This book achieves what its title describes: it serves as a guide in the pharmaceutical management of substance use disorders (SUD). It delivers on its summary and achieves much more, it is less of an expansive collection of factual information and more an interesting and useful guide to the complications of SUD management. There were many times while reading this book where I thought: ‘I had wondered about that’. It takes the confusion and enigma out of prescribing for those who use substances, specifically in prescribing related to management of their substance use and it’s effects. Truong T.T et al. have combined the latest research and accumulated experience from a relative paucity of evidence-based research on the area and combined it in one efficient and accessible guide which eases the reader through the many comorbidities and complications possible for these patients.
The book’s title, while describing it’s function well, does the book little justice. It does not cover the management of substance use disorders by discussing substances in tandem; it cuts through such tedious style reading and gets to the important questions like how to manage polysubstance misuse and how to manage such complexities in different vulnerable groups such as those under the age of 18 years and youth. The authors have dedicated chapters with a focus on managing substance use in those with HIV, pain disorders, LGBTQ + individuals and in pregnancy. It informs the reader and perhaps reminds the reader of why these groups are vulnerable and need additional care.
Due to its refreshing approach and helpful insights, I found it curious that there is little information about the authors online. The writers have largely achieved an MD or PhD for research on topics related to addiction and its management. Many of the authors have co-written various articles previously, and this appears for the vast majority to be their first book. Kosten T.R has an impressive research record and has written articles on ‘stress and substance misuse among drag performers’, ‘anti-fentanyl vaccines as medical solutions to overdose deaths’, ‘the opioid epidemic settlements: who will benefit?’, and ‘innovative non-opioids for chronic pain: ketamine and cannabidiol’. Kosten seems to ask direct questions and get to the crux of topics in his work, which is a style seen again and to be appreciated in this book. Kosten discusses sensitive topics and minority groups with an ability to understand their difficulties and how they may be affected by stigma.
The authors seem to be quietly successful, and little information gives away their backgrounds or true personas. This is evident in their book, which does not aim to argue or persuade; it simply seeks to inform and contribute experience to a paucity of research on pharmacotherapy for substance use disorders. Although not its main objective, this book convinces the reader to adopt an approach of dual management, the management of substance use disorders alongside mental health disorders. This idea may be novel to anyone working in mental health, other than those who have interest in the dual approach, who may prefer to direct treatment of SUD prior to and separately to mental health issues. The dual management approach advocated, however, is inclusive and works to manage both addiction and mental health difficulties simultaneously to maximise the benefits and proven efficacy for sufferers. As a trainee in psychiatry, I have noted how those with substance use disorders are advised to gain treatment for their addiction prior to accessing therapies for the mental health disorders and vice versa. Such useful and logical management guides make dual management attainable and beneficial. The patient is placed back into the centre of their own care and does not experience the inevitable failure of mismanagement with separate approaches.
‘Pharmacotherapy for complex substance use disorders’ takes the mystery out of how to treat those with complications related to substance use and offers practical advice using drugs which many psychiatrists are aware of and perhaps use already including gabapentin, clonidine, bupropion and topiramide among others. Many of those who need help with mental health disorders often suffer with substance misuse or substance use disorders; it is encouraging to have access to such succinct and uncomplicated guides on management of these complex and vulnerable people. While informing, this book encourages the reader to consider the possibilities for treatment. The book is useful for experienced clinicians and junior clinicians alike; it advises all on how to screen for substance use and how to frame questions to achieve relevant answers which of course facilitates decisions on treatment and management.
When considering the possible limitations for inclusion in this book review, I have to surmise that there are not many, perhaps, this book could have placed a focus on the need for community supports in recovery and how this is as important as medications and therapies; however, this is not what this book is hoping to achieve, and it does not seek to cover non-pharmacological supports. Overall, ‘Pharmacotherapy for complex substance use disorders: a practical guide’ is a knowledgeable and readily digestible book which is cleverly structured with good pacing and thought-provoking information. It can be used as a quick reference while it also serves as an appealing book for those interested, this book will likely be of benefit to many clinicians who work within the community and acute mental health units alike.
Competing interests
None.
