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Book Reviews   |    
The First Session With Substance Abusers: A Step-by-Step Guide ? Beyond the Influence: Understanding and Defeating Alcoholism ? Addiction Treatment: Theory and Practice
Reviewed by John Finneran, Ed.M.
Psychiatric Services 2002; doi: 10.1176/appi.ps.53.7.903
View Author and Article Information

by Nicholas A. Cummings and Janet L. Cummings; San Francisco, Jossey-Bass, 2000, 274 pages, $40 • by Katherine Ketcham and William F. Asbury with Mel Schulstad and Arthur P. Ciaramicoli, Ed.D., Ph.D.; New York, Bantam Books, 2000, 357 pages, $13.95 softcover • by Sandra Rasmussen; Thousand Oaks, California, Sage Publications, 2000, 435 pages, $69.95 hardcover, $34.95 softcover

Consider substance abuse or substance dependence as having a kind of inexhaustible core of energy that, once firmly established in a person's life, has the power to organize in astonishing detail the sufferer's thoughts, feelings, and behaviors. Consider further that this energetic center has the capacity to orchestrate the course of relationships the sufferer may have with others. Consider finally that the system of organization and orchestration behind the substance abuse employs a stealth technology that seeks its perpetuation and unfortunate completion for the most part outside of conscious awareness. In The First Session With Substance Abusers, Nicholas A. Cummings, Ph.D., and Janet L. Cummings, Psy.D., wade directly into this bewildering clinical scenario to discuss ways clinicians can work with such clients to help them defuse the energy generated by addiction and disentangle themselves from its grip.

The First Session is a shrewd, sensible, and informative book. Its authors waste no time in identifying a basic problem in the treatment of persons with substance abuse: "Most psychotherapists, particularly clinicians trained in the behavioral treatment of chemical dependency, know little or nothing about the properties of specific drugs and how they affect different individuals. This lack of information leaves therapists vulnerable to the patient's denial, resulting in a psychological diagnosis that completely overlooks the addiction."

The authors suggest that clinicians become familiar with the physiological manifestations of substances in their phases of intoxication and withdrawal; that they recognize the many psychological disguises of denial; that they interrupt the pattern of substance abuse by use of paradoxical intention; and that they use the challenge of abstinence to draw the client into treatment and recovery. The book's nine chapters address each of these areas as well as group and individual treatment modalities, interviewing strategies, building a therapeutic alliance, and handling countertransference responses. An appendix contains a sample first interview and commentary.

The use of a paradoxical intention may not be applicable to all clients, especially those who have severe cognitive impairments or active psychotic disorders. It also may not be applicable to all therapists. Challenging a client into treatment by first expressing doubt about the client's intention to quit—most addicts come into treatment not to change but to get others off their back, according to the authors—and then proposing a trial of abstinence to prove the therapist wrong are skills some clinicians may not wish to acquire.

On the surface, the book's tone is anecdotal and practical, but at a deeper level, one senses the hard-won truths the authors bring to the subject and the life-and-death nature of the problem of addiction. The authors demonstrate a keen psychological perception of the self-organizing and self-replicating dynamics of addiction. They ask the clinician to be "nobody's fool" when it comes to the treatment of substance-abusing clients. They then provide clinicians with a set of tools they can use to build an interpersonal connection that challenges the addict "to keep coming back" just long enough for the process of recovery to take hold with its own core of energy and hope.

Whereas The First Session keeps its focus mainly on the psychological and the clinical, Beyond the Influence: Understanding and Defeating Alcoholism, by Katherine Ketcham and William F. Asbury, with Mel Schulstad and Arthur P. Ciaramicoli, Ed.D., Ph.D., provides a superb overview of the physiological, neurological, genetic, and social aspects of alcohol use and alcoholism. The ease of reading and the comprehensive sweep of the chapters make this one of the single best volumes available on the subject of alcohol and alcoholism. This book would serve as an excellent introduction to the complexities of alcohol and alcoholism, both for readers new to the field and for those with many years' experience.

The authors look closely at the biochemical, nutritional, and genetic factors that contribute to the development of alcohol-related problems. Fairly up-to-date research is summarized and presented concisely and straightforwardly, without ever turning dense or dull. The progression of alcoholism and the stages of recovery are given ample explication. The book is written for the general reader but ends with a reference and resource section that the more serious reader can use for deeper and more comprehensive study.

Beyond the Influence carries on the focus of an important and popular book on alcoholism published more than 20 years ago—Under the Influence: A Guide to the Myths and Realities of Alcoholism, by James R. Milam and Katherine Ketcham (1), which focused on the physiological factors that shape the alcoholic's vulnerability to alcohol. Indeed, this new book is an expanded, updated, and worthy sequel.

Addiction Treatment: Theory and Practice, by Sandra Rasmussen, Ph.D., is a most competent and comprehensive textbook on the diagnosis and treatment of addiction. The book has an almost encyclopedic expansiveness. It includes solid and up-to-date information on a variety of drugs and on compulsive behaviors. A wide array of treatment philosophies and treatment modalities are presented.

This would be a most useful text to accompany introductory course work on addiction and its treatment. Each chapter is introduced with an outline and learning objectives. The book has a rich appendix containing sample assessment forms and contact information for organizations, associations, and other resources related to the treatment of addiction.

Each of these books serves its purpose nicely, whether as a guide to treatment, an exposition about a particular substance, or a solid reference textbook. All three books are worthy and practical additions to any practitioner's library.

Mr. Finneran is a dual diagnosis clinician who works with adolescents and adults at the UMass Medical Center in Worcester, Massachusetts. He also serves as curriculum adviser to the Assisi Program in Brattleboro, Vermont.

Milam JR, Ketcham K: Under the Influence: A Guide to the Myths and Realities of Alcoholism. Seattle, Madrona Publishers, 1981
 
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References

Milam JR, Ketcham K: Under the Influence: A Guide to the Myths and Realities of Alcoholism. Seattle, Madrona Publishers, 1981
 
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