Cocaine and Methamphetamine Dependence: Advances in Treatment

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edited by Thomas R. Kosten, MD; Thomas F. Newton, MD; Richard De La Garza II, PhD; and Colin N. Haile, MD, PhD. American Psychiatric Publishing, Arlington, VA, 2012, 216 pages, $65.00 (paper).

It was a classic case of judging a book by its cover, only this time the one doing the judging was my wife. When she noticed Cocaine and Methamphetamine Dependence: Advances in Treatment on the desk in our hotel room, she said, “Ew!” I had to laugh, because as medical director for an opioid treatment program and a Program of Excellence in Addictions Research, I deal with cocaine and methamphetamine addiction all the time. As an avid reader and well-educated person with a graduate degree in a health sciences-related field, my wife still had the reaction that a great deal of society has to these addictions and the people who experience them. When I asked her what she thought, she said honestly, “I don’ t want to be around those people.” So when I turned to chapter 4, “Behavioral Interventions,” and showed her Table 4-6, Summary of Spirit, Skills and Principles of Motivational Interviewing, and Table 4-9, Motivational Interviewing: MI-Consistent and Non-Consistent Responses, she was blown away. She said simply, “I’ d be doing it all wrong.”

That is why we need books like this one. There are exciting new developments in our understanding of addiction. Better understanding the biological, psychological, and social aspects of addictions has allowed the field to begin translating research in behavioral interventions, such as motivational interviewing, contingency management, and cognitive-behavioral therapy, as well as preliminary research in psychoactive medication interventions to treat psychostimulant disorders, into practical clinical applications. This book offers readers a current set of information and skills to immediately enhance clinical practice. This material is useful in teaching residents, medical students, and other members of an integrated behavioral health care team.

Well-organized, comprehensive, and manageable, it has a nice opening chapter on the epidemiology and psychiatric comorbidity of psychostimulant addiction. Chapter 2, “History, Use, and Basic Pharmacology of Stimulants,” may be daunting for some. I am a psychiatrist with a doctorate in pharmacology, and it is an excellent summary that could easily be translated into a workshop, seminar, or semester course all on its own. Chapter 3, “Diagnoses, Symptoms, and Assessment,” takes into account the revised diagnostic criteria in DSM-5, for the same reasons they were revised. For example, addictions are addressed as “use disorders” by severity, rather than “abuse” or “dependence.” As I hinted earlier, chapter 4 is filled with practical pearls for those wanting to understand human behavior better and communicate more effectively with clients, patients or family members, significant others, and colleagues. Clinicians will find “key clinical concepts” summarized in bullet points at the end of each chapter, along with additional resources and references.

Chapter 5 on pharmacotherapy for stimulant disorders is understandably short. Table 5-1, Potential Medications for Stimulant Dependence Evaluated in Clinical Trials and Other Studies, summarizes what is known about overall efficacy for trials of 8 antidepressants, 7 mood stabilizers/anticonvulsants, 10 direct and indirect dopamine agonists, and 2 others. Results were not encouraging. The authors present putative evidence for modafinil in cocaine and methamphetamine users, bupropion in combination with behavioral interventions in light methamphetamine users, medications that increase GABA levels but also have troubling side effects, and agonist treatment approaches with stimulant medications, similar to methadone maintenance treatment for opioid use disorders. The latter approach is obviously a high-risk option for addicts due to the potential for overuse and diversion, and it must be done in conjunction with very structured behavioral and psychosocial treatments.

Additional chapters on polydrug abuse, HIV, and other medical comorbidities and a good concluding chapter with a summary and future directions round out a book wherein the authors give their best efforts, wading into the literature and putting forth what is known on their particular topics of expertise and what they have to add. Even better, it is presented in an organized, digestible format. This book fits neatly into my carry-on bag and stimulates conversation: “Are you some kind of counselor or doctor or something?” “Addiction is really important, huh?” Addicts experience more collective stigma, with the associated shame and guilt of being marginalized, than arguably any other clinical population. In that moment of being vulnerable and truthful with herself, my wife took full responsibility for judging cocaine and methamphetamine addicts. And she showed how quickly an open mind can change, often with just the turn of a page.

Matthew E. Layton, MD, PhD

[email protected]

Author affiliations: College of Medical Sciences, Washington State University, and University of Washington School of Medicine, Spokane, Washington.

Potential conflicts of interest: None reported.

J Clin Psychiatry 2015;76(9):e1140

dx.doi.org/10.4088/JCP.15bk10004

© Copyright 2015 Physicians Postgraduate Press, Inc.