Book Review

Neurological Aspects of Substance Abuse

N Engl J Med 1994; 330:724March 10, 1994

Article

Neurological Aspects of Substance Abuse
By John C.M. Brust. 289 pp. Boston, Butterworth-Heinemann, 1993. $75. ISBN: 0-7506-9005-4

This book was written on the basis of the premises that “neurologists would welcome a book on drug abuse” and “that most biomedical aspects of drug abuse are in fact neurological.” Although it may not be politically astute for a psychiatrist to comment on the veracity of either of these assumptions, it is fair to say that this is a practical and thoughtful single-author book on drug abuse written in a terse and easy-to-digest style.

The author admits that the impetus for the book came from preparing a chapter on drug dependence for Clinical Neurology (New York: Hoeber-Harper, 1955). Accordingly, it is crammed with information and neatly packaged. There are many useful tables on various aspects of drugs of different pharmacologic classes that are almost encyclopedic in nature. Another striking feature of the book is the hundreds of references listed for each chapter. These references are comprehensive, rather than selective, and constitute almost 40 percent of the total page count.

The book is not tedious reading, however, in no small part because of the delightful appearance at the beginning of each chapter of pointed quotations relevant to the topic to be covered. It is apparent that the author has given a great deal of thought to the choice of these quotations, since they convey (to me, at least) considerable clinical and human insight.

The first chapter is a general one dealing with questions and definitions. Its down-to-earth and opinionated flavor is well captured by the opening quotations from Mark Twain -- “Giving up smoking is easy. I've done it hundreds of times” -- and Nancy Reagan -- “Just say no.” After reading this competent review, which in a few pages covers a very complicated field, one certainly has a good idea of the author's views as well as the major controversies in the field.

This introduction is followed by chapters devoted to the opioids, amphetamines and other psychostimulants, cocaine, barbiturates and other hypnotic agents and sedatives, marijuana, hallucinogens, inhalants, phencyclidine, anticholinergic agents, ethanol, and tobacco. The topics covered in most chapters include the history of the drugs, the social costs of drug use, genetic aspects, pertinent studies in animals, drug metabolism and pharmacodynamics, diagnosis and treatment of intoxication and withdrawal, medical and neurologic complications and their management, and the various commonly used treatments.

In my opinion this medicalized overview of drug dependence should have a very wide audience in addition to the neurologists for whom it was intended: specifically, not only medical students and house officers but also those involved in continuing their medical education. Readers will find in this book a contemporary survey of the biomedical aspects of substance abuse and dependence that bridges the standard discussions of this subject in textbooks of pharmacology, internal medicine, and psychiatry. As far as teachers are concerned, the tables are ready-made for use in lectures.

Peter Martin, M.D.
Vanderbilt University School of Medicine, Nashville, TN 37232