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Naperville, IL: Sourcebooks, Inc., 2009. 288 pp., paperback, $15.99.
To appreciate the value of Dr. Urschel's book, we first have to appreciate why it was written and the audience likely to benefit from reading it. Despite the title, this is not really a book about science, and it's not a book for academic types. This book is designed to get the attention of the suffering addict and alcoholic (or the attention of family and loved ones), and in that regard I think it's a useful publication. The book explains addiction the way a good clinician tries to explain medical problems in the clinic. The language is plain and simple.
The book follows a logical, readable trajectory. First, Dr. Urschel says, you have to understand that you are fighting a disease. He spells out how the brain works and why the brain is vulnerable to intoxicating substances. Second, he exhorts the addicted person to trade in “pro-addiction” thinking for “pro-recovery” thinking, again outlining in basic terms the way that cognitive-behavioral therapy works. Third, he discusses the topics that are part of every good addiction treatment program.
Beginning with triggers and cravings, the middle chapters of the book address medications, 12-step recovery (Alcoholics Anonymous and related programs), and how to make sense of coexisting problems like mood disorders and “dual diagnosis.” Subsequent chapters deal with the recovering family, relapse prevention, nutrition, and goal setting in recovery.
If every patient checking into a treatment program could have, on day one, a manual summarizing what the attending physician believes, and how the program works, and where to get more information, I think that would be helpful. For that reason alone—Dr. Urschel has spelled out his thinking and his belief system in straightforward fashion—this book is going to help people. The book should also inspire other doctors to write down what they think and how they conceptualize their approach. Patients need for us to take steps like this.
There are shortcomings likely to be corrected in future editions. There are no footnotes, there are imprecise references, and there is no bibliography. Instead, the reader is encouraged to visit the website for the treatment program Enterhealth, where Dr. Urschel is the chief of medical strategy. In that sense, critics will contend that the book is a marketing tool, but frankly I don't have a problem with that, because there is very useful information in the book. Dr. Urschel is trying to help people, and he makes a living practicing medicine. Dr. Urschel has done us a favor by putting so much of our current knowledge in one place.
Some of Dr. Urschel's claims about success rates, alternative therapies, and biological therapies are controversial. Some of them I question, and some I think are a bit too bold. For example, he advocates a novel approach to the treatment of stimulant abuse, but mainstream addiction professionals generally do not share his confidence and enthusiasm for the method. On balance, however, here is my bottom line: if an individual takes the advice in this book, working the program cover to cover, his or her chances of getting clean and sober will improve significantly. The sections explaining cognitive therapy, the basics of brain function, and the fundamentals of 12-step recovery are well done. I should also add that I have followed the recommended links to web-based information, and my findings are for the most part very positive. A person does not have to enroll as a clinic patient or go to the treatment center to benefit from the content and the modules offered by Enterhealth.
My final observation about this affordable, accessible paperback is that the busy physician—given that most physicians don't know much about addiction and don't know how to advise their addicted patients—can have a dozen copies in the office. It would not be a bad idea to tell a patient, “Take this home and read it. There is some good stuff here that may help you.” A good book becomes even better when we can say that it's worth giving to someone else.