Abstract
The prodigious and tragic increase in heroin-related deaths in this country, Australia, has deservedly attracted recent media attention. Unfortunately, too often it has been presented and used simply as a divide across which political barbs can be thrown. The kinds of treatments used by clinicians at an individual patient level have been used to drive political agendas. What is lost is the illness model of the disorder and thereby our capacity to advocate on our patients' behalf.
Swiss clinicians have been substantially more effective in helping their people with opioid dependence and this slim volume is a collection of papers presented in 1998 to commemorate the 60th birthday of the book's editor, D. Ladewig, a pioneer in this field. Of especial interest in this regard is the paper by Besson, which is a brief description of the principles underpinning the St Martin Centre in Lausanne. This is a multidisciplinary reception and ambulatory treatment centre for drug abusers which provides medical outreach to the street scene, minimal barriers to accessing treatment and an inclusive therapeutic facility with medical, psychiatric and social interventions available. Unfortunately, a detailed presentation of the PROVE study, the Swiss national project to determine the effectiveness of prescribed heroin, is not included, which otherwise may have added a higher degree of topical interest. Nevertheless, the assembled authors present a predominantly Swiss perspective on clinical and research issues pertaining to substance-use disorders.
The papers are grouped into biology, epidemiology, clinical science and historical sections, the latter represented by a potted summary by Richard Muller on the effects of social forces in transforming models of alcoholism. He pleads, in a truncated form, for the rejection of ideologies of individual blame espoused by a significant proportion of the Swiss population and, predictably, by health fund providers. Rather, he cites epidemiological evidence demonstrating the disease model of alcoholism which leads to unemployment, via multiple factors, and subsequent social disadvantage. The response should be one of treatment and assistance, not blame and stigmatisation. One wonders what his thoughts might be about incarceration for public drunkenness in some States in this country. The biology paper is by Rainer Spanagel who has developed a transgenic mouse model of addiction based on an impaired corticotrophin releasing hormone receptor, and presents a snapshot of recent work stemming from this. One study summarised well was the work by Wittchen et al. in Munich examining the aetiopathogenesis of substance-use disorders using a prospective longitudinal design in adolescents and young adults. This work, which was published in European Addiction Research, may not have come to the attention of many readers here, but is an important study into substance abuse and the development of dependence in young people.
As the proceedings of a symposium, it expectedly varies in quality suffering mostly from truncated space; however, there are some interesting papers which would appeal to those with an interest in substance disorders from both clinical research and treatment perspectives. It does, more importantly, highlight the clinical and research activity in Switzerland and Germany in an area desperately clamouring for more attention and resources in this part of the world.