Book Review: Substance Abuse: Treating Alcohol and Drug Use Disorders in Psychotherapy Practice: Doing What Works

Abstract

Substance Abuse Treating Alcohol and Drug Use Disorders in Psychotherapy Practice: Doing What Works Arnold M Washton, Joan E Zweben. New York (NY): Guilford Press; 2006. 312 p. US$35.00. Reviewer Rating: Excellent Review by David Crockford, MD, FRCPC, DABPN Calgary, Alberta Substance use disorders are highly prevalent in psychiatric practice and can limit the effectiveness of psychiatric interventions. Unfortunately, many psychiatrists have little training in the management of substance use disorders and thus feel ill-equipped treat patients with comorbid substance use problems. Although several excellent textbooks are available on substance use disorders, few books have been written that translate textbook knowledge into a means address alcohol and drug problems competently and routinely in the patients seen in clinical practice. This book does not attempt be a definitive source of current empirical evidence; instead, it focuses on the application of evidence clinical practice as a to guide, and it does so admirably. While it is aimed at psychotherapists in private practice, it is highly applicable psychiatry residents, psychiatrists in practice, and specialists in addiction medicine or psychiatry. It reads easily and in the manner of an expert clinician providing experienced and step-by-step advice on how care for substance-using patients, identifying practical strategies and potential pitfalls. Its clinical orientation blends together seemingly disparate treatment approaches, including 12-step-oriented, abstinence-based addiction counselling; harm reduction; cognitive-behavioural therapy; motivational interviewing; dynamic psychotherapy; and pharmacotherapy. The book argues effectively in favour of a blended approach that will best allow clinicians meet patients according where they are along the continuum of substance use problems facilitate both overall functional improvement and moving toward, or becoming, abstinent. Part I of this book, titled Basic Issues and Perspectives, provides a clinically focused and reasonably up-to-date review of current theoretical views on substance use disorders, actions of specific substances, the role of comorbidity, and the place for pharmacotherapy. It emphasizes the need address substance use problems in clinical practice and the basis for choosing a blended therapeutic approach. For less experienced clinicians, Chapter 3 provides an excellent tutorial on the psychoactive substances, but it is also replete with clinical pearls (for example, on the link between stimulant drugs and sexual behaviour and on controversies regarding benzodiazepines) that experienced clinicians will readily identify with. Chapter 4 is another strong chapter that describes how an integrated approach uses the stages of change model alter the treatment approach according current stage of change and how incorporate concepts from motivational interviewing, the disease model, self-medication, and self-help program facilitation into the seamless care of patients. Part II of the book, Clinical Strategies and Techniques, presents practical approaches the substance-using patient. This is the book's forte and the reason I highly recommend it. Chapter 7 describes how perform an assessment for substance use disorders that may be overly detailed for some clinicians but shines in its description of how offer clinical feedback from the assessment, assess stage of change, and facilitate treatment engagement. Chapter 8 is exceptional in its explanation of the process of setting treatment goals and how match appropriate motivational strategies each stage of change, further summarized in an easily referred-to table. Chapter 9 describes techniques for active intervention, including cessation techniques and managing withdrawal, using random drug screens, establishing adequate structure, developing a recovery support system, addressing other substances of abuse, early recovery psychotherapy, and managing triggers, cravings, and urges. …