Substance Use Problems, a Volume in Advances in Psychotherapy: Evidence Based Practice Series (Second Edition)

Substance use problems have a great impact on health, social function, employment, and economic outcomes. We are aware of the growing heterogeneity and complexity of the problem, as well as the size and importance of the health burden created by substance use. Variations in the treatment of substance misuse are very common. This variation itself is not a problem because different clients have different needs. Nonetheless, variation in the quality of care can become a problem if it is due to a lack of knowledge. We need up-to-date information to deal with the problem of substance abuse. This book aims to achieve this.

The book is concise and easy to read. Health care workers and medical professionals from diverse backgrounds may regard this book as a useful guide. Instead of dictating treatment options, it provides evidence that guides assessment and treatment for people with substance use problems. This book is based on a review of the evidence for the effectiveness of treatments, and on the clinical and research experience of the author. The author is a professor of clinical psychology, and provides a good explanation of various psychosocial techniques that may assist people who are at risk of substance abuse or who exhibit a dependence on substances. Some of them are relatively new concepts and may not be widely practised in some parts of the world. In clinical practice, we know that many factors may impact upon the effectiveness of treatment, for example, availability of resources, patient co-morbid disorders, and clinical skills of the health care professionals. Nevertheless this very useful book teaches the reader about the general and basic principles of various treatment methods for substance use problems. For example, there is a very good description of motivational interview, harm reduction, and relapse prevention concepts. It is especially important because the effectiveness of most non-pharmacological treatment interventions relies greatly on factors associated with the reality of health care delivery. The interventions cannot be effective unless they are delivered by committed health care workers with sound knowledge and experience of substance use problems.

This book is not a complete guide though. It lacks detailed discussion about the biological basis of addiction and pharmacological treatment. The author has not discussed at length the debate of residential versus non- residential rehabilitation. In clinical practice, we are often uncertain about which components of residential rehabilitation treatment work best, and in what situations residential treatment should be recommended.

We know that some substance users change without formal help or intervention. A complete account of substance use involves general societal factors such as the availability of substances, societal pressure to use or not use; as well as personal factors such as peer influence, familial and parental factors, life events, and genetic predisposition. There are various influences outside the formal treatment system that affect substance use, and formal treatment benefits only a proportion of substance users in society. There remains a need for a formal evidence-based approach to treatment. The author refers the reader to reference materials and existing guidelines for more detail about the use of particular treatment interventions. Meanwhile, the author has integrated, with acknowledgement, existing recommendations into his own.

Tin-po Chiang, MBBS, MRCPsych, FHKCPsych, FHKAM (Psychiatry)

(email: ctp571@ha.org.hk)

Castle Peak Hospital Hong Kong SAR China

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