Review

Calling time on booze and fags

ADDICTION: FROM BIOLOGY TO DRUG POLICY
Avram Goldstein
Oxford University Press, 2001, £10.95

I judge any work on addiction by its approach to alcohol misuse, the forgotten – or perhaps deliberately suppressed – epidemic of our age. On this score, as well as others, Goldstein cuts the mustard.

His avowed objective is to empower the ‘intelligent citizen’ to a better understanding of the drug problem, so that they will make the war on drugs more effective by persuading politicians to adopt more rational drug policies.

The book is divided into three parts: the first describes in admirably accessible language how drugs act on the brain; the second looks in detail at the various categories of drugs – including nicotine – and how they cause addiction; and the final section assesses how society, or rather several western societies, have responded to the problem and gives the author’s prescription for reform.

Goldstein’s perspective is that drug addiction should be regarded as a brain disease and a major public health problem – and addressed accordingly. To Europeans this smacks of a characteristically American medicalisation of what is essentially a social problem, but I think this perspective is helpful.

Surprisingly, in view of his overtly medical frame of reference, Goldstein concludes that all groups of drugs need to be regulated, but that this should vary according to the degree of harm caused to the individual and society. With cannabis, for example, he suggests that the current level of regulation is excessive and recommends controlled trials of deregulation to assess the impact on overall cannabis – and other drug – use. However, for cocaine he endorses a high level of control, as he does for the opiates, but with much greater availability of methadone substitution treatment, the adoption of the Dutch ‘low threshold’ treatment regime, and, interestingly, steps to facilitate regulatory approval of new maintenance medications to improve the range of treatments available.

For nicotine and alcohol, Goldstein proposes much tougher regulatory regimes than those currently in existence. In the case of alcohol, he advocates restricting sales to off licences, increasing taxation to a level that would discourage consumption without unduly encouraging a black market, abolishing ‘happy hours’ and other reduced-price gimmicks, making all official social functions alcohol free, banning all advertising in the media, and introducing tougher law enforcement on drink driving plus random breath tests. And as one example of his proposed measures against tobacco use, Goldstein favours restricting its sales to off licences.

This book is an important contribution to the substance misuse debate. One can but hope that lots of ‘intelligent citizens’ will read it and badger their elected representatives to press for the sorts of radical changes that Goldstein proposes – particularly for alcohol.