Archive for the ‘Books About Addiction’ Category

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.

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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

Bibliotherapy: Good Books for Recovering People

Recovering people need different things at different times in their recovery. For the first year or two, efforts are directed toward learning to stay clean, and clearing the wreckage from the past. Most recovering people must spend a great deal of time, energy, and attention on these tasks during the first year or two of recovery.

 

After mastering these essential tasks, recovering people often ask, “What’s next?”  They can experience what I call a mid-recovery-life crisis. Some people go through it after a few years, and some after ten or more. It’s sometimes described as a yearning for something deeper. For some, it means work on relationships – with other people, with one’s Higher Power, and with one’s self. For others, it means finding renewed meaning and purpose in life.  Many people find answers to their mid- recovery-life questions in the twelve steps, of course, but outside sources can also aid in this phase of recovery.

 

Books containing the wisdom and experience of other people can be a tremendous help. Here are a few titles that have helped recovering people on their journey of recovery:.

 

The Mindful Addict, by Tom Catton

This is a tale of one man’s spiritual journey in recovery. The author describes his addicted life in the first fourth of his book, then moves on to tell of his eclectic approach to spirituality. He embraced Buddhism, mindfulness, and meditation. The author elaborates on spiritual principles he’s found to be keys in his recovery. Toward the end of the book he explains how his spirituality helped him face some serious medical conditions. He talks about the importance of being wide-awake to life, and about the importance of showing up, serving others, and of radical acceptance. This is a book to read and re-read.

 

Mindful Recovery, by Tom Bien and Beverly Bien

This book discusses mindfulness and its relation to spirituality. It contains options for people, even in early recovery, who object to concept of a Higher Power. Mindfulness can be used to help heal addictions and other ailments, such as anxiety or other strong negative emotions. The book not only describes spiritual practices of awareness and enjoying the present moment, but also gives practical exercises to help. Short stories, scattered throughout the book, serve as examples for how these techniques can be applied. The authors explain how journaling, meditation, and storytelling can help recovery. This book contains tools for change, and may be a place to start with patients who object to the phrase “Higher Power,” but who are still open to a spiritual approach to recovery.

 

The Spirituality of Imperfection: Storytelling and the Search for Meaning, by Earnest Kurtz and Katherine Ketcham

This book promotes the idea that spirituality is attained by admitting and accepting our imperfections. The book also says our imperfections make for some really great storytelling, and our stories contain great truths. This book and the ideas in it are compatible with AA and 12-step recovery. Parts are interesting and inspiring, but it’s not a quick and easy read. Sometimes the book felt scattered, but after all, it is an imperfect book. I highly recommend this book to people with perfectionistic tendencies.

Sermon on the Mount: The Key to Success in Life, by Emmet Fox

This book, written sixty-five years ago or so, is still mentioned in AA meetings as a source for spiritual ideas. When I first read this book many years ago, I was intrigued by the idea that positive thoughts bring positive effects. I think there’s a certain amount of truth to this, but now I have difficulty with the book’s vending machine concept of God. The author states that we can control the events in our world by having positive thoughts, and that God will give us our hearts’ desires. I don’t think it’s that simple, and it fails to acknowledge our lack of control over many things. This book has no explanations of why bad things happen to good people.

 

Simply Sane: The Spirituality of Mental Health, by Gerald May

This wonderful book, written about twenty years ago, is thin at just 180 pages, but packed with interesting ideas. The book emphasizes the importance of being tolerant and patient not just with other people, but also with ourselves. We don’t have to try so hard. We don’t have to endure the stress of “having it all.” This book is the same author who wrote Addiction and Grace, another book worthy of reading and re-reading.

 

A Hunger for Healing: The Twelve Steps as a Classic Model for Christian Spiritual Growth, by Keith Miller

Warning: this is a book written by a Christian for other Christians. And it’s relatively old, published originally in 1992. The author discusses how Alcoholics Anonymous’ 12-steps can be used as a pattern for spiritual growth for anyone, not necessarily only for people with alcohol addiction. Unfortunately, too many people in churches think they dare not be completely honest about how broken and needy they are. Some church people believe that after salvation, Christians shouldn’t struggle with addiction. But it’s that façade of self-sufficiency that cuts off the healing available from other people. It takes humility to admit we need the help of other people. Many people would prefer God heal them privately, and leave other people out of the process.

 

You Can’t Make Me Angry, by Paul O.

This author is the guy whose story is in the Big Book of Alcoholics Anonymous, and contains that oft-quoted bit about “acceptance is the answer to all my problems.” This book elaborates on that idea. When I first picked it up, I thought, “How silly. Of course people can make other people angry,” but by the end I agreed with Dr. Paul: an emotionally mature person doesn’t have to let other people make her angry. This book is all about growing up emotionally, and taking responsibility for our own emotions and reactions. This is a book to keep, read and re-read. It’s written in a light-hearted manner, with nice vignettes for examples, so it’s enjoyable, not heavy. Also read his other book, “There’s More to Quitting Drinking than Quitting Drinking.”

 

Of Course You’re Angry: A Guide to Dealing with the Emotions of Substance Abuse, by Rosellini and Worden

This Hazelden book is kind of a counterpoint to the above book, and also is excellent. This book explains why addicts need to acknowledge angry feelings rather than suppressing them. When we suppress and deny feelings, they often come out sideways, and cause problems. The book explains that we can chose how and when to express angry feelings, instead of acting out anger in ways we later regret. I highly recommend this book for all recovering addicts, their families, and all other members of the human race.

 

Stage II Recovery: Life Beyond Addiction, by Ernie Larsen

More than any other book, this book is excellent for people in recovery who start asking “What’s next?” The author puts special emphasis on restoring relationships. He also discusses some of the more common ruts people can fall into during recovery. See also: Stage II Relationships: Love Beyond Addiction by this same author.

 

Lit by Mary Karr

This autobiography tells of the author’s struggle with both addiction and recovery. Full of zinging metaphors, the book elegantly tells an addict’s story. I particularly like how her book didn’t end at getting clean, but continued to describe her peaks and valleys in recovery.

Have you found books that helped you find meaning and purpose in your recovery and your life? Please write a comment to tell us about them.

A Bit of History

             In the 1980’s, President Ronald Reagan helped guide the thinking of the nation, and emphasized law enforcement as the solution to the war on drugs. The War on Drugs was born. Spending increased for police and other enforcement agencies, but decreased for addiction research and addiction treatment. When crack cocaine captured the attention of America in the mid-1980’s, it re-ignited old fears.

            As in times past, what people thought of drug addicts depended in part on who was addicted. There was much rhetoric about the nature of crime committed by minorities, addicted to drugs, and of crack babies, based more on media exaggeration than on science. As a result, the drug laws were again re-written.

          During the Reagan years, laws were passed that were quite similar to the draconian Boggs Act of the 1950’s. The death penalty was even re-introduced for drug dealers, under certain circumstances. Laws mandating sentences for simple possession were resurrected, and in general, drug laws were set back to the way they were thirty years prior.

            Parents of the 1980s observed with alarm the rise in cocaine abuse, with its hazards and easy availability. They leapt into action, by forming the Parent’s Movement.  They were a powerful political voice that helped coerce lawmakers into passing tougher drug laws. The American public had once again demanded more punitive drug laws.

             Laws passed against the possession of crack were different from those for powder cocaine. The penalty for five grams of crack was the same as the penalty for five hundred grams of powder cocaine. African Americans, of lower socioeconomic status, tended to use crack because it was cheaper than powder cocaine. Therefore, African Americans were more likely than whites to receive a mandatory sentence for drug possession, because it took so little crack, a hundred-fold less, to carry the same sentence. (1)

             State and federal laws differed considerably, because federal convictions could not, by new law, be shortened by more than fifteen percent. This meant that being convicted in federal court lead to longer sentences than being convicted in state courts. District attorneys had the power to decide in which jurisdiction to try an offender, and this gave them considerable influence over the fates of arrestees. Predictably, prisons filled around the country, and prison censuses doubled, at both state and federal levels. (1)

             Shortly before the first of the George Bushes took office in 1989, the 1988 Anti-Drug Abuse Act was passed, which re-organized the bureaucracies assigned to overseeing the drug addiction problems of the nation. Under this Act, the Office of National Drug Control Policy (ONDCP) was formed, and William Bennett was designated drug czar. This agency was given the task of monitoring all of the anti-drug programs in government agencies. The forerunner to the Center for Substance Abuse Prevention (CSAP) was formed in the Substance Abuse and Mental Health Services Administration (SAMHSA). There was much fanfare about new policies, which would both emphasize a zero tolerance toward drug use and also give more attention to treating addiction. However, Bennett resigned abruptly and the fanfare fizzled.

              When Clinton took office in 1993, he cut funding for the ONDCP by eighty-three percent, and exhibited a general lack of interest in addiction and its treatment. His Surgeon General, Jocelyn Elders, angered many when she appeared to advocate legalization of drugs. (2) Probably in response to public pressures, and concerns about the rising rate of marijuana use among adolescents, Clinton publically announced a new attack on drugs, just before the next election year, and nominated Barry McCaffery to head the revived ONDCP.

              Throughout the 1990’s, heroin purity on the U.S. streets was gradually increasing. In 1991, heroin was about twenty-seven percent pure, while by 1994, it had risen to forty percent. That was a dramatic increase in purity, compared to 1970’s and 1980s, when an average purity of three to ten percent was found in U.S. cities. Many potential addicts, scared off cocaine by high profile deaths of people like Len Bias and John Belushi, turned to experimentation with heroin. (1). Columbian drug cartels, diversifying from dealing only with cocaine, began selling heroin to meet an increasing demand by the U.S. Because heroin was so pure, it could be snorted, rather than injected, and many people who balked at injecting a drug would snort it, and did. By 1997, heroin accounted for more treatment center admissions than did cocaine. (2). “Heroin chic”, a trend of thin and ill-looking models as the ideal of beauty, came into vogue in the mid-1990s.

             At that same time, in the mid-1990s, several more ingredients besides higher potency heroin were thrown into the simmering caldron of opioid addiction: the pain management movement and access to controlled substances over the internet. Then, with the release and deceptive marketing of OxyContin, the cauldron began to boil. 

1. David Musto, The American Disease: Origins of Narcotic Control, 3rd ed., (New York: Oxford University Press, 1999) p 274.

2. David T. Courtwright, Dark Paradise: A History of Opiate Addiction in American, (Cambridge, Massachusetts, Harvard University Press, 2001) pp180-181.

excerpt from “Pain Pill Addiction: Prescription for Hope”

Great Book About Opioid Addiction!!!

I orginally started this blog to promote the book I wrote about pain pill addiction. As it’s turned out, the blog has been much more popular than the book (it isn’t exactly flying off the shelves), so I’d like to remind blog readers – again – that if you like the blog, you’ll love my book.

You can order it from Barnes & Noble, or Amazon. But I’m selling it for a much-discounted rate of $13.95 on EBay. That’s with shipping included.

http://shop.ebay.com/i.html_from=R40&_trksid=p5197.m570.l1313&_nkw=pain+pill+addiction&_sacat=See-All-Categories

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.