Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

Prefacexiiiwith respect for the particular and salient needs of each case. Slavish adherenceto one method or school of thought, hammering every nail with the same hammer,is not what most experienced, skillful therapists do. Addiction treatment,especially psychotherapy and psychopharmacology, is still very much an art.However, even the experienced clinician must stay abreast of treatment outcomeresearch, evidence-based approaches, and technical and pharmacologicaladvances in the field. Knowledge of how to address comorbid problems is vital,and integration of treatment is the best approach. Patients will seek therapistswith wisdom, compassion, modesty, honesty, knowledge, skill, and good judgment,and will want their therapists to be available, practical, affordable, andactive. Increasingly, patients and their families come to treatment well armedwith scientific knowledge and with high expectations that their health careexpenditure is a value proposition, and they reasonably expect to see positiveresults from their efforts.Addiction is a disease of denial, stigma, and hopelessness, and patientswith severe mental illness and addictions more often than not suffer their darkestdays without the compassionate, evidence-based care advocated in this volume,which can provide a path to a more productive and happier life that is frequentlythe product of recovery. Addiction is a disease of the brain and of thespirit. Helping patients and their families progress to acceptance of their illness,acceptance of a need for help, and making healthier choices to take actionrestores hope and is half the battle. Maintaining progress, developing a treatmentalliance that leads to continued engagement in help, rebuilding of selfesteemand self-care, and development of coping skills that help prevent relapseare essential ingredients of successful treatment programs.The mutual help that patients provide each other in self-help programs,groups, organized rehabilitation programs, network and family treatment, andthrough organized religion and in their daily encounters with others is a forcethat needs to be tapped by the skillful therapist. Some individuals with addictivedisorders are particularly gifted at helping others or providing models ofhope by communicating how they moved past their darkest days, accepted theirillness, reached out for help, developed coping skills, and restored balance intheir lives.Exciting research is under way studying the familial patterns of genetictransmission, localization and sequencing of multiple genes and alleles foraddiction and interaction with other illnesses, and how gene expression occurs.Effects on membrane chemistry, receptor sites, neurotransmission, neuroplasticity,apoptosis, and regeneration of nerve and glial cells, and localization ofbrain effects through imaging, are other areas of basic science that can lead tobetter targeted future treatments. Development of new agents that can provideneurotropic healing of damage caused by alcohol and other drugs and possiblyother psychiatric illnesses such as manic–depression or schizophrenia is a distinctpossibility.