Reading about . . . self-help books on drug misuse problems

A previous article about self-help books for problematic use of alcohol noted the large number of such books available ([Day, 2003][1]). The focus of this article is problematic drug use, but most available books cover ‘ addiction’ in general, and so there is some overlap with the alcohol


General information about drugs
There are many sources of information available about the potential medical, psychological and social problems caused by both licit and illicit drugs. Perhaps the best known reference book produced in the UK is Street Drugs (Tyler, 1995), a favourite reader on drug awareness courses and a staple in drug treatment services. It is written in a journalistic style and is full of practical and interesting information about all the major drugs misused.
Stories about drugs make interesting and lively reading, and they remain a popular publishing genre (see Day & Smith (2003)). However, many books combine factual information about drugs with details about their historical, political and social significance. One such is Forbidden Drugs (Robson, 1999). Written by a British psychiatrist and specialist in managing addictive behaviours, it starts with a summary of the prevalence of, the reasons for, and the potential consequences of using recreational drugs. Chapters are then devoted to each of the major classes of psychoactive substances providing historical background, information on methods of preparation and distribution, and possible beneficial and unwanted effects. Part three combines a description of the nature of addiction and the various treatment strategies available, with a more polemical chapter on drug policy and the arguments for legalisation.
Personal stories of battles against the effects of drugs can make dramatic and interesting reading, particularly when the author is a celebrity. However, less famous authors have also contributed work based on personal experience that can be useful in inspiring recovery. Ann Marlowe's How to Stop Time: Heroin From A to Z is a particularly good example, blending personal experience with analysis (Marlowe, 2002).

Narcotics Anonymous
As noted in the previous article on selfhelp for alcohol problems, the most widely written about model of therapy worldwide is probably the 12-steps, as practised by Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Both AA and NA are non-profit fellowships of people for whom alcohol or drugs had become a major problem. They are programmes of complete abstinence from all drugs, which use the 12-steps as a framework to guide progress. A vast literature exists around this process, and it can be difficult to know where to start. It is unlikely that reading a book will act as a substitute for attending NA meetings and becoming actively involved in the therapeutic process, but introductory and other material is available from the UK NA website (www.ukna.org), which also provides information about local meetings. In addition, online meetings are held three times a week allowing participants to read what other members type in real time. The Families Anonymous website (www.famanon.org.uk) is aimed at relatives and friends of people who misuse substances. It also provides introductory information about the Fellowship, a discussion forum for members and details regarding local groups.

Other approaches
The transtheoretical (stages of change) model developed by Prochaska & DiClemente is extremely popular in UK drug treatment services (although not without its critics -see West (2005)). Therefore, Changing for Good (1994), a self-help book explaining the development and practical implementation of the model may be a useful supplement to clinical practice.
Cognitive-behavioural strategies lend themselves well to self-help materials, and there are some excellent examples available e.g. Dryden & Matweychuk, 2000. Overcoming Your Alcohol or Drug Problem (Daley & Marlatt, 2006b) is a self-help workbook that is part of a series entitled 'Treatments That Work'. The accompanying therapist guide (Daley & Marlatt, 2006a) renders the material useful for both selfdirected and therapist-directed treatment. The information and recovery strategies presented can be used to tackle problems with any habit-forming substance and the book encourages the development of a personal recovery plan using materials from cognitive-behavioural treatment, coping-skills training, 12-step counselling and relapse prevention.
Rational Recovery was founded in 1985 by Jack Trimpey, a clinical social worker, and filled a gap in the USA for those who found 12-step groups unappealing. Although initially built around group meetings, Rational Recovery has now moved away from this approach and towards training in addictive voice recognition technique, a cognitive-behavioural strategy that relies on changing thinking patterns and controlling motivations. A readable and practical introduction to this approach can be found in Trimpey's book Rational Recovery: The New Cure for Substance Addiction (Trimpey, 1996).
Moving away from cognitivebehavioural therapy-based strategies, another approach comes from The Tao of Sobriety (Gregson & Efran, 2002), a book that shows how to apply Eastern philosophy to enhance recovery from addiction. Focusing on mental exercises, it provides a contrasting spiritual perspective to addiction to the one used very effectively in the 12-step approach. Finally, Granfield & Cloud's (2001) research on the methods used by people who stop using drugs without formal treatment has been turned into a self-help book that presents a unique 'user' perspective (Cloud & Granfield, 2001).

Books for family members
Get Your Loved One Sober (Meyers & Wolpe, 2004) is one of the most interesting books in the self-help market. It is based on the community reinforcement and family training (CRAFT) therapeutic model, an effective intervention for family and friends of substance users. It teaches 'concerned significant others' behavioural techniques to reduce their loved one's substance use and to encourage him or her to seek treatment. Furthermore, it assists the concerned significant other in reducing stress and introducing meaningful sources of satisfaction into his or her own life. In randomised controlled trials with treatmentresistant drug users, concerned significant others who learned the CRAFT approach were able to engage their loved ones in treatment at more than double the rate of the comparison NA approach, with twothirds entering treatment.
An intervention is also a popular method adopted by family members and friends in the USA to help someone with an addiction who does not wish to go into treatment. However, in contrast to CRAFT, it adopts a more directly confrontational approach. The book Intervention: A Step-by-Step Guide for Families and Friends of Chemically Dependent Persons (Johnson, 1986) describes how this can be Columns Reviews columns done effectively and efficiently, although it is reliant on responsive (and often residential) treatment services to accept the individual at the end of the process, a situation that is not always possible in the UK.
Internet sites FRANK is the Government's national drug awareness campaign and is aimed at young people, parents and the wider community. The FRANK website (www.talktofrank.com) has information about individual drugs including their effects, risks of use and potential for addiction. There is a searchable directory of local and national agencies, and a confidential email service (Frank@ talktofrank.com) to provide prompt answers to drug-related questions.
Drugscope (www.drugscope.org.uk) has a useful 'frequently asked questions' area covering general information about drug use, an overview of available treatments and a section on Government policy and legal aspects of drug use. The Addaction website (www.addaction. org.uk) includes a range of printable harm reduction leaflets and Patient UK (www.patient.org.uk) lists details of support organisations and self-help groups for people with drug and alcohol problems.
Know Cannabis (www.knowcannabis. org.uk) is a web-based self-help programme to assist in the reduction or cessation of cannabis use. It is designed to be followed over at least 4 weeks and employs motivational interviewing and relapse prevention strategies. Participants are encouraged to log on at regular intervals to monitor levels of cannabis use and cravings, and to identify risk situations in which they have difficulty controlling their cannabis use.
EgetGoing (www.egetgoing.com) and TeenGetGoing (www.teengetgoing.com) provide online substance misuse treatment programmes for adults and adolescents respectively. The EgetGoing programme provides a live, interactive, group therapy with members communicating in real time via a microphone and headset supplied on subscription. The group takes place under the guidance of a professional therapist using a treatment approach based on the 12-step philosophy.
Self-management and recovery training (SMART) recovery is another abstinencebased approach, similar to Trimpey's Rational Recovery, that offers itself as an alternative to the 12-steps. It does not subscribe to the disease model of substance dependence or draw on ideas from religion, but rather its philosophy and approach are grounded in the work of Albert Ellis and in cognitive^behavioural therapy. A rapidly growing organisation, SMART offers a four-point programme including strategies to enhance and maintain motivation to abstain, cope with urges, solve problems and achieve 'lifestyle balance'. Information can be obtained from www.smartrecovery.org.