Alcohol y alcoholismo

Book Reviews

1375

tively sparse scientific literature available, and Usts eight theoretical mechanisms for the interaction of mental illness and addiction. Although they show some doubts about the combination of atixiety disorder and addiction, the authors rather uncritically accept the "self-medication" hypothesis for the genesis of addictive disorders. This failure to present much of theevidence against the self-medication hypothesis is one of the few occasions when the authors fail to present both sides of a controversial topic even-handedly. A fascinating chapter entitled "Kava, khat, betel nut and marijuana" describes these substances which, except for marijuana, rarely come to the attention of American clinicians. In addition to the obvious importance of understanding thesesubstances if one does see such a patient, the discussions ofthe physical effects and cultural issues associated with each drug are fascinating in themselves. The chapter on opiates includes epidemiological data and a description of treatment including a thoughtful section on methadone maintenance. The section on opiate detoxification, however, fails to mention the use of "ultra rapid opiatedetoxification",' in which the patient is placed briefly under general anesthesia, and treated with a narcotic antagotiist to induce a swift detoxification. This procedure, while controversial in the field, is becoming more common in the United States and deserves explication in a volume such as this one. The supposed financial benefits of such a rapid detoxification are one of the main forcespropelling this procedure to the fore. In fact, this volume generally avoids discussions of economics and managed care issues. Further elucidation of these topics would have been interesting, especially in relation to new treatments and newer drugs of abuse. Overall, however, this book presents a clearly written summary of the state of knowledge on drugs of abuse world-wide. It should prove interesting forboth clinicians and researchers.

Alcohol y Alcoholismo SAUL PACURUCU CASTILLO Cuenca, Ecuador, Facultad de Ciencias Medicas de la Universidad de Cuenca, 1996 147 pp., no price given

This book is a summarized description of diagnoses and treatment aspects of alcohol dependence and its related disorders. It is organized into very short chapters, it is easy to read and contains up-to-datereferences. The author makes a consideration of the historical backgrotmds of alcohol use, its pharmacology, the organic and psychiatric problems induced by alcoholic beverages, and the different treatment strategies. Finally, the book includes some comments about prevention and education, together with a list of the treatment centres existing in Ecuador. The first chapters deal with the more generalaspects of alcohol, i.e. the different types of alcoholic beverages and the pharmacokinetic properties of alcohol, including some formulas to calculate blood alcohol levels. So far, socio-cultural, psychological and biological factors have been included as hypotheses in the aetiology of alcoholism. Previous attempts to classify alcohol dependence as the Jellinek, Cloninger and BaborClassifications are discussed. Special attention is given to diagnosis using medical signs and symptoms, biological markers or screening tests, such as AUDIT, CRA or MALT. The author also includes the DSM-IV diagnostic criteria of the alcohol-related disorders: alcohol use disorders such as alcohol dependence and alcohol abuse, and all the alcohol-induced disorders: intoxication, withdrawal, intoxicationdelirium, withdrawal delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction and sleep disorder. Additionally, in some cases there is a brief description of the pharmacological treatment. Some clinical consequences of alcohol use are also considered, such as alcoholic fetal syndrome, neurological disorders, high blood...