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A Comprehensive Guide on Addiction's Complexities

September 1, 2006
by Gary A. Enos, Editor
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Wiley Concise Guides to Mental Health: Substance Use Disorders

Nicholas R. Lessa and Walter F. Scanlon; John Wiley and Sons; Hoboken, N.J., (201) 748-6395; 2006; ISBN: 0-471-68991-2; softcover; 312 pages; $34.95

The authors of this guide to addiction's characteristics, history, assessment, and treatment leave out virtually no important topics in the field, and manage to present even the most technical of their material in a personal tone designed to engage a variety of helping professionals. Some clinicians may even want to share sections of this book with their clients, particularly a chapter that takes a refreshingly broad look at what the authors term the “neglected dimension” of spirituality.

Nicholas Lessa, executive director of the Inter-Care alcohol and drug treatment center in New York City, and Walter Scanlon, a consultant and interventionist, make a strong case for individualized approaches to addressing “substance use disorders” (their preferred term to “chemical dependency” and other commonly used phrases). In discussing the causes of substance use disorders, they write that elements of both a disease model and a moral model need to be considered, reflecting individuals' varied pathways to disordered use.

In fact, the authors do not tend to reject out of hand any potential tools at the professional's disposal for helping the individual. They do not even skirt ideas as controversial as moderation management and needle exchange. “While abstinence remains the ultimate treatment goal, harm reduction is now a viable alternative,” they write. “The logic here is a simple one: If we cannot get the addict clean and sober today, let's minimize health and safety risks until we can.”

Treatment's building blocks

The book includes a thorough chapter on assessment, diagnosis, and treatment planning, an area that the authors say only a generation ago was the purview of inexperienced paraprofessionals generally looking to bar undesirable clients from a program. The authors outline the important questions to ask in an assessment and discuss several specific tools in detail. They call the Substance Use Disorders Diagnostic Schedule (SUDDS) a favorite instrument of theirs; it formats the symptom categories of substance dependence and abuse into detailed questions and includes a checklist for determining specific substance use disorders.

A lengthy section of this chapter outlines an example of an assessment scenario, leading the reader through an assessment of a 22-year-old male presenting for treatment and offering a multi-axial evaluation, a determination of severity, level-of-care recommendations, and a presentation of treatment goals and services. Throughout the book, shorter case-study sidebars enliven the discussion of topics ranging from abuse versus dependence to co-occurring mental illness.

The authors devote somewhat less space overall to treatment, but focus here largely on stages of change theory and how counselors can incorporate specific skills at each stage of client readiness. They describe the seven essential counseling skills for the treatment professional as listening empathically, understanding the stages of behavioral change, educating the client, resolving ambivalence, knowing the available resources, teaching coping skills, and preventing relapse. These skills correspond to clients' level of readiness—for example, resolving ambivalence becomes important in the contemplation stage.

The spiritual realm

Unlike the case with the book's other chapters, Lessa and Scanlon describe their chapter on spirituality as a right-brain effort and call it “the most enjoyable to write and, in some ways, the most challenging.” They write that the value of spirituality as a growth objective cannot be denied, although they emphasize that spirituality transcends religion.

Their messages in this chapter focus on traits such as acceptance, responsibility, and living in the moment. Their words are simple and heartfelt: “Joy comes from within. It comes from profound satisfaction. It comes from appreciation for what is, not from what will be. It comes from living life according to your own values, fully and completely.”

Amid all the highly useful “textbook” information in this guide, this beautifully written chapter on spiritual values may best capture the special quality of a positive alliance between a helping professional and a client. Its lessons could prove useful for both to revisit.