Book and Media Reviews

Addiction Biology (1996) 1, 447–455

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 CDs, videos,etc.). However, specific “addictions” software applications seem to be relatively uncommon and, as theseitems are rarely reviewed elsewhere, we will endeavour to include reviews of some of the older programmes thatare still useful, as well as new titles that appear. I would appreciate suggestions of any items suitable forreview, but especially software and other media of specific relevance to the addictions.

Books

Alcohol and Public Policy

H. D. HOLDER & G. EDWARDS (Eds)Oxford, Oxford University Press, 1995288 pp. (hbk), £50.00, ISBN 0-19-262635-3

This book provides a companion volume to therecently published Alcohol Policy and the PublicGood by Griffith Edwards and others (OUP,1994). Alcohol and Public Policy is a very similarwork to its better-known sibling, with a substan-tial overlap in authorship. It covers very similarscope and all the major concerns of alcohol andpublic policy are to be found in both volumes.Beyond these basic similarities, Alcohol and Pub-lic Policy is a much more detailed work, andmore thoroughly referenced than its companion.Chapters are by named authors and are notablydifferent in their style. Accordingly, I found thatsome chapters made riveting reading and pro-vided a goldmine of useful information, whereasothers were frankly less readable and not asclearly argued as were the parallel chapters inAlcohol Policy and the Public Good. However, Ihave sufficient insight to realize that the vicissi-tudes in my enthusiasm while I was reading thisbook reflect my own interests in the field asmuch as they do the ability of the authors tocommunicate their material. There is no doubtthat this book provides a far superior source ofreferences than its older, but less weighty sibling.

In line with the earlier work, trends in alcoholconsumption and alcohol-related problems, indi-vidual and aggregate risks of alcohol problems,alcohol-related accidents, suicide, violence andwork performance are all covered in detail. On apersonal note, I was particularly pleased to seemore material on “inter-generational” effects.However, I still feel that this particular part ofthe book would benefit from more attentionfrom those familiar with the genetics researchfield. It remains a disappointment to me thatenvironmental and genetic aspects of aetiologyare so often dealt with in entirely different aca-demic circles.

Moving on to strategies and policies, the issuesof price, individually directed interventions andpublic discourse are all addressed. The value ofthe moderate drinking message is particularlyrelevant to those who have followed the recentcontroversies over the UK government’s revisedsensible drinking message. The final chapter oneconomic evaluation of alcohol policies providesa sobering reminder of how little we know aboutthe cost benefit analysis, cost efficiency and costutility of introducing these various measures.Considering that this field has such enormousimplications for public policy, in terms of bothhealth and economics, it is a salutary reminderthat we have much more research to do beforewe can be assured of a sound academic basis topolicy recommendations in this field.

For the connoisseur on alcohol and public

1355–6215/96/040447–09 Society for the Study of Addiction to Alcohol and Other Drugs

448 Book and Media Reviews

policy, this book is essential reading. For thelayman, and for the professional who requires amore easily digestible coverage of this importantsubject, Alcohol Policy and the Public Good is thebetter buy.

CHRISTOPHER COOK

National Addiction Centre,London, UK

Treatment of the Addictions—Applications

of Outcome Research for Clinical Manage-

ment

NORMAN S. MILLER (Ed.)New York, Harrington Park Press, 1995161 pp. (pbk), ISBN 1 56023 064 9

This book is a simultaneous publication of thecontents of Alcoholism Treatment Quarterly, 1995;12(2). As such it contains no more or less thanthe journal issue and merely provides the ma-terial in book form for those with no access tothe journal.

Five of the eight chapters are by NormanMiller and the book as a whole provides anoverview of current treatment methods in addic-tion linked to outcome research.

The first chapter provides an in-depth histori-cal review of the development of addiction treat-ment, focusing in particular on the outcomeresearch evidence related to abstinence-basedtreatment.

The second chapter, by Gregory Collins, ex-plores the finance driven modifications to treat-ment packages and reviews the evidence for theclinical effectiveness of these modified treat-ments. The need for continuation of a range oftreatments is explored and references are pro-vided to support the arguments for retention ofintensive inpatient treatments as one of a rangeof therapeutic options.

Further support from outcome-based studiesis offered within the following chapter whichreviews controlled and large-scale evaluationstudies of abstinence-based treatments. The re-maining chapters deal in a more general waywith topics of co-morbidity and treatment ofaddiction in a psychiatric setting; these chaptersdo not fit well into the overall theme of the bookand lend little to the aim of the book with regardto exploring outcome research for clinical man-agement.

The final chapter is a well-written review ofpharmacotherapy in alcoholism, but again con-tributes little to an understanding of the evidencebase for many treatments. Miller’s conclusionthat no pharmacological treatments for alco-holism beyond the acute withdrawal stage can berecommended for clinical practice apart fromdisulfiram may be true, but does little to help thepractising clinician in planning the treatment ofpatients.

This book provides a useful source of refer-ences on outcome research and a few chapterswhich are of value. The area of co-morbidity isdealt with in more detail and more usefully inother publications and does not seem to fit wellwith the other material.

For those who do not have access to thejournal form of the publication then this bookmay be of use, but they may find that obtainingreprints of the first four articles would satisfytheir needs.

R. N. BLOOR

University of Keele,UK

Alcoholism and Ageing: An Annotated Bib-

liography and Review

N. J. OSGOOD, H. E. WOOD & I. A.PARHAMWestport, CT, Greenwood Press, 1995£51.95 (hbk), ISBN 0 313 28398 2

Helping the elderly problem drinker and thoseaffected by his or her drunkenness can be aformidable clinical challenge. Particular chal-lenges can be countering the habits of a life-time,alcohol-induced personality change or intellec-tual decline, and the collusion of relatives orfriends with the problem drinker’s behaviour.Fortunately, there has been a burgeoning litera-ture on alcoholism and ageing over the last 20years. A book which sets out to summarize“What is known” is therefore to be welcomed.This one has sampled works published in En-glish since the late 1970s and contains approxi-mately 300 annotations, each up to a page inlength.

There is an overview chapter followed by theannotations divided into chapters according totype of work (i.e. overview articles, books andbook chapters, empirical studies, miscellaneous

Book and Media Reviews 449

works). Indexes are by author and subject.Consequently, this book represents an extremelyvaluable resource for researchers and cliniciansworking in addictions, mental health and geron-tology.

My reservation is that each annotation tendsto be a rather straightforward outline of a work’scontent with little or no critical appraisal of thework, i.e. a discussion of its strengths or short-comings. The same could be said also about theoverview chapter which offers little evaluation ofthe studies reviewed. A more critical approach tothe literature would have made this book evenbetter.

ROGER FARMER

Senior Lecturer, Centre for Addiction Studies,St George’s Hospital Medical School,London, UK

Integrating Behavioral Therapies with Med-

ications in the Treatment of Drug Depen-

dence. National Institute on Drug Abuse

Research Monograph 150

L. S. ONKEN, J. D. BLAINE & J. J. BOREN(Eds)Rockville, MD, NIDA, 1995190 pp.

This Monograph is one of the NIDA ResearchMonograph Series. It contains a series of 10excellent presentations given at the NationalInstitute on Drug Abuse Technical ReviewMeeting on “Integrating Behavioral Therapieswith Medications in the Treatment of DrugDependence”.

A chapter on “Medications and BehavioralTherapies” by Onken et al. emphasizes the im-portance of behavioural interventions and howthey could interact effectively with medicationsand enhance their effect.

Charles O’Brien et al. summarize a selection ofsome of the significant studies on enhancingthe effectiveness of methadone by using psy-chotherapeutic methods. This chapter concludesthat the efficacy of methadone can be enhancedby psychotherapeutic interventions such asindividual psychotherapy and contingency con-tracting.

A chapter on “Integrating Psychotherapy andPharmacotherapy for Cocaine Dependence” by

Caroll et al. presents a completed clinical trial ofevaluated psychotherapy and pharmaco-therapy,alone and in combination, as a treatment forambulatory cocaine abusers. The trial providedconstantly positive outcomes with behaviouraland cognitive behavioural interventions incocaine dependence.

Two chapters evaluate the efficacy of psy-chotherapy among opioid and alcohol addictstreated by Naltrexone. The chapter on “OpioidAddiction” suggests that Naltrexone should beoffered in the context of a programme of psycho-social interventions to maximize its potentialpositive outcome. The chapter on alcohol depen-dence addresses a very interesting hypothesis. IfNaltrexone blocks the response to drinking-stim-uli, these alcohol-related cues may lose theirability to elicit craving, alcohol-related thoughtsand alcohol-seeking behaviour. Based on thishypothesis, cue exposure techniques could becombined with Naltrexone in order to extinguishthe appetitive effect of these cues. This isdefinitely an area for future research.

In the chapter on “Disulfiram (Antabuse)Contracts in Treatment of Alcoholism” byO’Farrell et al., the disulfiram contract combinedwith a Community Reinforcement Approach(CRA) and “Behavioural Marital Therapy” pro-duced better compliance and less drinking thantraditional counselling with disulfiram. Also, thischapter suggests recommendations for future re-search on methods to increase compliance.

The rest of this Monograph deals with variousissues, including the role of integrated be-havioural and pharmacological therapy:“Combining Behavioral Therapy and Pharma-cotherapy for Smoking Cessation—An Update”;“Integrating Psychological and PharmacologicalTreatment of Dually Diagnosed Patients”;“Combining Pharmacotherapy with Psycho-therapy for Substance Abusers with BorderlinePersonality Disorder”; “Strategies for EnhancingCompliance and Integration of Behavioral andPharmacological Treatments for Panic Dis-order”; and “Implications for the Treatment ofSubstance Dependence”.

All professionals in the addiction field willdefinitely enjoy reading this Monograph and, af-ter all, it is a source of new ideas for futureresearch.

KHALID ALI AL-ABBADEY

National Addiction CentreLondon, UK


Alcohol Problems in the Community

LARRY HARRISON (Ed.)London, Routledge, 1996275 pp., £13.99, (pbk), ISBN 0 415 11043 2

Larry Harrison has successfully brought togethera series of review papers in one volume whichaddress important and often neglected social sci-ence topics in the alcohol field. With the shift inemphasis from hospital to community-based carefor problem drinkers, particularly with the recentchanges in community care legislation followingthe publication of the UK government’s WhitePaper Caring for People (1989), there has been arenewed need for rational debate informed byscience on the best way in which services shoulddevelop. Suddenly, social workers have foundthemselves thrust into a lead role in implement-ing community care alcohol policy and the chap-ter by Harrison, Guy & Sivyer describes the wayin which social services departments were notentirely prepared to take on such a new role.

Indeed, the book itself can be seen as mirror-ing the social science field’s ongoing struggle todefine its role in relation to alcohol. In his intro-duction Larry Harrison describes the change insocial workers’ attitudes from one of pessimismin working with “the most marginalised groupsin society” who had been rejected by highlyselective and predominantly medical services, togreater optimism in the new realization thatproblem drinkers may be ambivalent aboutchange and may need motivational intervention.However, many of the ensuing chapters proceedto examine alcohol problems in marginalizedgroups (such as the disabled, the elderly, ethnicminorities, children, women and the homeless)whom mainstream alcohol services traditionallyhave been accused of ignoring. Nevertheless, todescribe this book as a polemic against medical-ization of alcohol problems would be overstatingthe case and would serve to turn attention awayfrom what is a useful series of reviews. Further,few of us who work with or study alcohol prob-lems in the community would disagree withmuch of the book’s interpretation of the currentstate of the field.

What I found particularly useful was the wayin which several chapters highlighted the import-ance of social factors in the development, perpet-uation and treatment of alcohol problems. Thechapters on child abuse and alcohol problems(Downs & Miller) and social influences on treat-

ment outcome (Marshall) were particularly valu-able in this regard. To those who view thecausation and treatment of alcohol problemsfrom a predominantly biological perspective, thisbook will provide an important introductoryfunction. To the rest of us who have alwaysviewed social factors as important, the reviewswill help to highlight gaps in knowledge and newopportunities for research.

Clearly, the book is aimed at an audience ofsocial work practitioners and trainees for whomit will fill an important gap in the literature,particularly in view of the increased role of socialservices in the alcohol problems field. The careof alcohol problems in the community is one ofthe great social experiments of our time (as it isfor mental health more generally), and it willhave major effects on the pattern, configurationand delivery of services for many years to come.It remains to be seen whether this experimentwill yield the desired result. Nevertheless, no onewho works in the alcohol field can afford toignore such a major shift in policy. This bookshould help in empowerment through knowl-edge.

D. COLIN DRUMMOND

Department of Psychiatry of Addictive Behaviour,St George’s Hospital Medical School,London, UK

Models for Mental Disorder: Conceptual

Models in Psychiatry, 2nd editionP. TYRER & D. STEINBERGChichester, Wiley, 1993148 pp., £11.95

The essential purpose of this book is to describethe principal models used in understanding psy-chiatric disorders. These models include the Dis-ease Model, the Psychodynamic Model, theBehavioural Model, the Cognitive Model andthe Social Model. The final aim is to describehow these integrate forming an integrating (cor-relative) model.

The Disease Model is the one perhaps bestunderstood in the field of addictions by bothclinicians and biologists. Essentially, of course, itimplies a qualitative abnormality in the individ-ual and in the field of addiction it includesprocesses such as adaptation in relation to trans-mitters, cell membranes and voltage-operatedcalcium channels, among other biological possi-bilities. Critics of the disease process in the field


of addiction point out that it is still not clearwhat are the definite biological mechanisms inaddiction. Biologists and researchers, of course,would point out that particularly with a ubiqui-tous nature of certain addictive substances, e.g.alcohol, it is unlikely that one or even a fewabnormalities will explain addictive behaviour.Be that as it may, many individuals prefer to usethis as their model of addiction and outside thehospital field many workers reject the DiseaseModel of addiction. This rejection, of course, isnot new and has been debated for over 200years, particularly in terms of deviance versusillness in the United States.

In relation to the Psychodynamic Model theauthors tend to re-emphasize correctly that thereis not one model and recommended advisedlythat one should think of a psychodynamic ap-proach as “a particular style of clinical thinking”.They do not spell out, however, that the essenceof the psychodynamic approach is that it is ahistorical approach i.e. current behaviour has itsorigin in past events and experiences.

In relation to the Behavioural Model the em-phasis is predominantly on straightforwardclassical or operant conditioning and some be-haviourists would presumably object to a mini-mization of the cognitive factors withinbehaviour therapy. This chapter is, however,considerably more readable than the Psychody-namic chapter and more easy to understand. Inrelation to the field of addictions, particularlydependence on alcohol, it is the BehaviouralModel that in some countries has become thepredominant model to understand addictive be-haviour. This is true probably in the UnitedKingdom and in Scandinavia while in the UnitedStates the biological model still holds a strongposition. In simple terms, the behavioural modelputs forward the view that as alcohol is an inter-mittent reinforcer, the development of the habitof drinking will become increasingly strong.This, together with the reward-forming associa-tions linking with environmental stimuli (classi-cal conditioning) such as noise, smell and otherenvironmental cues, will permit the reward tooccur even in the absence of the pharmacologicalproperty of the alcohol. Of course, if somethingcan be learned, it can be unlearned. Therefore,such individuals may learn to control their drink-ing.

Essentially, the cognitive model is explained asthe patient having a pattern of thinking which

does not fit in with the facts and reality. Thoseworking in the addiction field use aspects ofcognitive therapy when they are trying to motiv-ate individuals to see the negative consequencesof their drinking or drug use and the rewards ofabstinence or modification of their drinking.

The Social Model emphasizes social causes. Inthe field of addiction this would include thequestion of supply of addictive substances andthere are many who believe that the only effec-tive way of dealing with problems of addictionwill be to restrict access through price or othermechanisms.

This volume is a useful, inexpensive referencesource enabling individuals to understand differ-ent methods of approaching psychiatric illnessand psychological disorders. In addition, al-though it does not focus on addictive processes,it can be recommended to workers in the field ofaddiction. It points out how far addiction biolo-gists have to go before their case is going to begenerally recognized, and also describes thealternative models that individuals use clinicallyin the field of addiction.

BRIAN D. HORE

Senior Consultant Psychiatrist,University Hospital of South Manchester,Withington Hospital, UK

The Thread of Life. The Story of Genes and

Genetic Engineering

SUSAN ALDRIDGECambridge, Cambridge University Press, 1996258 pp., £16.95 (hbk), ISBN 0-521-46542-7

There have been several attempts in recent yearsto provide a concise introduction to moderngenetics and genetic engineering for the generalreader, of which this book is one of the latest.Written by a practitioner both of science andscience writing, it is also one of the more suc-cessful. It starts with a section entitled “What isDNA?” that gives a lively and lucid account ofthe development of genetics to the present time.Although not strictly set out in chronologicalorder, it paints an intriguing picture of the waysin which ideas have developed and the majordiscoveries have been made. This is followed bya section called “Engineering genes”, providingan excellent account of the methods involved inmanipulating DNA and transferring genes from


one species to another. The third section, enti-tled “Biotechnology” looks at the ways in whichmolecular biological methods are exploited byagriculture and industry and the book ends witha section on the “Final frontier” taking a brieflook at what the future may hold.

In summary, this book has very little to dowith substance abuse directly and the possiblegenetic basis of alcoholism gets only the briefestof mention in a chapter entitled “The burden ofgenetic disease”. Nevertheless, its contents, par-ticularly the first two sections, will be of interestto anyone seeking a short guide to moleculargenetics, its place in modern biology and studiesof disease. Given the broad area covered, it isalmost inevitable that some errors and inaccura-cies have crept in but these are few. It cantherefore be thoroughly recommended for a gen-eral readership and, with its broad but succinctsweep across genetics, provides a quick and pain-less update for those who already have a special-ist interest in the field.

PETER MCGUFFIN

University of Wales College of Medicine,UK

Handbook of Molecular and Cellular Meth-

ods in Biology and Medicine

P. B. KAUFMAN, W. WU, D. KIM & L. J.CSEKEBoca Raton, FL, CRC Press, 1995496 pp., £65.00, ISBN 0-8493-2511-0

This is a concise text which the authors intend tobe used as a stand-alone “bible” of cell andmolecular biology; that the book is in a singlevolume will appeal to many researchers. Thebook covers a broad range of techniques, fromisolation of DNA, RNA and proteins, to theproduction of genomic DNA libraries, PCRtechniques, in vitro mutagenesis, DNA sequenc-ing, DNA fingerprinting, Antisense techniques,DNA binding experiments, in vitro translation,plant and animal tissue culture, antibody pro-duction and characterization and a variety ofmicroscopy techniques. The protocols are in aneasy-to-follow format and the methodology be-hind key steps is briefly explained with usefuldiagrams and figures. However, these brief ex-planations and the short introduction to eachprotocol will only provide readers with a minimalunderstanding of each technique. This brevity is

made up for by many references to other texts,but one asks oneself “shouldn’t I be reading theoriginal text?”.

Trouble-shooting guides and numerous“helpful hints” in many of the chapters willprovide invaluable advice to those attemptingthese techniques for the first time. The quality ofthe artwork in the book is poor and the repro-duction of one figure in particular makes itdifficult to determine what is being shown.Where a number of different methodologies areprovided, the authors give no indication as towhich protocol is most suitable for particularsituations. Some discussion as to the benefits oradvantages of each given method may have beenuseful.

Overall this book will provide a useful back-uptext in a laboratory context, and the bookachieves its secondary aim of bringing togetherdiverse protocols into a logical framework. How-ever, I feel that the authors have failed to achievetheir primary, and perhaps overly ambitious, aimof producing a book that will wholly satisfy theneeds of researchers, teachers and students.

ANDY MCQUILLIN

University College Hospital London,UK

Clinical Chemistry, 3rd editionWILLIAM J. MARSHALLLondon, Mosby, 1995320 pp.

Clinical Chemistry has been a popular textbookfor undergraduates since its first publication in1989. Whereas previous editions were similar informat, albeit in a different colour scheme of thecover and figures within, the third edition makesa leap out of this mould. This cover is colourfuland eye-catching when browsing over medicaltextbooks in a bookshop. More importantly thecontents are attractively presented. The 320pages of text are divided into 22 chapters cover-ing aspects of clinical biochemistry that a studentwould commonly encounter during trainingeither at undergraduate or postgraduate level.There is a useful introductory chapter outliningthe use of biochemical tests and concepts of whatis normal and abnormal when interpreting re-sults. Individual chapters encompass a core oftopics required during basic medical training andalthough there has been some amalgamation of


chapters of previous editions, more informationseems to be packaged within while still retainingthe overall structure and dimensions of the book.The style is clear and informative, as are thefigures represented pictorially to display bio-chemical pathways or as lists. When combinedwith case-presentations the relevance of tests inthe clinical process of diagnosis to managementis brought into much sharper focus. Clinicalchemistry is the study of body chemistry whenaffected by disease and therefore links clinicalmedicine with physiology and pathology. Thevariety of techniques used to enhance the con-nection between basic medical sciences withclinical medicine, is useful not only to the medi-cal student and postgraduate, but also to scien-tists specialising in laboratory sciences. Asummary at the end of each chapter not onlyconsolidates the information but is also a trea-sured resource for any student during the rushedfew hours left for revision at examination time.Readers will testify that it is an essential recom-mended text and makes clinical biochemistry amore palatable and certainly more digestiblesubject.

C. MONIZ

King’s College Hospital,London, UK

Models in Biology: Mathematics, Statistics

and Computing

D. BROWN & P. ROTHERYChichester, Wiley, 1994688 pp.

Biomathematics and biostatistics have tradition-ally been taught as separate modules in courseson mathematical biology. Biomathematics dealswith the problems associated with the formu-lation of deterministic and stochastic modelswhile biostatistics addresses the problems associ-ated with testing the applicability of such modelsusing real data. This book represents an originalattempt to integrate the two approaches into asingle text.

The book falls into four main sections. In thefirst section deterministic models of growth andgenetics are described. These are supplementedwith descriptions of the common distributionsassociated with stochastic models and considers

how these may be incorporated into the analysisof deterministic processes and discusses how theresulting models may be assessed using re-gression analysis. Section two deals with tech-niques for dealing with comparisons betweenpopulations with particular emphasis on theanalysis of variance. The further complicationsintroduced by interaction effects are dealt with inSection three, with particular emphasis on exam-ples deriving from Biochemistry, Physiology,Ecology and Epidemiology. In order to test thesemore complicated models the authors introducefurther analytical techniques such as GeneralisedLinear models for bio-assay and dynamic modelsfor yeast growth. The final section contains fourchapters on advanced topics—“Diffusion pro-cesses”, “DNA pattern and sequence”,“Multiple Regression” and “Neural networks”.

Throughout the text, emphasis is placed onevaluating the models through a combination ofmathematics, worked examples and computersimulations. This pragmatic approach is greatlyassisted by the inclusion of many helpful illustra-tions, a detailed mathematical glossary and thenecessary statistical tables. A computing sup-plement is separately available containing techni-cal details that enable the student to simulateand test many of the models described in thetext.

Brown & Rothery have succeeded in produc-ing a textbook for mathematical biologists thatshould be made available to all undergraduatesand postgraduates.

BOB BLIZARD

Institute of Psychiatry,London, UK

Software

eBNF (Electronic British National Formu-

lary) No. 30

London, British Medical Association and RoyalPharmaceutical Society, 1995CD-ROM, £50.00 (for two editions)

The paperback version of the BNF has beenavailable in its current format for 15 years. LastNovember saw the release of the latest develop-ment—electronic BNF, on compact disk (CD).

In order to access the eBNF CD, a CD-ROM,Windows (at least Microsoft 3.1) package and a


386 computer are required (a 486 is preferablefor faster access to information). There are likelyto be Macintosh, DOS and Unix versions avail-able in the future.

Loading the data from this striking redCD onto the hard disk is made easy bythe succinct directions on the back of thecover—there is no accompanying manual.The “eBNF Browser” then gives detailed infor-mation on access to the information containedon the disk, and lists contacts for problems orenquiries.

Initially a tree index appears on the left thirdof the screen, with colour-coded book icons forthe chapters. “Clicking” on a book opens thechapter and reveals subsections. The text of aselected item is shown in the upper half of theright side of the screen and can be scrolledthrough while the index is retained on the left ofthe screen.

The lower half of the right side of the screensimultaneously lists drug interactions associatedwith the subject selected instead of the separateappendix in the book. However, anomalies existin the text where it states “interactions:Appendix 1” as none exists, and “see page…”when page numbers are not traceable.

There is a Word Search facility, where anysubject can be free-text searched. For example,by entering “depression”, all monographscontaining the word will be listed. Some ofthe examples may not be relevant, suchas “depression of respiration” but trying toidentify depression as a contraindication orside effect would be a laborious task with thebook.

In contrast to the paperback, provided freeto NHS doctors and pharmacists, eBNFcosts £50 per user for two editions. In manyrespects it is a direct copy of the original. Theimmediacy of interaction information is adefinite advantage, and the search facility is auseful device.

The appendices on drugs in liver and renaldisease, pregnancy and lactation have not yetbeen included on the eBNF. Apparently theywill be included in subsequent editions, but untilthen the paperback is the more comprehensivetext for daily clinical use.

T. A. HILTON

Senior Clinical Pharmacist,Maudsley Hospital,London, UK

TICTAC: The Identification CD-ROM for

Tablets and Capsules

JOHN RAMSEY (Ed.)London, Chapman & Hall£1000 Subscription (single user)

TICTAC has been available for a number of yearsand is the only reliable method of identifyingtablets and capsules. In its original form, TICTAC

was perhaps slow, laborious and notoriously im-precise but, in the hands of an experienced oper-ator it could be used rapidly to identifyaccurately large numbers of tablets or capsules.

The explosion in generic and branded prod-ucts has forced the development of a more so-phisticated form of TICTAC—The IdentificationCD-ROM for tablets and capsules. This databasecontains information on over 10 000 productsand is illustrated with over 25 000 high resol-ution colour photographs. It is updated quarterlyand contains many facilities (such as informationon drugs of abuse) which were absent from theoriginal, mechanical version.

The system is simple to install and runs onWindows software (3.1 or higher). It is alsosimple to use and a half-hour browse through itsfacilities reveals many of its multifarious func-tions. The accompanying manual is easy to readand is essential for any new users wishing to usethe identification facility.

TICTAC can now identify “unknown” tablets,capsules, transdermal patches and drug-impreg-nated patches (“stamps”). Information is addedincrementally and a search can be started at anystage. Obviously, the more information pro-vided, the more precise the result.

Dimensions of dose forms may be added but apair of callipers measuring to 0.1 mm should beused for all measurements. If only a ruler isavailable the system allows for imprecision inmeasurement. A balance to weigh to the nearestgramme is needed. When all available infor-mation available has been in-putted, the search isinitiated. The system then shows colour picturesof possible matches so that identification can beconfirmed.

I tested the system with six tablets and cap-sules from our dispensary. One of my test tabletswas correctly identified only from its markings.Two more were accurately identified with moredata. With two others, several possible matcheswere displayed but a definite identification couldnot be made. No matches were found for onetablet despite the fact that any pharmacist could


identify it on sight. This perhaps illustrates thatno database of this type can be exhaustive.

The section on drug abuse is a welcome ad-dition. It contains information on chemistry,pharmacology, pharmaceutics and law and canbe used as an up-to-date reference and as aneducational tool. Clear pictures of drug para-phernalia may also prove to be of widespreaduse.

In general, TICTAC on CD-ROM is a vast im-provement over its original form. It provides arapid, easy-to-use and precise identification of ahuge range of products and gives useful datarelating to drugs of abuse. It is likely to beinvaluable to pharmacists in drug informationcentres, and of considerable use to casualty de-partments, forensic scientists and the police.

DAVID M. TAYLOR

Chief Pharmacist, Maudsley Hospital,London, UK

DRUGDATA: A new computer program about

drug use in the 1990s

J. COHEN & J. KAYLiverpool, Healthwise£49.95 (PC version)

This is an interesting and innovative softwareprogram developed by Healthwise in Mersey.This program should be of use to a wide range ofpeople including health professionals, educa-tional professionals and criminal justice profes-sionals. It contains key data on all aspects ofdrug abuse and contains in the demonstrationcopy video clips of drug preparation and drugadministration in a manner that brings drug edu-cation into the multimedia age. The use of suchan imaginative multimedia approach is to becommended and the quality of information andcomprehensiveness of information containedwithin the database is truly impressive. Thisdatabase and the upgrades of it should be anessential tool of all professionals involved in thefield of drug misuse.

MICHAEL FARRELL


Videos

LAAM: And Other Treatment for Opiate

Addiction

NIDA Technology Transfer Series NCADIvideo tape resource programme

LAAM is a long-acting opiate substitute treat-ment drug that can be consumed on a threetimes weekly basis.

If this video were for an antidepressant orantipsychotic medication it would be a standardpharmaceutical company video presentation onthe product. In the field of drug abuse treatmentsuch videos are virtually non-existent. The di-versification of the pharmacotherapy options forthe treatment of opiate addiction has become anarea for a substantial investment particularly bythe National Institute for Drug Abuse in theUnited States.

Two main substances have been in contentionwith methadone as alternative substitutionagents. Both buprenorphine and LAAM havebeen evaluated and compared with methadone,and have shown good results in specific settings.

This video is a helpful simple presentationwith two happy LAAM consumers and a numberof clinicians and NIDA researchers explainingthe mode of induction and utilization of LAAM.There is also a brief background history, andoverall this tape would be useful as a brief educa-tional video for anybody who wished to give abrief presentation on alternatives to methadone.

MICHAEL FARRELL


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Book and Media Reviews