Academic journal article American Journal of Psychotherapy

Textbook of Substance Abuse Treatment

Academic journal article American Journal of Psychotherapy

Textbook of Substance Abuse Treatment

Article excerpt

MARC GALANTER AND HERBERT D. KLEBER, ED.: Textbook of Substance Abuse Treatment. American Psychiatric Press, Inc. Washington, D.C. 1994, 475 pp., $71.55.

This excellent book is a compendium of the epidemiology and treatment results of a number of frequently abused drugs including alcohol, cannabis, stimulants, hallucinogens, phencyclidines, tobacco, benzodiazepines, and opioids.

Outcome studies from Alcohol Treatment Programs indicate that no single treatment is the most effective and suggest that several types of treatment should be offered. Therapist characteristics, particularly those of empathy, have a substantial effect on outcome. Disulfiram is effective in the treatment of alcoholism due to its psychological deterrent effect while lithium is of equivocal effectiveness. No single antidepressant is superior in the treatment of the depressed alcoholic and maintenance of an adequate dosage of the antidepressant for a sufficient period of time is required. Opioid-dependent patients have better outcome when maintained on methadone in full dosage.

Zinberg has criticized the use of 12-step programs in the treatment of cannabis abuse for fixating patients at the symbiotic level of development, not encouraging self-examination, and reducing complex psychological issues to the issue of chemical dependence. Others maintain that such groups alleviate isolation and may be essential if the abuser is to abandon primitive methods of coping and drug abuse. These positions illustrate some of the tensions existing between psychiatrists and proponents of the self-help groups.

Cocaine and its derivatives were considered relatively safe until about ten years ago, when it was estimated that 10% of the U.S. population had used cocaine. …

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