Book and Media Reviews

Addiction Biology (1996) 1, 201–212

Book and Media Reviews

COMPILED BY CHRIS COOK

Book reviews in this column will primarily be of titles focusing completely, or in part, on biological aspectsof addiction. However, significant titles of general relevance to the addictions field will also be included, evenif they are not “biological”, as will titles of general methodological and clinical relevance, even if they are noton “addictions”. Similar considerations will apply to other media (software, audio tapes and CD’s, videos,etc). However, specific “addictions” software applications seem to be relatively uncommon and, as these itemsare rarely reviewed elsewhere, we will endeavour to include reviews of some of the older programmes that arestill useful, as well as new titles that appear. I would appreciate suggestions of any items suitable for review,but especially software and other media of specific relevance to the addictions.

Alcohol and the Heart in Perspective. Sen-

sible Drinking Limits Reaffirmed

Report of a joint working groupLondon, Royal College of Physicians, RoyalCollege of Psychiatrists and Royal College ofGeneral Practitioners, London, 199536pp., UK £6.00, Overseas £7.50

andAlcohol: Guidelines on Sensible Drinking

Occasional paper from the BMA’s Board of Sci-ence and EducationLondon, British Medical Association, 199518 pp., £4.95

Here are two reports emanating from highBritish medical authority, each of which dealswith the ‘sensible limits’ question in the light ofthe current finding that light or moderate drink-ing may give some protection against coronaryheart disease (CHD) in older age groups. Withthat evidence duly taken on board the docu-ments both conclude that the currently recom-mended limits of 21 units weekly for men and 14units for women should not be relaxed. Each ofthese statements is eminently worth reading,they have overlap in argument and content, butneither is a pale copy of the other. Let’s first lookbriefly at the two publications separately andthen give a view on what might be taken as theoverall message.

The Colleges’ review group met under thechairmanship of Michael Marmot. It is remark-able for its success in presenting much complexanalysis within short space while at the sametime achieving admirable clarity. The difficulties,ambiguities and gaps in the evidence are notconcealed, but through all this complexity a pat-tern of findings can be discerned. Alcohol willgive some protection against CHD in older sub-jects, but beyond a moderate intake disbenefitwill exceed benefit.

The sections on alcohol and cardiovasculardisease, and on all-cause mortality, which arewritten within a risk-analysis framework andwhich are aided by helpful graphics are particu-larly persuasive, but the chapter on psychosocialproblems is also useful.

The BMA report is not so fully referenced andgoes quickly to what it sees as the nub of thenecessary conclusions—it is a simpler statementfor a different audience, but again terms excel-lently presented. The core conclusion is that“drinking above the limits is increasingly harmfulboth to the individual and to others, and the riskincreases with the amount consumed”. TheBMA puts forward a Public Health agenda inthis arena, favouring such measures as taxation,roadside breath testing and a lowering of thestatutory BAC limit from 80 to 50 mg per cent,health warnings on containers, and clearer label-ling of alcohol content.

1355–6215/96/020201–12 Society for the Study of Addiction to Alcohol and Other Drugs

202 Book and Media Reviews

And the broad implications when the two re-ports are read together? My own jottings wouldread as follows. First, for different types of prob-lem there are differing alcohol-related mortalityrisk functions, with different shapes and acceler-ations. Second, any advice on limits is in conse-quence an approximation, a best buy, but withinthat proviso the currently advised limits are in-deed sensible. Third, there remains an entirelyopen set of questions of the “so what?” variety,relating for instance to whether sensible pro-posals can in reality be transformed into effectivehealth strategies. Is the safe limits debate diver-sionary, merely symbolic, or about an importantreal-world Public Health issue?

GRIFFITH EDWARDS

National Addiction Centre,London,UK

Towards a Molecular Basis of Alcohol Use

and Abuse

B. JANSSON, H. JORNVALL, U. RYDBERG,L. TERENIUS & B L VALLEE (Eds)Birkhauser Verlag, 1994407 pp., £52.00

This book has arisen from a symposium held atthe Nobel-Forum Conference Center in 1993, toreview current knowledge on the molecular basisof alcohol use and abuse. After an initial openingpiece describing the position of alcohol in humanhistory there follows four sections on neurophar-macology, biological markers, enzymes and clini-cal features. Whilst the impressive authorshipwas asked to emphasise conceptual features,some chapters read more like an original paper.Despite this the 39 succinct chapters read wellwithout undue repetition, however the bookwould have benefited from an overview of eachsection.

Bert Valee provides the opening perspectivediscussing the 10,000 years of European historyduring which beer and wine were the major thirstquenchers, water being considered unsuitable.

The first section then describes ethanol as amolecule with both hydrophilic, and hydropho-bic properties, that allow it to interact with lipidsand proteins. Whilst the effects of alcohol arelegion, the recurring theme is introduced that

particular brain neurotransmitter functions aremodified, notably the GABA, 5HT, dopamine,NMDA and opiate systems.

In the second section George Uhl proposesthat multiple genes, in various systems, influencedifferent stages in the development of depen-dence, from initiation to organ damage. Thetheme of section one is further developed by invivo studies, including the controversial geneticassociation with DRD2, PET studies that indi-cate no change in central benzodiazepine recep-tors following alcohol and alcohol consumptionrelated to 5HT neurotransmission. In additionother systems are examined including those ofadenosine, the arachidonic acid cascade and an-giotensin.

In the third section the structure and functionof enzymes involved in ethanol metabolism areexplored, including core papers on ADH,ALDH and cytochrome P450. In additionSalaspuro proposes that the metabolism ofethanol to acetaldehyde by ADH in Helicobacterpylori, a reversal of the usual direction of thisenergy providing bacterial reaction, may accountfor some of its gastrointestinal morbidity. Fur-thermore Duester suggests that the teratogenicproperties of ethanol may be caused by competi-tive inhibition of ADH mediated retinoic acidsynthesis.

The clinical section opens with an overview oftreatment issues by Jansson. Marc Schuckit re-ports on a follow-up of his original sons of malealcoholics study, indicating that a reduced re-sponsivity to alcohol is a potent predictor offuture alcohol dependence. O’Brien’s appeal toconsider alcoholism a chronic disorder, similarto diabetes or arthritis, provides a valuable in-sight into relapses that are often seen as treat-ment failure. The general theme is recapitulatedin this final section as the roles for naloxonein alcohol dependence and ritanserin in the‘chronic withdrawal phase’ are explored. In ad-dition the use of Radix Puerariae (a traditionalChinese medicine) is evaluated and Bradybravely considers the potential for gene therapy.

In short this book provides an excellent, andinspiring, review of current research into themolecular basis of alcohol use and abuse.

DAVID BALL

Institute of Psychiatry,London,UK

Book and Media Reviews 203

Treatment Approaches for Alcohol and

Drug Dependence: An Introductory Guide

T. J. JARVIS, J. TEBBUTT & R. P. MATTICKChichester, John Wiley & Sons, 1995225 pp., £14.99 (pbk)

This book offers a succinct overview of psy-chotherapeutic approaches often encountered inthe addiction field. Counselling skills, motiva-tional interviewing, problem-solving and otherlife-skills, cognitive and behavioural techniques,couples therapy, “Antabusen”, self-help groupsand relapse-prevention (amongst other topics),along with their integration, are all covered.

The style of the book is crisp and clear. Eachchapter has a “Resources List” which helpfullyleads the reader to more detailed sources. Thereare numerous practice sheets and handouts. Thebook is full of good sense and practical insights.To give two examples: an intoxicated patient canstill be listened to; and we cannot assume thatsomething identified by a client as “less good” isactually a problem.

This is an “introductory” book for“therapists”. Do not expect to find in its pagesany significant details concerning detoxificationor methadone maintenance. Therapeutic drugsare barely mentioned, nor is the management of,say, delirium tremens or Korsakov’s. There arealso inaccuracies; for example, “MCV” is de-scribed as measuring “the level of red bloodcells”. In short, the “therapists” for whom thebook is written seem not to be those with aninterest in even rudimentary biological matters.

There is, of course, the chapter on disulfiram.Its use is to be considered as one measure amidstother psychotherapeutic interventions. Many ad-vocates of disulfiram regard it as a psychologicaltool, which may explain why it is the only drugto be considered in any depth in this book. Yetit makes philosophical sense to consider psy-chology and biology, including the possibilitythat drugs can have a direct effect on craving.Moreover, the studies which suggest thatdisulfiram works are not conclusive, implyingonly that it reduces alcohol consumption forsome people, usually as a part of a comprehen-sive treatment package. Hence, the warningwhich appears in the section on the 12 Stepswould be equally apt in the “Antabuse” chapter,that this “might not be effective for everybody”.

The book emphasizes rational planning oftreatment programmes based on the needs and

wishes of individual clients. Receiving less em-phasis are the physical complications and treat-ments of addictions. Even then, just over fourpages, for example, on “cognitive restructuring”will mean that most counsellors will soon wish tomove to one of the more detailed texts. Thisbook will have a useful, but circumscribed, func-tion as an introductory text for those entering thefield of addiction counselling.

JULIAN C. HUGHES

Warneford Hospital,Oxford, UK

Buprenorphine: Combatting Drug Abuse

with a Unique Opioid

ALAN COWAN & JOHN W. LEWIS (Eds)New York, Wiley-Liss, 1995326 � xv pp., £49.95

This timely volume coincides with a recent surgeof clinical research on buprenorphine. Buprenor-phine, a partial opioid agonist in use as an anal-gesic, is enjoying increased research interest fortreating substance abuse. The text, edited by thedevelopers of buprenorphine, traces the drugfrom its inception, through its preclinical trials,and concludes with an extensive review of hu-man substance abuse research.

The first chapter of the book focuses on thedevelopment of buprenorphine. A background inchemistry is necessary to fully appreciate thismaterial; however, the chapter provides an intel-ligible summary for those without such training.

The next section introduces the basic conceptsneeded to understand the preclinical pharmacol-ogy literature (e.g., affinity, efficacy, agonists andantagonists, schedules of reinforcement, andmeasurement of the behavioral and physiologicaleffects of a new drug). Binding and basic phar-macology are covered, and subsequent chaptersreview the animal data on appetitive behaviors,discriminative stimulus effects and abuse poten-tial, and their interpretation to characterize andclassify buprenorphine. Examination of dosingregimens and concurrent drug administration re-veals seemingly contradictory effects of this par-tial agonist and provides the reader with insightinto the intricacies of the opioid receptor system.

The section addressing toxicological assays,metabolism, and pharmacokinetics, is followedby a review of the analgesic properties of the


drug, and an especially interesting chapter onbuprenorphine’s effects on schizophrenic anddepressive symptoms.

The final third of the book is devoted tobuprenorphine’s potential as a pharmacologicaladjunct in substance abuse treatment. Acute andchronic physiological, subjective and behavioraleffects are explored, and the extensive labo-ratory and field research is critically reviewed.Buprenorphine is revealed as a promising drugwith relatively low abuse liability, low physicaldependence and overdose potential, and mildwithdrawal symptoms. It is comparable tomethadone in decreasing heroin use, and alsoseems to reduce cocaine use and needle sharing.

This text provides a comprehensive review andintegration of the substantial buprenorphineliterature, and has unraveled some of the myster-ies of this intriguing substance on the eve of itsinauguration into addiction treatment. A phar-macology background is not necessary to profitfrom the material, although some sections will beless useful to those unfamiliar with reading thepharmacological literature. Most chapters havesummaries appropriate for the reader unable tofully appreciate the text of the chapter. Thiscompelling book will become essential readingfor addiction specialists from a variety of disci-plines.

PATRICIA S. MEEK

Department of Psychiatry,University of California-San Francisco,California, USA

Brain Imaging of Nicotine and Tobacco

Smoking

E. F. DOMINO (Ed.)Ann Arbor, Michigan, NPP Books, 1995340 pp, $95.00ISBN 0-916182-10-X

This is a comprehensive book describing theeffect of nicotine and tobacco smoking on thebrain. The 21 chapters are divided into 4 sec-tions covering the distribution of nicotinic recep-tors, various imaging techniques and behaviourand nicotinic agonists as potential therapeuticagents. Each chapter also provides a useful intro-duction to the methodology used.

Historically, nicotine was one of the first sub-stances investigated which founded the basis of

modern pharmacology. The pharmacology ofnicotine from Dale through to today’s molecularbiology is reviewed. The importance of modernimaging techniques in delineating normal anddiseased brain function is well illustrated in thefollowing chapters. PET and SPET are the onlytechniques which can examine the effect of vari-ous drug treatments on the nicotinic receptorand will play a pivotal role in further developingthe therapeutic potential of nicotine. For in-stance, in Alzheimers disease, tacrine improvescognitive functioning which correlates with im-provement in glucose metabolism and nicotinicreceptors.

Tobacco smoking is known to increase the riskof stroke. Various imaging strategies have beenused to examine how tobacco smoking affectscerebral blood flow. Acutely, smoking and nic-otine increases cerebral blood flow, probablythrough multiple actions. Chronic smoking how-ever decreases overall cerebral perfusion, placingthe person at higher risk of stroke. The goodnews however is that on quitting smoking, perfu-sion improves and continues to do so for at leastone year.

EEG has also been used to gain informationon the effects of nicotine on the brain. In generalsmoking tends to globally increase high activityfrequencies. However there are differences inEEG profiles induced by smoking, which may beindicative of different personalities and motiv-ation to smoke. In smokers, abstinence inducesimpaired performance and cortical hyperarousal,which is reversed on smoking, which may explaintheir continued smoking. However, no absoluteenhancement in cognitive performance has beenshown in non smokers after a cigarette.

Although nicotine has primarily been thoughtof in the context of dependence on smoking,there are several potential therapeutic uses fornicotine. For instance, nicotine patches havebeen shown to improve cognitive function inpatients with dementia, which correlated withimprovements in abnormal event related poten-tials.

The book will be of interest to a number ofdifferent specialities, describing the basic phar-macology of nicotine and its relationship to brainfunction. It is highly recommended.

ANNE LINGFORD HUGHES

Institute of Psychiatry,London, UK


Medications Development for the Treat-

ment of Pregnant Addicts and their Infants

C. N. CHIANG & L. P. FINNEGAN (Eds)Rockville, MD, NIDA Research Monograph No.149, 1995Paperback

This NIDA monograph is an extremely welcomefocus on the issues surrounding rational drugtreatment of pregnant addicts and their off-spring, in that it fills a real gap in the literature.At present the principles of treatment havelargely evolved in an empirical fashion, not sur-prising since there are major practical difficultiesin conducting treatment studies in pregnantwomen and babies. Controlled treatment studiesare difficult enough in the general population ofsubstance abusers. Pregnant women and theirinfants present additional ethical complexitieswith regard to the relationship between drugtreatment in pregnancy and obstetric and neo-natal outcome. There is real difficulty in distin-guishing between the effects of substance abuseand pharmacological treatments in infant devel-opment which are likely to have legalramifications, an understandable turn-off forpharmaceutical companies. The upshot of this isthat this book is almost by necessity largely amanual providing a framework for developingrational treatments, because actual researchstudies are so thin on the ground.

All the major issues relating to the evaluationof drug treatment are covered, from basic chem-istry through to special considerations of clinicaltrial design, taking in teratogenicity, the effectsof pregnancy on drug pharmacokinetics, andnovel methods of drug administration (for exam-ple the transdermal route). In fact, the title ofthis book is somewhat misleading in that cover-age is broader than pharmacological treatmentissues alone. For example, there are good ac-counts of the effects of abused drugs on preg-nancy and the neonate. A chapter on clinicalmanagement of the pregnant addict emphasizesthe importance of co-ordinating care across ob-steteric, paediatric and substance abuse services,and has an interesting discussion about the par-ticular attitudes and prejudices that arise in pa-tients and professionals which are barriers toeffective treatment. During the entire chapter,not a single pharmacological treatment is men-tioned.

The UK reader will note some interesting

US/UK differences. For example, methadonemaintenance is the treatment of choice in theUS, whilst in the UK the pregnant addict ismore likely to be encouraged to detoxify. As yetthere is insufficient data to determine which isthe more effective. One result of the US treat-ment policy is that whilst methadone mainte-nance clearly reduces the use of street opiates,the neonatal opiate abstinence syndrome is com-mon. One chapter is devoted to the assessmentand treatment of these infants and provides adetailed practical guide to clinical management.The US also has a more significant crack cocaineproblem, which is particularly relevant to preg-nancy because it is the only abused drug which isclearly associated with increased teratogenic risk,resulting from its vasoconstricting action.

Parts of the book are insufficiently focused,whilst there are also significant omissions. Forexample, the chapter on teratogenicity is an ex-cellent account of the basic principles of estab-lishing an association between fetal abnormalityand gestational drug use. However, it is overin-clusive, and strays too far from the addictionremit. Meanwhile, the issues surrounding poly-substance abuse, benzodiazepine dependenceand treatment of pregnant patients with a dualdiagnosis are not mentioned.

The final chapters focusing on clinical trialdesign and the special ethical issues surroundingthe treatment of pregnant women and babies isparticularly useful and will hopefully spawn sys-tematic research to improve the lot of pregnantaddicts and their children.

JENNY BEARN

Bethlem Royal Hospital,Kent,UK

Discovery of Novel Opioid Mechanisms

R. S. RAPAKA & H. SORER (Eds)Rockville, MD, NIDA Research MonographSeries, No. 147, 1995309 pp. Paperback

This text is from the series of monographs pro-duced by the National Institute on Drug Abuse[NIDA], US Department of Health and HumanServices. In 1992 a preclinical programme within


the new Medications Development Division ofNIDA commenced, with the aim of discoveringpotential new medications for the treatment ofopioid abuse and dependence. The monographis intended to summarise current work in thebasic science of addiction and to act as a stimu-lus for further work.

The chapters cover the following areas.Targeting drugs to the brain by means of mol-ecular packaging. A chapter reviews the effects ofopioid agonists and antagonists, dopamine ago-nists and antagonists and histaminergic agentson brain-stimulation reward. The role of endoge-nous opioids is considered in a chapter aboutstimulation of opiate receptors without majorside-effects by inhibition of enkephalin metab-olism, and in a short chapter which describesdynorphin A as a ‘rectifying peptide’, able tomodulate the activity of other opioids dependingon the morphine history of the animal. Opioidagonist/antagonist properties are explored in de-scriptions of methoclocinnamox, a long actingmu partial agonist with greater agonist effective-ness than buprenorphine and of Etorphine,which has been re-evaluated and found to havehigh analgesic potential due to agonist activity atinhibitory opioid receptors, but low dependencepotential due to antagonist activity at excitatoryopioid receptors. Several chapters investigate therole of n-methyl,d-aspartate [NMDA] receptorsin opioid activity. NMDA antagonists have po-tential to improve the management of post-injurypain. Inhibition of opioid withdrawal by NMDAantagonists and nitric oxide synthase and therole of NMDA receptors and nitric oxide inopioid tolerance are discussed in several chap-ters. An NMDA/glycine receptor antagonistwhich produces anti-nociception but not toler-ance is also described. Finally, molecular biologygets a look in as second messenger mediatedprotein kinase C translocation is implicated inmorphine tolerance.

Although there is some overlap, for exampleseveral chapters consider the role of NMDAtransmission in various aspects of addiction, thechapters cover a wide range of topics. The infor-mation in the monograph is dense and does notmake for easy reading at times. However, it is arich source of information. Each topic is coveredin some detail and provides a reference point forthe particular subject. The monograph will beuseful if used for detailed information about onetopic, rather than as a whole entity, and is for

those with some pre-existing familiarity witheach topic.

LOUISE SELL

National Addiction Centre,London, UK

Diagnosis and Severity of Drug Abuse and

Drug Dependence

J. D. BLAINE, A. MACNEILL HORTON &L. H. TOWLE (Eds)Rockville, MD, National Institute on DrugAbuse, National Institutes of Health, 199584 pp.

This eighty-four page report is based on presen-tations from a work group meeting sponsored bythe National Institute on Drug Abuse in theUSA. This meeting aimed to develop a consen-sus on recommendations for future research andthe classification (in particular in DSM IV) ofthe diagnosis and definitions of severity of drugabuse and drug dependence. The report consistsof a number of short accounts of the discussionsin the work groups, provides summaries of perti-nent research and includes considerations of theconceptual issues implicit in all this work.

Some of the lists of recommendations on diag-nostic criteria make quite dry reading, thoughone can imagine the amount of lively debate thatcould have preceded them in the work groups atthe meeting. However, the frequent references toimportant underlying research questions (such asthe validity of abuse as a diagnosis and thepredictive validity of severity of dependence totreatment intensity and prognosis) and the wayresearch findings are used to sharpen diagnosticcriteria make the report more interesting to thegeneral reader.

I found the chapter by Skinner particularlyuseful as he clearly summarizes the critical issuesinvolved in the diagnosis of substance use disor-ders, including the limitations of the two mainapproaches to classification i.e. the categoricaland dimensional systems and the restricted gen-eralisability of the dependence syndrome. Healso reminds the reader of the various reasons forclassification systems and makes a plea for di-recting research at the full spectrum of alcoholand drug use to enhance our understanding ofthe determinants and effective treatments of al-cohol and other drug problems.


There are a number of interesting issues raisedaround the subject of diagnosis in the addictionswith complementary summaries of recent rel-evant field trials in this report and it may there-fore prove to be a useful addition to the library ofaddiction researchers interested in nosology. Thebook is however of only limited value and inter-est to the more general clinician. Nevertheless, asa clinician I found it a useful reminder of thechanging nature of diagnosis and the huge vol-ume of work involved in producing optimal diag-nostic classifications.

LOUISE HOWARD

Maudsley Hospital,London, UK

Problems of Drug Dependence 1994

Proceedings of the 56th Annual Scientific

Meeting, Vols. 1 & 2

Rockville, MD, National Institute on DrugAbuse Research Monographs 152 & 153, 1995237 & 563 pp. Paperback

As a clinician labouring in the potato fields ofShropshire I rather doubted that these two aus-tere volumes would do anything to lift my spirits.First impressions are not good—dull black andwhite paperback covers, text littered with graphs,molecular structures and unexplained abbrevia-tions, and chemical names that can fill two lines.My initial view that reading these books was theintellectual version of headbanging was under-mined by reading them. That just about sums upthe work in these volumes—the layout is func-tional, the detail tedious, but the content isstimulating and provides a panorama of the com-plex and varied exploratory work going on inlaboratories in the USA, plus the energetic andfertile thinking behind it.

Volume 1 is brief, being only 237 pages long.The first 83 pages are useful to those without abiological bent, summarizing the place of be-havioural science within the broad multidisci-plinary field of drug abuse inquiry, givingglimpses of the political aspects of research, andproviding updates on progress within a numberof areas—drug abuse and the health of women,drug/environment interactions, effects of theamount of service provision on treatment out-comes, and the natural history of heroin addic-tion. Biological topics are covered too—opiate

receptor cloning, the links between substanceabuse and affective disorders, brain imaging, andthe clinical pharmacology of buprenorphine.

What follows is of much less general interest,although it constitutes the bulk of volume 1,namely annual reports on testing programmesevaluating dependence and abuse potentials, andstimulant, depressant, and opioid activatingproperties of a range of compounds. Almostevery page is dominated by charts, tables,graphs, chemical structures and enormously longchemical names.

Volume 2 extends to 563 pages. It is an ency-clopaedic collection of research reports, one re-port per page for 516 pages. A vast range oftopics is covered, bridging areas as diverse asmolecular chemistry, infectious diseases, theteaching of parenting skills, psychiatric problemsand cultural effects, across the complete gamutof substances of abuse. As in Volume 1, theresearch work is summarized, enabling a broadgrasp of the subject matter to be rapidly gained,but giving the impression of Christmas crackertit-bits, or a scientific gossip column.

Notwithstanding the above criticisms, or prob-ably because of them, I found browsing thesetwo volumes unexpectedly enjoyable in a mara-thon-running sort of way. I could never, as aclinician, recommend purchasing them, but theywould be a bargain if you could get them forfree. Having been provoked into reading themfor the purposes of this review I have the unusualpleasure of believing myself to be just a bit closerto the cutting edge than I was (and maybe closerthan you!).

KERON FLETCHER

Shelton Hospital,Shropshire’s Mental Health NHS Trust,Shrewsbury, UK

Epidemiology of Inhalant Abuse: An Inter-

national Perspective

Rockville, MD, National Institute on DrugAbuse Research Monograph 148, 1995Paperback

This monograph consists of a series of chaptersby authors from many parts of the world, toreflect the current state of knowledge regardingthe epidemiology of inhalant abuse.

The initial chapter by Edwards and Oettinggives a helpful outline of definitions and terms. A


later chapter by Blanche Frank concentrates onmethodological issues. Although it is presentedtowards the end of the book, it is perhaps betterread first, as it helps to put into perspective thestrengths and limitations of the sources of datadescribed in other chapters. The author suggestsreasons why little is known about inhalant abuse;namely, the “hidden” nature of the behaviour;the difficulty in interpreting its sometimes subtleeffects; and, perhaps most importantly, the factthat inhalant abusers are not a vocal sector of thepopulation. This is consistent with the associ-ation of inhalant abuse with extreme youth, pov-erty and educational disadvantage describedthroughout the monograph. Frank’s chapter ad-dresses the limitations of using indirect indica-tors of rates of inhalant abuse (such asemergency room admissions, arrests, anddeaths). The problems of designing populationsurveys are also discussed, since commonly usedsampling methods may miss those most at risk.Ethnographic methods are considered, andagain, inhalant abuse poses particular problems.Inhalants are readily available from legal outlets,such that studies based around networks of ac-cess to the drug, as used for other drugs, are notfeasible. Overall, the chapter gives a clear ac-count of the challenges involved in epidemiolog-ical studies of inhalant abuse.

Individual chapters have been contributed byauthors based in Bolivia, Brazil, Colombia, Peru,Mexico, Nigeria, Hungary, Japan, Asia and thePacific region, the United Kingdom and theUSA. The chapters have different styles andfocus on different aspects of the epidemiology ofinhalant abuse: for example, the chapter byRamsey and colleagues from the United King-dom includes detailed data on mortality; Katonadescribes inhalant abuse in Hungary in the con-text of rapid socioeconomic change; and Suwakidescribes trends in Japan from treatment, edu-cation and law enforcement data. Chapters fromBrazil, Mexico and Bolivia describe the problemsof chronic inhalant abuse among street children.Many authors consider inhalant abuse in thecontext of patterns of other drug use, but com-ment on the relative lack of attention to inhalantsin otherwise comprehensive studies of drugabuse.

The overall production of the monograph,with each chapter standing as a separate account,gave an initial impression of under-editing assome repetition of background information oc-

curs. On further reading it became clear that thiswas the correct decision and diversity of ap-proach is one of the monograph’s mainstrengths. This is an impressive product of inter-national collaboration. It will help to guide fu-ture research into inhalant abuse and to promoteunderstanding of this worldwide phenomenon.

SARAH WELCH

Maudsley Hospital,London, UK

An Introduction to Recombinant DNA in

Medicine

2nd EditionALAN E. H. EMERY & SUE MALCOLMChichester, John Wiley & Sons, 1995206 pp., £14.95 (pbk)

It would be reasonable to ask why a title such asthis should be eligible for review in AddictionBiology. Whilst the subject matter is undoubtedlya legitimate area of biological research, the onlyreference that I could find to addictions was onthe last paragraph of the text.

As Iversen (1984) has pointed out, at present‘it is clear that ignorance greatly outweighsknowledge in the field of brain chemistry’, butuntil more is known of the molecular basis ofnormal behaviour, is it likely that disorderssuch as schizophrenia, depression and drugdependency will ever be completely under-stood?

I believe that Iversen is right in this assertion andthat the authors are correct in their application ofit to the field of drug dependency. It is perhapssurprising that more references to addiction werenot made in this text, given the increasingamount of molecular biological research which isnow being conducted in this field. However, thebook is an excellent introduction to the field foraddictions biologists and others who wish tobecome acquainted with recombinant DNAmethods. It also provides ample food for thoughtas to ways in which the addictions may in futurebenefit from research developments in thissphere.

The authors describe the history, methods andprinciples of recombinant DNA technology, themolecular pathology of various diseases, molecu-


lar biological methods of prevention and treat-ment of disease, and other issues including evol-ution and applications to agriculture. The bookincludes broad discussions of the clinical, ethicaland legal relevance of these areas of research. Itis a readable, clear and well illustrated text. Atthe end of each chapter references are given bothto research publications and also to relevant textbooks and review articles which would be ofinterest to those who wish to obtain more de-tailed information.

This book will be of interest to a wide varietyof readers. It is essentially an introductory textwritten for the clinician, but there are few of uswho are well enough versed in such a wide rangeof aspects of this field that we will not learnsomething from reading this book. The post-graduate researcher is likely to find many of theclinical, ethical and legal discussions to be ofinterest. Few clinicians will fail to learn some-thing about molecular biology. It will be interest-ing to see whether advances in the molecularbiology of the addictions warrant further cover-age of this important aspect of the field in thenext edition.

CHRISTOPHER C. H. COOK

National Addiction Centre,London, UK

Cell and Molecular Biology

D. RICKWOOD & D. PATELChichester, John Wiley & Sons, 1995224 pp., £12.95

Cell and Molecular Biology are both vast fieldsof knowledge and no pocket-sized handbookcould even begin to do justice. The authors ofthis “essential data” handbook have wiselyavoided overlaps with more extensive standardtextbooks on the subject. Instead, they have con-centrated on providing adequate factual data tosatisfy a researcher’s daily needs in an easy-to-refer format.

Short descriptions are provided of macro-molecules and small molecules, for example,proteins, nucleic acids, amino acids, coenzymes,etc. Most of the information is depicted in tabu-lated form which includes a diagrammatical rep-resentation of the chemical composition of themolecules and short comments on their salientproperties. As expected, the book contains basicinformation on commonly used buffers, labora-

tory detergents and surfactants, and otherreagents such as citric acid, ethanol, etc. Inaddition, there is a welcome section on filterhybridization with details on preparing solutionsand their applications. The list of restrictionenzymes includes the various suppliers. As mostmolecular biology labs utilise radioisotopes, thebrief description on principles of radioactive de-cay, detection and quantitation of radiolabelledproducts would be very useful. It can also sufficeas an introduction for any researcher inbiomolecular science. Nonradioactive detectionmethods are included in this section.

A commendable feature of the book is thesection on Safety. Most protocol manuals omitthis crucial aspect of laboratory work and stan-dard texts would naturally exclude it, despite itsunquestionable relevance. Although brief, the in-formation regarding safe working practice usingchemicals and radioisotopes would be beneficialfor the average biomolecular lab.

In all, this is a useful handbook full of practicaldata and essential facts. Its size makes it exa-tremely portable therefore making it a con-venient addition to a molecular biologist’slibrary.

GURSHARAN KALSI

University College London Medical School,London, UK

Understanding Genetics: A Molecular

Approach

N. V. ROTHWELLChichester, John Wiley & Sons, 1995656 pp., £24.95

In general Understanding Genetics: A MolecularApproach covers the middle ground between in-troductory texts in genetics and research publica-tions. The book appears to have four sections,though these are not formally recognized. Thesesections cover basic genetic principles, bacterialand viral genetic systems, genetic control mecha-nisms and an introduction to molecular genetictechniques and their applications. The book’sfocus on human genetics makes it relevant tothose in the medical profession who wish todevelop their understanding of this field. Eachchapter is supported by suggestions for furtherreading and a number of problems, with answers


provided, can be used to assess your grasp of atopic.

Rothwell writes well and develops the reader’scomprehension of difficult concepts such asLinkage through several chapters. In a similarmanner the early chapters on genetic principlesand bacterial and viral genetics clearly underpinthe later chapters on molecular genetic tech-niques. The book may alternatively be used as areference text suitable for dipping into to obtainan understanding of techniques such as PCRand DNA fingerprinting.

Understanding Genetics: A Molecular Approachhas several strengths, not the least of which is therecommended retail price of £24.95. The clarityof the presentation throughout, both as text andfigures, supported by details from recent re-search (up to 1992) means that the book is easyto read as well as informative. Unusually thereare two chapters given over to a consideration ofthe genetics of control mechanisms and differen-tiation. In addition sections which specificallyfocus on and discuss the misconceptions com-mon in genetics are invaluable. However like themajority of books endeavouring to cover themiddle ground I believe that the author hasfailed those trying to come to grips with currenthuman genetic research by not explaining thewidely used analytical method of Lod scores.Despite this shortcoming this book is undoubt-edly a worthwhile addition to any library.

DEBBIE HOLMES

Worcester College of Higher Education,Worcester, UK

Gel Electrophoresis of Nucleic Acids—A

Practical Approach

2nd Edition

D. RICKWOOD & B. D. HANES (Eds)Oxford, IRL Press, 1990£25.00

This comprehensive work follows from the suc-cess of the first edition, published in 1982. Itcovers the vast majority of nucleic acid elec-trophoresis techniques currently in use in mol-ecular biology. As well as chapters covering thebasic methodologies of DNA and RNA analysisand isolation, there are separate treatments ofoligonucleotide purification protocols; pulsed-field gel electrophoresis for the separation of very

large DNA molecules; two-dimensional gel elec-trophoresis for the resolution of very large num-bers of nucleic acid moieties; gel retardationanalyses for the identification of DNA-bindingproteins; footprinting assays for the identificationof peptide-binding NA elements; and examina-tions of current methodologies for electrophore-sis of nucleosomes (the basic units of chromatinin eukaryotic cells, essentially short lengths ofDNA wrapped around histone proteins), andribonucleoproteins. The chapters on PFGE,footprinting and retardation assays are new addi-tions, whilst the remainder is an update of sec-tions from the first edition. As with the firstedition, the examinations of all subjects are ex-tremely thorough. Most alternative protocolsavailable are either quoted or given, and educa-tive photography is presented where applicable.A less desirable facet shared with the first editionis the rather stern format of the work. As it is,this is not the kind of book that will draw under-graduates easily into its content. Extra attentionto detail in terms of presentation, for instancethe inclusion of schematic diagrams, bullet listsand flow charts, could have improved it’s acces-sibility. For professional laboratory personnel,however, it is an invaluable tool to have to handduring the construction and implementation ofresearch projects.

ADRIAN TURNER

Academic Department of Psychiatry,University College London & MiddlesexMedical School,London, UK

Guide to Libraries and Information Sources

in Medicine and Health Care

Compiled by PETER DALEThe British Library, SRIS, 1995162 pp., £39.00 (pbk)

This guide is one of a series published by theBritish Library to provide information on sourcesof information for the benefit of researchers andothers. This particular volume, on medicine andhealth care, is likely to be of value to addictionsresearchers and others, particularly those withclinically orientated interests.

The preface indicates that the guide does notaim to be exhaustive. Clearly some libraries thatmight have warranted inclusion have not been


identified or else have not responded to thecompiler’s request for information. The guideonly aims to include those libraries which are“prepared to accept serious enquiries from out-side, where a reasonable need exists”. Thesevarious factors presumably account for certainnotable omissions such as, for example, the li-brary of University College London, and withinthe addictions field the libraries of the MedicalCouncil on Alcoholism and Alcohol Concern.However, to emphasize the few omissions wouldbe to neglect the great value of this resource.Extremely useful information is provided onsome 1,200 organisations including in each casethe address, telephone/fax numbers, availabilityand opening hours, details of publications heldand other useful information.

Index entries on drug misuse, addiction, andalcohol (health aspects) included the libraries ofthe Health Education Authority, Institute for theStudy of Drug Dependence, Scottish Drugs Fo-rum, National Children’s Bureau, WhitchurchMedical Centre Library, the Institute of AlcoholStudies, and the Scottish Council on Alco-holism. However, it is clear that many of theother libraries listed would also have works ofinterest to addictions researchers.

This is clearly a very useful resource for thoseengaged in searching out information within theaddictions field and in other areas of medical andhealth care research. It would be a valuableaddition to any library.

CHRISTOPHER C. H. COOK

National Addiction Centre,London,UK

SOFTWARE

Reference Manager Special Edition: The

Bibliographic Solution

Research Information Systems, 1994Institute for Scientific InformationSupplied by Bilaney Consultants, SevenoaksProfessional edition £250 � vat

Programs for managing references obtained fromliterature searches become an essential tool inthe research environment, as the amount of re-search publications in different areas has ex-ploded in recent years. For example, over the last

few years, there have been thousands of refer-ences on nuclear magnetic resonance researchalone (an emerging diagnostic technique beingapplied to a wide range of medical conditions,including substance misuse). Therefore, a data-base program that can handle references andincorporate them into manuscripts is potentiallyvery useful and time saving. For the first time, Iused Reference Manager to handle and incorpor-ate the references that I had downloaded from anearlier Medline search into a manuscript that Iwas writing. First, the references were saved as atext file during the Medline search and it wasthen loaded directly into the database that I hadcreated in Reference Manager (the program sup-ports a wide range of literature search data-bases). The programme has the potential ofbeing able to add more references into the Refer-ence Manager database at later dates. Referenceswere then manipulated and edited into the de-sired format. Each reference was given a refer-ence number automatically in the program. Inorder to incorporate appropriate formatted refer-ences into manuscripts, a list of different journalformats and the options of creating and editingnew ones are available in the program. I createda new journal format for the British Journal ofRheumatology (where I will be sending my myosi-tis paper to). Creating a format for AddictionBiology will be just as easy! The manuscript wasfirst written in a standard word processing pack-age: I used Word for Window though the pro-gram also supports a wide range of otherword-processing packages, such as Word Per-fect, and references were cited in the documentin the form of reference numbers as given inReference Manager. The document was thenimported into Reference Manager and anotherversion of the document was automatically cre-ated with cited references properly numberedand incorporated into the manuscript with theappropriate format required by this particularjournal. The resulting manuscript was thensaved and outputted into my word processingpackage where the document was further editedand manipulated. The original version of themanuscript was kept. References and referencecitations can then be changed into a differentjournal format if required in the future.

I think Reference Manager is a very flexibleprogram which supports a wide range of litera-ture databases and word-processing packages.It makes searching for references a lot easier,


once the search has been downloaded into theprogram from the literature database. It quickensand simplifies the usual slow and tedious jobs,such as, typing references into manuscripts andrenumbering reference citations after inserting ordeleting references in the manuscript. Anotheradvantage of Reference Manager is that the pro-gram and the user guide are reasonably user

friendly, which is more than I can say for someof the other computer packages. I highly rec-ommend this package for all research groups.

YUEN-LI CHUNG,Department of Rheumatology,King’s College School of Medicine and Dentistry,London, UK

Announcement from The European Societyfor Biomedical Research on Alcoholism (ESBRA)

ESBRA NORDMANN AWARD 1996

The European Society for Biomedical Research on Alcoholism (ESBRA) has thepleasure of presenting an award in 1996:

To a young scientist for significant scientificcontribution in biomedical research on alcoholism

The applicant should be a European scientist, preferably under the age of 35, recom-mended (in writing) by an ESBRA member.

The winner will be awarded 2.500 Ecu at a ceremony headed by Prof. O. Lesch duringa symposium organized under the auspices of ESBRA in Vienna, Austria, 17–18October, 1996.

ESBRA members are also welcomed to give oral contributions during the same sympo-sium (please contact Prof. O. Lesch directly).

Candidates to the ESBRA NORDMANN AWARD should include the following in theirapplication:

(1) Curriculum vitae including a list of publications.(2) Copies of the most significant publications.(3) An original text of maximum 5 pages presenting either unpublished data or a

synthesis of already published results.

Deadline for receipt of applications is 31 May 1996.

Please forward applications (original � 5 copies of all materials) to: Philippe de Witte,President of ESBRA, Biologie du Comportement, 1, Place Croix du Sud, B-1348 Louvain-La-Neuve, Belgium.

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