ADDICTION TREATMENT: A STRENGTHS PERSPECTIVE

ADDICTION TREATMENT: A STRENGTHS PERSPECTIVE Katherine van Wormer and Diane Rae Davis, Pacific Grove, CA: Wadsworth, 2002. 456 pp. $57.95 paperback. ISBN: 0-534-59670-3.

Katherine van Wormer and Diane Rae Davis's Addiction Treatment: A Strengths Perspective (2003) presents a dilemma. Inclusion

of the term "strengths perspective" in the title of any book intended for a target audience of social workers imposes on a reviewer the dilemma of whether to respond only to its strengths. Must we be constrained to a critique that only addresses the strengths of the text under consideration, focusing solely on its merits, eschewing mentions of any deficits or shortcomings? If a text purports to espouse a "strengths perspective," are the "strengths gone awry" or limitations of the book still within the purview of the reviewer (personal communication with R. Nooe, August 23, 2003)?

The complexity of this dilemma is further amplified by the ambiguity of what actually constitutes a strengths perspective and whether the strengths perspective is in fact an efficacious or effective approach to treatment, either in substance abuse or more broadly in social work. Staudt and colleagues (2001) reviewed the empirical literature on the strengths perspective and concluded that "the strengths perspective is a value stance, but there is little support for it as a distinct and uniquely effective practice model" (p. 1). In the substance abuse treatment literature there is evidence that strengths-focused approaches to treatment, such as motivational interviewing, which avoids pathologizing, supports self-efficacy, and personal choice, are efficacious in substance abuse treatment.

The dilemma of whether to be bound by a strengths perspective in reviewing a book espousing a strengths perspective is less acute in the case of the work of Wormer and Davis as there is much to recommend in this book and very little that necessitates critique. Addiction Treatment: A Strengths Perspective (2003) is a presentation of the major issues in substance abuse treatment germane to social workers and others involved in the field of addictions treatment. The authors use a biopsychosocial model to frame their presentation of this broad-ranging field of practice. It is the breadth of topics associated with addictions treatment that challenges any text on the subject to be sufficiently comprehensive in its exploration of a particular topic and yet necessarily inclusive of the array of interrelated topics in the field, van Wormer and Davis's 13 chapters and epilogue cover the topics likely most important to social workers and other addiction treatment professionals.

The first three chapters provide an introduction to the nature of addiction, a historical overview of addiction across time and cultures, and a review of strengths-based strategies in substance abuse treatment. Of particular note in the third chapter is the inclusion of a discussion on harm reduction in substance abuse treatment. Harm reduction is widely used in European countries and unfortunately has received limited attention and application to date in the United States, especially in mainstream treatment facilities. The authors present both a compelling rationale for the use of harm reduction strategies and describe the number of implementations of this approach. Also in chapter 3 the authors introduce motivational interviewing, an approach to substance abuse treatment supported by an extensive body of evidence of its efficacy.

The second section of Addiction Treatment: A Strengths Perspective is devoted to the biology of addiction. In chapter 4 of this section, the authors address the pharmacology, metabolism, neurology, and health consequences of addiction. Chapter 5 describes interventions, including medical interventions that address biological factors manifest in addictions treatment. The substance of these two chapters is extremely important to addiction treatment and too often neglected in most substance abuse treatment texts. It is to the authors' credit that they present the essential elements of these topic areas, some of which are complex and not readily conveyed in the confines of a single chapter. However, readers would benefit from additional content in chapter 4 on basic pharmacology, metabolic mechanisms, and drug interactions. There are numerous resources on the Web related to these topics available from U.S. government agencies. A listing of a these Web sites at the end of the chapters would help readers seeking more detailed information about the biology of addiction.

The third section of the book addresses the psychology of addiction. The chapters in this section cover addiction across the life span; other behavioral addictions, including eating, gambling, and shopping; and substance abuse with coexisting disorders and disabilities. Chapter 6, entitled "Addiction across the Life Span" does a particularly effective job of reviewing adolescent substance abuse from the perspective of psychological development, gender, and social factors. The authors deserve praise for their inclusion of motivational enhancement strategies for adolescents. On the other end of the life cycle, the authors address substance abuse by elderly people, a subject all too often neglected in social work education and practice. The authors' coverage of other behavioral addictions in chapter 7 provides a solid introduction to the spectrum of compulsive addictive behaviors with particular focus on the use of cognitively based interventions. The coverage of these topics is insufficient for practitioners engaged in the treatment of individuals with one or more of these behavioral addictions. However, the content of chapter 7 is a sufficient and orienting introduction to the topics to allow readers to seek out more detailed information. Chapter 8, "Substance Misuse with Coexisting Disorder or Disability," addresses the challenges of substance abuse treatment with individuals who have historically been referred to as duly diagnosed or having coexisting disorders. The strengths of this chapter include its discussion of integrated treatment practices, case management teams, strengths-based interventions, and the inclusion of case studies. The authors' discussion of coexisting disorders was rather cursory-lacking in sufficient detail of the etiology, clinical manifestations, or specialized interventions for this difficult-to-treat population.

The fourth section of Addiction Treatment: A Strengths Perspective covers the social aspects of addiction, thereby completing the presentation of the biopsychosocial model. The risks and resiliencies of families to addiction are covered in chapter 9. The authors present family systems therapy and role theory and describe familial adaptation to addiction. Of particular note in this chapter is the authors' application of the Stages of Change Model to family treatment. They provide an innovative and original adaptation of the Stages of Change Model for working with families struggling with one or more addictive family members. Chapter 10, "Racial, Ethnic, and Cultural Issues," offers a particularly strong discussion of the necessary understanding and adaptation of intervention approaches necessary in substance abuse treatment with diverse populations covered in the chapter. The authors' discussion of each population group is framed from the perspective of prevalence patterns, socioeconomic factors, cultural factors, and treatment issues. Chapter 11 is concerned with the successful adaptation of substance abuse treatment services to accommodate gender and sexual orientation differences. The section of this chapter on substance abuse counseling and sexual orientation is both particularly welcome because it has been insufficiently addressed in many substance abuse texts and sufficiently comprehensive in its coverage of the topic. Chapter 12 is devoted to offering a strengths perspective on mutual-help groups. The major portion of this chapter is devoted to a rather charitable description of Alcoholics Anonymous and the roles it can play in the substance abuse treatment process. The authors devote some attention to self-help groups that did not promote a spiritual orientation such as Women for Sobriety, SMART Recovery, and Moderation Management. Finally, chapter 13 addresses current U.S. public policies that affect substance abuse on a societal and individual level, oftentimes with deleterious effect. The authors clearly advocate for public policies that offer a "reasoned compassionate approach" for those seeking to extricate themselves from a life of substance abuse.

Over the course of the 12 years I have been teaching substance abuse treatment, I have been looking for a textbook that provides sufficient depth and detail in its presentation of the spectrum of topics necessary to prepare graduate social work students for practice in substance abuse treatment settings. Typically, substance abuse textbooks focus on counseling and intervention skills with presentation of this information under-informed by recent research in effective interventions. Furthermore, substance abuse texts commonly either exclude or give scant attention to historical, pharmacological, social, and cultural content, and usually provide only limited coverage on issues of cultural diversity, gender, and sexual orientation. Thankfully, van Wormer and Davis's contribution to the literature has not neglected these important topics that provide context and perspective to the endeavor of substance abuse treatment. This book might be improved with additional content on the process of diagnosis and assessment, an enhanced discussion of intervention strategies, and greater use of linkages to substance abuse treatment content on the World Wide Web. Despite these reservations, Addiction Treatment: A Strengths Perspective is a very well-written, accessible, and empirically informed text that will likely be useful to both graduate students and substance abuse treatment professionals. I certainly plan to give it strong consideration the next time I order books for my substance abuse treatment class.

REFERENCE

REFERENCES

Staudt, M., Howard, M. O., & Drake, B. (2001). The operationalization, implementation, and effectiveness of the strengths perspective: A review of empirical studies. Journal of Social Service Research, 27(3), 1-21.

AUTHOR_AFFILIATION

David A. Patterson

College of Social Work

University of Tennessee

Knoxville