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Excerpts from JAMA Book Review New Treatments for Chemical Addictions, edited by Elinore F. McCance-Katz and Thomas R. Kosten (Review of Psychiatry Series, vol 17), 211 pp, paper, $29.50, ISBN 0-88048-828-7, Washington, DC, American Psychiatric Press, 1998.

Journal of the American Medical Association [06/09/99]
http://www.ama-assn.org/sci-pubs/journals/most/recent/issues/jama/review_2.htm

The chapters in New Treatments for Chemical Addiction-each a snapshot of the current research-enhance our understanding of a variety of addictions and are highly pertinent to the needs of today's practicing psychiatrists. The references are current and provide both the background and potential for further exploration of each entity. The index is well done and allows the reader to access information in the chapters easily.

The term dual diagnosis is one of convenience, used to capture the concept that some patients may have a substance use disorder in addition to another psychiatric disorder. There are severe program deficiencies in the provision of services for these patients. The epidemiology of this comorbidity is striking. Of individuals with a lifetime diagnosis of schizophrenia or schizophreniform disorders, 47% have also met criteria for substance abuse or dependence; of those with an anxiety disorder, 23.7%; obsessive-compulsive disorder, 32.8%; and affective disorder 32%, with distribution equal for males and females. Making the diagnosis is a pivotal component in the successful treatment of dually diagnosed patients, and it is very important to gather information from multiple sources, as corroborating evidence is essential for accurate diagnosis. Legal implications are involved in history taking, for it is necessary that we respect the integrity of the individual, whose rights must be protected. The duty and fidelity of the treating physician belong to the patient and not the institution, legal system, or public.

To end at the beginning, nicotine is a serious drug of addiction. It is now considered a "gateway drug," as it commonly precedes and is comorbid with other substance use. It is important that we actively address this problem.

We are indeed entering a new era of psychiatry. There is a potential to become the leaders of the medical profession in areas such as chemical addictions, which have heretofore been relegated to the sidelines because of lack of understanding of individuals' treatment needs and lack of compassion for their suffering. Armed with knowledge and with dynamic advocacy, we can hope for rehabilitation and recovery for a large and silent population.

This volume is packed with information. It provokes interest and even excitement for the new treatment opportunities that are available and, indeed, necessary for the successful treatment for chemical addictions.

Judith S. Yongue, MD
Greenville, NC

(JAMA. 1999;281:2145-2146)

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