© 2005 Society for the Study of Addiction doi:10.1111/j.1360-0443.2005.01076.x

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Blackwell Science, Ltd

Oxford, UK

ADDAddiction

0965-2140© 2005 Society for the Study of Addiction

100Book Reviews

Book Reviews

Compiled by Susan Savva and Griffith Edwards

100Book Reviews

Book ReviewsBook Reviews

Choice, Behavioral Economics and Addiction

RUDY V. VUCHINICH & NICK HEATHER, edsOxford, Pergamon, 2003, 544 pp, $105, ISBN0080440568

An éclair in the refrigerator poses the seemingly eternalproblem: should I eat that seductive, calorie-filled, avail-able éclair, or should I forego immediate gratification infavor of a healthier, svelter future self? If I avoid that éclairtoday, how about tomorrow, the day after and the dayafter that? What factors determine whether or not Ibecome an excessive consumer of éclairs and what fac-tors might help me halt that destructive behavior? Butthen again, who says my consumption is excessive whenperhaps I just really, really like éclairs?

The contributors (and commentators) to this volumeby Vuchinich & Heather remind their readers that thereare many theories and characterizations of choices simi-lar to my éclair-eating behavior, but the focus of this vol-ume is on how rational choice explains addiction.‘Rational choice’ means that my selecting the éclairrather than a stalk of celery is based on a personal assess-ment that the éclair promotes my wellbeing more thandoes a celery alternative. ‘Rational’ does not meandetailed reasoning or even consistent or consciouschoice. Rather, it means that I am responsive to environ-mental contingencies and make constrained decisionsbased on what I perceive to be in my self-interest. Brainchemistry, genetic predisposition and pathological think-ing may influence behavior, but they need to play no rolein a rational choice theory.

Although contributors to this volume disagree amongthemselves, a working definition of addiction is a condi-tion such that when my choice is made at a distance(especially but not exclusively with respect to time) fromthe éclair, I would typically choose the celery; but whenmy decision is made in the immediacy of the éclair (again,especially with respect to time), I typically eat the éclair.Moreover, my choice is repeated to the point that anexcess of éclairs imposes long-term, seemingly intolerablecosts, yet my behavior persists. The contributors seek anexplanation, grounded in rational choice theory, for thisapparently perverse behavior.

Given the title, this book (and perhaps the éclair)would seem to be the stuff into which an economist couldsink his or her teeth, but of the 27 contributors I countedjust three or four economists. And while the seminal

work of economists Becker and Murphy finds its way intothis volume (via Chaloupka, Emery and Liang), PaulSamuelson’s version of economics is largely absent. Psy-chologists dominate this volume of 14 essays and com-mentaries, but additional contributors range fromphilosophers to biochemists. These interdisciplinary con-tributors offer readers a more critical view of contempo-rary approaches to understanding addiction as rationalbehavior than might be provided by a group of relativelylike-thinking representatives of a single discipline. Thereis a cost, however. While most of these essays are acces-sible some are a difficult read and, as pointed out byMacCoun in his closing essay, policy analysts mightstruggle to find enlightenment in the behavioral econom-ics approach.

WILLIAM RHODES

ABT Associates, Inc.CambridgeMAUSA

100Book Reviews

Book ReviewsBook Reviews

Hideous Absinthe: A History of a Devil in a Bottle

JAD ADAMSLondon, I.B. Tauris, 2004, 294 pp, £18.95, ISBN186064 920 3

This well-written book traces the history of absinthedrinking culture in the late 19th and early 20th centu-ries. The book’s main virtues are color and black-and-white plates of paintings, drawings and posters producedabout absinthe by drinkers such as Van Gogh, Degas,Toulouse-Latrec, Picasso and Gaugin, each accompaniedby the author’s engaging commentary. The mid-sectionof the book is slow reading, however, as the lives andcareers of people who drank absinthe even occasionallyare discussed in detail almost as a series of movie starwalk-on parts designed to prop up a minor theater pro-duction. In these desultory chapters, Adams alternativelyoverplays the role of absinthe in the life of genuinelyimportant people such as Manet, or overplays the impor-tance of people such as Alfred Jarry, to whom absinthewas an abiding preoccupation.

Sociologists of addiction will find more interestingAdams’ account of how ‘absinthism’ became conceptual-ized as a disorder separate from alcoholism, and how and

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why medicine, the wine industry and the temperancemovement embraced this shaky distinction. Adams alsoreviews the absinthe panic of the period, noting that thedrink’s opponents portrayed it as the scourge of the work-ing classes, a tempter of women to promiscuity and lesbi-anism and a debilitator of national character andmasculinity at a time when every European country wasliving in dread of the next German invasion. His coverageof this terrain is adequate, but it will be very familiar toany addiction specialist conversant with Berridge’s(1999) writings on opium or Warner’s (2002) on gin,neither of which, alas, is cited.

The existence of this book and the many absinthe-related sources upon which it draws beg the question ofwhy so much has been written about the ‘green fairy’.Adams’ citation of the 15-fold increase in absinthe con-sumption in France from 1875 to 1913 is deceptive, foras he himself acknowledges late in the book, absinthenever composed more than 3% of French alcohol con-sumption. Why, then, do we need yet another book on anminor historical phenomenon? Even though the 1920sin the United States was a religiously and politically con-servative decade in which alcohol consumption plum-meted, the period is often remembered as filled withglamorous parties populated with liberated flappers,flashy gangsters and boozy socialites because the peopleat those parties wrote good books we still read today. Theabsinthe boomlet of the late 1800s is similarly remem-bered as far more interesting and important than it wasbecause some creators of magnificent, enduring art madereference to it in their work. When Adams discusses thisart the book comes alive, but the hundreds of pagesdevoted to the drink itself feels like much ado about verylittle.

KEITH HUMPHREYS

Veterans Affairs and Stanford University Medical CentersxPalo AltoCAUSA

References

Berridge, V. (1999)

Opium and the People: Opiate Use and DrugControl Policy in Nineteenth and Early Twentieth CenturyEngland

. London: Free Association Books.Warner, J. (2002)

Craze: Gin and Debauchery in the Age of Reason

.New York: Four Walls Eight Windows Press.

100Book Reviews

Book ReviewsBook Reviews

Pathological Gambling: A Clinical Guide to Treatment

JON E. GRANT & MARC N. POTENZAWashington DC, American Psychiatric Publishing Inc.,2004, 270 pp, $37.50, ISBN 1 58562 129 3 (paperback)

From the outset it is underscored that this book doesnot, as a reader may be reasonably led to infer incor-rectly from its title, offer a set of therapeutic guidelines,a set of step-by-step instructions or a conceptual modelfor the treatment of client presenting with a pathologi-cal gambling disorder. Rather, based on the premise thatmany clinicians remain unfamiliar with the topic ofpathological gambling and its management, this refer-ence is designed to offer the core information required togain a broad appreciation of the underlying publichealth issues and clinical characteristics associated withgambling, problem gambling and its treatment. Like animpressionist painting, brushstrokes of information dot-ted in chapters combine to form a coherent picture ofpathological gambling when viewed as a whole. Thebook is divided into four sections, with the first three set-ting the foundation for understanding the extent,nature and clinical characteristics of pathological gam-bling, with the last section an overview of preventionand treatment, including a listing of screening andassessment instruments.

In Part I, Shaffer & Kidman offer an insightful con-sideration of the need for an integrated theory-basedstrategy that freely incorporates both an individualizedmedical and population-based public health approachto inform social engineers and policy-makers. In theirmodel, four steps to achieve effective public healthaction are recommended, each step containing funda-mental principles or components that in combinationwill result in primary prevention, guidelines for healthygambling and the efficient allocation of limited treat-ment resources. The chapter by Cunningham and hercolleagues provides a good synopsis of prevalence ratedata, but disappointingly omits any critical discourse onthe construct validity of pathological gambling or thesensitivity and specificity of existing screening instru-ments used to determine such rates. In like vein, thesection on current and projected internet gamblingneglects any critical analysis of the validity and reliabil-ity of estimated expenditure and participation rates,particularly given the reliance on self-report measuresand data extracted from off-shore unregulated and‘unscrupulous’ sites.

The strength of Part II is its compilation of detailedstatistics describing the phenomenology and relatedclinical aspects and personality dimensions and subtypesof pathological gambling, and its inclusion of separatechapters dealing with youth, older adults and gender dif-ferences in gambling. The chapter on categorization liststhe primary conceptual models applied to gamblingwithout delving into an evaluation of their underlyingpremises or supporting/contradictory evidence. Theimpulse control, addiction, obsessive–compulsive spec-trum and affective disorder are dealt with at a descriptive

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level useful for those readers who simply wish to gain anoverview of conceptual models. The treatise on olderadults is a very useful discourse on the relative influ-ences leading to the development of impaired controlover gambling in this segment of the population that is ofimmense utility in assisting a clinician dealing with anelderly patient presenting with pathological gamblingproblems.

There are two chapters contained in Part III that dealwith aetiological factors. Both meet the needs of noviceclinicians or undergraduate students wishing to gain ageneral appreciation of explanatory models but do notreally provide any in-depth coverage, critical analysis ordiscussion of methodological issues that impinge uponthe strength of conclusions drawn.

For the clinician, Derevensky, Gupta & Dickson’s sec-tion on the prevention and treatment of adolescent prob-lem gambling is extremely valuable, setting out aframework that focuses on improving resilience throughthe promotion of personal skills, autonomy and socialcompetence, among others. Risk and protective factorsare outlined, with special attention directed toward theneed to take into consideration the developmental andmaturational status of the adolescent.

Despite the importance of erroneous perceptions, irra-tional beliefs and misunderstanding of probability inher-ent in the pathogenesis of pathological gambling, there issurprisingly little coverage of this topic in the chapter oncognitive and behavioural treatments. In contrast,despite the limited number of controlled clinical outcometrials currently available, the pharmacological treat-ments covered in Part IV are detailed in content and ofclinical relevance to the practising psychiatrist or familyphysician. The empirical evidence for pharmaceuticalinterventions and their neurochemical foundations ingambling are described, with appropriate recommendedregimens offered for medication based on current levels ofknowledge.

The compendium of psychometric screening and diag-nostic instruments listed in the last chapter is useful but,again, the absence of a critical analysis of their propertiesand construct validity relegates this to the equivalence ofan appendix.

This book is an excellent resource that is highly rec-ommended for clinicians and undergraduate studentswishing to gain an overview of the field of pathologicalgambling. There is a wealth of useful statistics and thestrengths and weaknesses of what is known about theaetiology and clinical treatment of pathological gamblingarticulated clearly. Those expecting to find a practicalclinical guide to the treatment and rehabilitation ofpathological gambling will be disappointed, as will themore seasoned researcher or academic seeking criticalinsights.

ALEX BLASZ CZYNSKI

School of PsychologyThe University of SydneyNSWAustralia

100Book Reviews

Book ReviewsBook Reviews

Treating Alcohol and Drug Abuse

M. BERGLUND, S. THELANDER & E. JONSSON, edsHoboken, NJ, Wiley-VCH, 2003, 654 pp, $95.00,

ISBN 352730682XHow best to spend available health-care resources?

That was the Swedish government’s question that gaverise to this comprehensive review of treatment outcomeresearch, now translated into English and extended toinclude studies up to 2002. Berglund and his colleagueshave given a remarkable gift to the addiction field, a per-spective spanning thousands of outcome studies. Theirgeneral advice is to shift resources away from ineffectiveapproaches and towards treatment methods with the bestscientific evidence of efficacy. This evidence-based treat-ment perspective is rapidly being adopted by governmen-tal agencies in an era of shrinking health-care resourcesand escalating costs.

Like reviewers before them, and consistent with theapproach of the Cochrane collaborations, the authorsfocus primary attention on controlled clinical trials (nownumbering about 700) as the strongest form of evidencefor efficacy. Their review encompasses both psychosocialand pharmacotherapies for alcohol and other drugdependence, early intervention for alcohol problems,medications for alcohol and opioid withdrawal and thetreatment of substance abuse during pregnancy. Tablesthroughout the book detail the methods, outcomes,methodological quality and observed effect sizes for hun-dreds of individual clinical trials. The devil here is notonly in the meticulous detail, but also in how to summa-rize it in a way that informs policy makers. The executivesummary comprises 10 pages (pp. 599–608), and athree-page distillation of conclusions (pp. 595–597). Avexing challenge for any meta-analyst of this literature isin how to lump intervention methods. From my perspec-tive, the lumps in this report are too few and large. Col-lapsing hundreds of trials, they dub as effective a broadcategory called ‘re-educative’ therapies, whereas ‘non-specific supportive treatment’ is deemed ineffective. Theformer includes heterogeneous methods that varywidely in efficacy: aversion therapies, behavioral skillstraining, cognitive behavior therapies, relapse preven-tion, the community reinforcement approach, contin-gency management, cue exposure, modeling, relaxationtraining, 12-Step treatment and therapeutic communi-ties. Managers could easily read ‘re-educative therapies’

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as supporting an array of traditional educational andconfrontational methods that have consistently beenfound to be ineffective. The broad category of supportivetreatment similarly subsumes a diverse array ofmethods, some of which appear promising fromcontrolled trials.

To be sure, one could also quibble with the details. Anymeta-analysis of this scope requires the authors to makethousands of semi-arbitrary decisions about categoriza-tion, variables, error terms and inferences. Many of themeta-analytical computations and methodological rat-ings were carried out by only one author, without double-checking for consensus resolution. The authorsresponded to some published quibbles with their originalreport, attempting to correct errors in preparing theEnglish translation.

On the whole, the scope of work is impressive, and thisis a fine encyclopedic resource for those interested in themethodological detail of addiction treatment outcomeresearch. This is, in essence, a 631-page meta-analysis inwhich the authors show their work, allowing readers toevaluate each step along the way. The level of detail willbe beyond the tolerance of most policy makers, andunfortunately the level of generalization in the executivesummary is often too coarse to guide implementation,particularly with regard to psychosocial treatment.

WILLIAM R. MILLER

University of New MexicoAlbuquerqueNMUSA