Alcohol and Alcoholism Vol. 35, No. 6, pp. 629-630, 2000
© 2000 Medical Council on Alcoholism
Book Reviews
Community Treatment of Drug Misuse: More than Methadone.
By Nicholas Seivewright. Cambridge University Press, Cambridge. 1999, 260pp., £22.95. ISBN: 0521665620.
The old ‘British System’ of drug treatment policy probably ended at about the same time as Glam Rock in the mid- to late-1970s. The explosion in heroin misuse that occurred in the cities of the UK during the late-1970s and early-1980s and the identification of HIV among intravenous drug users in the mid-1980s led to a search for new systems.
What then has replaced it? For anyone coming new to the field of drug misuse in this country, from the point of view of a practitioner, a researcher or just an interested outsider, as well as for our foreign colleagues, this book will provide an excellent overview.
Nick Seivewright is, as he says, both an experienced clinician in the field of drug misuse and a researcher. He is also, as those who know him will readily testify, an entertaining and amusing companion. All these qualities are evident in this book.
The book provides as good a picture as I have seen of where drug services in the UK are today. It describes our practice (and its many variants), describes and analyses our dilemmas and ponders our future. Its style is often personal and discursive, but its judgements are balanced and well referenced.
I looked up two particular topics about which I am often asked my views by purchasers, fellow workers, and especially patients. Dr Seivewright discusses diamorphine prescribing at some length. He reviews the literature, gives a balanced description of his own practice and includes a case history describing a patient who began her treatment with prescribed diamorphine from a private practitioner who was found not to have a licence to prescribe the drug, so that the local clinic had to take the prescription over. This is certainly the day to day of every-day drug dependence work as I know it!
I then looked at what Dr Seivewright had to say about the treatment of cocaine misuse. Again, the style is discursive, but the content well researched. Dr Seivewright records a visit he made to a USA treatment centre during which he asked ‘what works for cocaine misuse?’ and says he received the simple answer ‘alcohol treatment’. The quote is easily memorable but provides food for thought both within the book and for further reflection by the reader.
This is an excellent book. It would provide a good introduction to the practicalities of drug treatment for a junior doctor beginning a specialist post, serves as a useful guide to the literature for those tussling with a clinical problem, and its personalized style makes it an enjoyable book, both to read from cover to cover or to dip into.
Most importantly however, it describes, as well as I have seen anywhere, where treatment services in this country are both practically and ideologically at the start of the new millennium. This is the new British System.
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