The Science of Addiction: From Neurobiology to Treatment

By Carlton E.Erickson.Norton Professional Books, 2007.£21.00. 288 pages

Review by Dr KillianWelch,Specialist Training Registrar in Substance Misuse, Edinburgh, UK

Professor Erickson’s book is ambitious. His stated goal is to improve the care and outcomes for people with drug and alcohol dependence problems by educating their professional caregivers on the latest ‘addiction science’ research (sic, he loathes the term addiction). To try and distil the accumulation of neurobiological research on compulsive alcohol and drug use into a jargon-free, lucid, accessible and comprehensive text is a remarkable undertaking; to attempt this in less than three hundred pages even more so.

As an educational resource ‘The Science of Addiction’ largely achieves its objectives. After a discussion of terminology, it moves on to outline the neuroanatomical and neurochemical basis of addiction, describes the complexities of genetic studies and comprehensively summarizes the characteristics of the various drug groups. Treatment follows, and then a discussion of treatment research and the techniques and technologies employed in this. Additionally it includes a section dispelling drug myths, boasts a useful glossary and is rigorously referenced throughout.

The style is well judged; while informative and certainly not simplistic, jargon is indeed avoided, and the interested reader will remain engaged even if they have only the most rudimentary scientific background. This is one of the book’s great strengths. When a grounding in basic scientific concepts is essential to comprehend research findings, then a clear and eloquent explanation of these concepts is provided. As such, the reader is educated in the basics of neuroanantomy, neuroscience, physiology and human genetics. Perhaps most impressively, in the chapter discussing the methodology of addiction research, the reader is taught the basics of critical appraisal.

Though ‘The Science of Addiction’ has huge breadth and covers disparate topics, some themes are evident throughout. Prominent among these is the repeated emphasis on the disease model of chemical dependence. This is understandable and unsurprising; it is a natural consequence of placing emphasis on the deranged neurochemistry associated with compulsive drug and alcohol use. Related to this model is the distinction, emphasised repeatedly throughout the book, between abuse of a drug, in which choice is involved, and dependence, a chronic brain disease which prevents the sufferer from exerting control over their substance use. Professor Erickson likens the latter state to conditions such as type I diabetes or Parkinson’s disease, believing that the individual can no more be held responsible for their condition than can the person afflicted by these illnesses. It is an important message, convincingly argued, and one which may well have great utility in tempering the stigma frequently experienced by drug users.

The adoption of the disease model does have other consequences however. It also provides the rationale for Professor Erickson’s belief that while reducing availability of alcoholic beverages will certainly reduce wilful abuse of the substance, it will not reduce alcohol dependence; ‘the people with the disease will use alcohol any way they can get it’ (p219). He may well be right, and of course detailed discussion of social interventions to address substance use is anyway largely beyond the remit of his book. It is important, however, that in the pursuit of a medical explanation for substance dependence, societal interventions known to have major benefits for the population as a whole are not sidelined.