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Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment, 5th ed.
Am J Psychiatry 2000;157:1894-1895. doi:10.1176/appi.ajp.157.11.1894
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Sayville, N.Y.

By Marc A. Schuckit, M.D. Dordrecht, the Netherlands, Kluwer Academic/Plenum, 1999, 380 pp., $49.95.

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Marc Schuckit has made many important contributions to the addiction field. Not the least of these is his textbook on addictions, which first appeared in 1979 and has been updated every 5 years or so. The fifth and latest edition features 380 pages of current information, with 70% of the references dated 1995 or later, arranged for the convenience of clinicians and students. Unlike most textbooks, Schuckit’s is written in the first person. He tells the reader his opinions (e.g., he opposes legalization of drugs), expresses his clinical preferences (e.g., he provides suggested sedative detoxification regimens using barbiturates but states that he prefers to use the particular drug of abuse itself and taper the dose), and refers to his "biases." This provides a refreshing alternative to the more ponderous multiauthor textbook written in the third person, and the reader gets a feeling of the author’s personal experience and clinical style.

The book will be most appreciated by health professionals and students, especially those in primary and emergency care settings. It is organized by drug type (e.g., sedatives, stimulants, inhalants, cannabinols), and each chapter contains brief sections on pharmacology, epidemiology, medical uses, the natural history of dependence, and making a diagnosis. Following this are sections on emergency problems involving the particular class of drugs, including their diagnosis and treatment. Alcohol and alcoholism receive the greatest emphasis, reflecting Schuckit’s interest and experience, but the other drugs are not short-changed. The author includes clinically relevant discussions of caffeine, nicotine, and over-the-counter and prescription drugs, including laxatives and anabolic steroids among many others. Additional chapters provide general overviews of addiction, rehabilitation, and prevention. Finally, there is a summary chapter on emergency problems related to substances: toxic reactions, withdrawal states, delirium and other cognitive disorders, psychosis, flashbacks, and anxiety/depressive states. For each problem category, the most common clinical pictures, differential diagnosis, and principles of treatment are clearly outlined.

Unavoidably, the author of such a text has to make choices and will omit some drugs of importance, perhaps on the basis of regional experience (Dr. Schuckit practices in California). Although he discusses such obscure substances as catnip, locoweed, and betel nut, he omits two of the most common prescription drugs of abuse, at least on the East Coast, hydrocodone (Vicodin) and butalbital (Fiorinal, Fioricet, Esgic). The latter is important because the drug is marketed in combination with aspirin or acetaminophen, so that addicts taking large amounts of butalbital may also be ingesting potentially toxic amounts of these analgesics. Thus, undertaking a detoxification regimen for butalbital with the drug of abuse in its combined form will only add to that toxicity.

A great convenience, especially for newcomers to the field, is that all medications are identified by both their chemical and brand names. The text is also very well indexed, and there are many references to other sections of the book in each chapter. This makes it valuable both for reading cover-to-cover and for use as a reference book for specific clinical problems. There are some oddities in organization (for example, the discussion of psychiatric comorbidity is placed in the chapter on alcoholism, although it certainly applies to all substance use disorders), but the index minimizes any difficulties.

In summary, Dr. Schuckit has brought us a clinically useful, readable, down-to-earth, and up-to-date textbook not just once, but for the fifth time. That in itself is remarkable.




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