Mind Altering Drugs: The Science of Subjective Experience
MITCH EARLEYWINE, ed
New York: Oxford University Press, 2005
ISBN-13: 9780195165319, 416 pp. Price: US$49.95 hardback
This book examines subjective drug use experience with chapters ranging from behavioural theories of choice, to sex and drugs, ethnicity and subjective effects of alcohol. The primary focus is exploring the acute subjective effects of drugs though a few chapters deviate a little from this theme.
The intended audience of lay readers, students in other disciplines and professional researchers are likely to enjoy this diverse piece, though for the lay reader, some of the chapters may be inaccessible due to the high number of citations and technical language. The majority of the chapters are written by experts in the field and edited by Mitch Earleywine, who also contributes a chapter on cannabis.
There is a wide range of drugs explored, though the targeted approach for subjects of interest may prove more rewarding than the cover-to-cover read. The first chapter gives an overview of some of the laboratory research and theories around drug use including the importance of environment and other factors affecting substance use including drug and alternative enforcers. The behavioural theory of choice perspective is used to examine issues such as why some individuals may use drugs while others do not.
The next chapter examines drugs that induce and alter states of consciousness. Drugs are divided into being either consciousness expanding (e.g. hallucinogenic or psychedelic drugs) or consciousness contracting (e.g. opiates and alcohol). The altered consciousness is explored not only in relation to substance use, but also through non-drug methods such as mediation and yoga. The set and setting hypothesis is discussed as evidence for the way in which the same drug can provide vastly different experiences depending on the context in which it is consumed.
Following are three chapters examining subjective effects of alcohol including the effect of ethnicity. Hangovers are examined as ‘the common negative consequence associated with alcohol use’, though other commonly experienced and potentially more serious alcohol related harms are not included. A summary of the pharmacological actions of alcohol that mediate the subjective effects, and a discussion the impact of environmental cues and expectancy on behaviour when intoxicated with alcohol is provided as well as examining impact of individual genetic differences and ethnicity.
A chapter on sex and drugs is less racy than the name may indicate, highlighting the issue of hormonal fluctuations affecting how some drugs are subjectively experienced, noting some studies are limited in their comparison of how drugs effect men and women as they have not controlled for female hormonal fluctuations.
The tools developed to assess subjective effects and abuse liability of opioids are described in the chapter on opioids. Variables such as route and speed of administration, pharmacokinetic properties of the opioid (such as onset of action), and repeated administration on subjective effects including the subjective rating of the drug are considered.
A number of chapters follow using a similar format exploring different substances such as stimulant drugs and nitrous oxide and the significant factors that can affect the subjective experience such as setting and individual differences.
Mitch Earleywine's own chapter on cannabis contains statements such as ‘despite consistent propaganda to the contrary cannabis does not lead to … amotivation … [or] mental illness’ which, along with suggestions that a development of a ‘connoisseur’ attitude to cannabis smoking (along the lines of a wine connoisseur) may lead to reduced cannabis consumption may be unpalatable to some. This chapter appears to be in contrast to the format and content of the majority of the book. Additionally, the chapter titled ‘Corporate highs, corporeal lows’ is less scientific raising questions such as ‘Is depression a form of crowd control?’ and ‘is someone making us depressed in order to sell more antidepressants?’. This chapter gives a (n = 1) report of the author's personal subjective experience of being prescribed two different antidepressants. This chapter, while of interest to give a personal viewpoint is dissimilar to the majority of chapters in the book.
Overall the chapters are well written and reasonably easy to read for those with some familiarity with the topic. Introductory and conclusion chapters may have assisted in bringing together the varied content, which minus the mentioned exceptions generally followed a similar format presenting a review of the literature and methodologies around subjective experiences of a particular drug class. The digression from the main theme in some chapters may reduce the utility of the book, but does add some diversity to the subject matter. Notwithstanding the book generally does an admirable job exploring a less frequently explored aspect of drug taking. I would recommend this book to those involved in research or clinical work with mind-altering substances who wish to further explore the subjective aspect or the experience, or alternatively for those interested in the tools used in this field to measure subjective experience.
Suzanne Nielsen
Turning Point Alcohol and Drug Centre
Fitzroy
Victoria
Australia
© 2007 Suzanne Nielsen
Introduction to Addictive Behaviors, 3rd edn
DENNIS L. THOMBS
New York: The Guilford Press, 2006
ISBN-10: 1-59385-278-9, 322 pp. Price: AU$78.00 hardback
Alcohol and drug workers engrossed in client work, overloaded by expectations of complex clients, comorbidity and bureaucratic performance expectations need occasionally to settle back and flick through a book that covers the A&D field broadly but succinctly.
This is one such book. Aimed at a broad audience, and useful as an eclectic refresher text, it identifies and recognises structural and pathological difficulties of working with alcohol and drug dependent people in a complex society.
The alcohol and drug sector in Australia has a wide range of workers from diverse backgrounds, some with qualifications in the field others with very little. The complexities of working in the field are compounded by confusion about who the clients are and what levels of intervention should be operating. Evidence-based practice not withstanding, the complexities of treatment and social variables often militate against our best intentions for alcohol and other drug dependent clients.
The third edition of this book, gives coverage of the spectrum of substance abuse and addiction with chapters covering the disease and public health models; cognitive approaches, family systems and particularly useful chapters on social and cultural foundations, conditions that facilitate and inhibit change and comorbidity.
The book is aimed at a broad range of readers from experienced health professionals to people learning new skills in the A&D field. The expanded third edition covers a spectrum of alcohol and drug use theories and therapeutic and counselling approaches.
The book presents some interesting research and statistical analysis of the use of DSM-III as a benchmark. Of concern is that for comorbidity among drug users there is a strong and eager tendency to label and classify all drug users, particularly of illicit substances, as having a mental disorder.
The section on problem behaviour theory and the definition of variables hints without stating that there are significant class and socioeconomic status indices of comorbidity. The family system earns a chapter which is useful as a refreshing oasis to the parched worker looking for a more environmental influence approach useful in assessment and therapeutic interventions.
Pinches of realistic scepticism spice the text in places, reminding us that drug and behavioural addiction processes are based on social mores and cultural norms. ‘Abstention from alcohol is considered almost as deviant as binge drinking’ (p. 25).
Internationally, the alcohol and drug services have used a baseline of motivational interviewing as a treatment foundation. The chapter ‘conditions that inhibit and facilitate change’ has an update on motivational enhancement with a useful view of the structure of change theory and practice related to coercion (mandated client) models. The significance of client place in the cycle of change and work required with mandated clients from pre-contemplation to contemplation hints at the need for more work on the role of change theories in relation to mandated court diversion programs increasingly popular in Australia.
In the new chapter, ‘Towards an understanding of comorbidity’, Thombs notes interestingly that with the move towards treating mental illness in community-based programs, clients are often left unprotected from the dangers of street life, including alcohol and drug use thus increasing their problems with life management. If we are going further down the track of comorbidity and working with complex clients we need to take note of studies bolstering the view that long term, comprehensive treatment is important for engaging and managing dual diagnosis clients.
Alcohol and drug services are increasingly expected to work with complex mental health clients. While Thombs identifies the problem of mental illness and substance abuse as a major public health problem in the US, increased counselling and therapy do not replace a more comprehensive and integrated care direction. Thomb's comments on managed care programs in the US would suggest that our best intentions of case management do not replace high cost funding for major problem clients; and that those dual diagnosis clients need safe, stable, sober living environments to learn skills to maintain abstinence and that acquisition of these skills is less likely in intensive short term programs. While we often define comorbidity as problems of anxiety and depression so we can work with them, more intensive mental health therapies are being expected from A&D Workers.
The book tries to do too much but the author provides a useful text for refreshing current knowledge and reference. The book is readable, interesting and in places constructively critical. The review questions at the end of each chapter provide a framework for revision focus. This is a good shelf book to be kept close to the desk for reference. It is both a primer text for new workers and students, and a refresher for old hands looking to support old tricks and find some new ones.
I agree with Thombs that ‘This volume has provided an in-depth review and critique of contemporary theories of addictive behaviour and supporting research and implications in each area’ (p. 253) aiming to ‘bridge the gap between theory and research on the one side and practice on the other’ (p. 16).
Tony Dix
Alcohol & Drug Service
Department of Health and Human Services
St Johns Park, New Town
Tasmania, Australia
© 2007 Tony Dix