The tragic societal losses caused by alcohol affect the work of all physicians. To what extent does this book meet the formidable challenge of enhancing the medical care system's responses?
Babor's chapter succinctly and readably presents for the generalist the complex controversies regarding definitions and diagnosis of alcoholism. The delightful geriatric vignettes in Ofman's chapter vividly describe the pathos and show how coordination of services produces dramatic outcomes, even with the cognitively impaired elderly. Unfortunately, the text immediately preceding these stories iterates the lack of data on this admittedly understudied group.
Lewis writes dynamically about treatment. He focuses on primary care and presents behavioral interventions and valuable "how-to" clinical notes, backed by rationale and data. Schuckit's chapter features academic and dry writing that outlines well the elements and principles of treatment. However, some unsubstantiated treatment suggestions are debatable; for example, he theorizes that generalists might treat patients in medical or psychiatric units without groups or counselors.
Addiction specialists will appreciate the up-to-date reviews of the medical aspects of alcoholism, such as the encyclopedic endocrine chapters, which integrate animal and bench research with clinical data and interpret them as well. The book also includes fascinating current findings on molecular mechanisms of tolerance, pharmacokinetics, and neurotransmitters, but the presentations lack a consistent clinical orientation. The otherwise fine, extensive neurologic chapter is marred by reliance on "classic" data. The editors redress the field's male bias in four of the 17 chapters; editor Mello's chapter on the female neuroendocrine system is a well-organized goldmine, with strong clinical relevance and a good summary.
In place of the abundant duplications in the book (for example, definitions, listings of medical complications, and withdrawal treatment), I would have welcomed chapters on psychiatric issues or the "dual diagnosis" patient, the "disease"/abstinence versus controlled drinking controversy, or family issues as encountered by physicians.
Mendelson and Mello take a more academic, less clinical orientation than their title suggests. The abilities of researchers who need a current review, or addictionists who wish in-depth reading are more enhanced than generalists' skills. Primary care physicians might prefer a chapter in a medicine textbook, or a short primary care text on alcoholism; excellent editions of these have been recently published.
http://www.annals.org/cgi/content/full/119/5/443-a
