Book Review
Addiction 
Pagliaros’ Comprehensive Guide to Drugs and Substances of Abuse Louis A Pagliaro, Ann Marie Pagliaro. Washington (DC): American Pharmacists Association; 2004. 462 p. US$89.00.
Reviewer
rating*: Good
Review by: Florence Chanut, MD, FRCPC
Montreal, Quebec
The need for an authoritative, referenced, and up-to-date compilation of consumption trends and individual pharmacology for drugs and substances of abuse in North America cannot be overstated. It is this book’s main objective, according to the authors’ statement in the preface, and the text achieves it well. Pagliaros’ guide is designed, first, to assist general health care professionals and, second, to serve as a review and quick reference for clinicians who specialize in the treatment of patients with substance use disorders. Given the text’s emphasis on pharmacologic mechanisms, I suggest that physicians and pharmacists are the targeted readers. The 2 Canadian authors are well-known faculty at the University of Alberta, Edmonton, Alberta. They have published numerous articles and textbooks on the pharmacology of substance abuse, and they have taken great care to provide us with as much information from Canadian sources as possible, which is without any doubt a clear advantage of this book.
First, let me offer some clarifications about the exact content of Pagliaros’ guide, which follows an unusual format for a publication in the substance abuse field. Those who may want a guide to treating substance abuse or dual diagnosis will find that these subjects are beyond the book’s scope (although they are the focus of a planned companion text). In fact, it would have been possibly more appropriate to use the term “dictionary” instead of “guide” in the title to avoid confusing potential readers. Notwithstanding this detail, the book is worth reading and is well organized in 2 major parts.
Part I provides an overview of the history and pharmacology of almost all substances of abuse, along 3 broad categories: psychodepressants (that is, opiates, sedative- hypnotics, alcohol, and inhalants), psychostimulants (that is, amphetamines, cocaine, nicotine, and others), and psychedelics (including cannabis, amphetamine-like psychedelics, and indoles). Drugs that may be abused for reasons other than their specific effects on the brain, including vasodilators (such as amyl nitrate) and anabolic steroids, are not discussed anywhere in this text. This first part is scholarly documented, yet pleasant to read, thanks to the clear and concise writing style. I personally enjoyed the few literary quotations that punctuate the text, but they are easy to skip for those who want to stick to the essentials. In each category, a substantial portion of the discussion is devoted to historical landmarks in the discovery and synthesis of the major substances, to wars and laws ruling their availability, and to the cultural attitudes surrounding their use in North America—definitely an aid to better understanding the present trends in drug consumption.
Part II contains individual monographs on 101 drugs and substances of abuse relevant to North Americans, including a few exotic substances more likely to be used by recent immigrants. This part is intended as a quick practitioners’ reference on specific substances. To fulfill this goal, the text presents all drugs in alphabetical order. The content of each monograph is organized along standardized subheadings that cover a summary of the essential information in 2 to 5 pages. The authors in this section have undertaken a huge effort to synthesize the most recent literature. The side effect of this efficient format is that some important information is relegated to small notes at the end of each monograph or in the related chapter in Part I. Inevitably, there is an extensive overlap between the content of Parts I and II, as well as between monographs on related substances, because the 2 major parts have complementary purposes.
The authors complete this volume with an extensive index section that has both a subject index and a drug name index including street names—a useful feature in clinical practice (and unique, to my knowledge). Unfortunately, a long introduction tarnishes the otherwise excellent layout. With the exception of 2 tables, the introduction’s content is either redundant or digressive in regard to the book’s purpose. I had the impression that this section was more a means to advertise the authors’ work or affirm their expertise, which in this case is unnecessary. I also deplore the price, which is relatively high, even for a hardcover book, and may unfortunately limit its dissemination.
My global appraisal is that Pagliaros’ guide reflects competently and concisely on the current knowledge about the pharmacology of substances of abuse: not more, not less. I would have appreciated a title that indicated its content more accurately—content that does not include anything on treatment, either psychological or pharmacologic. The monograph section of the book, with its attractive and to-the-point layout, summary information, and complementary indexes, will probably be the most appreciated part of the volume. To have information both on prescription drugs with abuse potential and on illegal drugs contained in a single, condensed book is a too rare feature that makes it more practical to use, compared with our usual textbooks or pocket manuals. I hope this book will be available for health care professionals on the shelves of many hospital libraries, if not in their own private collections. However, unless a softcover version is published in the future, the price may deter medical students or psychiatry residents from buying it.
*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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