book reviews : compiled by susan savva & griffith edwards

© 2003 Society for the Study of Addiction to Alcohol and Other Drugs

Addiction,

98

, 129–132

Blackwell Science, Ltd

Oxford, UK

ADDAddiction

0965-2140© 2003 Society for the Study of Addiction to Alcohol and Other Drugs

98Book Reviews

98Book Reviews

Book ReviewsBook Reviews

Book Reviews

Compiled by Susan Savva & Griffith Edwards

LEAD REVIEW

Tobacco or Health? Physiological and Social Damages Caused by Tobacco Smoking

KNUT OLAV HAUSTEINBerlin, Springer, 2002, 446 pp, £63 /

€

89.95, ISBN3 540 44031 3

Tobacco or Health

is an excellent new book on tobacco,covering everything from the toxicology of tobacco addi-tives to diseases, treatments and policy. This book, includ-ing more than 2000 references, is a comprehensivecompilation of information on all aspects of tobacco.

The only two publications that come close to this bookare Larson, Silvette and Haag’s

Tobacco

,

Experimental andClinical Studies: a Comprehensive Account of the World Lit-erature

and the 1988 US Surgeon General’s report,

Nico-tine Addiction

. In contrast to the two former titles, thisexhaustive book is the work of a single author. Althoughthere are pros and cons with anthologies and single-author books, it is increasingly common to use theanthology form for broader topics in order to secure thebest expertise. Nonetheless, this single-author book doesnot suffer from a lack of expertise and is meticulous in itsdetail. A benefit of the author’s German origin is access toGerman literature; most other books on tobacco havebeen authored by Anglo-Saxons, who are generally onlyfamiliar with scientific literature in English. This bookprovides a more European perspective, without sacrific-ing insight into the English literature.

Professor Haustein is primarily a clinical pharm-acologist (which is evident in his thorough understand-ing of areas such as the pharmacological effects oftobacco additives and constituents), but for the lastdecade he has also run a smoker counselling centre inErfurt, Germany. With his medical and pharmacologicalbackground, the author describes mechanisms by whichsmoking causes various diseases in such detail that dif-ferent chapters on smoking-related disorders could havebeen written by oncologists, chest physicians and otherexperts. The level of detail does make parts of the book dif-ficult to follow, and my task as a reviewer was not easy.For example, I was unaware that tobacco smoking waslinked to so many disorders of the eye (Graves’ ophthal-mopathy, cataract and lens opacity, macular degenera-

tion, glaucoma, diabetic retinopathy, strabismus, oculartumours and retinal detachment). Nor was I aware thatGoodpasteur’s syndrome and Langerhans’ cell granulo-matosis were related to tobacco smoking. In the litera-ture, 60 mg of nicotine is often cited as a lethal dose butthere is seldom a reference; here it is included among2300 citations.

The first chapters, on the history and epidemiology oftobacco use, are followed by chapters on tobacco constit-uents and the pharmacology of nicotine, where theauthor really is on familiar ground. A major part of thebook is devoted to tobacco-caused or -related disorders,covered according to organ: lungs, cardiovascular, cen-tral nervous system, eyes, ears, oral cavity and larynx,metabolism, gastrointestinal tract, urinary tract, mineralmetabolism and bone, skin and mucosa, the haemato-poietic system and the problem of smoking duringpregnancy. The last section covers treatment (bothbehavioural and pharmacological), primary prevention,tobacco industry behaviour, policy and effective tobaccocontrol strategies. The book ends with a description of thepractices of the Erfurt smoker counselling centre.

This book’s strength is its breadth and depth—it israre to find these combined so well. Of course, with hismedical background and interest, the author is well qual-ified to cover the pharmacology. It is somewhat moresurprising that the chapters on behavioural treatment,primary prevention and policy are also of such a highstandard. I particularly like the fact that that the author,in contrast to many researchers, goes to great lengths todifferentiate the effects of nicotine vs. smoking.

The book would have benefited from a summary at theend of each chapter. In addition, there is some repetitionand overlap. The author fully acknowledges, as do I, theefficacy and safety of nicotine replacement for treatingtobacco dependence, but I would not completely agreethat 30–40% of smokers treated with nicotine replace-ment and counselling abstain long-term. The authorclearly favours nicotine replacement over the otherlicensed drug bupropion, in contrast with other expertswho treat them more equally. I find the programme at theErfurt clinic to be very sound, but many of us cliniciansbecome somewhat fixated on our specific methods andprocedures, tending to ignore other ways of treatingtobacco dependence. The openness to reducing the risk

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and harm among smokers unable to stop is an approachthat is very welcome.

This book is too demanding to read from beginning toend without a particular interest in the subject. However,everyone with a strong interest in any aspect of tobaccoand with some medical background will need this book. Itcould be used as an encyclopaedia of tobacco. The book isideal for physicians, as a medical school textbook ontobacco, or for postgraduate education. However, itwould be difficult for nurses or psychologists, for example,to benefit from many chapters without a particular inter-est in tobacco.

This is an extraordinary book. If this sounds too posi-tive, the only way to find out is to get a copy.

Statement of interest

I am a consultant to various pharmaceutical companieswith an interest in treatments of tobacco dependence.

KARL FAGERSTROM

Smokers Information CenterFagerstrom ConsultingHelsingborgSweden

98Book Reviews


FURTHER REVIEWS

One Hundred Years of Heroin

DAVID MUSTO, ed.Auburn House, Westport, CT and London, 2002, 252 pp,US$19.95, ISBN 0 864569 324 2

Heroin Century

TOM CARNWATH & IAN SMITHLondon and New York, Routledge, 2002, 216 pp,£14.99, ISBN 0 415 27899 6

I suppose the turning of a century may in some way helpto mark out the march of history, and be more than ahook on which a publisher can hang a book. Given thatheroin was first synthesized in 1874, the publishers inthese two instances are reaching for fairly bent hooks.But let’s take down the volumes from the pegs, and look atwhat each has to tell.

Musto’s edited text puts together papers from a con-ference that was held in New Haven, CT, USA in Septem-ber 1998 to mark the centenary of the drug’s commerciallaunch. The book undoubtedly conveys the excitementand distinction of a meeting that had many of America’sleading scientific authorities from the addiction studiesand policy communities present their papers. However,that distinction is tinged with a certain element of fusti-

ness, a feeling that it is all about the Good talking to theGreat, and we have heard some of it before. Everyonewore suits, that’s the tone of the thing. But David Court-wright, Daniel Moynihan, Egil Krogh, Jerome Jaffe, SallySatel, Robert Du Pont, Bruce Johnson with AndrewGolub, William White, Herbert Kleber, Peter Reuter withRobert MacCoun, Richard Schottenfeld, Kathryn Meyer,Jill Jonnes—that’s quite some cast.

The background to that meeting was, of course,America’s vast and continuing problem with heroin,albeit that in the USA heroin is now overshadowed bycocaine and crack cocaine. Against that backdrop, thelegitimate question to the assembled experts might be:please, can you, on the basis of your vast accumulatedexperience and high expertise, tell us how your countrymay now perhaps better handle the problem? There is norounding-off chapter that directly addresses the question,but we have calls for stronger political and organizationalsupport for methadone maintenance. Reuter and Mac-Coun suggest that the USA should experiment with her-oin maintenance.

In contrast, the book by Carnwath and Smith reads asdistinctly not a ‘suits’ kind of production. Carnwath is apsychiatrist who works with addicts in Manchester, UK.Smith is a former heroin user who now works as a healthservice manager. Their combined credentials and front-line experience are impressive. and the British heroinbackdrop is today as dire, pro rata, as that in America.Ask these British authors what policies they advocate forthe future and they will not hold back. Legalize heroin,that is their simple and absolute call. They are advocatesfor this cause rather than dispassionate analysts, andrhetoric is the order of their day. The same thing is fre-quently said three or more times in quick succession,resoundingly and passionately.

Let me recommend both these books to

Addiction’s

readership and suggest that to swallow either one with-out the other might be a great mistake, even fatal. Eachwill serve as the other’s antidote.

GRIF FITH EDWARDS

Editor-in-Chief

98Book Reviews


Understanding and Treating the Pathological Gambler

ROBERT LADOUCEUR, CAROLINE SYLVAIN, CLAUDEBOUTIN & CELINE DOUCETWest Sussex, UK, John Wiley and Sons, 2002, 183 pp,£27.50, ISBN 0 47084 378 0

This book describes the aetiology and treatment of exces-sive gambling. The authors are a combination of researchand/or practitioner psychologists with strong back-grounds in the field. The book is structured almost chro-

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nologically, from the history of gambling, psychologicaltheories, assessment, treatment, relapse prevention anddifficulties in treating the pathological gambler. Gener-ally, the writing style is very good, and the book is writtenin a manner that is accessible to most people with somebackground in psychology. There are some very clear andeffective explanations of difficult concepts, and theauthors maintain an objective view of problem gambling.There is no preface in this book but it would seem mostsuitable as an introduction for student therapists andthose just wanting to know more about excessivegambling.

One unfortunate aspect about this book is the use ofterm ‘pathological gambler’ in its title. At first glance, theuse of this term and an assessment technique based onthe DSM IV and SOGS (South Oaks Gambling Screen)suggests the conceptualization of problem gambling as amental disorder. However, the authors acknowledge thatthe evaluation of excessive gamblers involves severaldimensions. They have developed their own diagnosticinterview, which includes modified DSM IV criteria andthe evaluation of gamblers’ cognitions, behaviours, moodand the presence of other problems. Certainly, the cogni-tive behavioural treatment suggested in this book doesnot fit the mental disorder model and the term ‘excessivegambler’ is used frequently enough throughout the bookto have warranted inclusion in the title.

The principle driving the treatment outlined in thebook is that excessive gambling stems from faulty cogni-tions. To oversimplify, excessive gamblers erroneouslybelieve they can win when playing games of chance morethan other gamblers. The authors cover the major cate-gories of erroneous beliefs about gambling: illusion ofcontrol, superstitions and a failure to understand theindependence of events in gambling. I was mostimpressed with the way in which the authors explainederroneous beliefs surrounding the independence ofevents in games of chance. This is not easy to do, and anytherapist working with excessive gamblers will need tounderstand this common fallacy. The only weakness withthis section was with regard to horse racing and sportsbetting, and the authors make some erroneous conclu-sions themselves. The performance of a racehorse orsports team is not independent of their previous perfor-mance. Form does exist and the evidence lies in the vari-ation in odds offered for different horses and teams.

The misperception of horse racing highlights anotherproblem with the book. It is without references, and noneof the arguments and empirical claims can be sourced bythe reader. Furthermore, the treatment program has yetto be evaluated. Nonetheless, the treatment outlined inthe book is quite thorough, with numerous examples oftherapist and client dialogue along with detail on tech-nique and therapy exercises; this could provide a platform

for the development of a therapy manual. However, in itspresent form the book should only be considered asdescriptive and not instructional.

JOHN HAW

University of Western SydneyNew South WalesAustralia

98Book Reviews


Dual Diagnosis: Substance Misuse and Psychiatric Disorders

G. HUSSEIN RASSOOL, ed.Oxford, Blackwell Science, 2001, 240 pp, £22.50,ISBN 0 63205 621 5

The title and front cover design of this book addresses inplain English and fading images the schizophrenic situa-tion that a patient suffering from these two disorders hasto face in order to get help and proper treatment—notalways synonyms in present clinical practice. The con-tributors, mostly practitioners and academics, have facedthe challenge of writing a book on a most prevalent,though disguised, problem of clinical practice in mentalhealth and the social sciences. The book offers a WesternEuropean perspective of an integrative caring approach.

Despite the lack of extensive UK epidemiologicalresearch in this area, the authors manage to draw infor-mation from different sources to present the issue of dualdiagnosis clearly to the reader. In clearly conceptualized,easily readable English, the chapter on theories of sub-stance abuse and dual diagnosis introduces the basicsnecessary to understand the rest of the chapters, andtherefore how to treat and care for these subjects.

The chapter on the problems and issues of conceptu-alization of comorbid disorders discusses the appropriatescrutiny and study of the patient, the desired goal being tocover both addictive and psychiatric areas. An importantissue is the need to review the means of assuringinformed consent for patients affected by both psychoac-tive substances and psychiatric disorders.

The chapters on psychopathology and the Europeanperspective deal nicely with the psychopathology ofaddiction and psychiatric problems on the one hand, andthe providers of care for these problems (i.e. mentalhealth centres and therapeutic communities) on theother. These treatment providers often compete for,rather than co-operate in, the care of the patient. Despitethe word ‘European’ in the chapter heading, this stillseems to be the case all around the world, even in SouthAmerica.

The integration of a psychological perspective on thedual diagnosis problem is refreshing. However, the coin-ing of new terms such as ‘complex behaviour’ neither

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helps our understanding nor adds anything to our expe-rience in clinical practice. It seems that an attempt isbeing made to reopen the dichotomy between psychiatricand psychological diagnoses, largely resolved worldwideby both DSM and World Health Organization diagnosticmanuals.

Perhaps the main accomplishment of this book is its‘hands-on’ approach. It shows how to bring about a sys-tem of real shared care for these patients, through thecreation of a multidisciplinary approach. This clearlystems from the clinical practice background and aca-demic experience of the UK model, in which the authorsand collaborators seem to be well versed. The chapter onnursing interventions, which compares the roles andskills of psychiatric, addiction and dual diagnosis work-ers, should also be applied to psychiatrists and doctorsto potentiate resources and bridge the gaps betweenprofessionals.

Perhaps the need to summarize has led to short andinexact statements regarding some treatment strategiesand interventions, which might induce misunderstand-ings and/or debatable clinical practices. A larger andmore specific chapter on pharmacological approachescould have proved useful for this purpose. A well-handledchapter is entitled ‘dual or separate services dilemma’,where the presentation of the Greenbank model gives agood example of how to organize a dual diagnosis serviceprovision. The last chapter on educational approachesfaces up to the aim of this book: to train health workers inhow to deal with dual diagnosed patients and their care.Rassool poses a valid question: ‘a case for less diagnosisand more action?’

I would recommend this book to both my colleaguesand students in psychiatry and addictions, and will readit again myself.

DANIEL SEIJAS

Pontificia Universidad Catolica de ChileSantiagoChile

98Book Reviews


Buprenorphine Therapy of Opiate Addiction

PASCAL KINTZ & PIERRE MARQUETTotowa, NJ, Humana Press, 2002, 148 pp, US$89.50,ISBN 1 58829 031 X

Drug treatment programs in many countries have begunusing buprenorphine for the detoxification and mainte-nance treatment of persons with opiate dependence.France is the country where it has been used most widely,and it is thus appropriate that the authors originate from

this country. This book provides a wide-ranging overviewof the current state of knowledge about buprenorphine.The first chapter reviews its pharmacology and is fol-lowed by chapters on buprenorphine effects in humans,an excellent review of treatment studies, the potentialadvantages and limitations of the buprenorphine/nalox-one combination, the French experience with buprenor-phine in primary care, buprenorphine experience inAustralia, laboratory techniques to determine buprenor-phine content in tissues and body fluids, buprenorphine-related deaths and use of buprenorphine with pregnantaddicts.

Among the many facts that are presented, readersshould not miss the graph on p. 73 showing the markeddecrease in heroin overdose deaths associated with therecent increase in buprenorphine use by French primarycare physicians. This finding is striking, and demon-strates the concept of population effectiveness—some-thing that can only be realized if a large number ofaffected individuals are involved in an effective treatment.The shape of the curves in this graph is very similar tothat of curves showing the decrease in HIV-related deathsthat has been associated with the rise of triple therapy inthe USA, where a similar demonstration of populationeffectiveness has occurred but with a different disease.

I came away from the chapter on buprenorphine-related deaths with the impression that too many benzo-diazepines are prescribed to opiate addicts in France,since almost all the deaths in which buprenorphine wasfound in bodily tissues or fluids were associated with useof benzodiazepines, alcohol or other drugs. Althoughsome data were presented about use of these other drugsin deaths where buprenorphine was found, there was animplication that buprenorphine caused all the deaths—this does not seem accurate, since other drugs werealmost always involved.

This emphasis on possible adverse effects associatedwith buprenorphine probably reflects the interests of theauthors as faculty members at the Institute of Legal Med-icine in Strasbourg (Dr Kintz) and at the Department ofPharmacology and Toxicology at the University Hospitalin Limoges (Dr Marquet), but it does not detract from theexcellent overview of the field that this book provides, andthe potential role of buprenorphine in reducing the dam-age to individuals and society that occurs in associationwith untreated heroin addiction.

GEORGE WOODY

Treatment Research InstituteUniversity of PennsylvaniaPhiladelphia, PAUSA

book reviews : compiled by susan savva & griffith edwards

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