Substance Use Disorders: Assessment and Treatment
The authors of this book indicate in their introduction that “the knowledge domains assessed by the American Psychological Association certification exam served as a basis for organization and inclusion of material for this publication.” Further, they state that “other professionals seeking certification in their respective fields (psychiatrists…) are required to master the same information.” To provide this information, the authors “set out to faithfully present the current thinking, as reflected in professional journals and books, on important aspects of psychoactive substance use disorders.” This book thus presents itself as useful to all professionals in substance abuse, including psychiatrists, especially those preparing for substance abuse certification examinations.
Problems develop for psychiatric readers, however, in the book’s first section, which deals with clinical pharmacology of psychoactive substances and epidemiology of substance use disorders. The material is often too basic (“the cells in the brain are called neurons”), the information is sometimes outdated (“six different types of neurotransmitters have been identified”) and occasionally incorrect (phencyclidine is classified as a Schedule III, not a Schedule I, drug), chemical names are misidentified (THC is identified as tetrahydracannabis), medical terms are misclassified (pupillary constriction and respiratory depression are listed under acute psychological effects of opioid use), and incorrect physiological statements are made (“alcohol…is sometimes thought of as a stimulant; the increased energy that is observed is due to increased blood sugar”).
Some of these errors are probably due to the fact that most of the discussion on specific drugs is based on a single 1984 review article. Most of the book’s references are to such secondary sources. Very few references occur after 1995 (the book was published in 2000), and most of the text seems to have been prepared in 1995 or earlier with little apparent attempt at updating after that time.
After the clinical pharmacology section, the book discusses etiology in six pages with one-page overviews of genetic, psychodynamic, behavioral, and family system etiological theories. Similar brief discussions on course and prevention follow. A larger section is devoted to substance abuse screening and assessment instruments. However, there is no substantial or sustained discussion of why the authors choose to discuss the particular instruments, what the validity and reliability of these instruments are, and for which substance abuse populations and settings they are most useful. The authors include their own basic unpublished assessment instrument, which would not be adequate for a psychiatrist assessing substance abuse (it provides for an inadequate mental status examination and an incomplete medical history and review of systems).
A chapter on comorbidity appropriately emphasizes the necessity to treat co-occurring psychiatric illness and substance abuse together in an integrated fashion but gives little guidance on how to do this. The next two chapters on treatment allot one sentence to several paragraphs of discussion to specific types of psychotherapy. Pharmacotherapy is covered in four pages with two paragraphs; the section on pharmacotherapy of alcohol dependence makes no mention of such drugs as naltrexone or the experimental use of acamprosate. The following chapter covers special populations and is equally telegraphic, with a page or less on substance abuse in physicians, ethnic minorities, people with HIV, the elderly, and the homeless. The final chapter covers legal issues, including confidentiality and coercion concerns and the relation of substance abuse to the Americans with Disabilities Act.
In summary, for whom is this book appropriate? Anyone new to the substance abuse field with no background should benefit from this overview. The book might benefit professionals intending to take a certifying exam in substance abuse who are not psychiatrists or any other type of physician. This book would not be very useful for physicians because it is not current and does not sufficiently weigh information based on evidence that would give practitioners direction as to the best methods to use in assessing and treating patients with substance abuse disorders.
