Abstract
The alcohol and drug field is a quagmire of differing and often conflicting beliefs, and the information available to people affected in some way by alcohol and drug use problems – which, when it comes down to it, is most of us – is frequently influenced by the moral views of those who choose to speak publicly. On the one hand we have those who believe that any drug is dangerous to all individuals and to the fabric of society. Drugs should therefore not only be prohibited, they and their providers should be fought and defeated – hence the ‘war on drugs’ embraced so fondly by politicians and self-publicists. On the other hand we have those who believe that certain drugs are completely harmless, and that most drugs are relatively harmless for most people. Individuals should therefore make their own choices about drug use. These extreme viewpoints traditionally bolster their arguments with highly selective misreadings of the research literature. The middle ground seems heavily but quietly populated, and when it comes to the information available to the public on important issues of drug misuse, the balanced view is often difficult to hear in a coherent and persuasive way. Not surprisingly, many people are confused about what to believe, and choose to hear views that sit comfortably with their own prejudices. This doesn't do much to help those people and their families suffering alcohol and drug problems understand their struggles and know what to do about them.
This book aims to present a balanced and evidenceinformed overview of the causes, complications and treatment options available for substance use problems at a level that is understandable to people with little background in science or healthcare. In other words it speaks to the general public about the nature and extent of alcohol and drug problems and tries to present an impartial picture of current mainstream clinical thinking in the area.
For the most part, the book succeeds in these aims. While it is comprehensive, it also has considerable depth of information. It tackles the potentially complex area of the biological basis of addiction clearly and intelligibly, it is even-handed in the way it addresses most of the political issues around alcohol and drugs and it covers in depth the major drugs and the current range of treatments available. That it does all this in a manner that is both engaging and passionate without falling into the trappings of jargon or dogma is one of the strengths of the book.
Another strength of the book is its authority. The author is admirably qualified as both an academic and a clinician, and his understanding of the research literature behind his views is impeccable. While the book is not widely referenced, there is an extensive bibliography which allows the reader to follow up on comments of interest and on the various studies he discusses.
Which leads me, as a clinician working in New Zealand, to my one strong criticism. While most of the content of the book is applicable to a range of cultures, the first chapters on basic concepts are particularly American, without acknowledging this. Discussions of the ethnic aspects of alcohol and drug use only mention African Americans and Hispanics. Prevalence rates and patterns of drug use across society apply to America, ignoring the important differences in patterns of drug use between that country and Australia and New Zealand. The frequent mention of laws and government regulations, while well done, refer only to laws and regulations in America. and some of the basic concepts are a little different as well, for example, the use of diagnostic terms such as ‘harmful use’.
There are also some areas of omission. As is common in the alcohol and drug field (as in many others) the large and grey areas where the alcohol and drug field overlaps with other areas could be better dealt with. For example, there is little mention of the interaction between psychoactive substances and mental health disorders other than the comments under each drug of those symptoms that are secondary to the drug's actions. and while there is a section on young people and alcohol and drug misuse, accompanied by useful advice for the families concerned about the use of illicit substances by their children, more information about prevention from both individual and public health perspectives would have been useful.
Overall, however, this book provides detailed, high quality information on drugs of misuse and most of the issues associated with them. It is accessible to consumers, their families and the general public. It is also detailed enough to be of interest as a primer to a wide range of health professionals who do not specialize in the alcohol and drug field but who see patients who have alcohol and drug issues among their problems. I wouldn't hesitate to recommend it to patients and their families, especially if they were living in America. However, most of my patients and colleagues are not, and none of them are working there. My preference would be for a similar book that was more culturally appropriate to Australia and New Zealand. While the recently published Management of alcohol and drug problems by Hulse, White and Cape (eds) published by Oxford University Press, is intended for health professionals, it could serve a similar purpose to Stimmel's work while being more relevant locally.