Brain Imaging in Substance Abuse: Research, Clinical, and Forensic Applications
Psychiatrists come across colorful pictures of imaging data with increasing frequency in the articles they read, pharmaceutical advertisements they scan, and conferences and grand rounds they attend. Many of these psychiatrists, no doubt, wonder how these images are generated, what they really represent, and what they reveal about the diagnosis, treatment, and prognosis of psychiatric illness. This book provides answers to these questions in the process of comprehensively reviewing the current place of brain imaging in substance abuse.
The book is clearly organized. The first three chapters are devoted to explaining the techniques involved in producing and interpreting EEGs, positron and single emission tomographs, and magnetic resonance images (MRIs). Each of these chapters is written clearly with most technical details at the level of the informed nonexpert physician. All major subcategories of imaging are covered, including tomographic EEG, functional MRI, magnetic resonance spectroscopy, and dynamic susceptibility contrast MRI. A realistic and measured account of the types of physiological and clinical knowledge gained from these technologies is outlined. At the same time, the multiple technical, methodological, and statistical problems that are yet to be resolved and that greatly inhibit the reliability, validity, and practical use of the data produced are forthrightly acknowledged.
The next three chapters are devoted to an exhaustive review of the use and value in substance abuse research of each imaging technology. General and relevant comments are made about the difficulties in conducting such research given the limitations of both imaging technology and substance abuse clinical research methods. These chapters are followed by a summary of the imaging studies relevant to alcohol, benzodiazepines, opiates, stimulants, marijuana, hallucinogens, and solvents. One is left with the impression that there are few consistent imaging findings in substance abuse research (with several notable exceptions). However, the authors appropriately remind the reader that most imaging technologies are less than 10 years old and have only recently and sporadically been applied to substance abuse.
A chapter follows on neuropsychological testing in substance abuse. Its value in a book on imaging is explained satisfactorily by the close relationship between behavioral function and neuroanatomy. Although providing a credible summary of neuropsychological test findings in subjects using various substances, this chapter provides no information or speculation linking these data with imaging data.
The final chapter on neuroimages as legal evidence is relevant to the physician reader and provides an excellent overview of the current scientific and forensic status of imaging technologies. It also provides a cogent reminder to overly enthusiastic interpreters of available data, especially psychiatrists, that
a field of research may be technologically advanced but methodologically immature, generating exciting hypotheses but few broadly generalizable findings and little normative data. Such is decidedly the case for neuroimaging techniques to study cognition and mental illness.…Neuroimaging findings in the areas of cognitive neuroscience and mental illness are essentially group effects of small magnitude; the imaging literature has yet to produce any tests or techniques that are sensitive and specific enough to reliably diagnose cognitive deficits or psychiatric disorders.
The book ends with a well-designed structured bibliography of 128 pages containing 1,350 references followed by a thorough, logical index.
What does this book teach psychiatrists trying to make sense of the images of brains with which they are increasingly presented? The clear message is that the powerful techniques used to produce these images have great research and clinical potential but remain of limited value for clinical psychiatrists seeking guidance on how to care for their patients with substance use disorders. However, development of neuroimaging techniques is occurring rapidly, and their utility and probable necessity for adequate patient care are not far off. This book will greatly assist clinicians, teachers, and researchers in understanding the underlying structure of this evolving revolution in psychiatric knowledge.
