The Chemically dependent
How best to treat the chemically dependent? What combination of psychological, biological, and social theory will translate into the most effective clinical approach to treatment? Are recovery and relapse prevention even reasonable goals? Editor/author Barbara Wallace has called upon 23 highly respected colleagues to provide access to the latest thinking from the front lines of the addictions field; together, they offer clarity and hope in an area often overwhelmed by confusion and frustration. The concept of phases of treatment for specific phases of recovery - the linchpin that holds the overall framework of the book together - stipulates that knowledge of the particular phase of recovery being negotiated by the client should dictate the appropriateness of a specific treatment modality. Whether inpatient, outpatient, or long-term residential therapeutic community, the decision, then, is made based on where the client is in the recovery process, rather than on one "preferred" approach. In Part I, Dr. Wallace lays the foundation by delineating the core concept, explaining the utility of an integrated theory drawing from a biopsychosocial approach, and underscoring the integral component of relapse prevention at every stage of recovery. In-depth discussions of progressive contemporary treatment modalities follow: inpatient (for the first phase of recovery), intensive outpatient, and the therapeutic community. Psychoanalytic/psychodynamic approaches come to the fore in Part II, beginning with a valuable synthesis of historical and current perspectives. Contributors then offer insight into the role of psychotherapy throughout recovery, the dynamics of compulsive drug use, and working with character-disordered patients. Part III examines cognitive-behavioral, self-help, and relapse-prevention strategies. Explored first is the topic of stress, with an emphasis on the need to build upon the stress-coping resources within a person's overall life context. An increasingly pivotal part of our recovery vocabulary, the 12-step perspective is described in the next chapter, encouraging a greater understanding and appreciation of its potential. In closing, this section features a multidimensional view on relapse, which embraces biological, psychological, and social-environmental interventions. The focus of Part IV is on current trends in research and their implications. These essential chapters present the most up-to-date information available on their subjects: neurogenetics of compulsive disease, early object representations and recovery in alcoholic women, outcome evaluation of cocaine- and crack-dependent patients, and family therapy as an adjunct to treatment with adolescents in the therapeutic community. Finally, Part V considers the characteristics of specific populations as variables in assessment and treatment, starting with a discussion of cultural factors and the Africa-American patient. Issues in the treatment of the dual-diagnosis patient is the next area investigated, followed by a chapter on special populations, including criminal, pregnant, HIV-positive, and homeless. Dr. Wallace concludes the volume with a cohesive summary of how the contributors have attempted to generate positive reform in the field in order to address the many and varied needs of the chemically dependent. Further, she provides a powerful argument for early intervention in childhood abuse as a key strategy in preventing the development of addictive disorders. Nowhere in the current literature on chemical dependency will the reader find a more comprehensive, balanced, or informed volume. For anyone doing clinical work or research in the field, it is a resource of incomparable depth and scholarship.
