Alcohol and Alcoholism Vol. 38, No. 3, pp. 288-289, 2003
© 2003 Medical Council on Alcohol
BOOK REVIEW
Substance Abuse in the Mentally and Physically Disabled.
Edited by John R. Hubbard and Peter R. Martin. Marcel Dekker, New York. 2001, 221 pp., £86.95. ISBN: 0-8247-0587-4.
For some time, there has been growing interest and attention to the issue of the important link between substance abuse and psychiatric or general medical illness, and this has led to the opening up of different sub-specialities in addition to psychiatry and addiction medicine. This interesting book provides much useful and important information on this topic.
It is broadly divided into three parts. In part 1, there are discussions about assessment instruments, laboratory data and major epidemiological studies. In part 2, there are six chapters on different specific mental health morbidity and substance abuse. In part 3, there are four chapters on substance abuse and the implications of general medical illnesses.
In part 1 it is commented that the word abuse is used in many chapters of this book, interchangeably with dependence or addiction, and it is mentioned that in DSM-IV a clear distinction between the terms abuse and dependence are made, but addiction is not defined. There are discussions in this chapter about assessment instruments for substance abuse screening, including CAGE, MAST, and Brief MAST, DAST, AUDIT and AUQ, and a mention of two more comprehensive instruments of general current use, namely Structured Clinical Interview for DSM-IV Disorder (SCID) and Psychiatric Research Interview for Substance and Mental Disorder (PRISM) as well as a brief discussion of several laboratory tests, followed by some major co-morbidity epidemiological studies. This chapter concludes by a consideration of the dual diagnosis of substance abuse and psychiatric/medical disorders.
In part 2, there are eight chapters written by different authors with the headings of Substance Abuse and Mental Health, detailing the co-morbidity of different mental health problems and substance abuse, including, anxiety, depression, bipolar disorder, schizophrenia, personality disorder, and also a very good description of mental disorders in adolescents with substance abuse disorders (SUD) and some comments on the psycho-analytically-informed treatment of alcoholism.
I found these articles to be very well written, which has given the psychiatrists and others working in the field of mental health a good dimension of thinking. In anxiety disorder, there is a greater than average likelihood that patients will have co-existing substance abuse disorders. In the article on depression, it is mentioned that substance abuse and depression co-morbidity is an active area of research and there are many aspects which remain to be learned and researched.
Common neurobiological mechanisms have been proposed to link abuse and depression. In some cases, substance abuse appears after the onset of depression, but in other cases depression may occur first, and this important link is often overlooked by psychiatrist, physicians and other medical professionals.
In bipolar disorder, it is said that several studies suggest the co-morbid SUD co-occurs more frequently than is expected by base-rate estimates and the authors recommend that future research will require perspective evaluation of bipolar disorder patients with and without SUD, who are followed longitudinally to determine how these co-occurring syndromes develop and interact over time, which will be very important for their management.
In schizophrenia, the authors suggest that substance abuse occurs with a higher prevalence than in all other psychiatric disorders and they think that multiple factors appear to be involved in this process. The biological mechanism underpinning both substance abuse and schizophrenia appear to be a significant factor in the high rate of co-morbidity. They also mention the role of clozapine and risperidone in reducing some substance abuse disorders.
In the section on personality disorders (PD) and substance abuse, detailed information has been provided about the nature of the relationship between cluster B personality disorders, particularly antisocial PD or borderline PD and substance abuse. It is apparent that there is a high rate of co-morbidity of these PD with substance abuse, both in the general population and also of the population being treated for substance abuse.
In the section on mental disorder in adolescents and substance abuse, it is mentioned that substantial challenges remain in understanding the influence of co-morbid mental disorders on adolescent SUD and it is explained why this association is complex with problems of multiple aetiologies, and genetic, family, epidemiological and clinical studies may help to prove meaningful definition and sub groups for identification of individuals at risk, and structure management.
This last article in this chapter regarding comments on psycho-analytically informed treatment of alcoholism is brief, but informative, providing a framework for thinking through the different dimensions of this issue.
In part 3, there are five chapters on substance abuse and physical disabilities, all of which are very well written and stimulating for different dimensions of thinking on this topic. In the first chapter, it is mentioned that alcohol is the most commonly abused substance in the world, followed by drugs like cannabis, cocaine and heroin; the detrimental effect of these drugs on cardiovascular and neurovascular health are only partially understood. In the chapter on substance abuse and HIV, an overview is provided of the epidemiology and prevention of HIV transmission in the substance abuse population, and the complexities of diagnosing and managing various psychiatric and substance use disorders in HIV-infected patients is detailed very clearly. It is mentioned in a chapter about chronic pain and substance-related disorders, but very little has been adequately researched in this area, and it is suggested that studies on the incidence and prevalence of substance dependency in the elderly need to be completed. It also mentions that prescription medication dependency patterns are not well understood as yet.
In the last chapter, on neurological disorders and head injuries, there are many informative discussions on traumatic brain injury and association with alcohol and drug abuse. Also alcohol or drugs related seizures and the management of the same are clearly discussed. Discussions are also made of the co-occurrence of stroke movement disorder and other neurological disorders, which are very interesting and well written, providing much useful and practical information for clinicians and others.
In conclusion, I find this book, without any doubt, a most scholarly and significant contribution on the topic of substance abuse in the mentally and physically disabled. I am very certain that, overall, this is an expert book which is extremely informative and is likely to stimulate more thinking and understanding of this problem in the population throughout the world.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||