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254 Review QUITTING COCAINE: THE STRUGGLE AGAINST IMPULSE By Howard J. Shaffer, Ph.D., and Stephanie B. Jones, Ed.D. 198 pp. Lexington, MA: DC Heath, 1989. $24.94 (hardcover), $9.95 (paper). QUJTTiNG Cocaine is a two-part exploration of the unique niche cocaine occupies among recreational drugs and the tension that marks the struggle between indulging in the impulse and turning away from it. In Part I, the authors, both from the Harvard Medical School Department of Psychiatry, present a history of the drug in the United States; demographic statistics of users; and a summary of health consequences. The authors present models for understanding addictive behavior, and in a brief chapter on cocaine and the media, they note the confession of one noted journalist who "comes clean" by admitting his addiction to the overwhelming negative reputation drugs have, and the unfettered license this gives a "journalist to write almost anything he chooses because nobody was going to defend drug abuse in America , least of all people who use drugs every day." Shaffer and Jones suggest that while cocaine offers a convenient scapegoat for a society that craves analgesic balms for emotional pain, grandiose media comparisons between the war on cocaine as the biggest story since the war in Vietnam obscure the larger annual death toll wrought by tobacco and alcohol. After this depiction of the parameters of the problem, the final section of Part I explores recovery from cocaine addiction. The authors question the widespread assumption that without professional intervention or peer counseling, chemically dependent persons will suffer a progressively downward spiral leading to premature death. They counter this notion by discussing research on persons who have recovered spontaneously from the compulsive use of opiates, alcohol, and tobacco. They also cite common characteristics—from meaningful religious experiences to physical problems—that seem to motivate typical spontaneous recoverers. In Part II, Shaffer and Jones use case histories to chart the course of addiction from first experiment to full-fledged addiction to the turning points that mark the beginning of recovery. The remainder of the book, still based on case histories, is devoted to such topics as the maintenance of cocaine abstinence and lessons to be learned from former cocaine users who without professional Journal of Health Care for the Poor and Underserved, Vol. 1, No. 2, Fall 1990 ___________________________________________________________255 intervention left the drug behind. The book concludes with 13 pages of references drawn from both professional and lay sources. Quitting Cocaine claims to be a comprehensive review of cocaine addiction , but the volume suffers from disorganization. In Part I, the causes, consequences , and theories of cocaine use are thrown together as if the section were a series of newspaper articles, each bearing little relationship to the other. Each of these complex issues has been the subject of major treatises, but in this book they often end up as incidental paragraphs. Another key problem for this book is the question of readership. Whether the material is meant for a professional audience or a lay news reader who is occasionally impressed with professional jargon, is unclear. Part II holds out the greatest promise for further exploration. But here the authors suffer from limited vision. Part II points to a variety of types of addicts and types of addiction, but it does not place them into a classification system that has social context. One may ask: If the influences on cocaine use—low selfesteem , difficulties with interpersonal relationships, career crises—are present in many parts of our society, how does "impulse" help explain such a major cocaine problem in the cities? It is well known that many addicts "mature out," or die, or go to jail, as the authors note, but there is little in their description that is ethnographic. Similarly, the authors' case histories appear drawn from the experiences of the college-educated middle class, although not all users fit this description. Is it impulse that defines the struggle to survive in a family mired in poverty for five generations, and living in the ghettos of Los Angeles, San Francisco, New York, Boston, Philadelphia, Detroit, Chicago? Poverty is the struggle—not impulse. —Richard Brotman, Ph.D. Associate Dean for Academic Planning...

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