DRUGS OF ABUSE: BODY FLUID TESTING

© 2006 The Authors. Journal compilation © 2006 Society for the Study of Addiction

Addiction,

101

, 610–612

Blackwell Publishing Ltd

Oxford, UK

ADDAddiction

0965-2140© 2006 The Author. Journal compilation © 2006 Society for the Study of Addiction

2006

101

••••

Book Reviews

101Book Reviews

Book ReviewsBook Reviews

Book Reviews

Compiled by Susan Savva and Griffith Edwards

THE TAMING OF COCAINE II

TOM DECORTE & SARAH SLACKBrussels, Brussels University Press, 2005, 346 pp,

€

33.95, ISBN 90 5487389 2

William Shakespeare said in

The Taming of the Shrew

that‘as the sun breaks through the darkest clouds, so honourpeereth in the meanest habit’. There can be few meanerhabits than those with cocaine, and yet for many usersthe sun does break through. As they gain control ofcocaine with difficulty and persistence, their honour does‘peer’ through. The book is a description of how they cando it.

The Taming of Cocaine

reports a 6-year follow-up studyof 77 Belgian cocaine and crack users. The original groupof 111 comprised ‘experienced creative users, preferablyfrom non-institutionalized, non-captive or hidden popu-lations’. They were drawn from the night life of Antwerp.Almost all were white and Belgian and the average agewas 39 years. Approximately a third were women. It is aremarkable achievement that after 6 years the authorscould track down 77 of the original, surely hard to find,111 cocaine users. We are fortunate to have such a book.I know of no similar report which equals it for sample size,diligence in follow-up or detailed reporting.

The emphasis in the book is on how informal controlsand self-regulating mechanisms allow cocaine users tocontrol their use and keep it from taking over their lives.Restrictive rules and rituals for cocaine use and informalsocial controls were all important in keeping problems tomanageable levels. Throughout, the authors are scepticalabout ‘pharmacocentrism’, i.e. an over-emphasis on thepharmacological aspects of drug use and a neglect of thepersonal and social controls which can be achieved.

Some readers may find the book too data-orientatedand empiricist. There is no overall theory or rationale forwhy some users gain control and frequently little inter-pretation is given. There are 191 tables and figures in lessthan 300 pages of text. Most of the tables are descriptive,merely setting out the response record so that the bookresembles a technical report. There is little multivariateanalysis. It does have a stellar review of previous follow-up studies, a good summary and the questionnaire usedis included.

It may seem impolite to criticize such a useful book.However, I was surprised to find so little on formal treat-ment experiences. A question on treatment was included,but there is almost nothing on how many received treat-ment or what difference it made. I also yearned for case

studies and more in the respondents’ own words abouttheir experiences. More could have been made of the pol-icy and treatment implications of the findings.

The transactions of human life mean that the sundoes not break through the clouds for everybody. Manycocaine users did not seem to improve greatly and hadsymptoms of addiction at times. There is no good score-card for how many were addicts or remained users andhad no symptoms of addiction. Despite some limitations,I recommend the book to all those interested in cocaineresearch.

REGINALD SMAR T

Centre for Addiction and Mental Health, Toronto, Canada

101Book Reviews


A BIOGRAPHY OF MRS MARTY MANN: THE FIRST LADY OF ALCOHOLICS ANONYMOUS

SALLY BROWN & DAVID BROWNCenter City, MN, USA, Hazelden Information andEducational Services, 2001, 384 pp, $15.95, ISBN1 56838 626 5

Marty Mann is, arguably, the most dominant figure in themodern alcoholism movement in the United States. Fol-lowing her own recovery from alcoholism, she organizedthe National Committee for Education on Alcoholism in1944 (forerunner of today’s National Council on Alco-holism and Drug Dependence) around five ‘kinetic’ ideasthat were developed in collaboration with Dwight Ander-son: (1) alcoholism is a disease, (2) the alcoholic thereforeis a sick person, (3) the alcoholic can be helped, (4) thealcoholic is worth helping and (5) alcoholism is our no. 4public health problem, and our public responsibility.

Modeling her reform movement on the success ofother public health organizations that had been formedto support education, research and treatment for tuber-culosis, cancer and heart disease, Mann spent her lifereshaping successfully national policy toward alcoholismand organizing local educational and treatmentresources throughout the United States. Part of herunique contribution as a public health pioneer was toheighten the synergy between emerging recovery mutualaid groups (Alcoholics Anonymous), post-Repeal organi-zations committed to the science-based management ofalcohol problems (the Yale Center of Alcohol Studies andthe Research Council on Problems of Alcohol) andphilanthropic organizations focused on the problem ofalcoholism (the Smithers Foundation). Marty Mann had

Book Reviews

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Addiction,

101

, 610–612

obvious assets to devote to her campaign of public educa-tion and policy advocacy. She was bright, articulate,attractive, passionately committed and offered her ownlife to thousands of audiences as living proof of the realityand transformative power of recovery from alcoholism.

But who was the person behind this powerful per-sona? This is the question that Sally and David Brownanswer eloquently in their biography of Marty Mann.Their biography is based on a meticulous reconstructionof Mann’s family history, hundreds of interviews withthose who knew and worked with Mann and a review ofthe available archival documents related to Mann’s con-tributions. This is a very well-researched biography andan engaging story that reveals much about the evolutionof attitudes toward alcoholism in America. It also pro-vides a window into the struggles public health reformersexperience as they try to balance excessive professionaldemands, their public personas and their sometimesquite complicated personal lives.

There are disclosures in this book that were hiddencarefully when Mann was alive, such as her sexual orien-tation and long-term relationship with Priscilla Peck, anda relapse that Mann experienced very late in her life (thelatter being the real bombshell of the book), but overallthis is a detailed account of how a deeply woundedwoman who had experienced multiple treatment epi-sodes finally found recovery and dreamed that she couldchange the world. And she did, with a skill and grace thatwill inspire many readers. Of the many lessons in thisbook, I was most struck by the potential for one person totouch personally so many and by so doing reshape his-tory. The

Biography of Mrs Marty Mann

should be addedto the reading list of those aspiring to leadership in thisfield.

BILL WHITE

Chestnut Health Systems, Port Charlotte, Florida, USA

101Book Reviews


CLINICAL MANUAL OF ADDICTION PSYCHOPHARMACOLOGY

HENRY R. KRANZLER & DOMENIC A. CIRAULO,edsWashington, American Psychiatric Publishing, Inc.,2005, 384 pp, $52.95, ISBN 158562 132 3 (pbk)

During the last decade the field of addiction psychophar-macology has developed rapidly, in particular with regardto pharmacotherapeutic options of relapse preventionand abstinence maintenance treatment. The editors mustbe congratulated for bringing together a high-qualityboard of experts to comment and evaluate the degree ofpublished evidence in this heterogenic field and to enablethe reader to gain an overview on the state of the art ofpharmacological treatment of the addictions.

In 10 chapters, data on epidemiology, pharmacologyand pharmacotherapy on alcohol, opioids, sedative-hypnotics, cannabis, cocaine and psychostimulants, hal-lucinogens and phencyclidine so-called ‘club drugs’(GHB, MDMA, ketamine), on inhalants and on tobaccoare consolidated, closing with a chapter on psychosocialtreatments combined with pharmacotherapy.

All chapters provide a broad theoretical background;however, they focus first on the pharmacotherapeutictreatment options and secondly on the underlying neu-robiological mechanisms. Hence, they fulfil ideally therequirements of a clinician and are most valuable as aguide for treatment. Using this guide the reader is enabledto find quickly information on particular pharmacologi-cal treatment strategies for both treatment of withdrawaland abstinence maintenance treatment. It is apparentthat the authors who wrote these chapters are experi-enced in clinical practice as well as in the theoreticalbackground of treatment.

In a second edition (and it is safe to say that the secondedition will come) the value of this clinical manual wouldbe enhanced by harmonizing the structure of the chap-ters. Whereas some chapters provide tables on typicalsymptoms of intoxication and withdrawal, tables on out-come of clinical studies as well as tables on dosing strat-egies, others do not. In particular, a short overview on themain results of studies on addiction pharmacotherapymight complete every chapter. However, even withoutthis additional information, the

Clinical Manual of Addic-tion Psychopharmacology

is a great help and an importantguide for clinicians and mental health practitionersassigned in the treatment of addicted patients. It would beworthwhile that not only practitioners already applyingpharmacological options in relapse prevention read thisbook to deepen their knowledge and to search for aspectsof differential indication, but that also those who (untilnow) do not include psychopharmacological options intheir treatment strategies will use this book to updatethemselves regarding the developments of the last10 years and to seize the chance to gain clinicalexperience.

FALK KIEFER

Central Institute of Mental Health, Mannheim, University of Heidelberg, Germany

101Book Reviews


DRUGS OF ABUSE: BODY FLUID TESTING

RAPHAEL C. WONG & HARLEY Y. TSE, edsTotowa, NJ, Humana Press, 2005, 312 pp, $145.00,£85.50, ISBN 1 58829 435 8

The editors state that this book is intended to be infor-mative and timely, and I consider this to be the case.

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Book Reviews


Addiction,

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, 610–612

The coverage of the topic is excellent and, although basedlargely on the situation in the United States of America,also covers the European perspective including a chapteron the roadside drug testing assessment project of theEuropean Union. There is a wealth of well-selected refer-ences although, on occasion, there are some gaps, suchas for gas chromatography.

The book starts logically with chapters on the historyof the development of drugs-of-abuse testing in the UnitedStates and a discussion about the use of urine, oral fluidand other specimens sampled currently, including hair,sweat and even a mention of nails, breast milk, semenand vitreous humor. The wide range of analyticalapproaches is then described briefly. There is some repe-tition, but this allows the reader to dip into each chapterwithout having to refer to other sections. The use of morefigures in this section would aid the better understandingof the techniques being described. Intriguingly, gas chro-matography using packed columns is mentioned as amajor approach; I had thought that only capillary col-umns were generally used nowadays. Some points aremade with little explanation or are oversimplified; forexample, it is stated that the flame ionisation detector ismass flow rate-dependent whereas the thermal conduc-tivity detector is concentration-dependent; no mention ismade that this is because the former is destructive. Also itis stated that the quadrupole mass analyser is limited interms of resolution, whereas the ion trap ‘boasts highmass resolution’; this is a misleading simplification, being

dependent on the instrument and operating conditionsrather than on the fundamental physics employed by thetechnique.

This book should appeal to those who would like tounderstand the mechanics of modern point-of-collectiontesting (POCT) devices. Chapter 4 deals in some detailabout the processes used for nitrocellulose membranes inlateral-flow assays. The next two chapters explain howantibodies may be linked to gold and, somewhat surpris-ingly, how to contract out the production of lateral-flowassay devices; very few readers will be likely to make useof the advice contained therein. The next four chaptersdeal with commercial oral fluid and sweat testing devices(Intercept

®

, Dräger Drug Test

®

, Oratect

®

and Drugwipe

®

)and are written by staff of the companies producing thedevices. Chapter 11 deals with hair analysis.

Because of sample collection practices and the use ofimmunoassay screening procedures, adulteration and/ordilution of specimens is all too common and it is thereforeappropriate that two chapters deal with the problem andmeans to detect adulteration. Drug testing and the UScriminal justice system is covered, although there is a gapwith respect to rehabilitation.

The book is rounded-off with a final short chapterdealing with trends in drug testing. Overall, the quantityof useful information makes this book a valuable tome.

DAVID COWAN

Drug Control Centre, King’s College London, London, UK

Au: is this Volume 11 or 2

nd

edition?

Documents

DRUGS OF ABUSE: BODY FLUID TESTING