The final chapter, “Psychiatric Services,” echoes the problems encountered in Canada. There appears to be a yearning for closer collaboration between pediatricians and child psychiatrists in the delivery of services. To encourage such collaboration, the co-editors and some of the authors, particularly those dealing with multimodal interventions and psychiatric services, might be invited to a joint session of the Canadian Academy on Child and Adolescent Psychiatry and the Canadian Pediatric Association.
1. Reiss S, Aman
MG. Psychotropic medications and developmental disabilities: the international
consensus handbook. Columbus (OH): Ohio State University Niesonger Centre;
Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions. Pat Denning. New York: The Guilford Press; 2000. 262 p. USD35.50
Reid Finlayson, MD
In this book Dr Denning describes her approach, based upon 25 years of clinical experience, to counselling patients with addictions. She also describes the problems associated with counselling patients who have concurrent mental illness. Although she quotes Peele and Rotgers, Dr Denning’s description of her harm-reduction approach is less incendiary in its criticism of standard recovery-treatment practices. Dr Denning agrees that abstinence is preferable for severely mentally ill individuals, but, in place of an autocratic insistence on abstinence, she proposes assistance for patient concerns and needs.
In place of active confrontation with subsequent exclusion from treatment due to relapse, she promotes a gentle, supportive, patient-centred, harm-reduction approach.
Dr Denning disagrees with those who view addiction as either a disease or a moral weakness. She reviews the history and epidemiology of substance use, contrasting substance use with the concept of dependence, and she considers the theories that drug abuse may be adaptive in some forms of psychiatric illness. Dr Denning is candid enough to provide illustrative case examples with less-than-ideal outcomes. She reviews diagnostic and therapeutic procedures for patients who have concurrent addiction and psychiatric issues. She describes the importance of teamwork and collaboration in caring for persons with addictions and mental illness. Dr Denning emphasizes the role of safe, adequate housing in any treatment plan and gives examples of her consultations to housing projects for HIV-positive patients with addictions and mental illness.
Dr Denning is to be commended for this book, which supports a patient-centred and patient-driven approach to treatment and yet does not exclude support for abstinence and 12-step fellowship attendance. Unfortunately, she does not include conclusive experimental evidence to support the superiority of her approach compared with other treatment strategies. One is left questioning whether the patients themselves, government agencies, or insurance companies would be willing to pay for ongoing supportive treatment without some expectation that substance-induced morbidity would be reduced.
Further, the question of third-party liability is not well addressed in this book. Dr Denning does not describe the harm-reduction strategy in relation to the substance user in safety-sensitive positions—for example, in relation to health care professionals, pilots, motor vehicle operators, and those responsible for child care. In these circumstances, the requirements for mandatory reporting of disability may adversely affect the therapeutic relationship, yet on the other hand, failure to report concerns may expose the therapist both to legislated penalties and to civil liabilities.
Dr Denning seems to be a competent and caring psychologist. This book adequately reviews the field and describes her approach to harm reduction. In it, she shares her extensive knowledge and experience of treating patients with addictions and mental illness. As well, she shares her experience of collaborating skillfully with treatment teams and housing project administrators. The book is concise, well written, and attractively packaged. It gives a balanced description of the harm-reduction model of addiction practice and should be of interest to those concerned with assessing and treating persons suffering from addictions and mental illness. At the price (hard cover), readers may wish to evaluate this text through their local library, prior to purchase.
The Social Psychology of Stigma Todd F Heatherton, Robert E Kleck, Michelle R Hebl, Jay G Hull, editors. New York: The Guilford Press; 2000. 450 p. USD50.00
A Josiukas BA, BSc, MD, FRCPC
This book is the outcome of a conference organized by Dartmouth University faculty. Discussed, planned, and written by selected experts, it comprises 14 chapters organized in 3 sections. The authors present information on why people stigmatize, on how the stigmatized individuals respond, and on stigmatization’s effect on social interactions. This is a volume for the advanced student of social psychology, who will probably access it in a library. Some chapters invite the reader to learn and to think, whereas others are mired in the linguistics of social psychology research. Each chapter closes with an extensive bibliography.