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Book Reviews   |    
The Violence and Addiction Equation: Theoretical and Clinical Issues in Substance Abuse and Relationship Violence
Reviewed by Joe Tupin, M.D.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.12.1642
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edited by Christine Wekerle, Ph.D., and Anne-Marie Wall, Ph.D.; New York, Brunner-Routledge, 376 pages, $59.95

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This book is a well-organized and well-edited collection of papers on the complex problem of addiction and violence. The editors provide useful opening and concluding chapters that admirably introduce the book and summarize and focus its conclusions. It is conveniently divided into three sections: theoretical frameworks, relationship violence and addiction across the lifespan, and clinical issues in intervention for intimate violence and addiction problems, enhancing the ease of use of this densely packed volume. All chapters are exceptionally well supported by their bibliographic thoroughness.

The first section, on theory, examines the biological and developmental basis of addiction and aggression, co-occurring psychopathology, and cognitive learning models. Each of the five chapters in this section is well written and comprehensive. Many readers will find this the most interesting and enlightening section because of the careful analysis of research and theory underlying aggression and addiction.

The lifespan section covers adolescents, college students, marital and child abuse, and older adults. Readers will be grateful for this categorization, particularly in the case of the chapter on older adults, a group that is often neglected.

The third and final section, on treatment, is strengthened by the inclusion of references to the theoretical and operational systems that underlie clinical intervention. For example, there is an informative discussion about access to care, ethnicity, and insurance coverage as well as aspects of the legal context of addiction and abuse. The book urges appropriate caution as different therapies and theoretical issues are discussed. In the chapter on behavioral couples therapy, the authors recommend that "evidence, rather than ideology, should guide intervention." Prevention of adolescent risk behaviors is well discussed. Alcohol abuse is the main focus in these chapters, probably because there are fewer data about other individual substances, but it would have been desirable if some guidance had been offered. There is little discussion of management of substance withdrawal and the problems of maintaining abstinence.

Finally, I wish the editors had paid a little more attention to two areas. The index is too heavily oriented to the referenced authors at the expense of topics. Also, some mention of the role of medications in intervention strategies and of the controversies would have been welcome.

The Violence and Addiction Equation will be particularly important to policy makers, health care leaders, and administrators in planning and staffing programs. It encourages use of resources on a rational, skill-specific, and systems-sensitive basis. Researchers will welcome this detailed review. Clinicians who commit a substantial portion of their time to these patients need to be familiar with the issues discussed in this book.

Dr. Tupin is professor emeritus of psychiatry at the School of Medicine of the University of California, Davis.




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