Abstract
This book is one of a series of research monographs on the addictions. I do not know what colour the other ones are; this one is apple green. There are not many pictures in it. It will not look good on my coffee table. But it was borrowed three times in the first month I had it and I needed professional support to get it back. I keep it hidden now, reaching for it only when I want to know something about cannabis.
Cannabis use is so widespread it is difficult to imagine clinicians in the mental health area not coming across it regularly. It may not always be the immediate focus of clinical attention, but it is often there in the background. As the importance of addressing cannabis use in our patients has become increasingly apparent over the past decade, the evidence guiding how we should do this has begun to emerge.
Most of that evidence is presented in this book in a little over 350 pages. Fifteen chapters, divided into five parts covering diagnostic aspects, pharmacology, epidemiology and health consequences; various interventions; interventions with adolescents and young people; policy implications; and a concluding chapter on implications for future research. The chapters are each written by leading experts in that particular area and this is the strength of the book – its authority. And do not be fooled by the cover blurb that asks “does cannabis dependence exist?” Of course it does, the evidence has been around for many years and those likely to find this book useful will already know that. As a marketing device, this cover teaser sells the book short.
A few chapters present detailed results on key studies, especially outcome studies on specific interventions, and this could be hard going for those who simply want a review of what these data show. However, there are some gems hidden within. For example, that while motivational interviewing and relapse prevention are the mainstays of current clinical approaches, empirical support for this is rather flimsy to the point that I think their pre-eminence may not yet be justified; that motivational enhancement therapy seems to work, but not necessarily through increasing motivation; and that relapse prevention approaches also seem to work and of the attributions and behaviours targeted, the abstinence violation effect may be more important than others. Personally I find that having the researchers interpret studies in detail and from a clinical perspective adds nuances that are illuminating. But that is just me.
As a “state of the science review” of cannabis dependence the book fills a large gap very well. There are a few areas of weakness especially for clinicians working in the mental health and addictions fields. The coverage of cannabis and psychosis/schizophrenia and cannabis and mood disorders is somewhat light; I would supplement this book with Marijuana and madness [1] and with the Degenhardt et al. excellent review “Exploring the association between cannabis use and depression” [2].
If you are a clinician who thinks that cannabis abuse and dependence are clinical problems that impact on the patients you see, then you should dip into this book. If you do not think that, you should buy it! If you are a tertiary student in the health area, especially at postgraduate level, I think you should have access to this book and use it often. If you, like me, are a clinician working in the addictions field you should own it and chain it to a desk or know a good repo man.
Fraser Todd
Christchurch, New Zealand
© 2007 Fraser Todd