Book Review
Addictions
Drugs and Addictive Behaviour. Hamid Ghodse. Cambridge (UK): Cambridge University Press; 2002. 501 p. CAN$32.95
Reviewer
rating*: Excellent
Review by: Nady el-Guebaly, MD, FRCPC
Calgary, Alberta
The US, through the National Institute of Drug Abuse (NIDA), funds reportedly 85% of the research on drugs conducted globally. While US taxpayers are to be thanked for their significant contribution, concerns have been raised about the overwhelming volume of data and publications originating from a single national perspective. To its credit, NIDA is now also developing an international network of researchers. It was with anticipation, therefore, that I reviewed this basic book, originating from the UK and now in its third edition. The author, Dr Hamid Ghodse, is a professor of psychiatry and director of the Centre for Addiction Studies at St George’s Hospital Medical School in London. He has just completed a distinguished stint as 6-times president of the UN International Narcotics Control Board. The book includes a dozen chapters and several appendices.
The initial chapter reviews terminology, based on the recently published Lexicon of Alcohol and Drug Terms (1); it also offers a thoughtful essay on the inter- active etiologic variables of drug, individual, and society that contribute to drug dependence.
The extensive second chapter reflects Dr Ghodse’s ability to interweave British and international data. The major development in the global picture of drug abuse is the merging of traditional forms that employ crude plant material having relatively low concentrations of active ingredients with highly potent, synthetic or semisynthetic substances employed mostly by young polysubstance users in industrialized societies. Traditional plants have now also been primed for higher yields of active ingredients; hydroponic marijuana is an example. However, the book’s factual information depends on the data collected inter- nationally. For example, a comparative tally of seizures and other law enforcement activities (that is, supply reduction) is presented with almost no data on prevention and treatment activities (that is, demand reduction). In North America, available data often reflect the law enforcement activities and priorities of police forces rather than supply data.
The third chapter succinctly reviews the properties of the gamut of drugs available. It is followed by a new and welcome chapter that deals with the properties of alcohol in a similar succinct manner. The main value of this chapter is, in my opinion, its highlighting of the fallacy of the artificial dichotomy between illegal and legal drugs. Worldwide, the “legal” drugs—tobacco and alcohol—have the greatest impact on public health. I hope that future editions of this book will also include a chapter on tobacco.
Chapter 5 is an introductory review of the medical assessment process conducted with a drug-using patient. The appended St George’s Substance Abuse Assessment Questionnaire has an interesting format. In North America, its mental health section would be considered too brief, and current instruments appear to increasingly include behavioural addictions. The ICD and DSM classifications are also compared.
Chapter 6 offers an overview of the array of intervention options available to treat drug users. Missing, perhaps, are the noted efforts to develop practice guidelines for selecting these intervention options, such as the American Society of Addiction Medicine Patient Placement Criteria (2). As various forms of managed health care spread globally, awareness of these efforts becomes increasingly important. For my purposes, I found Chapter 7’s focus on the management of opiates, sedative hypnotics, and cocaine–amphetamine more useful. The focus allows the author more opportunity to display his considerable clinical experience. Readers may disagree with some statements, but clinicians will find many opportunities to compare their own experience with the author’s.
The same can be said of Chapter 8’s overview of drug use complications. By contrast, Chapter 9 offers a more elaborate discussion of problems specific to on a UK experience. For example, in North America, if an opiate abuser became pregnant, the situation would be an indication for initiating or maintaining methadone maintenance, rather than withdrawing from it. Brief sketches are provided of other populations— physicians who abuse drugs; patients with comorbid conditions; and attendants at emergency departments, general practices, and in the justice system. Readers get a taste of the wide array of management issues arising from addiction problems!
Chapter 10 offers a thoughtful essay about the definition of treatment outcomes and an overview of the benefits and limitations of each major variable considered. Treatment outcome studies for opiate users from both the UK and the US serve as a template. Attention is justifiably drawn to the unknown group of users who do not come to the attention of health care workers and (or) pursue a course with fleeting or no formal intervention.
Chapter 11 briefly outlines preventive measures and presents a rationale for careful evaluation and perseverance. The last chapter is an exposé of international supply-reduction policies; here again, the author displays his unique expertise. Spanning the efforts of the Shanghai conference in 1909, the Hague conference, the League of Nations, and the UN’s current bodies, he presents a masterful historical summary of the international community’s attempts to control a select number of drugs under 4 schedules, according to their potential harmfulness and therapeutic usefulness. During most of the 20th century, these efforts emphasized suppressing supply and trafficking; however, in 1998, the UN adopted principles to support demand reduction and a balanced approach to the problem. In 2004, the international community is due to review the components of a balanced and integrated strategy in the 21st century. The book ends with a sample of database and assessment instruments, together with a list of references.
This single-authored book is eminently readable. A commendable attempt to simplify complex issues is uniformly evident across all chapters. Topics are treated dispassionately; the author makes a deliberate effort to introduce empirically based balance and adds welcome tips derived from his extensive experience. Dr Ghodse’s clinical experience in the UK underpins the book; North American readers will appreciate the similarities and differences with regard to their own practice. Dr Ghodse has made a considerable effort to add an international dimension to many of the chapters, some of which reflect his unique international career. For North American trainees, this book provides a complementary inter- national experience. For practitioners in both the enforcement and treatment fields of addiction, this brief compendium of international experience is well worth adding to the library. Compared with similar publications, its price is moderate.
References
1. World Health Organization. Lexicon of alcohol and drug terms. Geneva: WHO; 1994.
2. American Society of Addiction Medicine. Patient placement criteria for the treatment of substance-related disorders. 2nd ed. Revised. (ASAM PPC-2R). Annapolis Junction (MD): ASAM; 2001.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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