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REVIEW: Patients with Substance Abuse Problems - Effective Identification, Diagnosis, and Treatment
By Jenna Bensoussan
 Patients with Substance Abuse Problems is an adequate book for the beginning counselor or student in the addiction treatment field.
Substance abuse is a rising epidemic in America. The first chapter attempts to explain the challenge of treating this disease with out-dated statistics. In fact, it is overwhelmed with them. These stats would have better served the reader if they had been sprinkled throughout the entire book in appropriate sections, rather than crammed into one section at the beginning of the book.
Chapter two talks about the effect drugs and alcohol have over the reward pathway in the brain, as well as the role dopamine plays in a person's desire to use their drug of choice. High-level descriptions concerning different medications available to aide people in recovery by blocking the euphoric effects of the substance desired is mentioned with reference to an upcoming chapter containing more in-depth information.
The focus on the next chapter revolves around a patient's inability to believe there is anything wrong with them. Why do people continue their self-destructive patterns? Don't they know what is going on? The answer is - yes - they do know. The problem is, their knowledge is limited to varying degrees of denial and clarity about their situation. Chapter three formally discusses the common psychological process that keeps an addict in denial.
Determining whether a patient actually has a substance abuse problem is key to guiding them on the road to recovery. Chapter four actually proves quite useful, providing various approaches to obtaining pertinent information that can determine whether an individual has a substance complication. Included are suggested bullet-point avenues for would-be detectives when trying to determine the big picture with combined screening results, collateral, emotional and medical clues.
Categorically, substance abuse harbors two types of sufferers: substance dependents and substance abusers. Chapter five digs deep into the process of diagnosis, as well as co-occurring, psychiatric disorders common in cases of substance abuse and dependence. Further, it gives the reader a clear explanation on how to present the findings to the patient. The flow of this chapter is a bit out-of-sequence. Some information seems repetitive in places, but overall, it is well-equipped and informational.
Once a diagnosis has been made, treatment is the next step in a patient's long journey to recovery. Chapter six explains several different types of treatment, with the three main methods being outpatient, residential and hospitalization. In addition to treatment types, motivational strategies are discussed as well. All of the information contained in this section is easy to digest, providing valuable information to those new in the addiction treatment field.
Chapter seven is disappointing. It is centered around adolescent substance abuse, barely providing anything other than common sense on the subject. While it does provide some important information to the reader, much of it is garbled, irrelevant and lacking in organization with regards to diagnosing and treating this age group. Statistics about genetics and probability do not help a counselor practically screen or treat a troubled teen user.
The following chapter is amazing compared to its predecessor. It discusses the geriatric culture, their substance abuse issues, diagnoses, biological concerns and special treatment considerations.
There are three main contributors to the geriatric substance community: alcohol, sedatives and opiates. Abuse in older adults is much worse than it is in other age groups, primarily because, well, they are old and already prone to health issues. Substance use only increases biological woes for their liver, nervous system and brain.
After a very in-depth description of the whys and hows behind the elderly substance abuse, treatment for this age group is touched on, as well as how to approach this particular geriatric culture with their diagnosis. Much of the information in this chapter can be used in a practical setting.
Chapter nine covers the all-powerful, god-like substance, most affectionately referred to as "cigarette", or rather, that very addictive substance within the cigarette - nicotine. Even though the statistics in this chapter are out-dated, the reasons explaining our society's need to light up are still relevant.
Because those with substance use problems so often smoke in conjunction with their addiction, doctors are advised to screen for other substance use disorders once they determine their patient is a smoker.
Numerous treatment methods are explored to aide in smoking cessation, including nicotine replacement therapies and psychosocial approaches. Roadblock prevention is another major topic in this chapter that also proves to be quite informative and useful.
Patients with Substance Abuse Problems tops off with a final chapter about pharmacological treatments for alcohol and substance abuse. Beyond the initial introduction and history behind this type of treatment, the actual medications are discussed in detail. Everything from disulfiram to buprenorphine is explained in regards to their appropriate use, side effects and effectiveness.
There is no real "concluding" chapter to sum things up, but there is a very nice Substance Abuse Word List at the back of the book for those unfamiliar with some of the terminology; followed by a beefy appendix on office-based treatment of withdrawal.
If you are already well versed in the addiction treatment field, this probably isn't a book worth your while. If you are new to the field, however, Patients with Substance Abuse Problems will easily provide a solid, basic foundation behind the identification, diagnosis and treatment of substance abusers.
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