Alcohol and Alcoholism Vol. 35, No. 4, pp. 411, 2000
© 2000 Medical Council on Alcoholism
Book Reviews
Dealing with Drink — Alcohol and Social Policy.
How enjoyable it is to read this volume. Essentially it deals with the care of individuals who have had problems with alcohol over the last 50 years in England. It charts the changes over this time from the management of alcoholism through specialist centres to the shift in dealing with a wider base of individuals, those who were not, in today's terminology, suffering from dependence on alcohol, but are misusing it, and the reduction in specialist care towards the generic basis. It also charts the rise, particularly important in England, of the role of clinical psychologists frequently at odds in their view of the nature of alcohol misuse and treatment goals with psychiatrists holding traditional views. In this country, whilst many psychologists have little interest in this field, they have exerted a greater influence than their colleagues in the USA.
This book also looks at important developments in relation to the habitual drunken offenders which occurred in the 1970s, and also issues such as special groups, including women.
The book is thoroughly researched, not only by using the relevant literature, but also by a very extensive series of interviews, which the author carried out, with key people in the field of alcohol misuse and prevention during the period under consideration. For someone whose professional career in this field overlaps a considerable part of the problem, it is of course immensely fascinating, as many of the key individuals are known. Irrespective of that, however, it is an extremely valuable document for new workers in the field, because it explains how many of the current developments came about. It has a useful non-polemical approach, is extremely comprehensive and easy to read.
There are some omissions such as the important issue of lack of education of medical students and the work done by the Medical Council on Alcoholism in this field. There is also perhaps not enough emphasis on how generally the caring professions have avoided becoming involved in this area, be they from medicine, nursing, social work, clinical psychology etc, and why this is so. Many believe it is the frustration of dealing with people who frequently are not prepared to address their problems in a way that is quite unique, together with an extremely pessimistic view of outcome.
However, perhaps the most revealing message of this book is how, firstly, governments of most dispositions have really not shown a great interest in this field, which again stands in stark contrast to the USA. There, it has been the individual efforts of important figures, often members of Alcoholics Anonymous but working in an individual capacity, that has brought about political change. It is only recently in England, i.e. within the last two or three years, that people who are known to the public and have alcohol problems have declared themselves. Be that as it may, there is an air of lack of government interest apart from occasional spurts throughout the whole period and at present the situation seems very serious indeed, i.e. little interest in alcohol problems, certainly in relation to drug problems, which relates predominantly to the government's interest in juvenile criminality and its link to drug dependence. Further it is clear that governments have taken little note of experts in the field, often relying on views expressed by lay people who are well known to government.
In conclusion this is an extremely valuable contribution to the field of alcoholism and drinking problems in England over the last 50 years and should be on the bookshelf of any workers who deal with such clients.
FOOTNOTES
By Betsy Thom. Free Association Books, London. 1999, 277 pp., £15.95. ISBN: 185343 450 7.
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