Academic journal article Journal of Cognitive Psychotherapy

Heroin Addiction: Wars and Wherefores

Academic journal article Journal of Cognitive Psychotherapy

Heroin Addiction: Wars and Wherefores

Article excerpt

Heroin Addiction: Wars and Wherefores Heroin Addiction: Theory, Research, and Treatment (2nd Ed.). Jerome }. Plait. Malabar, FL: Robert E. Krieger Publishing Co., 1986. (447 pp.)

In reading Jerome J. Platt's Heroin addiction: Theory, research, and treatment, one is reminded of Thucydides' reportage of the Peloponnesian War: He is relentlessly balanced and impartial, though sparing praise and mild reproaches at times appear, as when he remarks, "Hirt and Greefield . . . appropriately warn of possible methodological limitations of their study, something done all too infrequently by treatment researchers in the drug abuse field" (p. 229). Platt is similar, too, to the chronicler of that long-ago war in that the immensity of the subject matter is bound to lead to intentional and unintentional omissions. Platt is fully aware of that fact. This is the second edition of his and Labate's 1976 book, which itself was based on approximately 2000 publications, and in the introduction to the current edition Platt reports that more than 1600 more publications on heroin addiction have been produced since then. The most recent publications in his bibliography are from 1983. Platt takes responsibility for decisions to omit and to include specific references, and he points out that readers' suggestions and criticisms of the first edition were part of his motivation to do an update. He can add the present reviewer's name to the list of those who have ideas about the third edition we surely can look forward to in the next decade.

Criticisms of a work of such studied scope will inevitably amount to quibbles, for Platt succeeds in doing very well what he aims to do. He presents a massive array of findings and issues in orderly fashion without pumping for any pet point of view. Where conclusions emerge, they seem to do so from the data and the trends in the research findings rather than from the mind of the writer, and their emergence is more often provisional than robust. Time and again Platt presents a series of studies on an issue with no consensus and even contradictory results. Far from being offputting, his approach leads the reader to become more absorbed and appreciative of the complexity of the phenomena in question, much more fully informed, and more alive with notions of new or replicative research.

FROM MEDICINE TO MENACE

The book's first section, "The Historicolegal Context of Heroin Addiction in the United States," traces heroin from its beachhead through the latest stages of warfare against it. The history of anti-heroin legislation in America, just how and why it came to be illegal, the many campaigns to control its availability (all have failed to date), and how it moved from a middle/upper class licit medication to a criminal underworld illicit drug, are subjects presented in enough detail to give new perspectives to the modern drug abuse treatment practitioner. It appears, for instance, that the nature of heroin abuse in a country can be predicted from the nature of the laws regarding it. Britain took a relatively benign stance towards heroin use in contrast to America. Until comparatively recent times the total number of registered heroin addicts in Britain was about the number registered presently at just one of the four clinics at which this reviewer is clinical supervisor!

THEORIES AND THERAPIES

The book's second section pertains to the physiology and pharmacology of heroin addiction. The major surprise here for most psychotherapeuticallyinclined readers is that the mechanisms of tolerance, dependence, and abstinence syndrome are far from completely understood, and numerous theories compete with differing explanations. Platt's review of literature on endorphins seems relatively scant, and Ho, Wen, and Ling's work (1980) on the endorphin levels of heroin addicts and matched controls would have seemed worthy of discussion. Unquestionably, the third edition of the book will have much more to say about endorphins. …

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