Manual of Therapeutics for Addictions

Rating:
Summary: A Little Green Book That Costs Big Green Dollars
Review: Being dissatisfied with my previous text for a graduate course in Substance Abuse Treatment, I went to the Internet to see what was out there. I found a 1997 book with good reviews and a detailed outlining of chapters. I was familiar with one of the authors, David E. Smith, founder and Medical Director of the Haight-Ashbury Clinic. It was a straight medical model, which was not necessarily negative, as that still represents the mainstream of addiction treatment. In addition, I appreciated how closely the comments on assessment and diagnosis remained true to DSM IV. The inclusion of chapters on treatment of addictive disorders; the treatment of gambling, eating and sex addictions; cultural considerations; AA; treatment efficacy; managed care; and ethics sounded like the outline for the course. The book does have medical sections of use to the behavioral science student that are not included in most texts. A strong point is made that assessment for drug abuse should be a part of any assessment, and that more than one drug is likely to be abused. I appreciated the inclusion of drug testing and the pros and cons of the various tests. It is useful to know that psychotropics are not very useful in the treatment of addictive disorders. The authors see addiction as the cause of many psychiatric symptoms and state that the first step is to separate the drug from the person. A major repeated point of the authors is that psychiatric symptoms are usually the

antecedent rather than the consequence of drug abuse. The authors' position is that drugs are taken for their "positive, brain reinforcing effects" and not for relief from psychiatric symptoms. The argument seems a revision of the "which came first question." The sections on managed care and legal and ethical issues in substance abuse are well done and informative. The preface states that the book is appropriate for "physicians and other mental health care specialists." The back cover states that the text is " Designed to meet the diverse needs physicians, psychiatrists, mental health professionals, medical students and residents, this authoritative text offers clear, step-by-step recommendations on the selection and application of both pharmacological and psychosocial therapies." While useful in supplying pharmacological information and data on diagnosis and assessment, this manual misrepresents itself as giving an adequate representation of psychosocial treatments- the chapter titles and subheadings do not present what they state. The preface states that "As many as 50% of general medicine populations and 75% of general psychiatric populations contain patients with addictive disorders." The authors state, "Enthusiasm for treating addictive disorders can result from developing and possessing knowledge and skill in their diagnosis and treatment, especially when patients are followed into their recovery." This is the only place enthusiasm is found in the entire book. The interior of the book is clinical in the worst sense of the word, and contains unfounded generalizations and statistics. The psychosocial parts are done with such superficiality that only someone unfamiliar with this material would benefit from reading it. The UglyMost prevalent forms of treatment are included, but represented by a brief one-paragraph description. The only chapter with any depth or passion is the one on Alcoholics Anonymous. This chapter is the most

poorly written of the manual. It contains bias, lack of analysis of the findings and more erroneous generalization than fact. The author of this chapter borrows statistics without questioning from AA's big book and other AA surveys. For example, they report that 50% of those starting AA drop out within the first three months; of those sober less than a year, 41 % continue for another year; and of those sober over 5 years, 91% will continue in AA for another year. The implication is made that the longer in AA, the more likely the abstinence, which may be true. However no mention is made of all the people for whom AA is not working. The author of the AA chapter makes generalizations that are contradicted elsewhere in the manual. He states, "All physicians are viewed as friends of AA." On page 264, he states, "...several pitfalls can occur between treatment professionals and members of AA, primarily involving conflict and rivalry." Other areas of conflict are noted, which imply the relationship with medical and mental health personnel is sometimes less than endearing. The commitment to AA and its derivatives as the only form of effective treatment is disquieting. It is stated that "AA and NA are compatible with the treatment of all medical and mental disorders. They should be considered essential in the treatment of all addictive disorders." Norman Miller (1995) concluded in another book, that "Only one method of treatment appears to be effective and to consistently work in the long run, mainly abstinence based treatment when combined with either regular continuous and indefinite attendance at AA meetings." This reader can mostly accept that abstinence based programs are the most effective, although it has not been empirically established that AA is the only effective treatment for alcoholism. In Project Match (1996), a study sponsored by National institute on Alcohol Abuse and Alcoholism, a comparison of the treatment modalities of "twelve step facilitation", cognitive-behavioral therapy and motivational enhancement therapy, found all treatments to be equally effective. Also, it seems very odd to me how someone so familiar with the drug area would choose to classify alcohol separately from all the other drugs. For the last two decades in professional circles, the rallying cry has been that alcohol is a drug like any other drug. Summary: Although the manual contains many important statistics and discussions, due to the inadequacy of the psychosocial sections, I would not even recommend this book to the medical student or physician interested in the non-medical aspects of addiction.

Rating:
Summary: Addiction & Therapy
Review: Norman S. Miller, Mark S. Gold and David E. Smith collaborate with other writers to form a book titled, Manual of Therapeutics for Addictions. The text uses many writers from different fields to add to the book's body of knowledge and research data. Some of the strong points of the book include: Definitions of many medical terms which are related to addictive disorders. It also gave a thorough explanation of drug addiction, including the many types, prevalence rates, intoxication and withdrawal symptoms. The book also covered treatment issues for the many addictive disorders and explained rates of comorbidities. Another positive aspect of the book was that the chapters were rather concise, in that they focused on one or two particular issues and discussed them in a way that was readable and easy to follow . Also, the use of DSM-IV diagnoses throughout the book helped the reader relate explanations of disorders to the actual criteria for which diagnoses are given. Now on to the aspects of the book which I felt to be unsatisfactory, or should I say, the meat of my critique. First of all, though acquiring the aid of professionals in the field to help make a book has its many benefits, it also has its downfalls. There were a number of times in the book when authors of different chapters had completely strong and opposing viewpoints. For instance, the use of psychotherapy was encouraged in one chapter and totally debunked in another. Statistical information throughout the book also proved to be inferior. There were numerous times when the data being given were based on studies and surveys completed over 20 years ago. I find it hard to believe that more recent data could not be collected if a little more effort was given on the part of the authors. Another negative aspect of the statistics given were that the percentage ranges of findings were so large that the reader virtually had nothing to go by. For example, it was not surprising to find ranges of between 20% and 75% when the writer was trying to make a statement about a particular topic. Worst yet is that the writers never acknowledge their unfortunate lack of preciseness to the reader, instead they continued on as though they had just given the reader a valuable piece of information. The explanation of diagrams and statistics were also not well thought through. I found on occasion, other possible and likely explanations for the data that was given. This makes me question the objectivity of the specific writers of those chapters. Furthermore, I was very surprised to see in some chapters, such as the one concerning Alcoholics Anonymous groups, that information was given and stated as factual, when in actuality most individuals who are familiar with the field and even many who are not familiar with the field would be able to easily decipher that it was nothing more than mere opinion. This aspect of the book was very insulting to the reader, especially when one considers the caliber of the three editors of this book, all of whom are MD's, and who should know better than to allow opinion to be stated as fact in their text. Another negative aspect of the creators of book, as told to me by my professor, is that it was advertised on the internet to be a good handbook for social workers and the psychological professions. Rather ironic, when one considers, as I stated earlier, that the book periodically debunks the effectiveness those types of related interventions have. Lastly, though equally important, is the price one is required to pay for this book. To the browser it might come across as a good text to have in one's collection yet upon further investigation by the reader the shortcomings of the book become apparent. Save your money and look harder for a decent book.

Rating:
Summary: Addiction & Therapy
Review: Norman S. Miller, Mark S. Gold and David E. Smith collaborate with other writers to form a book titled, Manual of Therapeutics for Addictions. The text uses many writers from different fields to add to the book's body of knowledge and research data.Some of the strong points of the book include: Definitions of many medical terms which are related to addictive disorders. It also gave a thorough explanation of drug addiction, including the many types, prevalence rates, intoxication and withdrawal symptoms. The book also covered treatment issues for the many addictive disorders and explained rates of comorbidities. Another positive aspect of the book was that the chapters were rather concise, in that they focused on one or two particular issues and discussed them in a way that was readable and easy to follow . Also, the use of DSM-IV diagnoses throughout the book helped the reader relate explanations of disorders to the actual criteria for which diagnoses are given. Now on to the aspects of the book which I felt to be unsatisfactory, or should I say, the meat of my critique. First of all, though acquiring the aid of professionals in the field to help make a book has its many benefits, it also has its downfalls. There were a number of times in the book when authors of different chapters had completely strong and opposing viewpoints. For instance, the use of psychotherapy was encouraged in one chapter and totally debunked in another. Statistical information throughout the book also proved to be inferior. There were numerous times when the data being given were based on studies and surveys completed over 20 years ago. I find it hard to believe that more recent data could not be collected if a little more effort was given on the part of the authors. Another negative aspect of the statistics given were that the percentage ranges of findings were so large that the reader virtually had nothing to go by. For example, it was not surprising to find ranges of between 20% and 75% when the writer was trying to make a statement about a particular topic. Worst yet is that the writers never acknowledge their unfortunate lack of preciseness to the reader, instead they continued on as though they had just given the reader a valuable piece of information. The explanation of diagrams and statistics were also not well thought through. I found on occasion, other possible and likely explanations for the data that was given. This makes me question the objectivity of the specific writers of those chapters. Furthermore, I was very surprised to see in some chapters, such as the one concerning Alcoholics Anonymous groups, that information was given and stated as factual, when in actuality most individuals who are familiar with the field and even many who are not familiar with the field would be able to easily decipher that it was nothing more than mere opinion. This aspect of the book was very insulting to the reader, especially when one considers the caliber of the three editors of this book, all of whom are MD's, and who should know better than to allow opinion to be stated as fact in their text. Another negative aspect of the creators of book, as told to me by my professor, is that it was advertised on the internet to be a good handbook for social workers and the psychological professions. Rather ironic, when one considers, as I stated earlier, that the book periodically debunks the effectiveness those types of related interventions have. Lastly, though equally important, is the price one is required to pay for this book. To the browser it might come across as a good text to have in one's collection yet upon further investigation by the reader the shortcomings of the book become apparent. Save your money and look harder for a decent book.

Rating:
Summary: Bucko Bucks, Bucko Disappointment
Review: The Manual of Therapeutics for Addictions was an assigned textbook for my substance abuse diagnosis course. I am in a Marriage and Family Therapist (MFT) program. I found this book to be of little use to people in the clinical field. This book was advertised as being a good source for mental health professionals. This book is primarily focusing on discussions and treatment plans that either devalue the role of clinicians or are impertinent to our scope of practice. This manual should have been advertised to medical students only. I'd first like to mention that this manual did provide helpful information on the various physiological effects of different substances. I found that many of the physiological effects, and withdrawal symptoms are very similar to DSM IV disorders. This made me aware that as a MFT, I must never overlook the possibility of substance use/abuse. This information will also help me better educate family members as to the drug effects of opiates, stimulants, sedatives, hallucinogens, and cannabis. This manual doesn't value the therapeutic experience, nor does it consider therapy a viable source in treatment planning for substance abuse. This book advocated the use of methadone and other outside help, such as AA and NA. Most treatment modalities discussed in this manual were geared towards medical professionals. Clinicians cannot prescribe methadone, use restraint harnesses, pump client's stomachs, or give them drug tests. Most of the treatment discussed in this manual revolved around the ER and inpatient treatment. How relevant is this to outpatient clinical work? It isn't. I also found many encompassing statements in the AA chapter. I find it very difficult to believe that so many of the generalizations are true. For example how is it possible that the "...first epidemic of alcoholism occurred after 1750..."? The Bible records drunkenness back in the times of Noah. Is it possible that humans have exhibited such self discipline that alcoholism didn't existed until after 1750? Another outlandish generalization is that "..in over 60 years of existence there has not been one fight..." in AA over the topic of a Higher Power. I am wondering how the author of this chapter can make such blanket statements. There are millions of AA members across the nation. Is it possible that he is omniscient? As a whole, this manual is not a good tool for MSWs, MFTs, psychologists. Considering that only a small fraction of this manual provided helpful information, I'd recommend finding a less costly way of obtaining the information. The internet is a good source.

Rating:
Summary: Bucko Bucks, Bucko Disappointment
Review: The Manual of Therapeutics for Addictions was an assigned textbook for my substance abuse diagnosis course. I am in a Marriage and Family Therapist (MFT) program. I found this book to be of little use to people in the clinical field. This book was advertised as being a good source for mental health professionals. This book is primarily focusing on discussions and treatment plans that either devalue the role of clinicians or are impertinent to our scope of practice. This manual should have been advertised to medical students only.I'd first like to mention that this manual did provide helpful information on the various physiological effects of different substances. I found that many of the physiological effects, and withdrawal symptoms are very similar to DSM IV disorders. This made me aware that as a MFT, I must never overlook the possibility of substance use/abuse. This information will also help me better educate family members as to the drug effects of opiates, stimulants, sedatives, hallucinogens, and cannabis.This manual doesn't value the therapeutic experience, nor does it consider therapy a viable source in treatment planning for substance abuse. This book advocated the use of methadone and other outside help, such as AA and NA. Most treatment modalities discussed in this manual were geared towards medical professionals. Clinicians cannot prescribe methadone, use restraint harnesses, pump client's stomachs, or give them drug tests. Most of the treatment discussed in this manual revolved around the ER and inpatient treatment. How relevant is this to outpatient clinical work? It isn't.I also found many encompassing statements in the AA chapter. I find it very difficult to believe that so many of the generalizations are true. For example how is it possible that the "...first epidemic of alcoholism occurred after 1750..."? The Bible records drunkenness back in the times of Noah. Is it possible that humans have exhibited such self discipline that alcoholism didn't existed until after 1750? Another outlandish generalization is that "..in over 60 years of existence there has not been one fight..." in AA over the topic of a Higher Power. I am wondering how the author of this chapter can make such blanket statements. There are millions of AA members across the nation. Is it possible that he is omniscient?As a whole, this manual is not a good tool for MSWs, MFTs, psychologists. Considering that only a small fraction of this manual provided helpful information, I'd recommend finding a less costly way of obtaining the information. The internet is a good source.