Book Review

Medical Diagnosis and Treatment of Alcoholism

N Engl J Med 1993; 328:1858-1859June 24, 1993

Article

Medical Diagnosis and Treatment of Alcoholism
Edited by Jack H. Mendelson and Nancy K. Mello. 699 pp., illustrated. New York, McGraw-Hill, 1992. ISBN: 0-07-041491-2

“To know alcoholism is to know medicine.” Medical scholars will quickly recognize that I have used literary license in paraphrasing an adage attributed to Sir William Osler, one that referred to syphilis, a disease that in the pre-antibiotic era was certain to tax the diagnostic and therapeutic skills of the physician. The protean clinical manifestations of alcoholism are an equal challenge to the modern clinician, as demonstrated by this multidisciplinary book, which “was prepared to assist health care providers to alleviate both the symptoms and consequences of alcohol abuse and dependence.”

This compendium covers a wide range of topics related to alcoholism. It contains 17 chapters written by experts who express with proficiency the accepted knowledge as well as their own opinions. There are state-of-the-art reviews of the basic and clinical pharmacology of alcohol; the pathogenesis, diagnosis, and management of alcoholism and its complications; and problems of alcohol in special populations (defined by race, sex, and age). The reference lists are recent and reasonably complete. This book could aid those who are studying for the certification examinations of the American Board of Psychiatry and Neurology or the American Society of Addiction Medicine in this field, but who do not want to delve too deeply into the literature. Other clinicians who simply want to learn how to take care of the often difficult patients who have alcoholism may find this book's focus on ethanol as the psychoactive substance of abuse a practical limitation; it echoes the artificial division of the field by the biomedical research establishment into two independent institutes of the National Institutes of Health.

The complexity of alcoholism is evidenced by the fact that each of the contributors elucidates only certain facets of the problem and the editors do not seize the opportunity to provide the reader with the necessary integration. For example, one of the more straightforward clinical problems in alcoholism, the management of withdrawal, is dealt with in some depth in at least three of the chapters, with resulting inconsistencies and even contradictions. How will the clinician approach more controversial issues such as the genetic determinants of alcoholism, the psychological and sociocultural factors that contribute to and exacerbate it, and the toll this disorder takes on future generations, without some guidance from the editors? There may well be a lesson to be learned from this question. Alcoholism is perhaps even more complex than syphilis must have appeared to our predecessors, and there are few who can hope to have the Oslerian breadth of knowledge required for its understanding.

Peter R. Martin, M.D.
Vanderbilt University, Nashville, TN 37232