Book Reviews

Social Work in Mental Health: Trends and Issues. Uri Aviram, ed. Binghamton, NY: Ha- worth Press, 1997, 134 pages.

Social Work in Mental Health: Trends and Issues, edited by Uri Aviram, is a collection of articles previously presented at the First International Conference on Social Work in Health and Mental Health held at Hebrew University in Jerusalem in 1995 and later published in journal form for Social Work in Health Care. It will have special interest for social workers in health care and community settings. The authors, who are both academics and practitioners, share their research and strategies to help recover and empower clients with chronic mental illness and families in the context of decreas- ing resources and managed care. A major strength of the book is in the authors' commitment to qual- ity social work practice with persons with chronic mental illness within a climate that has elevated cost containment and substandard care almost to a religion.

The book opens with an informative overview, ',Social Work in Mental Health: Trends and Issues in Social Work in Health Care Settings," written by Uri Aviram. Although each of these chapters has value, some chapters are especially worthwhile. Patricia Deever, for example, relates her own com- pelling story of her personal experience with mental illness. She gives mental illness a face to both new and practicing social workers; her chapter should be required reading for any student entering the field of mental health. The chapters on "Community Care and the Origin of Psychiatric Social Work" by Paul Stuart and "Working Collaboratively with Families" by Agnes Hatfield are notewor- thy and interesting. Other informative chapters focus on strategies for "Helping Young Adults with Serious Mental Disorders," "Social Networks and Psychological Disabilities among Housed and Homeless Users of Self-Help Agencies" "Discharge Planning and Community Housing in Ontario" "The Ethics of Informed Consent," and "Revamping Mental Health Policy in Israel" The social work values that make up the profession's knowledge base and that are present in many of these chapters hopefully will never go out of style, regardless of the economic times in which we live. Among these are respect for persons with chronic mental illness, a belief in the self-help and empow- erment of clients and families, the need for an integrated and less stigmatizing mental health system, and the emphasis on an ecological grounding for both practice and policy interventions. A major fo- cus of the book by its editor and contributors is in the interplay of health and mental health, a notable goal that is, for the most part, achieved. Varying populations described in this book are the homeless, vulnerable adults, families, and substance abusers, and both practice and policy recommendations are offered.

There are only two concerns. Although no book can be all things to its readers, it would have been strengthened with attention to other compelling populations in need--the frail aged, especially those suffering from dementia, and AIDS patients--and more attention to ethnic and gender diversities of clients. Second, as with many edited books, especially one that was originally a journal, the tone is inconsistent, and there is an unevenness in writing style. The chapters, well written and informative, vary in form. Some are self-reflective, some descriptive, some empirical, and some conceptual. Nonetheless, Social Work in Mental Health is an informative resource for social workers in mental health and health care and will be a welcome addition to their personal libraries. It also will be of in- terest to others, especially mental health administrators, psychologists, and policy makers. Students in social work, public health, and psychology also might find this book to be good supplemental reading.

Colette Browne, Dr.P.H. Associate Professor

School of Social Work University of Hawaii

470 The Journal of Behavioral Health Services & Research 25:4 November 1998

Achievement and Addiction: A Guide to the Treatment of Professionals. By Edgar P. Naee. New York: Brunner/Mazel, 1995, 264 pages.

As a mental health professional who has had the misfortune to work with several addicted and im- paired peers during a relatively short career, I welcomed this book with eagerness. From the fore- word, it was apparent that Nace approaches this important and delicate subject with kindness, under- standing, and sincerity, a combination that can be very helpful in interventions with persons with chemical dependency. He apprehends the paradox of highly trained, intelligent professionals re- duced to struggling at the common, low level of existence by the universally condemning disease of substance dependence, and he admits freely that his is knowledge gained through listening and at- tending to patients rather than from the wisdoms of having lived through addiction in his own life.

Nace initially posits that professionals as addict-patients bring advantages of education, disci- pline, insight, and inner resources to treatment. I might argue that, in fact, the very personality strengths that made those same people effective in and satisfied with their work (independence, thor- oughness, responsibility, capacity for social reward) also can render them more denying and resis- tive than some other folks. Moreover, I might point out that, albeit well intended, his description of professional helpers as wanting to assist "their fellow humans" (p. 3) is sexist and limiting.

Written in clear, straightforward language, with accessible terms and constructs, the 14 chapters progress from philosophy to when/how specifics. I particularly appreciated the discussion in chapter 2 of the benefits of using drugs as related to their uses in strengthening defenses and offering repair of psychic injuries.

Although I am a staunch believer in ultimate physiological commonalities across all substances of abuse, as well as in the crucial contribution of psychic dependence, I do take issue with Nace's contentions that (1) all drugs can be addressed together in terms of comprehending their specific and individual effects on the human body and on human life, (2) a primary function of drugs is to provide social adaptation and/or enhancement, and (3) addiction and chemical dependency and substance abuse represent comparable phenomena.

For a layperson, those might be useful generalizations to be eventually confronted with street ex- perience and the hard-won savvy of teachers in the field. For the more experienced addictionologist, not only must each distinct class of drugs be studied and treated separately from every other, but every specific drug also must be studied and treated separately from every other in its class. Nace is correct in asserting that a complete drug history must be obtained before treatment can effectively begin, yet the internal inconsistency in his presentation weakens his conclusions.

The details in chapter 6 of behaviors, attitudes, and adaptations that can signal trouble with sub- stances of abuse are excellent, as are the comprehensive discussions of discipline-specific symptoms and problems for physicians (chapter 6), nurses (chapter 7), pharmacists (chapter 8), attorneys (chapter 9), and executives (chapter 10). The later-chapter descriptions of recovery, patient-matched care, 12-step programs, and examples of specific types of intervention and treatment are thorough and accessible, and the appendixes supplying real-world information about services and resources are equally relevant.

This book attempts to deliver a wealth of information pertaining to the "special" issues of addiction-impaired professionals. Although it does provide some of that knowledge in readable and adaptable terms, some of the overarching assumptions seem skewed; this is a better book for those so new in the field that it can provide a useful starting place or for those so experienced that they can avoid the philosophical pitfalls.

Laura L. Post, M.D. Chair, Department of Psychiatry

Commonwealth Center Saipan, CNMI

Book Reviews 471