Book Review
Addictions
The Treatment of Drinking
Problems: A Guide for the Helping Professions. Griffith Edwards, E Jane Marshall, Christopher CH Cook. New York: Cambridge University Press; 2003. 412 p. US $50.00.
Reviewer
rating*: Very good
Review by: Nady el-Guebaly, MD, FRCPC
Calgary, Alberta
As I began reviewing this book, now in its fourth edition, it dawned on me that I had the pleasure of reviewing the third edition as well (1). Our patients commonly present a clinical picture of polysubstance abuse; teaching texts devoted exclusively to drinking problems are less common. Thus, in comparing the third and fourth editions of this focused publication, I expected to gain a good sense of recent advances in the field.
Dr Griffith Edwards is the founder of the National Addiction Centre, London, England, professor emeritus at the University of London, and editor-in-chief of Addiction. The coauthors since the third edition, Dr Jane Marshall and Dr Christopher Cook, are noted for their own pioneering work.
Like the third edition, the book is aimed at a multidisciplinary audience of professionals in the field and is divided into 2 main sections. The first section has 13 chapters. A new introductory chapter on the history of treatment reminds us that it was Trotter, as early as the beginning of the 19th century, who posited that, far from being a sin, “the habit of drunkenness was a disease of the mind” (2). An overview of the causes of drinking problems follows, integrating the related sociocultural, psychological, and biological dimensions across the lifespan. The next chapter focuses on the drug alcohol and includes an update on its receptors’ action.
The book’s midsection begins with a description of the clinical sensitivities surrounding the alcohol-dependence syndrome, masterfully covered by the group who powerfully helped define it. A synopsis of the consequences on the family and social functioning follows. The array of neuropsychiatric as well as psychiatric comorbidities receive expanded attention in this edition. The common comorbid use of other drugs alluded to in my introduction is reviewed in the next chapters, along with the physical complications. The section appropriately ends with an overview of special clinical presentations among women, as well as an overview of different age, cultural, comorbid, and social groups. However, no mention is made of affected health professionals. The challenges involved in defining and estimating long-term outcomes conclude the section.
The second section addresses screening, assessment, and treatment issues. The seasoned clinical skills of the authors are evident in the chapters on screening and assessment and the management of withdrawal. (Why, however, was the Canadian Clinical Institute Withdrawal Assessment Scale not mentioned?) This subject is followed by a discussion of the therapeutic basic work of engagement and an essay on Alcoholics Anonymous.
The next part is, in my opinion, less rewarding. In 24 pages, it reviews a series of psychological approaches (for example, motivational interviewing, cognitive-behavioural therapy, behavioural self-control, relapse prevention, and psychotherapy), along with the current pharmacotherapeutic armementarium. This enumeration of treatment options may be confusing to the newly initiated. To guide the reader in choosing an approach, the authors briefly note the results of project MATCH and Miller’s analysis of treatment outcome studies.
The concluding chapters are reminders of the need for patient-focused flexibility in goals: Who is a candidate for a resumption of normal drinking? What are the techniques for establishing and maintaining control? A very thoughtful chapter describes “when things go wrong in treatment.” Clinical tips with vignettes address fine-tuning expectations for both patient and therapist, the frequent abuse of defenses, and getting out of a therapeutic block.
The book concludes with a description of the UK experience in the organizational structure of treatment services. A note about the US experience with placement criteria would have been appropriate.
My overall impression is that each chapter in this teaching text is a synopsis of a great deal of literature. The synopsis is not free of biases. The North American literature is often criticized for being too “American” and neglecting the depth and breadth of European contributions. This book presents a compendium of the British literature with occasional, sometimes critical, references to the US experience. Can we ever reach a balance?
As a compendium of seasoned clinical wisdom, the book remains an excellent primer for any student or practitioner in the field of alcohol-related problems. I was disappointed to find that updated parts in this fourth edition are the exception rather than the rule. The tables, figures, and clinical vignettes are largely the same as those in the third edition. The number of references after 1996 is limited. This book’s prior editions have done well and are now translated in 6 languages: Why meddle with perfection? The problem is that the field of related publications is increasingly crowded and that the next edition may require a fundamental “rethink” to keep up with new insights. The knowledge base in the alcohol field is rapidly expanding internationally.
For newcomers requiring a primer on alcohol-related problems, this book is a sound investment at the current cost. For owners of the prior editions, reinvest in a different book and await the fifth edition.
References
1. El-Guebaly. The treatment of drinking problems: a guide for the helping professions. 3rd ed. [book review]. Can J Psychiatry 1999;44:88–9.
2. Trotter T. An essay, medical, philosophical and chemical on drunkenness and its effects on the human body. London: TN Longman and G Rees; 1804. Facsimile reproduction. London: Routledge; 1988.
*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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