
5.Always include relevant medical care at every step of the healing process.
6.Stay cautious of and prepared for such hindering euphemisms as "problem drinking," unspoken resistances from family networks, and the human inclination of patients' friends to enable and rescue.
7.Remain aware of possible confounding cultural variables of individuals from special populations, such as homosexuals, the disabled, health care workers, youth, and the elderly, as well as physically modifying factors like size and ethnic origin.
The clear, accurate, and useful summary chapter is a good place to begin; it introduces all of the principal themes without excessive detail. The introductory sections describing the historical interactions among medicine, mental health, and addiction are illuminating, as is the review of sequelae of untreated substance abuse. Patient placement criteria, as developed by the American Society for Addiction Medicine, are outlined, with annotations. The least compelling areas entail predictors of outcome, since these are so mutable and so little researched.
Within the text, each chapter is logical in presentation, rich with bulleted lists and therefore easy to adapt practically, and filled with winning juxtapositions of theoretical references, case reports, and hard-won bits of wisdom and advice. The most novel segments are the chapters Screening and Assessment, Management and Monitoring, Anonymous and Other Groups in Recovery, and Training. Excellent coverage is also provided by the chapters Talking Therapies, Somatic Therapies, Social Networks, and Myths in Dealing With Female Clients, although these are more conventional in content. The end sections, containing listings of GAP (Group for the Advancement of Psychiatry) committees and publications, provided a very worthwhile bonus.
Footnotes
Dr. Post is Chair of the Department of Psychiatry, Commonwealth Health Center, Saipan, and Acting Medical Director, Division of Mental Health and Social Services, Commonwealth of the Northern Mariana Islands.
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