As the subtitle indicates, Drug and alcohol abuse is a clinical guide, no more, no less. The fact that it is in its sixth edition shows that it sums up important and indispensable information for specialists working in clinical addiction medicine, ranging from the basic concepts of addiction medicine, through the diagnostic criteria of the different addictive syndromes, to the specific treatment methods. Right in the first chapter the author emphasises that the book has undergone considerable changes and development since the appearance of the first edition (1979). A separate study could be made of the contemporary development of addiction science by comparing the different editions. In each edition, in defining the priorities for the different drugs, Schuckit takes into account how popular the particular substance is with users at the time. As a result, this edition contains no information on ketamine, a drug that was given considerable attention in the previous edition. From the Hungarian viewpoint, this is regrettable because ketamine use is increasing among young people in Hungary. In the same way, although the fifth edition devoted a chapter to prevention, this is not found in the present edition. If the reader skips over the reasons for this given by the author in the first chapter, by the time he or she reaches the end of the book he or she will have a strange feeling that something is missing. This feeling can arise in the individual chapters too because the preventive view is lacking from the approach of the whole book. This lack is reflected, for example, in the fact that concepts such as gateway do not appear in the book. If the aspects of the gateway phenomenon had been examined for individual drugs, the author would have been able to expound his ideas on how the process leading to addiction can be halted in the early stages. Schuckit had earlier received feedback leading him to the conclusion that his book is read mainly by clinicians who are interested in clinical cases and the specific tasks in the given situation. If this is true, then we must conclude with regret that the clinicians do not have a preventive attitude. This in turn points to the shortcomings in this aspect in the training provided in addiction medicine. It would certainly have been more fortunate if the author took advantage of the popularity of this book to broaden the horizon of clinicians in the direction of community health and prevention.
The greatest merit of Drug and alcohol abuse is that it does not contain a single superfluous sentence. The author expresses what he has to say concisely, giving only the most important and most reliable information. He does not recommend any form of treatment if the efficacy tests leave any doubt about its value. One example: in the chapter on opioids, the author mentions the possibility of ultrarapid detoxification with naltrexone, but he does not recommend its use because research to date has not shown its efficacy compared with the longer‐term outcome, and the potential dangers of its use are well known.
Schuckit places the different syndromes in the widest perspective, which also includes the epidemiological data, not only giving the reader recommendations for the course of clinical treatment for individual patients but also giving a comprehensive picture of the spread of the syndromes in the USA as well as the historical aspects of this spread. The reader in Europe and other continents is left with a feeling of something missing: where suitable information is available, the American figures could have been supplemented with those for Asia, Australia, Europe and Africa. This would undoubtedly make the book longer, but would give the reader a much more comprehensive picture of the problem of drug misuse in the contemporary world.
The 14 chapters of the book give a description of the syndromes related to what the author considered to be the most prevalent drugs (depressants, alcohol, stimulants, opioids and other analgesics, cannabinols, hallucinogens and related drugs, glues, inhalants, and aerosols, over‐the‐counter drugs, prescription drugs, xanthines and nicotine), information on the drug combinations and the emergency problems. Finally, the book ends with a chapter on the rehabilitation of chronic drug users, which broadens the perspective of the earlier chapters focusing mainly on psychopharmacological aspects, with a brief, factual description of the psychosocial and other biological, naturopathy treatments.
At the end of each chapter is a detailed bibliography containing an average of more than a hundred of the most relevant items on the topic.
Schuckit's clinical guide provides practising doctors with an important conceptual framework and information for the solution of daily clinical problems.