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resources : newsletter archive : book reviews 2000 Book Reviews 2000 Volume 19, Issue no. 5 Health
Issues related to Alcohol consumption (2nd edition) The reviews in this work have been completely rewritten and updated since the first edition. They cover numerous aspects of alcohol including assessment of consumption, genetics, body weight, cardiovascular system, pregnancy, breast cancer, bone and central nervous system. Chapters on digestive tract cancer and liver disease have also been included unmodified from the first edition. Like many multi-author works the style of the chapters varies. I found the chapter on genetics very hard going but this probably reflects the complexity of the subject rather than any shortcoming in the authors. The chapter on the cardiovascular system was masterly and makes a coherent picture from a mass of data. The referencing of each review is extensive and up to date. This book would undoubtedly be a good starting point for anyone wishing to read up some aspect of the effect of alcohol on physical health. It would be a valuable addition to any organisational library. John
Kemm
2000 Volume 19, Issue no. 4 Drug
and Alcohol Policies It is good to see that the Institute of Personnel and Development have added Drugs and Alcohol Policies to their Good Practice Series of books for the management and development of people at work. The book follows the series pattern being concise, easy to read and clearly laid out. Why Drugs come before Alcohol is a mystery. Perhaps to emphasis the growing importance of the drugs culture but their impact is still less than that of Alcohol. The book, unfortunately, does not have an index but the chapters are well defined with a summary of the subheadings at the beginning of each chapter. The book follows the pattern of a question and answer session. Each chapter heading is a question which might be asked by a Managing Director, or Human Resource manager looking at implementing a policy The first four chapters deal with the fundamentals of a Drugs and Alcohol Policy. Chapter 5 is perhaps the core chapter highlighting the important rights and duties under the law and discussing the thorny question of whether misuse is misconduct or incapability. It also has a good flow diagram of the correct management procedures under the disciplinary or capability routes. This chapter also has some good case law studies which will be "sobering" to the overzealous manager. Chapter 6 on testing does not define the difference between evidential alcohol testing and clinical testing. This is a pity because the Occupational Physician has a good battery of tests (such as GGT, MCV and C-DT) which are often used to identify the dependant drinker as well as for monitoring the rehabilitating employee. These should not be confused with evidential or direct testing for alcohol. When discussing pre-employment screening reference is made of the limited usefulness of alcohol type testing but the landmark case in which a television executive was refused employment after preemployment blood tests (Baker vs Kaye 1996) is not mentioned. The identification of alcohol dependency by medical questionnaire at pre-employment is unreliable. However the main body of the chapter on testing provides sound advice but could possibly have been elaborated on, as this is such a complex subject. Nevertheless additional information on evidential testing can be sought from the appendix. The remaining chapters focus on the policies; how to go about developing a policy; what the policies should contain and how to make them work. Important mention is made of the issue of relapse which is often difficult to manage and also the agreement or contract which employees would need to make when accepting treatment. These two points are not often effectively considered. Managers are well aware of Risk Assessment and Audit and these could have been utilised more effectively particularly when relating to safety critical work. The Appendix provides, as an example, the Railtrack policy. This has a detailed description of the disciplinary elements and the testing that is required but says little about the issues of capability and dependency. Perhaps another policy should have been provided for balance. This book is not prescriptive but lays the foundations for an individual company to make up its own mind of what it requires for its own policy.
M.G.McCann Commissioning
Standards: Drug and Alcohol Treatment and Care This is a very useful publication. At its core are 6 standards indicative of good commissioning practice and 14 standards covering service specification. For each standard a set of criteria are listed by which one can judge whether the standard has been met. Though the document is aimed at commissioners, service providers will also find it well worth reading. Its approach brings transparency and clarity to commissioning. Its adoption should improve relations between commissioners and providers, give better value and improve services. John
Kemm
2000 Volume 19, Issue no. 3 Detoxification This simple handbook gives an account of the effects of alcohol and other drugs, withdrawal syndromes and detoxification programmes in a residential setting. There is a brief forward on the philosophy of the abstinence programme at Clouds house, where the author is medical advisor. The preface explains that the purpose of the book to give advice on "the short term, medical assistance of withdrawal from physical chemical dependence". This is followed by a long introduction in which the role of harm minimisation programmes is acknowledged. There is a table describing physical, mental and social consequences of harmful drinking, misuse of opiates and stimulants. This table does not include the particular dangers of substance misuse in pregnancy and hazards to the foetus, although detoxification in pregnancy is dealt with in a later chapter. Individual chapters describe the physical harm and withdrawal syndromes of alcohol and other chemicals. The detoxification regimes described are designed as part of a six week psychotherapeutic programme in a residential centre. The chapter on alcohol refers to chlordiazepoxide as the treatment of choice and does not describe diazepam loading or other methods of alcohol detox. The author reports that blood tests of liver function are unhelpful during primary treatment. However there is evidence that demonstrating improvements in test results as treatment progresses improves prognosis. The chapter on opiate detoxification describes a clonidine programme with advice for treating hypotension but the more usually prescribed lofexidine lessens this risk of hypotension. I would have preferred detoxification schedules to be included in the chapters describing the individual drugs rather than separated from them as they are in the book. This is a useful handbook for those working in facilities such as Clouds House. It would be very helpful to the uninitiated. However it does not cover many valid detoxification schedules and is not a book for those with substantial experience of this field. Morfydd
Keen Tackling
Alcohol Together: The evidence base for a UK alcohol policy This book seeks to lay out the evidence base for a national alcohol policy. It is the outcome of a project organised by the Society for the Study of Addiction and has been compiled from papers written by a very impressive list of experts and skilfully edited to form a coherent and clearly argued text. It is in four sections. The first covers the historical background and the contemporary context for an alcohol policy, The second section describes drinking patterns in different groups, intoxication, the notion of risk and the risk of various alcohol related harms. The first part of the third section discusses possible ways of influencing consumption including price, regulation of alcohol sales and consumption and alcohol education (which is curiously included under the chapter heading mass media). The second part of this section discusses the response of generalist health services, minimal intervention, specialist treatment and professional training. The final section suggests a series of policy objectives and strategies. The book is extremely well referenced and can be recommended without hesitation to anyone wanting an authoritative introduction to the considerations affecting alcohol policy in the UK. It invites comparison with the document "Proposals for a national alcohol strategy for England" published a few months earlier by Alcohol Concern (Reviewed in this newsletter volume18 part 5). The two cover very similar ground and draw on the same sources. Those with an academic interest in the subject will I think find "Tackling Alcohol together" the more useful of the two books. On the other hand I suspect policy makers will find the Alcohol Concern document easier to use because it addresses their issues more directly. John
Kemm, Public Health Physician
2000 Volume 19, Issue no. 2 Alcohol
Detox in London - GLAAS Report This well referenced report gives clear information about all aspects of detoxification and would be useful either as an introduction to detoxification or as further reading for people with existing knowledge. The report is in 4 separate sections and examines the various issues associated with alcohol detoxification in general and the resources available in London specifically. It examines the theoretical framework behind detoxification and discusses current practice. It explores the debate about the usefulness of this type of treatment and the increasing difficulty in obtaining funds for it. The report notes that there has been a shift from more costly residential treatment to cheaper community based options and acknowledges the growing involvement of General Practitioners. Finally there is a synopsis of the GLAAS led conference held in october 1998 which provides a good insight into the differing needs of the client groups that present to voluntary and statutory sector services. Jo Betterton Tteam co-ordinator, Consultancy Liaison Addiction Service, South London and Maudsley Trust.
2000 Volume 19, Issue no. 1 Overcoming
Addiction This well organised book draws from a number of sources including the author's own experiences to expand on the theme that there is life beyond addiction. A wide range of addictive disorders were introduced, ranging from alcohol abuse to co-dependancy. This comprehensive coverage created a style that was overly detailed and the sections on pre - birth experiences and dysfunctional behaviours were the least satisfactory. The strength of the book lies in its explanation of the root causes of addictive behaviours. It explains how painful childhood experiences can be understood. Poor parenting can inflict on us repressed feelings and frozen needs to be accepted, loved and validated. The book explains how we can address these needs and use the power within ourselves to make us the best we can be. In order to understand the origins of these unmet needs the book offers practical help in the form of searching questionnaires and diaries in which to record upset emotions. These can be used to identify and then change harmful patterns of behaviour and so allow the user to take charge of their lives. The book recommends the use of support groups to heal deep seated emotions. A typical session with a recovering alcoholic is described in which he was able to face up to his repressed feelings of isolation and fear, Facing his fears led him to understand that they were feelings and not reality while group support allowed him to release his feelings of isolation, and begin to form suitable friendships. He later described this experience as the turning point for his recovery. The message of the book is that we are all capable of change. Support is available to those who are willing to accept it from counsellors, helplines, and contact groups. However in order to break free of addictions one must take a few practical steps such as connecting with supportive groups and adopting a self nurturing lifestyle (taking physical exercise and eating a healthy diet). Once physical and mental needs have been met, we can pay attention to the intellectual, spiritual, and creative, side of our natures and become in touch with our real self, the core of our being. Cathy Kemm, Relate Counsellor, Dudley Not
Born Yesterday: The manual is designed for use with care workers who look after the elderly. It starts with a useful section on background information. This enables the trainer to learn about the participants who would be attending the training session. Skillfully designed to be compatible with the S/NVQ in Care at level 2, attendance at this course can be used as evidence of training. The topics covered include information on alcohol relevant to older people, issues around mixing medication with alcohol and practical solutions to help carers approach the issue sensitively, yet confidently, with their clients. The manual anticipates the way care workers will behave and very cleverly develops the structure of the pack accordingly. It contains everything that will be needed for the sessions including handouts, overhead materials and evaluation sheets. The manual is well produced in a ring binder, which enables the trainer to lay it flat for use. This design also helps photocopying the handouts. As a trainer, I welcome this manual to my bookshelf but it will not stay there for long. It will be used again and again. Ms Raby should be complimented on an important, thorough and extremely useful training manual. Moira Plant, Alcohol and Health Research Centre, Edinburgh Drink,
drugs and work don't mix: Promoting drug and alcohol policies in
the workplace This 60 page handbook is aimed at all who might be concerned with introducing or operating a work place alcohol and drug policy. It covers the nature of substance misuse, the size of alcohol and drug problems, the problems they cause in the workplace, the role of a policy, how to establish a policy, legal aspects, disciplinary issues and drug and alcohol testing. The section on how employees with alcohol and drug problems can be helped (including how to strike the balance between assistance and disciplinary action) and the section on drug testing are particularly helpful. This publication would be ideal to guide a personnel manager through the stages of establishing a policy.
return to the Alcoholis archive last modified: 17th March 2001
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