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Book Reviews

Book ReviewsBook Reviews

Book Reviews

Compiled by Susan Savva and Griffith Edwards

ALCOHOLISM IN AMERICA: FROM RECONSTRUCTION TO PROHIBITION

SARAH W. TRACYBaltimore, Johns Hopkins University Press, 2005, 384pp, US$48.00, ISBN 0801881196

Over the past several years, the Johns Hopkins UniversityPress has published a series of groundbreaking books onthe history of drugs and alcohol in America. Theseinclude

Domesticating Drink

, by Catherine Murdock,

TheRise and Fall of Synanon

, by Rod Janzen and

Manhood Lost

,by Elaine Parsons. The latest in the series is Sarah Tracy’s

Alcoholism in America

. It is based on her doctoral thesis,and at times the rough edges show.

This is a minor failing in what is otherwise a fine pieceof scholarship.

Alcoholism in America

tells the story of alargely forgotten treatment industry: the inebriate asy-lums that sprang up during the Progressive era. Theywere started in 1870, when a small group of men formedthe American Association for the Cure of Inebriates. Theyset themselves a seemingly impossible task: to convincethe public that intemperance was a disease and should betreated as such. Towards that end they lobbied for the cre-ation of inebriate asylums. Six years later, in 1876, theAmerican Medical Association endorsed the concept, see-ing in it an opportunity to expand the profession’sauthority. In 1920, with the coming of national Prohibi-tion, the asylums were abandoned, and with them thelessons that they might teach.

Their history is of obvious interest to anyone in themodern treatment industry. However, the book hasequally interesting things to say about the disease conceptof alcoholism—about the doctors who promoted it andthe lay groups who resisted it. This part of the book com-plements well Mariana Valverde’s

Diseases of the Will

.Tracy approaches the problem from the historian’s per-spective, which is to say that it places the sources first andtheory second. The debates Tracy documents have an eer-ily modern ring. In 1876, for example, the AmericanMedical Association tried to have it both ways, definingintemperance ‘as both a vice and a disease’.

Plus ça change

.Tracy gives her book an added dimension by docu-

menting what the patients themselves thought abouttheir condition and treatment. This is by far the book’s live-liest chapter. The case studies, based primarily on the let-ters patients wrote after their release, make for fascinatingreading. They reveal not only the extent to which patientsinternalized the disease concept of alcoholism, but also the

ways in which they helped each other, forming whatwould today be called support groups. Some of theiraccounts are profoundly moving, as in this letter from apatient to his doctor. It was written in 1915: ‘When Isometimes look back at the misery and suffering I enduredall through that “fatal cup” it spurs me on. No one knowsbetter than you do, Dr, how hard it is for a fellow to over-come that terrible thirst which had me in its grip.’

JESSICA WARNER

Centre for Addiction and Mental Health, Toronto, Canada

INJECTING DRUG USE

RICHARD PATES, ANDREW MCBRIDE & KARINARNOLD, edsOxford, UK, Blackwell Publishing, Addiction Press, 2005,182 pp. £35.00, ISBN 14051 1360 X

Of the estimated 400 million people who use illicit psy-choactive drugs in the world [1] only a modest number—estimated at 13 million [2]—do so through injection.However, the practice of injecting drugs, with its greaterpotential for addiction, overdose, spread of blood-bornepathogens and multiple other health problems clearlymakes injecting the most socially problematic route ofdrug administration. The Pates, McBride & Arnold book[3] is certainly the most detailed examination of the prac-tice of injecting. Among the 11 chapters, there are specialchapters by Pates & Wichter on the history of injection,Grund on the ethnographic study of injecting, Scott onthe pharmaceutical aspects of injecting, Orietti & Gregoryon women injectors, Shewan, Stover & Dolan on injectingin prison and Southwell on transitions to and from inject-ing. Approximately a third of the book is devoted toadverse consequences of injecting, with chapters byHeimer on HIV/AIDS, Crofts on hepatitis C, Peterson &Best on overdose and McBride & Wichter on other healthconsequences (termed ‘Odde Commontions’ by the RoyalSociety in 1665). The individual chapters are almost allvery informative and well written. The chapters are, how-ever, relatively short (the entire book is less than 200pages). The book is not a standard medical text with 100chapters and thousands of pages.

The book is written from a harm reduction perspec-tive. The chapters on the various harms often providevery detailed information on how the harms might bereduced. There are also chapters by Williams & Norman

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on safer injecting and Haemming & van Beek on operat-ing supervised injection facilities.

There is one critical issue in harm reduction that thebook illustrates repeatedly but does not address explicitly.This might be called the ‘lack of empathy’ and the ‘grue-some’ factors. The stigmatization of injecting drug use is afundamental problem in adopting harm reduction poli-cies throughout the world. This stigmatization is deter-mined by many factors, including social class, economicfactors, racial and cultural factors and internationalpower relationships. There also seems to be a strong neg-ative emotional reaction by most of the general popula-tion to many of the specific aspects in drug injecting,including the pain of inserting a needle, the sight of bloodand the likelihood of injecting various microbes and othercontaminants into one’s body. Many of the chapters,including those on the history of injecting, the ethnogra-phy of eastern European injecting, the pharmaceuticalaspects of injecting and needle fixation, provide graphicillustrations of activities that will probably appear to beinherently repulsive to most people. It may be necessaryto find ways in which ‘ordinary people’ can go beyond thisinitial negative reaction before they can develop empathywith injecting drug users and support harm reductionpolicies fully.

This may be similar to what gay rights activists havecalled the ‘ick factor’ in many heterosexuals’ response tothe thought of male-with-male sex [4]. The ‘ick factor’ isseen as a major impediment to approval of same-sex mar-riage. There is also a similar ‘repugnance’ or ‘yuck factor’used as an argument against

in vitro

fertilization andhuman cloning research [5].

The final chapter by Jimmy Dorabjee is a brief biogra-phy of his life as an injecting drug user. The story is bothhorrifying and inspirational. Words, metaphors andgraphic descriptions are certainly not adequate to conveyfully the highs and lows of prolonged addiction, butJimmy’s descriptions are eloquent. After many years ofcompulsive, self-destructive drug use, Jimmy changed hislife radically and has made critical contributions to harmreduction work in Asia. His transformation is attributedto finding a larger purpose in life and buprenorphinemedication.

No single book can summarize all we currently knowor all we need to learn about injecting drug use, but thisshort book provides an excellent overview.

DON C. DES JARLAIS

Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York City, NY, USA

References

1. UNAIDS (2005)

AIDS Epidemic Update 2005.

Geneva: WorldHealth Organization.

2. Aceijas, C., Stimson, G., Hickman, M. & Rhodes, T. (2004)Global overview of injecting drug use and HIV infectionamong injecting drug users.

AIDS

,

18

, 2295–2303.3. Pates, R., McBride, A. & Arnold, K. (2005)

Injecting IllicitDrugs

. Oxford: Blackwell Publishers.4. Nava, M. & Davidoff, R. (1994)

Created Equal: Why Gay RightsMatter

. New York: St Martin’s Press.5. Wilson, J. & Kass, L. (1998)

The Ethics of Human Cloning

.Washington, DC: AEI Press.

LICENSED PREMISES: LAW & PRACTICE

PHILIP KOLVIN, ed.Haywards Heath, West Sussex, Tottel Publishing, 2004,1461 pp, £70.00, ISBN 1845 92023 6

With the advent of the much-decried change in Britishlicensing laws at the end of 2005 comes this much-needed summary of the ‘Licensing Act 2003’, its impli-cations for alcohol outlet licensing reform in England andWales and a summary of strategies to support the devel-opment of ‘the night-time economy’ while maintainingpublic safety. This edited work, although doubtful sum-mer reading at the weight of 1.85 kg, is a ‘must read’ foranyone interested in local alcohol licensing policies andthe controversies attendant thereon. The chapters of thisbook reflect the legal and regulatory conflicts that sur-round licensing activities at the local level, snapping indi-vidual commercial and public interests into focus. It is avaluable read for anyone interested in the local regula-tory maelstrom in which the implications of nationalalcohol policies are played out. National regulatory poli-cies are put into effect in local communities, and it iswithin these communities that licensing and enforce-ment authorities attempt to ensure that these regulationsare followed. Local implementation can fail becausenational policies are written poorly or local licensing andenforcement authorities are supported poorly in theirefforts to protect public welfare. To observe the legal andregulatory processes by which one national policy grap-ples with these issues, there is no better educator thanthis text.

The ‘education’ provided, however, is of two kinds.Chapters of the work present solid summaries of the newlicensing framework (chapters 1–7), types of licenses andconditions for licensing (chapters 8–18), summaries ofseveral main policy issues (chapters 19–24 and 32), anddiscussions of issues in policing, noise abatement and reg-ulation of sex establishments (chapters 25–33). I recom-mend the summaries provided by Kolvin (chapters 21and 22) and Hadfield and colleagues (chapters 23 and24) for instructive reviews with regard to alcohol use.These chapters ostensibly review the science-base ofproblems related to alcohol outlets but they are conceivedvery narrowly, covering a narrow slice of problemsrelated to drinking at public establishments (primarily

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violence) to the exclusion of others (e.g. drinking anddriving). Room provides some redress for this oversightand offers an excellent, although all too brief, summaryof the international literature on alcohol control (chapter32).

The most important lessons that alcohol policyresearchers can glean from this work, however, are of adifferent kind. They are the lessons to be learnt from aromantic view of alcohol use that focuses on a misleadingresearch agenda and plays into the hands of commercialinterests and government agencies indifferent to publicwelfare.

The predominant tone of the book emphasizes thepleasures of alcohol use, and the despoiling of these plea-sures by the drinking of ‘punters’ and ‘angry young men’(chapter 19). John and Jane, the innocents brought ontothis stage, experience an unpleasant evening at the pub,are unlikely to come back and so represent a loss to the‘night-time economy’. To prevent this loss, pub ownersare encouraged to manage and monitor their establish-ments, police to enforce alcohol and public nuisancelaws and communities to provide opportunities for prob-lem drinkers to behave better (e.g. by providing trashbins). Regulators are encouraged to develop a 24/7night-time economy to reduce any negative conse-quences that ‘John and Jane’ might experience and tomaximize their opportunities to drink (extending late-night trading hours). In a pattern that mirrors the worstaspects of the consumer economy of the United Statesdrinkers are encouraged to drink more, and more often,but ‘use responsibly’.

Viewed from the perspective of contemporary alcoholresearch and prevention science this romance is ludi-crous. Harms related to drinking are not confined to‘punters’ and ‘angry young men’, but are spread broadlythroughout populations of drinkers. Moderate drinkersand moderate drinking also leads to many alcohol-related problems. Alcohol-related violence, a central fea-ture of many chapters, is not the only or the most impor-tant problem related to drinking at outlets. Drinking anddriving causes far more injury and death. There are noscience-based arguments that support any benefit due tolater trading hours. There is science-based evidence thatsuggests that later trading hours will lead to greaterharm.

Perhaps, if there is any romance to this story at all, it isa tragedy. The government of England and Wales, for-merly a leader in the development of alcohol policies toprotect the public good, is now defaulting on its respon-sibility to protect the public health. Citizens of Great Brit-ain are now witness to a change in licensing authorityfrom the Home Office, charged to ‘lead the government’salcohol harm reduction strategy for England’, to theDepartment for Culture, Media and Sport. Unless drink-

ing is to become a regulated sport in England, this makeslittle sense.

PAUL J. GRUENEWALD

Prevention Research Center, Berkeley, CA, USA

ETHICAL EYE: DRUG ADDICTION

COUNCIL OF EUROPEEuro Strasbourg, Council of Europe Publishing, 2005,173 pp,

€

15, ISBN 92 871 5638 7

There is renewed interest in the ethical issues raised bythe phenomenon of addiction and the way in which werespond to those affected by addiction. The recent interestin Europe reflects large increases in illicit drug use amongyoung people in many countries during the 1990s,unwelcome consequences of EU policies, the removal ofborder controls and the internationalization of youth cul-ture and drug use.

This book provides an interesting European perspec-tive on ethical issues, which has a stronger human rightsfocus than has often been true of recent North Americancontributions on the topic. It comprises a series of paperson a variety of topics written by European authors whobring different disciplinary (e.g. education, addictiontreatment, ethics, social science, law, etc.) and nationalperspectives (British, French, Italian, Portuguese, Rus-sian and Swedish) to the analysis of familiar ethical quan-daries that arise in various guises in the addiction field,namely, data confidentiality in treatment, drug preven-tion programmes, compulsory treatment of addicts, drugtesting in the work-place, access to treatment by adoles-cent substance users and the care of pregnant womenand mothers using drugs.

The chapters on compulsory treatment of addictionare particular interest, given that two have been writ-ten by authors from countries with a long history ofcoerced treatment of addiction: Russia and Sweden.Both authors reveal some disillusionment with both theethicality and efficacy of the coerced form of addictiontreatment practised in their countries. The Portuguesecontributor makes an important distinction betweenthe ethical concerns raised by compulsory treatmentagainst being offered a constrained choice of treatmentas an alternative to imprisonment, suggesting that thelatter form of coercion may be more justifiable than theformer.

What is missing from the collection? One interestingomission is a discussion of the ethics of opioid substitu-tion treatment, a form of treatment that is supportedwidely and ambivalently in many countries in Europe.The topic is broached in several chapters, but perhapsdeserves a chapter of its own, especially as the ethicalityof heroin maintenance has been questioned by some

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North American ethicists. Also missing is any discussionof the social policy and ethical implications of neurobio-logical research on addiction and the interventions thatmay arise from this research, e.g. drug vaccines, depotformulations of antagonist drugs and neurosurgery.

However, these are quibbles. This book is a welcomestart in what I hope will be a more detailed and sustaineddialogue about the different ways in which different Euro-

pean ethical and cultural traditions influence the waythat we respond to the societal challenges in preventingand treating addictive disorders while respecting basichuman rights.

WAYNE HALL

Professor of Public Health Policy, School of Population Health, University of Queensland, Herston, Queensland, Australia