Book Review
Substance Abuse 
Integrated Treatment for Mood and Substance Use Disorders. Joseph J Westermeyer, Roger D Weiss, Douglas M Zidonis. Baltimore (MD): Johns Hopkins University Press; 2003. 199 p. US$ 39.95.
Reviewer
rating*: Good
Review by: Nady el-Guebaly, MD, FRCPC
Calgary, Alberta
The call for integrated treatment of substance use disorders and mental illness is now 15 to 20 years old. To date, most empirical data on the outcome of integration come from samples of populations with severe and persistent mental illness receiving care in the US public health system. There is a need for the separate systems of mental health care and addiction services to pool their resources to care for those suffering from concurrent disorders; beyond that, clinical trials are also required to define practice guidelines customized according to diagnostic interaction as well as biopsychosocial interventions. It is with this expectation that I reviewed the 8 chapters of this new book focusing on the interaction between mood disorders and substance use.
The 3 editors, who each contribute a chapter, are well-known faculty in the field of addiction psychiatry from the University of Minnesota Medical School, Harvard Medical School, and Robert Wood Johnson (New Jersey) Medical School, respectively. The remaining authors are also well-known contributors to the area of concurrent disorders.
In the introductory chapter, Jo Westermeyer reviews the epidemiologic and clinical ambiguities involved in developing a consensus regarding the management of cooccurring mood and substance use disorders.
The second chapter, by Nerissa DelBello and Stephen Strakowski, is a scholarly review of the research underpinning each of the following 3 hypotheses: 1) affective disorder initiates substance dependence, 2) substance dependence initiates affective disorder, and 3) affective disorders and substance abuse share a common risk factor. Subsets of patients can be found with each of these presentations.
Shelly Greenfield discusses in detail the concurrent assessment process for 4 general clinical presentations, depending on the respective prominence of either substance use or mood disorder or both, as well as on the presentation of a mood disorder after remission from substance use disorder—a challenge often clinically dismissed as evidence of “lack of motivation”! Clinicians will appreciate the case vignettes.
The next 2 chapters, by lead authors Dennis Daley and Douglas Ziedonis, respectively, complement each other. Daley reviews the concept of recovery espoused by the field of chemical dependency. According to this concept, both disorders need to be managed, but in the context of changes in self and lifestyle. Management issues to be tackled during each of 6 phases of recovery are discussed. Ziedonis’ detailed description of a phase-based motivational enhancement therapy complements Daley’s chapter. Relevant principles of other psychotherapies, including psychodynamic, cognitive, and behavioural approaches, complete that chapter.
In the sixth chapter, Roger Weiss reviews the clinical controversies surrounding the decision to prescribe and the choice of medication, as well as the need to enhance medication compliance. A solid doctor–patient relationship is critical to the entire process. Chapter 7, by Jill Williams and Caroline Eick, appropriately reviews the common reasons for treatment nonresponse: inaccurate diagnosis, inappropriate treatment, comorbidities, and clinician–client mismatches.
The last chapter, by John Slade and Betty Vreeland, describes the management of tobacco dependence and the impact of mood disorders on the timing, course, and outcome of integrated management. A brief listing of suggested reading, support groups, Web sites, and videos concludes the book. I was surprised by the absence of concluding remarks, which leaves the reader with the impression—perhaps accurate—that the development of evidence-based guidelines for the management of this clinical challenge is very much a work in progress.
My overall impression is that the book reflects appropriately and competently on the current art and science of dealing with these common comorbidities. Experienced clinicians will readily identify with many of the management issues raised. As in many edited books, the chapters differ in style and readability. Duplication of material is minimized—a tribute to the editors.
Despite its stated goal of being a primer appealing to a wide audience, this book will, in my opinion, be most appreciated by those with a special interest and knowledge in mood disorders and concurrent disorders involving substance abuse. They will understand the complexities and will most likely gain new knowledge about the breadth of management options available. They will also recognize that the last word on the matter is far from written. At the price, this well-laid-out book will be a welcome addition to the libraries of those with that special interest.
*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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