Abstract
It is a real pleasure to find this book. There is a dearth of decent clinical literature on treating substance abuse, particularly for those new to the field, and this small book fills a needed gap. The book is written in an easy to read style, with a lot of illustrative case vignette material, all of which has a very plausible ring about it, together with many ‘key points’ to hold the reader's attention. The book has a practical approach as its title implies, and gives in tutorial style many good suggestions about the management of patients with substance abuse, including the difficulties encountered.
The book is in three sections. The first section covers the principals of management of patients with problems of substance abuse. It offers an overview of substance disorders, diagnostic approaches, investigations, screening techniques and history taking. This last chapter may at first be seen as ‘teaching one to suck eggs’; substance abusers are experts in denial and are notoriously difficult historians.
The second section is a review of commonly abused substances, covering alcohol, sedatives, heroin, amphetamines, cocaine, LSD, marijuana and surprisingly nicotine. Two notable gaps are caffeine and anabolic steroids. The section on alcohol covers the subject well, even briefly covering the use of acamprosate, not currently available in the US. The weakest of these generally excellent reviews is the chapter on marijuana, where the somewhat controversial, but nonetheless important, subject of cannabis-induced psychosis is not discussed.
The chapter on sedatives covers barbiturates as well as benzodiazepines, and the three chapters on heroin are excellent.
My main criticism of this section is the use of American trade names for many of the drugs mentioned; some drugs are not available in Australia and the use of generic names would have been useful.
The final section is on treatment of substance abuse. Again this covers useful material, but here the US origins of the book come into play, with programmes mentioned being unavailable in Australia. However, it does not require much common sense to apply the information to the Australasian scene.
The chapters on the ethical aspects of treatment provide interesting and thought-provoking ideas. The legal aspects are covered again from the US point of-view, and are certainly of interest. I was surprised at the legal blood alcohol levels in the US–0.08 or 0.1! There is a welcome chapter sensibly discussing 12-step programmes, not always favoured but probably the most popular recovery programme in both the US and Australasia.
I believe this book should be recommended reading for all medical students and candidates for the Fellowship of the Royal Australian and New Zealand College of Psychiatrists.
I regret that I am not familiar with conditions for treating substance abuse disorders in New Zealand, and apologize for this.