Book Reviews
though not always enough to come to a different con-
clusion by one’s own thought.
She acknowledges her debt to the work of G. Alan
Marlatt and his colleagues on “Relapse Prevention,”
which is certainly evident in the text. This stance raises
the question of whether the reader might do better
here- and in some other sections- to rout out the
standard text on the subject, rather than read about it
in a digest.
The second half of Volume 1 deals largely with em-
pirical and clinical issues of alcoholic families. It seems
apparent from the enthusiasm with which this mate-
rial is set forth that this is one of Dr. Littrell’s stron-
gest suits. The empirical findings, and the suggestions
about approaches to families, seem sound and reason-
able to me. For instance, she summarizes case exam-
ples of approaches by various authors to situations,
prototypes of themes which may arise in family treat-
ment of alcoholism. (There is also a series of appen-
dices, somewhat more apologetically labelled as “what
I use,” rather than research-based, of structured inter-
views for various settings.)
Volume 2 contains more explication of the back-
ground studies for alcohololgy. The three sections of
this book deal with Heredity, Physiology, and Cogni-
tive and Attitudinal factors in alcoholism. The first
section is a good and sensible update about attempts
to establish what may constitute the genetic compo-
nents of transmission in alcoholism. I must say that
there is a (usually subtle) bias, which is to attempt to
undermine the array of evidence on the side of alco-
holism as a genetic disease, most importantly the twin
adoption studies. Although this happens to be my
bias, too, I was slightly disconcerted to see what I
know are arguments set forth by others on this subject
without always finding the proper accompanying
references.
The middle section on physiology is the weakest of
all five in the two volumes. It probably is necessary to
round out the text, but deserved more elaboration, for
example, on the subject of the possible role of various
neurotransmitters, than it received.
On the other hand, the last section is principally
about psychological research on alcoholism. Here Dr.
Littrell is probably at her strongest. There were a num-
ber of areas of research reviewed here that were new
to me, and I suspect might be to all but specialists who
focus on these topics. For example, she discusses stud-
ies on mood, its relationships to drinking, and exper-
iments to manipulate this as a variable.
Understanding and Treating Alcoholism is a worth-
while set, and definitely worth publishing. The author
is serious, hardworking, and sensible in her approaches
to elucidating the research underpinnings of clinical
practice. However, there are also significant limita-
tions to these texts. For one, it seems to de directed
largely to the astute clinician who wishes to understand
189
and update her/his knowledge about the research in
the field. However, the writing is often quite dry, and
hard to read for extended periods. Fortunately it is di-
vided into convenient briefer topical headings, which
could be used for reference.
The price is high for this audience. Volume 1 could
stand alone, but it is the bulk of the publisher’s retail
price. The set has some utility for academic researchers,
again, as a reference text from which to find the orig-
inal sources. However, it does not pretend to be com-
prehensive, and so, is only a starter for this purpose.
The editor’s and publisher’s work is first rate, with
easily readable text, variation in type, and substantial
indices.
Marc Hertzman, MD
Department of Psychiatry and Behavioral Sciences
The George Washington University Medical Center
Washington, DC
The Drug Legalization Debate
James A. Inciardi, Editor
Newbury Park, California: Sage Publications, 1991,
$29.95 (hardcover), $14.95 (softcover),
230 pages.
The Drug Legalization Debate is a collection of arti-
cles which examines the issues surrounding legalization
of illegal drugs. The articles are by different authors;
several have appeared in the periodical American Be-
havioral Scientist. The book is part of a series, “Stud-
ies in Crime, Law, and Justice;” other topics covered
in the series have included serial murder, misdemeanor
crime, domestic violence, and burglary. However, the
book is not confined to criminal and legal analysis. As
befits the subject, it also provides a sociological anal-
ysis of the drug problem. It is a balanced, informative
look at both sides of the drug legalization debate.
The articles fall into three categories: those that ad-
vocate some form of legalization, those that are
against legalization, and those that provide a more
general overview of the drug problem. One universal
conclusion is that the current “war on drugs” by the
United States has been a failure; where the authors dif-
fer is how such policy could be made more effective,
with or without legalization as part of the solution.
Nadelmann’s article, “The Case for Legalization,”
points out that the supply and availability of illegal
drugs has not been lessened. The successes have been
in punishing the drug dealers who are apprehended,
and perhaps some minor disruptions in established
drug markets. He paints a rosy picture of a society
without drug prohibition: more money in public trea-
suries, less crime, and improved quality of urban life.
190
But he does not make any more specific recommenda-
tions and admits that “It is . . . impossible to predict
whether legalization would lead to much greater lev-
els of drug abuse . . . lessons that can be drawn from
other societies are mixed . . .”
Karel’s article, “A Model Legalization Proposal,”
makes recommendations on a drug-by-drug basis.
For example: coca would be allowable as an extract;
however, crack would not be legal, at least not ini-
tially. For cocaine, he suggests a form of chewing
gum similar to that which is available for nicotine.
He also suggests that granular cocaine be available
in one-gram amounts. To regulate all of this, he pro-
poses a ‘bank-card’ system analogous to the ATM
(Automatic Teller Machine) system, with a limit on
how much drug could be dispensed with a 48 to 72-
hour period. Dispensing, as with other legal drugs,
would be by pharmacies. His justification for his pro-
posals is the relative addiction potential of the various
substances. He realizes that such a system is open
to abuse, but believes that is better than criminal
involvement.
Inciardi and McBride’s piece, “The Case Against
Legalization,” is the only one to take that stand; yet
it is the most persuasive of all of the articles. They
point out that, Karel’s work notwithstanding, there are
very few concrete and logical legalization proposals.
Furthermore, they dispute the assumption that the be-
havioral and public health problems caused by legal-
ization would be relatively minor compared with the
benefits. Less persuasive is their argument that there
have been some social gains in the war on drugs. They
cite surveys of high school students and of the general
population as proof of decreased drug use; however,
such gains have come mostly as a result of educa-
tion, and not from actual interdiction, treatment, or
research. Their major objection to legalization is that
itis“. . . an elitist, racist policy supporting the neo-
colonialist views of underclass population control . . .
since legalization would increase the levels of drug de-
pendence in the ghetto, it represents a program of so-
cial management and control that would serve to
legitimate the chemical destruction of an urban gener-
Journal of Substance Abuse Treatment
ation and culture.” A powerful statement which de-
serves further consideration.
Of the overview articles, the one by Jonas, “The
U.S. Drug Problem and the U.S. Drug Culture: A
Public Health Solution,” is the most sensible. He sug-
gests a back-to-basics approach, which requires re-
search into certain fundamental questions: the true
nature and scope of the drug problem, its principal
causes, and the weaknesses of the current approaches.
The answers to these issues would lead to the discov-
ery of what constitutes a workable, effective antidrug
program, and what would need to be done to put it in
motion. He correctly concludes that (a) the legal rec-
reational drugs, namely, tobacco and alcohol, cause
far greater mortality in the general population than do
the illegal recreational drugs; and that (b) “. . . the le-
gal status of the [illegal drugs] has been determined
chiefly by (changeable) economic, political, and moral
considerations . . . ,” as opposed to by logic, scientific
knowledge, and true social and economic costs. He
also describes the existence of a ‘Drug Culture’ as a
major cause of drug use and abuse in the U.S. This
Drug Culture appears in the way tobacco, alcohol, and
even vitamins are promoted, sold, and used, and in
medical practice. He includes an 1l-point program for
solving drug abuse, including continuing investigation
into and discouragement of the Drug Culture, a com-
mon and uniform system and policy for the sale and
distribution of legal drugs, whatever they may be, and
comprehensive efforts at rehabilitation and job re-
training programs for former drug abusers.
The book is up-to-date; the earliest article is from
1988, while the remainder were written specifically for
this book. And it is indeed readable; there is very lit-
tle legal jargon. In short, I highly recommend The
Drug Legalization Debate to anyone interested in the
issues surrounding the legalization of drugs.
Bernard0 J. Mora, MD
Department of Psychiatry
North Shore University Hospital-
Cornell University Medical College
Manhasset, New York