Ana Drug and Alcohol Review The Electronic Cigarette, an Alternative to Tobacco? by Jean-François Etter CreateSpace Independent...
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bs_bs_banner R E V I E W Book Reviews Part 3 discusses the roles of law enforcement, prevention, harm reduction and clinical responses, as well as case studies, personal perspectives on functioning while using ATS and the impact on families who live with ATS users.The chapter on prevention approaches is essential as it is a literature review of the various types of prevention approaches which have been trialled for all drugs (not just ATS), including summaries of findings from large-scale school-, peer- and workplace-based programs. Prevention approaches targeted specifically at ATS are also covered, including a literature review of pharmacotherapies and clinical trials using different medications to treat ATS. Several chapters throughout the book discuss use of contingency management, cognitive therapy and motivational interviewing, and these discussions are highlights of the entire volume. Part 4 discusses evidence-based interventions with emphasis on identifying and providing responses to particular challenges. Clinical examples and case studies show the challenges, frustrations and opportunities available in working with ATS users. Screening options are not only discussed, but the link with prevention and treatment interventions is emphasised, with a case using motivational interviewing to illustrate this approach. A copy of the ASSIST V3.1 screening instrument along with suggestions for its use in a brief intervention is included. In addition, a chapter illustrating the value of an intervention to reduce the risks of methamphetamine use is well described with case notes suggesting methods that can help in working with the user. Part 4 also includes a broad overview of issues associated with engaging ATS users in drug treatment, with particular attention to reinforcing approaches to engage the treatment-resistant individual through incentives and motivators. Use of Prochaska and DiClemente’s stages of change is described, as well as techniques to manage withdrawal. Another chapter discusses effective; means to meet the needs of young ATS users, including improving access and using stages of change, cognitive behavioural approaches, and family-focused interventions. Another chapter discusses working with same-sex attracted and sex and gender diverse persons and barriers to treatment, as well as guidance for counsellors. Co-occurring ATS and mental health problems are covered in a chapter with helpful case studies specifically for Post-Traumatic Stress Disorder, Social Anxiety Disorder, Bipolar Affective Disorder, mood disorders, schizophrenia and Attention-Deficit/Hyperactivity Disorder, as well as use of various medications to treat the disorders in ATS-using individuals. The steppedcare approach, with an extensive case description, is recommended for use when less intensive treatment has not been effective, as well as incorporating the techniques for treatment for ATS users with co-occurring issues. 635 In summary, this is a very extensive handbook on ATS, with good descriptions of the needs and recommended responses. It should be the basic document used to understand ATS and the various options available for ATS users, as well as to help respond to the demands ATS makes on the individual, the family, and the community. But as with any volume of this nature, the reader should use this as the foundation for information and access the more recent academic literature to stay abreast of the latest developments in treatment. This is particularly important for those working in the fast-changing ATS drug field. Jane Carlisle Maxwell Senior Research Scientist Addiction Research Institute Center for Social Work Research The University of Texas at Austin Austin, Texas, USA The Electronic Cigarette, an Alternative to Tobacco? JEAN-FRANÇOIS ETTER CreateSpace Independent Publishing Platform (Amazon): i.e. self-published via Amazon, 2013 ISBN 978 1 4810 6188 9, 119 pp. Paperback and ebook. Price: US$5.48 (paperback), US$2.99 (e-book) For decades Australian drug policy has run two things in parallel: with respect to all drugs but one, our approach has been to prevent or minimise the use of drugs, and to minimise the harms experienced by people who use drugs and by other people affected by that drug use. For one drug only—nicotine—we have taken a different approach: people should be either dependent tobacco smokers or totally tobacco abstinent. In this approach, nicotine replacement therapy can be used for brief periods, but only as a smoking cessation aid, not as a maintenance intervention. Does this sound ridiculous? Many believe it is. But tobacco harm reduction is now creeping onto the agenda, a set of strategies that sits between dependent tobacco consumption and total abstinence from nicotine. Etter’s book about electronic cigarettes (e-cigarettes) is the best contribution we have to date to inform at least part of this third way. The book is highly accessible. It is self-published (through Amazon), brief (119 pages in length), clearly written and sold online at a modest price. It has 10 short chapters, with the text adequately, though not overwhelmingly, referenced. The author starts with the (correct) assumption that many readers will not know much about e-cigarettes, so © 2013 Australasian Professional Society on Alcohol and other Drugs bs_bs_banner 636 Book Reviews the first two chapters get us au fait in this area. He then discusses ‘Why do people use e-cigarettes?’. Subsequent chapters deal with the safety and toxicity of these products, what we know about the toxicity and addictive properties of nicotine, and the nicotine withdrawal syndrome. He then answers (in the affirmative) the question ‘Can e-cigarettes help smokers to quit or cut down?’ and spells out a range of legal, political, economic and social considerations.The final chapter comprises five sets of recommendations, one each for would-be users, current users, health professionals, policy makers and regulatory agencies, and researchers. Useful appendices are included that are aimed at assisting current and former tobacco smokers to quit or avoid relapse. The key message that this reader gains from Etter’s book is found in his section on ‘Recommendations for policy makers’ (page 74): How well e-cigarettes are regulated and taxed will have a decisive impact on the number of users, the number of smokers who quit, and the number of people who die from smoking-related diseases. From a legislative perspective, it is necessary to assess whether the benefits of e-cigarettes outweigh their drawbacks in comparison with tobacco. One of the author’s best achievements is his careful identification of what we do not know about e-cigarettes with respect to patterns of use, the beneficial and detrimental consequences of use, and the optimal policy settings to manage this innovation. This has implications for a range of stakeholders. Etter’s book is timely. Millions of people are using e-cigarettes. Addiction professionals, policy makers and therapeutic product regulators need to learn about this phenomenon and what the science tells us about it.This makes the book a ‘must read’, particularly for people who have, until now, had closed minds about the possibility of tobacco harm reduction. David McDonald Visiting Fellow National Centre for Epidemiology and Population Health The Australian National University, Canberra, ACT, Australia The Drug Problem in the Americas Organization of American States Organization of American States, 2013 ISBN 978 0 8270 6006 7; Part 1: 108; part 2: 79 With growing concerns and calls for drug policy reform from around the world, in April 2012, the Summit of the Americas held a special session on the drug problem. © 2013 Australasian Professional Society on Alcohol and other Drugs Consensus amongst leaders was achieved on the need to explore new approaches. As a result, the Organization of American States was given a mandate to prepare a report reviewing the drug problem and new approaches. The Drug Problem In The Americas (2013) is the final report of this work, launched on 17 May 2013 in Bogota, Colombia. There are two parts to the work: the socalled analytic report (http://www.oas.org/documents/ eng/press/Introduction_and_Analytical_Report.pdf), which outlines the nature and extent of the problem, and the scenarios report (http://www.oas.org/documents/eng/ press/Scenarios_Report.PDF) which provides four possible stories or futures. The analytic report is certainly comprehensive, with chapters on drug effects, cultivation, production, distribution, sale, consumption patterns, violence and insecurity. Each chapter is pithy but mentions the variety of topics within each heading. Thus, mention is made in the report to, for example social exclusion, medical marihuana, displacement of drug violence, homicide rates in association with transit countries, barriers to treatment access, alternative development, risk and protective factors and environmental impact of drug cultivation. In this sense, the report is an excellent primer for all the issues, aspects and concerns associated with drugs. On the other hand, given the brevity of the chapters, it is light on in terms of analysis. Evaluation of the effectiveness of different policy arrangements is not provided. The strengths, weaknesses, evidence base and trade-offs associated with different policies are mentioned but not analysed (there are six appendices which are written by experts and do provide a greater level of detail and analysis). The scenarios report details four different possible stories about the drug problem in the Americas. The purpose of the scenarios is to support informed debate. Each scenario represents one possible story about how the drug problem is understood, the responses consistent with that understanding, and the opportunities and the challenges. The first scenario is ‘Together’, which is characterised by a coordinated approach to tackling insecurity and corruption without change to international (or domestic) laws. The second scenario is ‘Pathways’ characterised by drug law reform. The third is ‘Resilience’ characterised by a public health approach. The final scenario, one which in contrast to the others is ‘cautionary’ (and not possible) is characterised by abandonment of the fight against drugs and concomitant escalating violence. The scenarios are well articulated and provide food for thought. They would serve well as dialogue instruments—particularly given that they make different assumptions about the nature of the problem. Prior to its release, the work had been heralded as paving the way for substantial policy reform.The report