Book Review

Adolescent Substance Abuse: Assessment, prevention, and treatment

N Engl J Med 1995; 333:1158October 26, 1995

Article

Adolescent Substance Abuse: Assessment, prevention, and treatment
By Oscar Gary Bukstein. 260 pp. New York, John Wiley, 1995. $39.95. ISBN: 0-471-55080-9

Songwriters and performers who are fortunate enough to have a song played on the radio have instant access to millions of listeners who may buy an entire new compact disk because of a single song. Authors do not have the luxury of enticing us with a single, best chapter. It is not often that you pick up a book on the basis of the title and are pleasantly surprised by its content and readability. Bukstein's Adolescent Substance Abuse is filled with pleasant surprises in the form of valuable, clinically relevant information.

This book starts slowly and seems, at first, like many other medical books designed for academic and clinical readers. But after 50 pages, it becomes clear why the background information is relevant, and the rest of the book (another 150 pages of text) is well constructed, thoughtful, and filled with facts, citations, and clinically useful information about adolescent substance abuse in the United States. In fact, we were struck by the breadth and amount of information presented. We also found that the clarity of presentation and the choice of topics and subtopics helped us to realize what is missing in the literature and what still needs to be done.

This book contains 11 chapters that address historical and theoretical perspectives on substance abuse, diagnosis, epidemiology, developmental issues, coexisting psychiatric disorders, assessment, medical evaluation, treatment issues, and prevention as they relate to adolescent substance abuse. All these topics are well presented, with some particularly strong chapters and some weaker ones. The truly outstanding chapters include those on adolescent development, coexisting psychiatric disorders, assessment, and treatment. The thorough, well-referenced discussions of these topics should be useful to practitioners, researchers, and others interested in substance abuse. The information is nicely organized, clearly stated, and practically focused.

The material in the weaker chapters of the book is not wrong; it is incomplete. In other words, what is presented is correct and useful, but in some places this book misses opportunities. For example, the inclusion of tobacco in some sections of the book is interesting, useful, and relevant. But tobacco is not mentioned in other sections. The information on steroids, 3,4-methylenedioxymethamphetamine (“ecstasy”), methamphetamine (“ice”), alcohol, cocaine, opiates, hallucinogens, and so on is apropos, but the absence of a discussion of the abuse of solvents (e.g., gasoline and turpentine) is unfortunate because these substances, which many adolescents abuse, are neurotoxic. The inclusion of differences in patterns of substance abuse according to sex, race, ethnic group, socioeconomic status, and sexual practices is laudable and valuable, but these distinctions do not appear in every chapter where they are relevant. The book presents information on the medical consequences of the use of specific drugs, but a discussion of the effects of common drug interactions (e.g., tobacco and oral contraceptives, alcohol and opiates, and tobacco and alcohol), especially in the light of the incidence of multidrug abuse, would have been welcome.

Although we could nit-pick about details, Bukstein deserves a lot of credit for writing such a useful and informative book. It is particularly noteworthy that adolescent substance abuse, although recognized as a critical problem in our society, has received relatively little useful scholarly attention. In our review of the National Library of Medicine's 2330 book titles on substance abuse, we found that less than 5 percent focus on adolescents, and these books report primarily epidemiologic data. Bukstein's book meets a need and does it well.

Neil E. Grunberg, Ph.D.
Laura Cousino Klein, M.S.
Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799