Alcohol: The ambiguous molecule,
Griffith Edwards, Penguin
Reviewed by Chris Cook

Alcohol is a drug with a long social and cultural history. Too often, its properties as a drug are considered in isolation from this history – or else the history is studied without reference to pharmacology and biochemistry.

There are, of course, few experts who can claim to understand both the medical science, in its biological and social strands, and the social history of this fascinating molecule. Yet, the problems that we face in the UK and internationally, in respect of the use and misuse of beverage alcohol, cannot be understood properly unless we take into account both an historical and a scientific perspective on their causes and their consequences. Only an inclusive and multidisciplinary overview of this kind can do justice to the full complexity of our collective relationship with this "ambiguous molecule". This book provides such an overview.

Griffith Edwards shows an unique familiarity with his subject across diverse areas of interest – including epidemiology, mythology, pathology, medical history, pharmacology, and psychology. He looks at heavy drinking and drunkenness, as well as the choices facing the social drinker. He considers social policy, and treatment of the individual. He does not over emphasise his own significant contributions to this field, but readers will find that they are succinctly and clearly outlined. For example, the alcohol dependence syndrome is described in such a way as to convey a vivid understanding of the day to day experiences of the dependent drinker. Here, as elsewhere, the use of brief case histories helps to bring to life the theoretical material.

The treatment of people with drinking problems is reviewed in such a way as to convey clinical wisdom and human insight, but also so as to inform the reader about important research findings. Especially interesting are the insights in respect of the history of research on the possibility of controlled drinking as a treatment goal for the dependent patient. The role of abstinence, the 12 step philosophy of Alcoholics Anonymous, and the place of the disease concept of alcoholism, are also sympathetically but critically reviewed. In a field where controversies continue to rage, we are warned of the need to steer a course between extreme and opposing views. But this is done without compromise, and it is not a naïve or superficial overview.

It is easy to take a polarised view of alcohol in more respects than merely that of treatment. Griffith Edwards avoids the pitfalls of either viewing alcohol as unmitigated evil, or being seduced by its benefits. This is therefore a very balanced book, and one which necessarily portrays clearly the ambiguities to which the title alludes. It is thus difficult not to be polarised in ones view of the book itself. There will be those who will be infuriated by its author's failure to speak out in favour of the need for temperance and those who will be angry at its criticism of their actions in support of their product. There will be therapists who will disdain the failure to advocate only abstinence as a treatment goal, and those who will see it as insufficiently critical of the 12 step approach. Equally, this reviewer finds it hard not to be uncritically delighted with such a balanced and thoughtful book as this, which eschews simple answers or extreme positions. Doubtless it has its weaknesses, but I failed miserably in my attempt to find anything of note to say against it.

This book manages to convey information in such a way as to be accessible to the lay person, but also informative to the expert. It is highly interesting to read – even for someone who is already familiar with the field. It conveys a fundamental grasp of the issues and problems, and this is its greatest strength, but it also conveys a lot of factual information in the process and has an excellent bibliography. It is an important book for the individual who is concerned with their own drinking, or the drinking of a relative or friend, but it is also an important book for those concerned with the health, economy and security of communities.

Those who know Griffith Edwards personally will be aware that he searches and asks questions in a way which is both infectious and addictive. He does this supremely in his own field, which is the subject of this book, but he has not lost interest in exploring other fields as he encounters them along the way. Do not read this book unless you want to be infected with interest in this ambiguous molecule. Do read it if you want to be stimulated and drawn on in an addictive process of inquiry into one of the major public health issues of our time.

Chris Cook is Professor of the Psychiatry of Alcohol Misuse at the Kent Institute of Medicine & Health Science, University of Kent at Canterbury.

The Ambiguous Molecule is available from IAS at £7.99 not including p&p.