Archive for the ‘Books’ Category

Craving: a Book Review

cravingI just read a great new book related to addiction.

“Craving: Why We Can’t Seem to Get Enough” was written by Omar Manejwala, M.D., a friend of mine, a nationally renowned addiction psychiatrist, and an expert on compulsive behaviors of all kinds. This nonfiction book is, as the title suggests, all about the phenomenon of craving. It is published by Hazelden and will be released today. You can go to this link to buy the book: http://www.amazon.com/dp/1616492627/?tag=ommamd-20

Dr. Manejwala has been the medical director of Hazelden and other prestigious addiction treatment facilities, and has worked with all sorts of addicts including addicted healthcare professionals. He’s even appeared on television on show like 20/20.

This book is about more than just drug addiction; his information about craving pertains to any substance or activity. I love his definition of craving as a desire so strong that when unfulfilled “produces powerful physical and mental suffering.” (p2) His description of craving is eloquent and easily understood.

In this book Dr. Manejwala explains abstract ideas and concepts in plain language. I’ve heard him give lectures on addiction-related topics and I’ve always been impressed his skill of distilling the complicated into understandable bits. His writing also shows this gift. Though his book is easy to understand, it’s not dumbed down, as too many books on addition written for the public tend to be.

The first part of the book defines cravings and compares them to weaker wants and urges. He tells us why cravings matter: cravings lead all of us to indulge in behaviors that undermine success. In subsequent chapters, Dr Manejwala gives some simple information about brain anatomy and neurotransmitters, and shows how the brain’s structure and function affect our ability to make choices.

In a later chapter he shows how cravings can drive not only behavior, but also thought patterns, in some really interesting ways. When a person intends to act on a craving that is obviously destructive, all sorts of irrational and false beliefs can pop up, and seem to make perfect sense. These thought patterns keep the person stuck in destructive behaviors for long periods of time, leading to negative life consequences.

Another chapter shows how addictive behaviors tend to be related; that is, how a person with alcohol addiction is more likely to have or develop addictions to other drugs. That person is also more likely to develop a behavioral addiction like gambling, compulsive overeating, or compulsive shopping. This chapter explains why these behaviors can occur together.

My favorite chapter is about the brain’s plasticity. The term “plasticity,” when applied to the brain, means the brain is changeable. Our thoughts, actions, and experiences actually change the structure and functioning of the brain. This is important, because it means there are things we can do to change our cravings. Dr. Manejwala explains how thoughts, behavior, and even spirituality can free us from cravings. This fascinating chapter has some great references, too.

The next chapter tells more about how spirituality is important to recovery. The author explains why 12-step recovery and other spiritual approaches work to reduce cravings. He explains specifically how groups help reduce urges and improve behavior in ways that can’t be done by a lone individual.

Later chapters explain how insight into problem behavior is only a start in the direction of change, and how many people mistakenly think facts alone will reduce cravings. This chapter clarifies how apparently irrelevant decisions can actually be subconscious decisions to act on a craving. In this chapter, healthier substitute activities are suggested. The latter chapters have solid advice on where to go to find help with problem behaviors, and have specific tips to help with cravings for smoking, alcohol and other drugs, sugar, gambling, and internet addiction.

This gem of a book is relatively short, at 190 pages, and highly readable. I’m keeping it on my bookshelf for the references listed in the back.

This book will help addiction professionals be better able to explain cravings and addiction to patients. Anyone who has ever tried to squelch a craving – unsuccessfully – by willpower alone will be interested in this book.

Don’t miss this book if you’re interested in book about addiction and recovery.

Finding a Better Way to Treat Addiction

In my previous blog, I mentioned a great new resource that CASA has published about the condition of addiction treatment in this country. The book, “Addiction Treatment: Closing the Gap between Science and Practice,” is available for free as a download at http://casacolumbia.org

I’ve been reading this document in detail, finding facts that support what I see in the real world of treatment. In the U.S., our approach toward funding of addiction treatment is exactly backwards. We spend a relatively small amount on prevention and treatment of the actual disease of addiction, but billions on the constellation of medical issues caused by addiction.

Most addiction-related medical expenses are paid for from public funds. In fact, over ten percent of all federal, state, and local government dollars are spent on risky substance use and addiction problems. Sadly, over 95% of this money is spent on the consequences of drug use and abuse. Only 2% is spent on treatment or prevention.

Untreated addiction costs mightily. People with untreated addiction incur more health care costs than nearly any other group. An estimated one third of all costs from inpatient medical treatment are related to substance abuse and addiction. Untreated addicts (I include alcohol addicts with drug addicts) go to the hospital more often, are admitted for longer than people without addiction, and require more expensive heath care than hospitalized non-addicts. The complications these people suffer could be from underlying poor physical health and lack of regular preventive healthcare, but most of the cost is incurred treating the medical problems directly caused by addiction and risky substance use.

That data is consistent with my experiences when I worked in primary care. I always felt like I was slapping Band-Aids on gaping wounds when I treated people with alcohol or other drug addictions. I never felt like I was treating the real problem, and I wasn’t, as this report so eloquently indicates. My practice had a handful of “frequent fliers” who came to the ER several times per month with the same addition- related illnesses, over and over. I admitted one patient to the hospital at least twenty times over four years for the treatment of alcoholic gastritis. Each hospital visit lasted four or five days until he was well enough to go home and drink again. Another patient was admitted about every two months after he got pancreatitis from another bout of binge drinking. This went on for years.

This was in the early 1990’s, in my former life as a doctor of Internal Medicine. I didn’t know what to do with these people. They frustrated me. Maybe I told these patients to go to Alcoholics Anonymous, and probably I asked the social worker to arrange inpatient treatment if possible. But I didn’t have the knowledge or tools to really help these people, and instead only did what I was trained to do: treat the medical problems caused by addiction.

In my Internal Medicine residency, I admitted many patients to the hospital for endocarditis (infected heart valve) contracted from IV heroin use. Each time, this required six month of intravenous antibiotics. Back then we kept such patients in the hospital the whole time. You can imagine the cost of a six week hospital stay, not that these addicts had any money to pay. Just a fraction of that amount could have paid for treatment at a methadone clinic, the most effective way to treat heroin addiction, and prevent dozens of medical problems. But I never referred them to the methadone clinic available in that city. I didn’t know anything about methadone or the medical-assisted treatment of opioid addiction, and apparently my attending physicians, responsible for my training, didn’t know about it either. It was a shame, because in those years, the late 1980’s, we were making new diagnoses of HIV almost daily among IV drug users. Since then, a study showed a patient using IV heroin drops his risk of contracting HIV by more than threefold if he enrolls in a methadone clinic.

Family members of people with untreated addiction have higher health costs, too. Families of people with addiction have 30% higher health care costs than families with no addicted member. I presume that’s from the stress of living and dealing with a loved one in active addiction. Often family members are so caught up in trying to control the chaos caused by active addiction that they don’t take time for routine health visits.

The costs of untreated addiction aren’t only financial. Addiction and risky drug use are the leading causes of preventable deaths in the U.S. Around 2.9 million people died in 2009, and well over a half million of these deaths were attributable to tobacco, alcohol, and other drugs. Overdose deaths alone have increased five-fold since 1990.

We know addiction is a chronic disease, yet we spend far less on it than other chronic diseases.

For example, the CASA report says that in the U.S., around 26 million people have diabetes, and we spend nearly 44 billion dollars per year to treat these patients. Similarly, just over 19 million have cancer, and we spend over 87 billion for treatment of that disease. In the U.S., 27 million people have heart disease, and we spend 107 billion dollars on treatment.

But when it comes to addiction, we spend only 28 billion to treat the estimated 40.3 million people with addiction, including nicotine. Most of the money we do spend is paid by public insurance. For other chronic diseases, about 56% of medical expenses are covered by private payers, meaning private insurance or self-pay. But for addiction treatment, only 21% of expenses are paid from private insurance or self-pay. This suggests that private insurance companies aren’t adequately covering the expense of addiction treatment. Indeed, patients being treated with private insurance for addiction are three to six times less likely to get specialty addiction treatment than those with public insurance such as Medicaid or Medicare.

In the U.S., we don’t treat addiction as the public health problem that it is. Some people still don’t believe it’s an illness but rather a moral failing. Doctors aren’t educated about addiction is medical school or residencies, and we often have an attitude of therapeutic nihilism, feeling that addiction treatment doesn’t work and it’s hopeless to try.

Families and medical professionals often expect addiction to behave like an acute illness. We may mistakenly think addiction should be resolved with a single treatment episode. If that episode fails, it means treatment is worthless. Families want to put their addicted loved one into a 28-day treatment program and expect them to be fixed forever when they get out. They’re disappointed and angry if their loved one relapses.

This reminds me of an elderly man I treated for high blood pressure many years ago. I gave him a month’s prescription of blood pressure medication, and when he came back, his blood pressure was good. I was pleased, and I wanted to keep him on the medication. He was angry. He said he was going to find another doctor. He thought the one prescription should have cured his high blood pressure so that he would never have to take pills again, and was disappointed with my treatment.

If we keep our same attitude toward addiction treatment, we are doomed to be as disappointed as my patient with high blood pressure. Addiction behaves like a chronic disease, with period of remission and episodes of relapse.

We have a lot of work to do. As this CASA publication shows, we have to change public attitudes with scientific information and do a much better job of training physicians and other health care providers. We should pay for evidence-based, high-quality addiction treatment, rather than spend billions on the medical problems caused by addiction as we are now doing.

Check Out CASA’s New Free Publication

If you’ve never browsed CASA’s website, you need to do so. CASA, which stands for Center on Addiction and Substance Abuse, at Columbia University, has helpful information about addiction and its treatment that you can download for free. They have information about how to reduce the risk of addiction in teens (“The Importance of Family Dinners” series), information about the cost and impact of untreated addiction on society ( “Shoveling Up”), in formation about substance abuse and the U.S. prison population (“Behind Bars” series), and the availability of drugs on the internet (the “You’ve got Drugs” series). All of these contain useful and thought-provoking data.

This summer, they published a masterpiece: “Addiction Medicine: Closing the Gap between Science and Practice.” I’ve read most of this book, and admire the clarity and call to action it presents. This publication outlines all aspects of what is wrong with addiction treatment in the U.S., and how to fix it.

Every politician should read it. Every parent should read it. Physicians and treatment center personnel should read it. Anyone who is concerned about the extent of addiction and its poor treatment in the U.S. should read it.

CASA describes their key findings of the drawbacks of the U.S. system – or non-system – of addiction treatment. This nation is doing many things wrong, to the detriment of people afflicted with addiction, their families and their communities. Our mistakes are based on ignorance, misperceptions, and prejudice. All of these impede our ability to help our people with addiction. The CASA report clearly describes these factors, saying they all contributed to our present situation. We have declared a war on people who use drugs, not on drugs.

The CASA report describes how public opinion about addiction isn’t based on science. We now have science that proves addiction is a brain disease. We know that continued use of addicting substances alters the structure and function of the brain, affecting judgment and behavior about the continued use of drugs even when bad consequences occur. We know that at least half of the risk for developing addiction is determined by one’s genetic makeup. Yet surveys show that about a third of U.S. citizens still feel addiction is due to lack of willpower and self-control. Why are public attitudes so disconnected from science?

Addiction is a complicated diagnosis, existing as it does at the end of the continuum from occasional drug use to regular use to compulsive use. People often compare a drug user with a drug addict. They say that since the drug user was able to stop when he wanted that the drug addict should be able to stop when he wanted. This compares apples to oranges. If someone can comfortably stop using drugs when given a good enough reason to do so, this person isn’t an addict. They may be a drug abuser, a problem user, and at high risk for addiction, but they haven’t crossed the line into uncontrollable use.

The CASA report illuminates what addiction medicine physicians have been saying for years: addiction treatment and prevention isn’t treated by physicians and health professionals. Most addiction treatment is provided by counselors who, for the most part, aren’t required to have any medical training. Only six states require a bachelor’s degree to become an addiction counselor, and only one (Alabama, go figure) requires a master’s degree.

Even when physicians are involved in the treatment of addiction, most of us have very little, if any, training in medical school or residencies about addiction prevention or treatment. Ironically, most of our training focuses on treating the consequences of addiction.

In medical school and residency, I spent countless hours learning about the proper treatment of cirrhosis, gastritis, anemia, pancreatitis, dementia, and peripheral neuropathy from alcohol addiction. I had little if any training about how to treat alcohol addiction, and none about how to prevent it.

We know brief interventions by physicians during office visits can reduce problem drinking and are an effective way to prevent problems before they occur. Yet few physicians are trained to do this brief intervention. Even if they are trained, primary care physicians and physician extenders are being asked to do more and more at each visit with patients, and asked to do it with less and less time. Often, primary care providers aren’t paid to do brief interventions, and an opportunity for prevention is lost. Yet that same patient may consume hundreds of thousands of healthcare dollars during only one hospital admission for the consequences of with alcohol addiction.

When I practiced in primary care, I often thought about how I never got to the root of the problem. I felt like I was slapping Band-Aids on gaping wounds. I would – literally – give patients with addiction strikingly absurd advice. “Please stop injecting heroin. You got that heart valve infection from injecting heroin and you need to quit.” I could see it was ineffective, but I didn’t know any better way at the time. I thought if there was a better way to treat patients, I’d have learned about it in my training.

Wrong. Instead, I learned about this vast body of scientific literature about addiction treatment by accident, when I worked at an addiction treatment center for a few days, covering for a doctor friend of mine.

In coming blogs, I’ll outline more of the points made by this timely publication. In the meantime, read it for yourself at  http://www.casacolumbia.org

Great New Book to Recommend!

by Rebecca Janes, LMHC, LADC

So there I was, cruising Amazon.com, looking for new books about opioid addiction and treatment, when I saw an intriguing title: Methadone: The Bad Boy of Drug Treatment.

I ordered it, and just finished it.

I fully recommend this book for anyone interested in learning more about methadone treatment. It’s written by Rebecca Janes, LMHC, LADC. The book’s cover says she has around fifteen years’ experience working in methadone treatment centers. She’s obviously knowledgeable about the studies supporting treatment of opioid addiction, and she’s able to summarize this knowledge succinctly. She explains complicated ideas in simple ways that make sense.

 It’s a small book, at 120 pages, and doesn’t have many references, but it covers most essential areas. The price is $12.95, and it’s published by Outskirts Press. As I said, you can buy it on Amazon, where it’s also available as a Kindle edition for only $2.99.

 The first chapter is dedicated to correcting mistaken impressions the general public has about methadone treatment, and Chapter Two corrects myths addicts often tell each other. Chapter Three describes what does not work in treatment, and Chapter Four tells what does work. Chapter Five tackles more controversial aspects, such as appropriate treatment of pain and anxiety for patients maintained on methadone.

 Patients on methadone will find this an ideal book to give to important people in their lives who nag them about getting off methadone. It’s great for parents and other relatives. It would be ideal to give to doctors with negative or judgmental attitudes, since it’s a quick read, and doctors aren’t likely to want to spend much time reading about a treatment they don’t believe in. It would be a great book to recommend to probation officers and social workers who don’t have much knowledge about methadone and its use. 

The only criticisms I have of the book are its few references, and it doesn’t cover buprenorphine at all. But then, if you want more in-depth information about opioid addiction, methadone, and buprenorphine, complete with references, you should buy my book: Pain Pill Addiction: Prescription for Hope. You can get it for $13.95 on EBay, shipping included. Or have I mentioned this before?

Top Ten Books for Methadone Counselors

I have a fair number of methadone counselors who read my blog. I’m often asked by these counselors what books I recommend, which is like asking me what kind of dessert is good. The list is so long. But here are the ones all methadone counselors should read:

  1.  Medication-assisted Treatment for Opioid Addiction in Opioid Treatment Programs, by the Substance Abuse and Mental Health Services Administration. This is better known as “TIP 43,” because it’s the 43rd book in the series of treatment improvement protocols published by SAMHSA. You can get any book in the series for FREE! Yes, this book and several others are free resources. The website is: http://store.samhsa.gov. While you’re there, order TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, and TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment. Then browse around, and see what else interests you. This is a great website, and all addictions counselors should be very familiar with it. There’s great material for counselors and their clients.
  2.   Pain Pill Addiction: Prescription for Hope, by….me. Hey, it’s my blog, so of course I’m gonna list my book. At least I didn’t put it at number one. But seriously, I do think my book describes what opioid addiction is, why this country is having such problems with opioid addiction now, and the available treatments for this addiction. I focus on medication-assisted treatments, which means treatments with methadone or buprenorphine, better known as Suboxone. After reading my book, any substance abuse counselor should be able to talk intelligently with patients and their families about the pros and cons of medication-assisted treatment. I tried hard to base this book on available research and not my own opinions, though I do state some of my opinions in the book. My book also has summaries of the major studies done using medication-assisted treatments, so that if you need resources to prove why methadone works, you’ll have them. OK. I’m done blathering. Order it on EBay and you’ll save some money.
  3.      Motivational Interviewing by William Miller and Stephen Rollnick. This is a book all addiction counselors should have… and read. I’ve learned so much about how to interact with people as they consider if, how, and when to make changes in their lives by reading this book. The authors demonstrate how the Stages of Change model easily fits with this style of counseling. There are some solid examples of how to incorporate MI techniques.
  4.      Cognitive Therapy of Substance Abuse, by Aaron Beck et. al. This is a venerable text describing cognitive therapy as it applies to substance abuse. The book is relatively concise, but it’s still dense reading. Get out your underliner because you’ll want to find some parts to read again. The dialogues in the book that serve as examples are instructive. This book has been around for some time, as texts go, since it was published in 2001.
  5.     Narcotics Anonymous Basic Text, by Narcotics Anonymous World Service. Now in its sixth edition, this is one of the books that serve as a foundation for 12-step recovery in Narcotics Anonymous. If you are a counselor who’s in recovery, you’ve probably already read it. If you’re not, you need to get it, read it, and be able to talk intelligently about the 12-step recovery program of this 12-step group. The AA “Big Book,” which is AA’s version of a basic text, has much of the original old-time words and phrases, and speaks mostly of alcohol. For these reasons, some addicts won’t like the Big Book as well as the NA Basic Text. However, the Big Book does have a certain poetry that will appeal to others. (….trudge the road of happy destiny…) You can order it at http://na.org or go to that site and download it as a pdf.
  6.  The Treatment of Opioid Dependence, by Eric Strain and Maxine Stitzer. Written in 2005, this is an update to a similar title written in the 1990’s. This book reviews the core studies underpinning our current treatment recommendations for patients in medication-assisted treatment of opioid addiction. I don’t know why more people haven’t read this book, because it’s relatively easy to understand. Don’t make the mistake of assuming it will be too advanced for you. Get it and read it.
  7. Addiction and Change: How Addictions Develop and Addicted People Recover, by Carlo DiClemente. This book describes the paths people follow as they become addicted and as they recover. It’s focused on the transtheoretical model of the stages of change, so named because it can be used with many counseling theories. I think this is a practical book, and easier to understand than some texts.
  8.  Diagnosis Made Easier: Principles and Techniques for Mental Health Technicians, by James Morrison M.D. This is an improvement of his earlier book, DMS IV Made Easy, written in 1992. At any work site, addictions counselors will have to be familiar with the criteria used to diagnose mental illnesses. Since around 30 – 50% of addicts have another co-occurring mental illness, you need to be familiar with the criteria used to diagnose not just addiction, but these other illnesses as well. And this book makes learning relatively painless. It’s practical and easy to read, and based on common sense. It contains many case examples, which keep it interesting.
  9. The American Disease: Origins of Narcotic Control, by David Musto. This book has been updated and is on its third edition, but so much has happened since this last edition in 1999 that the author needs to write an update. This is an interesting book, and it moves fairly quickly. This information puts our present opioid problem into the context of the last century or so. As an alternative, you can read Dark Paradise: A History of Opiate Addiction in America, by David Courtwright in 2001. I included this book, but be warned it’s heavier reading. This author is an historian, so maybe his writing style didn’t resonate with me as much. Still, he has much good information. You can’t go wrong with either book. You could also read The Fix by Michael Massing, which is another book about the history of addiction and its treatment in the U.S… This last book doesn’t focus on just opioid addiction, but still gives all the pertinent history. This book is written by a journalist and will keep your interest. It was written in 2000.
  10.  Hooked: Five Addicts Challenge Our Misguided Drug Rehab System, by Lonnie Shavelson. This book, written by a journalist, follows five addicts through the labyrinth of addiction treatment. You’ll see the idiotic obstructions addicts seeking help are asked to negotiate in our present healthcare system. I was angry as I read the book, seeing obvious simple solutions that couldn’t be enacted for one administrative reason or another. Let this book make you angry enough to demand change from our system. Be an advocate for addicts seeking treatment.

 Have I left out any? Let me know which book have helped you be a better counselor or therapist.

Bibliotherapy: More Addiction Memoirs

If I Die Before I Wake, by Barbara Rogers

Anyone struggling with addiction to drugs including alcohol can get something out of this book. The author describes what her addiction was like, what happened to get her into recovery, and what it’s like now. And she went further than that. She described the trials she faced while in recovery, and how she applied the spiritual principles of the twelve steps as she went through these trials. This book is like going to a really good speaker meeting. It will resonate with both newcomers and old-timers in recovery. I will be recommending it to my patients.

Pill Head, by Joshua Lyons

I was envious as I read the book, because he did such a great job of writing an interesting, engaging book, while also educating the reader with (mostly) accurate facts about the disease of opioid addiction. It’s more interesting than my own book, Pain Pill Addiction, though I have more science in mine. Anyway, the author shows the dividedness of many addicts. He wants to be in recovery, and hates the negative consequences that are occurring as a result of his addiction, but he still wants to use pain pills. I don’t think people newly in recovery should read it because it may trigger cravings in the places he describes drug euphoria. His story isn’t one of hope, and I wish he’d waited until he was further into recovery to write the book.

 

Loaded, by Jill Talbot

            Ugh. I didn’t like this book. It was false advertising, for one thing. It was more about her unhappy love life than it was about her alcohol addiction. For the first two-thirds of the book, she laments about how dating married men made her lonely. Duh. Then toward the end she does talk of some sticky situations due to alcohol, and describes her fellow patients at a drug rehab. But then she is vague about her relapse back to drinking, and if she was able to do controlled drinking, or if she went back to her former state.

Wired: the life and Fast Times of Jim Belushi, by Bob Woodward

            It could have been cut in half and been a much better book. The renowned author put in a great many details of the days and nights during the years leading up to the star’s death from drug overdose, and it felt like too much after a few chapters. We get it. He was a wild and crazy guy. He did outrageous things and was tremendously talented and deeply flawed. Maybe knowing the ending made it sad from the start. Another big talent obliterated by addiction.

Broken, by William Cope Myers

            He’s the son of the famous journalist William Myers, and now a spokesman for Hazelden recovery center in Minnesota. This memoir is one of the better ones. He does a good job of describing the guilt that comes after a drug binge, and about his family’s disappointment in him. With a famous father, the press of expectations was an added stress that may have pushed his addiction further.

Go Ask Alice, by Anonymous

I came across a paperback copy in a bargain bin at a thrift store, and bought it to re-read. I read it as a teen, and at that time suspected it was written by an adult to scare kids away from drugs. I wondered if I’d think differently reading it as an adult. I didn’t. I certainly didn’t sound like it was written by a fifteen year old. It’s a fair book, but probably fictional.

Can’t Find My Way Home, by Martin Torgoff

I’ll re-read this one. It’s a comprehensive history of drug addiction in the U.S. from 1945 until 2000. Focused on the various political movements and popular trends of different years, it puts drug use into cultural context. It also gives some specifics behind some famous drug users and drug legalization proponents. It was fascinating. At the end, the author unexpectedly described his own recovery. Anyone wanting to read more about the 1960’s and 70’s drug culture should read this book.

“The End of My Addiction,” by Dr. Oliver Amiesen

            I only got this book because a few patients mentioned it. I pre-judged this book, thinking the author must be a pompous doctor, hater of Alcoholics Anonymous, who wrote a lame book on a half-baked theory about addiction treatment, just for his self-glorification. I was completely wrong. The author writes about his own addiction with self-awareness and humility. He doesn’t claim to have all the answers, but presents a credible treatment that may benefit alcoholics. He started himself on high-dose baclofen, a muscle relaxant that’s been around for years. It quenched his thirst for alcohol. He presents a good enough argument to justify a large randomized controlled trial to test the theory that high-dose baclofen suppresses alcohol cravings. The book is well-written and interesting. Dr. Amiesen describes his own travails with addiction in some detail.

Books for Addiction Counselors and other interested parties:

Here’s my list of favorite addiction-related books. Some are more traditional textbooks, and some were written more for entertainment, but all of these have helped me understand addiction and its treatment better. I highly recommend them all.

Principles of Addiction Medicine, ed. by Ries et. al.,  for the American Society of Addiction Medicine

            It’s expensive, but worth it. It contains comprehensive information about the whole field. If you’re going to work in this field for any length of time, you should buy it. And read it. It’s a mighty tome, and big enough to cause hernias if you lift it the wrong way, at 1408 pages. Get the 2009 4th edition.

Substance Abuse : A Comprehensive Textbook, by Lowinson et. al.

 Published by the American Psychiatric Association, it gives information about addiction from the psychiatrist’s perspective. More heavy lifting, at 1200 pages. This book may function better as a reference. Obviously, the information covered overlaps with information in Principles of Addiction Medicine. (But the latter is the better book, in my opinion) There’s also a distillation of information contained in a paperback version: Substance Abuse Handbook, by Ruiz, which is half the size at 500+ pages.

Addiction Treatment: Science and Policy for the Twenty-first Century, edited by Henningfield et.al.

            This is a small book packed with up-to-date information. If you don’t have much time to read (and I pity you) then this is one of the best books to stay informed. The book is divided into small chapters, written by different people who are experts on the given topic. It even gives space to minority opinions, like the chapter written by Stanton Peele. Once again, he describes in detail how apples are different than oranges. Yeah, I know, doesn’t seem worth discussing to me either. But that’s a short chapter.

High Society: How Substance Abuse Ravages American and What to Do About It, by Joseph Califano

            This book is packed with information and well-written enough to hold anyone’s attention. The book does a great job of describing the current U.S. situation with drug abuse and addiction. Critics of the book may say the book overstates the severity of addiction in the U.S., but sadly, I don’t it does. He cites extensive references, so go check them out yourself if you doubt what you read.

Rethinking Substance Abuse: What the Science Shows, and What We Should Do about It, edited by William Miller and Kathleen Carroll

            This book gives the latest update on which treatments are evidence-based, and discusses why these treatments aren’t being used to their fullest.  In this country, there is a gap between what we know to be the best kinds of treatments for addiction, and the treatments that are actually delivered. If you read this book, you’ll be better able to recognize which treatments we should be using. Some might find this book a little dry. The sections are written by people who know what they’re talking about.           

Addiction and Grace, by Gerald May

            This is still my all-time favorite. A small book, it talks about the nature of addiction, and the spiritual aspects of addiction and recovery. It describes the behaviors addictions can cause. It points out how all of us have addictions to varying degrees, which the author calls attachments. These attachments may not be to drugs, but they can be to activities, people, or behaviors.

Motivational Interviewing, by William Miller

            This book, along with Stages of Change by Prochaska and DiClemente describe the nuts & bolts of the motivational interviewing techniques. It goes into great detail about how MI is done, and points out the underlying reasons why this method works. Many people think they already “do” motivational interviewing, and they may – but reading this book will help you do it better. This method really works well with chronically angry clients.

Women Under the Influence, by the National Center on Addiction and Substance Abuse (CASA)

            Probably the most extensively researched and annotated book describing addiction in women. Not only is the book itself interesting and educational, it has dozens of useful references. Be sure and check out CASA’s other books, most of which can be downloaded for free from their website: “You’ve Got Drugs,” about controlled substances access via the internet, “Shoveling Up,” about the cost of addiction to society, and “Under the rug” about how addiction is under diagnosed in some groups.

 I could go on and on, but this is a start….

Oh. Of course. I need to mention my all-time, number one favorite book of all time: Pain Pill Addiction: A Prescription for Hope, by me. It’s at the publisher’s now, and I am hoping it will be out by early September.

Bibliotherapy

I love books. I love to huff that magical smell of a library, or a bookstore. (Bibliophiles can detect the slight differences in the aroma of these two.) I love to stick my nose into a book, and draw a quick sniff. I do this furtively, looking around to make sure no one is watching me, sensing how ridiculous I would look to anyone except another book huffer. Thankfully, my sister also huffs books, so we often go together to the bookstore.

I read all types of books, but some of my favorites have described some aspect of addiction or recovery. My bookshelves sag from the weight of these books, but some are so good I have to keep them. Frequently I’ll prescribe this book or that to help a patient. I give recommendations for books to friends even when they don’t ask. Many of these books have never made it to the best seller list. Many are hard to find.

Here’s a partial list of my favorite addiction memoirs:

“Junky,” by William Burroughs, reminds me addiction is nothing new. This classic addiction memoir of an intravenous opiate addiction is graphic, and may trigger people in early recovery. The author tells about his life, day to day. He shows the despair and hopelessness of active addiction. Though written in the 1950’s, he describes the same old actions and feelings as addicts have now.

“Leaving Dirty Jersey” by James Salant. This memoir tells how the author’s life went downhill while using methamphetamine. He does a great job of describing the daily struggles for drugs, food, and shelter, usually obtained in this order. It’s interesting to read what social niceties remained important to addicts, and to watch even those fall away as addiction progresses.

“Dry,” by Augusten Burroughs. I love this author. Once I listened to another of his books, “Side Effects,” on CD while I was driving. At one point, I had to pull off the road because I was laughing to hard. “Dry” isn’t that kind of hilarious book, but still funny in some places, and touching in many places. I found myself really wanting the author to be successful in recovery.

“Rolling Away,” by Lyn Marie Smith gave me an intimate feel for what it’s like to use and fall in love with the drug Ecstasy. Honestly, it kind of made me want to use Ecstasy, so this book could trigger people in early recovery. But then the author conducts the reader through the hell of active addiction, with all its poor decisions, shame, and rupture of important relationships.

“A Million Little Pieces,” Oh, seriously. I only read a few of the first page, then laid it down. I knew he was lying. Prominent inpatient treatment centers don’t do dental surgery without anesthesia. There’s no reason to do so, because Novocain and similar anesthetics aren’t addictive, and don’t give cocaine-type feelings. Duh. This one I don’t recommend, but listed it because I wanted to vent about it.

“Beautiful Boy,” by David Sheffield was a wonderful description of the pain of a loving father, heart broken by his son’s methamphetamine addiction. Beautifully written, it reminds me it isn’t only the addict who suffers. I haven’t yet read the book by the son, Nic Sheffield, “Tweaker,” but I plan to.

“Drinking: A Love Story,” by Caroline Knapp. Get it and read it, particularly if you are a female alcoholic, in or out of recovery. She describes alcohol addiction and despair, and then her recovery. Sadly, this wonderful author died of cancer a few years after this book was written.

“Lit,” by Mary Karr. This is a recent book and a bestseller. For a change, it’s a bestseller that I really enjoyed. She gives a lyric description of how addiction creeps into a life slowly, like a mist, gradually obscuring common sense and healthy living. She also described how recovery helped her handle life events that happened later in life.

“Addiction By Prescription,” by Joan Gatsby. She explains the hell of her benzodiazepine addiction. She conveys her emotional states well, and the writing was interesting. But it was hard for me to read the sections where she seemed to shirk responsibility for her addiction. She mixed benzodiazepines with alcohol, with the predictably bad results. She seems to blame the doctor for this. Didn’t her pill bottle have that little label that says, “Do Not Take With Alcohol?”

“Happy Hours,” by Devon Jersild. This isn’t so much a memoir as a collection of the experiences of many female alcoholics. It’s entertaining, and also a great book for addiction professionals to read. The gamut of emotions of female addicts is portrayed well.

“More, Now, Again,” by Elizabeth Wurtzel. I was spellbound by this book; I couldn’t put it down. She gives such an interesting description of the personal details of methamphetamine addiction. Don’t miss her other book, “Prozac Nation.”

I’m a big believer in bibliotherapy, meaning using books as therapy. The written word has as much power to heal as the spoken word. It’s not just non-fiction that teaches. Some of the most important lessons are taught in stories. Remember the “Velveteen Rabbit?”

Next time, I’ll list books for addiction professionals to read.

Meanwhile, let me know your favorite addiction memoirs.