Book Review

The Science of Addiction: From Neurobiology to Treatment

N Engl J Med 2007; 357:1671-1672October 18, 2007

Article

The Science of Addiction: From Neurobiology to Treatment
By Carlton K. Erickson. 290 pp., illustrated. New York, W.W. Norton, 2007. $32. ISBN: 978-0-393-70463-1

Recent advances in addiction medicine have been driven by advances in neurobiology. In The Science of Addiction, Carlton Erickson attempts to enlighten the caregivers of patients with substance abuse problems and the patients themselves about advancements in the science of addiction so that clinicians will, as Erickson explains in the book's preface, “empathize with their patients and apply such science to principles of treatment.” This is an ambitious goal and a broad audience.

The book is organized in a traditional and well-considered manner. Basic terminology, neuroanatomy, neurobiology, and the genetics of addiction are reviewed; the effects of drugs are described; and the quality of current research is discussed, followed by an overview of evidence-based research for the future. The four background chapters give readers the basic tools for understanding addiction and its neurobiology. In chapter 1, Erickson admits, “I don't like the word `addiction',” and goes on to examine the term from various vantage points. He then introduces more conventional terms related to addiction, such as “abuse” and “dependence.” This approach effectually highlights controversial aspects of addiction for readers who are unfamiliar with these concepts.

The next three chapters cover the brain science, anatomy, neurobiology, and genetics of dependence. The chapter on basic science appears to have been written for patients, although many professionals could benefit from the overview. The more complex chapter concerning anatomy and neurobiology goes into detail about the reward pathway. The discussion of how preoccupation with a substance can lead to addiction is particularly interesting. Case studies illustrate these concepts in a way that is accessible to readers. The chapter on genetics provides a detailed discussion of basic principles that, like some earlier material, seems appropriate for readers who are not medical professionals. The review of the evidence for the role of genetics in addiction is somewhat cursory in both scope and depth.

Polarized-Light Micrograph of Dopamine Crystals.

The middle section of the book contains three chapters that present basic information about stimulants and depressants, alcohol, and other drugs. Although these chapters are readable for a lay audience, they also provide clinicians with a particularly useful and well-referenced review of basic pharmacology and the effects of drugs of abuse. The chapter on alcohol clarifies the concepts of social use, moderate use, binge drinking, heavy drinking, problem drinking, and unhealthy use. This terminology can serve as a guideline to help clinicians determine the most appropriate treatment. The remainder of this chapter focuses on the effects of alcohol and seems to be oriented toward lay readers. The chapter on other drugs touches on nicotine, marijuana, and “club drugs” — a rather imprecise term. The discussion of steroids and prescription drugs — two areas of great relevance in current practice — is too brief.

A later chapter in the book examines the scientific basis of treatments for addiction, reviewing basic concepts along with the principles of 12-step and counseling programs. However, the material on counseling falls short of a state-of-the-art discussion of specific modern techniques. A major portion of this chapter is devoted to misunderstood and controversial treatments. Although sophisticated readers may not find methadone maintenance or harm reduction controversial, most will agree that “moderation management” and faith-based treatment are controversial. Erickson rightly points out that scientific evidence supporting some of these approaches is lacking. The remainder of the chapter is a discussion of pharmacotherapies for alcohol and drug abuse. This material, which pertains to alcohol, nicotine, and opioid dependence, is particularly relevant to modern-day practice.

The last two chapters focus on present and future directions in research. Readers are provided with the basic tools for interpreting the literature and are given examples of how to apply some of these tools to research on addiction. Selected studies are discussed to illustrate the principles that are being presented, although this presentation is far from comprehensive. More enlightening is the book's final chapter, “Evidence-Based Research for the Future,” which nicely summarizes current efforts in the area of brain imaging.

This book is appropriate for motivated patients with addiction disorders and for professionals who are seeking a basic refresher in the area of addiction medicine. It is a highly commendable attempt to translate and summarize a fast-moving scientific field.

Patrick G. O'Connor, M.D., M.P.H.
Yale University School of Medicine, New Haven, CT 06520