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Cocaine Addiction: Theory, Research and Treatment
BOOK
REVIEWS Cocaine Addiction: Theory, Research and Treatment by Jerome J. Platt, Harvard University Press, 1997. £33.50 (xiv 1 458 pages) ISBN 0 674 13632 2 The author has applied his considerable knowledge and experience in the drug abuse field to the topic of cocaine addiction. He has previously produced this kind of book on heroin addiction, and he now turns his attention to another high profile problem – cocaine. His goals in this book are to provide an overview of the topic, to review the history of cocaine and how it produces its effects, to cover new strategies on how to address the problem, and to make some recommendations. The book is well written and reads smoothly. It is exceptionally well documented with about 1200 references by my estimation, with the most recent covering 1995 and one or two in 1996. Although there are no tables or figures, the text is laden with quantitative information including statistics, doses, and percentages. The text covers a broad area from basic pharmacology to legal and social issues. Within
this realm I found every interesting topic in the field including comorbidity, polydrug use and cost effectiveness of treatment. There is an excellent description of the history of the problem; it seems that Freud was wrong at least once, and that society has a poor memory about the problems of cocaine. The pharmacology and physiology of the drug and behavioral effects are well described. Cocaine is obviously a highly seductive drug. The crack user can obtain intense feelings of power, pleasure, confidence and well being, for a cost considerably less than medical school, graduate school or becoming president. Its pathology and medical issues, and finally, treatment issues are well covered and accurate. The successes, limitations and failures of various treatments are described. The great need for a pharmacological treatment, a medication, is cited. The interesting issue of legalization is covered from
The Lower Brainstem and Bodily Homeostasis by William W. Blessing, Oxford University Press, 1997. $85.00 (592 pages) ISBN 0 143 507511 0 This book deals with the neural mechanisms controlling life – breathing, blood pressure, and other vital functions. This area of neuroscience has a rich tradition that dates to back to the 1870s when it was discovered that the medulla oblongata regulates the heart and blood pressure1. For the next 100 years, only physiologists studied this area, but progress was slow. Two factors impeded progress: experimental manipulation of the brainstem required a high level of surgical skill because any slight damage to this region can be lethal; and experiments were approached from a ‘black box’ point of view because no accurate neuroanatomical ‘roadmaps’ existed. This situation changed in the 1970s, when the anatomists gained the upper-hand through the use of an array of axonal transport methods to map this forbidden territory. In the following thirty years, a substantial body of information has been gathered, which until now, has not been reviewed in depth. The present book provides a comprehensive review of how the brainstem controls our basic functions. From the start, the reader will learn that Blessing is not a ‘yes’ man. He suggests that traditional concepts like autonomic nervous system, limbic system, and 270
TINS Vol. 21, No. 6, 1998
reticular formation should be abandoned because they are imprecise scientific ideas. This has been discussed previously2,3 and for the most part, I suspect that Blessing’s polemic will be dismissed because scientific terms take on a life of their own and become refined as more information is gathered. For example, it is now well recognized that the autonomic nervous system is a not pure visceral motor system, but also contains its own sensory feedback systems (via the sympathetic and parasympathetic afferents and also via a hormonal feedback system that operates through the circumventricular organs). In addition, this motor outflow system rarely functions alone, but seems frequently to operate in tandem with specific hormones, such as vasopressin, adrenaline, and angiotensin. This book is a tour de force and likely to be the major sourcebook for anyone wanting to enter the field of central autonomic control. In many ways, it would be the perfect book for advanced graduate students interested in understanding this area of neuroscience. Blessing begins by tracing the history of this field with an emphasis on the major concepts. Contributions by the major luminaries, such as Claude Bernard, John Langley, and Walter Cannon are summarized in a criti-
both perspectives. The experience of other countries and the net result of legalization is described. A citation describing legalization as a ‘colossal gamble’ is noteworthy. No book can be everything to everyone. A major limitation of the book is the lack of information on research in the molecular and basic behavioral area. Cellular and mechanistic issues are touched upon, but only five pages or so of the book are dedicated to the neurobiology of cocaine. Nevertheless, a molecular scientist could very well learn about these other aspects of the field from the book (this is not necessarily an admonition). In spite of some few inevitable limitations, the book is an excellent resource, and I have put it on my shelf as a ‘keeper’. I expect to use it to help prepare lectures for medical and graduate students. I think it would be useful for a broad range of educated people from parents to professionals. Michael J. Kuhar Yerkes Regional Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA 30329, USA.
cal fashion. This is followed by a panoramic view of the anatomical and physiological techniques used to map central visceral pathways along with some humor such as Blessing’s citation of English physiologist David Whitteridge’s remark that electrical stimulation of peripheral nerves ‘should be a punishable offence’ because it is a nonphysiological stimulus. Of course, the same can be said about its use for mapping central pathways. In addition, Blessing explains the basic visceral pathways of the brainstem and also, along the way, touches on a range of additional topics, such as how the brainstem develops under the control of homeobox genes, the intellectual history of the reticular formation and how to define a cytoarchitectonic region. Although these introductory chapters are excellent, all of this is merely a warm up, because the bulk of the book is about the specific CNS circuits that regulate blood pressure, breathing, arousal, pain, food intake, and metabolism, with the final chapter being devoted to the human lower brainstem and related clinical material. What is so appealing is that Blessing addresses each subject by providing the experimental evidence and alerts the reader where gaps or errors exist. This monograph is not a compression of information from a Medline search, but a very scholarly, thought-provoking treatment of how the brain controls our basic functions. This book is aimed at an audience that has a fairly sophisticated background in
REVIEWS Cocaine Addiction: Theory, Research and Treatment by Jerome J. Platt, Harvard University Press, 1997. £33.50 (xiv 1 458 pages) ISBN 0 674 13632 2 The author has applied his considerable knowledge and experience in the drug abuse field to the topic of cocaine addiction. He has previously produced this kind of book on heroin addiction, and he now turns his attention to another high profile problem – cocaine. His goals in this book are to provide an overview of the topic, to review the history of cocaine and how it produces its effects, to cover new strategies on how to address the problem, and to make some recommendations. The book is well written and reads smoothly. It is exceptionally well documented with about 1200 references by my estimation, with the most recent covering 1995 and one or two in 1996. Although there are no tables or figures, the text is laden with quantitative information including statistics, doses, and percentages. The text covers a broad area from basic pharmacology to legal and social issues. Within
this realm I found every interesting topic in the field including comorbidity, polydrug use and cost effectiveness of treatment. There is an excellent description of the history of the problem; it seems that Freud was wrong at least once, and that society has a poor memory about the problems of cocaine. The pharmacology and physiology of the drug and behavioral effects are well described. Cocaine is obviously a highly seductive drug. The crack user can obtain intense feelings of power, pleasure, confidence and well being, for a cost considerably less than medical school, graduate school or becoming president. Its pathology and medical issues, and finally, treatment issues are well covered and accurate. The successes, limitations and failures of various treatments are described. The great need for a pharmacological treatment, a medication, is cited. The interesting issue of legalization is covered from
The Lower Brainstem and Bodily Homeostasis by William W. Blessing, Oxford University Press, 1997. $85.00 (592 pages) ISBN 0 143 507511 0 This book deals with the neural mechanisms controlling life – breathing, blood pressure, and other vital functions. This area of neuroscience has a rich tradition that dates to back to the 1870s when it was discovered that the medulla oblongata regulates the heart and blood pressure1. For the next 100 years, only physiologists studied this area, but progress was slow. Two factors impeded progress: experimental manipulation of the brainstem required a high level of surgical skill because any slight damage to this region can be lethal; and experiments were approached from a ‘black box’ point of view because no accurate neuroanatomical ‘roadmaps’ existed. This situation changed in the 1970s, when the anatomists gained the upper-hand through the use of an array of axonal transport methods to map this forbidden territory. In the following thirty years, a substantial body of information has been gathered, which until now, has not been reviewed in depth. The present book provides a comprehensive review of how the brainstem controls our basic functions. From the start, the reader will learn that Blessing is not a ‘yes’ man. He suggests that traditional concepts like autonomic nervous system, limbic system, and 270
TINS Vol. 21, No. 6, 1998
reticular formation should be abandoned because they are imprecise scientific ideas. This has been discussed previously2,3 and for the most part, I suspect that Blessing’s polemic will be dismissed because scientific terms take on a life of their own and become refined as more information is gathered. For example, it is now well recognized that the autonomic nervous system is a not pure visceral motor system, but also contains its own sensory feedback systems (via the sympathetic and parasympathetic afferents and also via a hormonal feedback system that operates through the circumventricular organs). In addition, this motor outflow system rarely functions alone, but seems frequently to operate in tandem with specific hormones, such as vasopressin, adrenaline, and angiotensin. This book is a tour de force and likely to be the major sourcebook for anyone wanting to enter the field of central autonomic control. In many ways, it would be the perfect book for advanced graduate students interested in understanding this area of neuroscience. Blessing begins by tracing the history of this field with an emphasis on the major concepts. Contributions by the major luminaries, such as Claude Bernard, John Langley, and Walter Cannon are summarized in a criti-
both perspectives. The experience of other countries and the net result of legalization is described. A citation describing legalization as a ‘colossal gamble’ is noteworthy. No book can be everything to everyone. A major limitation of the book is the lack of information on research in the molecular and basic behavioral area. Cellular and mechanistic issues are touched upon, but only five pages or so of the book are dedicated to the neurobiology of cocaine. Nevertheless, a molecular scientist could very well learn about these other aspects of the field from the book (this is not necessarily an admonition). In spite of some few inevitable limitations, the book is an excellent resource, and I have put it on my shelf as a ‘keeper’. I expect to use it to help prepare lectures for medical and graduate students. I think it would be useful for a broad range of educated people from parents to professionals. Michael J. Kuhar Yerkes Regional Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA 30329, USA.
cal fashion. This is followed by a panoramic view of the anatomical and physiological techniques used to map central visceral pathways along with some humor such as Blessing’s citation of English physiologist David Whitteridge’s remark that electrical stimulation of peripheral nerves ‘should be a punishable offence’ because it is a nonphysiological stimulus. Of course, the same can be said about its use for mapping central pathways. In addition, Blessing explains the basic visceral pathways of the brainstem and also, along the way, touches on a range of additional topics, such as how the brainstem develops under the control of homeobox genes, the intellectual history of the reticular formation and how to define a cytoarchitectonic region. Although these introductory chapters are excellent, all of this is merely a warm up, because the bulk of the book is about the specific CNS circuits that regulate blood pressure, breathing, arousal, pain, food intake, and metabolism, with the final chapter being devoted to the human lower brainstem and related clinical material. What is so appealing is that Blessing addresses each subject by providing the experimental evidence and alerts the reader where gaps or errors exist. This monograph is not a compression of information from a Medline search, but a very scholarly, thought-provoking treatment of how the brain controls our basic functions. This book is aimed at an audience that has a fairly sophisticated background in