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Book Review   |    
Carl Fulwiler
Psychiatric Services 2009; doi:
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edited by Marc Galanter, M.D., and Herbert D. Kleber, M.D.; Arlington, Virginia, American Psychiatric Publishing, Inc., 2008, 828 pages, $165

Dr. Fulwiler is assistant professor of psychiatry at University of Massachusetts Medical School and director of clinical neurosciences at Lemuel Shattuck Hospital, Worcester.

The fourth edition of The American Psychiatric Publishing Textbook of Substance Abuse Treatment edited by two respected leaders in the field is highly readable and has been substantially updated since the last edition in 2004. The bulk of its pages are devoted to treatment as the title implies, with opening chapters on the science of addiction and a concluding section on special topics, such as prevention and medical education. Individual sections on the major drugs of abuse also start with a chapter on the neurobiology of each drug class.

For a multiauthored text, the chapters are remarkably even and current. The book is richly illustrated with figures and tables, and each concludes with key points and recommended readings. New chapters have been added. The section on psychosocial treatment now includes separate chapters on cognitive-behavioral therapy and motivational enhancement. Separate chapters are devoted to the major psychosocial treatments, rehabilitation, special populations, and Alcoholics Anonymous and other 12-step programs.

I particularly liked the chapter on co-occurring disorders titled "The Mentally Ill Substance Abuser." The discussion of the theoretical basis for diagnosis provides a well-balanced overview of etiological theories, including the self-medication hypothesis. "Diagnostic Assessment" is another excellent section that includes a helpful table for diagnostic formulation and discussion of the importance of collateral information. Following a general overview of the principles of treatment are sections devoted to the most common psychiatric disorders seen in this population, with information on both pharmacological and psychosocial treatments.

The chapters on opioids also stand out. The chapter on buprenorphine is a welcome addition. On top of thorough discussions of induction, maintenance, and monitoring, the authors also provide practical recommendations for setting up a buprenorphine practice and even a sample treatment contract. In contrast to the four chapters on opioid dependence, pharmacologic treatment of alcohol dependence is covered in a single 13-page chapter. The result is less useful information and some notable omissions. For example, to know the recommended dosages of the two most commonly used medications, the reader would have to look elsewhere. The discussion of the COMBINE trial doesn't mention that the dosage of naltrexone used was twice that used in the negative studies cited and twice the usual recommended dosage.

As befitting a general textbook, the focus is on the major drugs of abuse. The reader looking for information on some common drugs of abuse such as dextromethorphan and oxycontin will be disappointed. The absence of a chapter on older adults is surprising given our aging population. A brief discussion in the chapter on alcohol limits itself to the prevalence and consequences of alcohol abuse in the elderly population without discussing the evidence base for treatment. Despite these limitations, this is an excellent resource for clinicians working in primary substance abuse treatment settings as well as mental health facilities and primary care, and it is particularly useful for medical students, residents, and general psychiatrists. For an additional $25 there is an online version that is searchable and provides access from anywhere.




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