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Book Review   |    
Narrative Means to Sober Ends: Treating Addiction and Its Aftermath
Mark J. Albanese, M.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.4.538-a
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by Jonathan Diamond, Ph.D.; New York, Guilford Press, 2000, 386 pages, $37.95

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Jonathan Diamond wrote this book to offer hope to therapists who treat people with addictions. In laying out a narrative approach that gives new meanings to people's experiences and lives, he accomplishes his goal.

Diamond points out that he is not describing new methods of treatment but offering a set of ideas about psychotherapy and narrative. He exhibits good knowledge of psychotherapy's theoretical underpinnings in his lucid explanations of analytic concepts such as transference and countertransference. He is careful about acknowledging where he has built on the work of others.

Through case vignettes, the author demonstrates how he uses tools such as patients' narratives and letter writing in his therapy with people with addictions. For example, he might have a patient write a good-bye letter to alcohol as a way of acknowledging and exploring how important her relationship with alcohol has been in her life. Interestingly, he uses his own letters to his patients and to their other caregivers as therapeutic tools. Narrative metaphors do not replace other understandings of addiction but complement them.

Diamond is careful to avoid producing a cookbook or a manualized description of his treatment. Instead, what comes through is the experience of a compassionate, successful therapist who integrates 12-step and psychotherapeutic principles in the treatment of his patients. He is frank about his own evolution as a therapist and acknowledges mistakes he believes he has made. He is also careful to describe patients who have made modest gains as well as those who have had more dramatic breakthroughs. And because he is such a good writer, the reader feels his and his patients' joys and sorrows.

The book is divided into four parts. The first part, in which the author fleshes out the narrative approach, describes the journey from addiction to recovery. He elucidates the stages of denial, anger, acceptance, bargaining, and letting go. In part 2 he gives a masterful description of Alcoholics Anonymous, which is a narrative approach to addictions, and how it must be integrated into psychotherapy with people with addictions. In part 3 Diamond applies his ideas on addiction and its treatment to work with children, families, and therapists in recovery as well as to people with addictions who have comorbid trauma and eating disorders. In the final part he offers a summary, conclusions, and some additional thoughts.

Diamond, whose own family was affected by his mother's alcoholism, brings to the writing of this book 15 years of experience in treating and training in the fields of psychotherapy and the addictions. Although it is not an introductory text, Narrative Means to Sober Ends will appeal both to new addiction treaters and to experienced therapists. With its integrated approach, the book should likewise attract a multidisciplinary readership.

Dr. Albanese is associate chief of psychiatry at Tewksbury Hospital in Tewksbury, Massachusetts.

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