Alexander Lichtenberg

by Adam Bisaga with Karen Chernyaev; New York: Experiment Publishing, 2019

Reviewed by Howard L. Forman, MD and Alexander Lichtenberg

Dr Forman is Assistant Professor of Psychiatry, Albert Einstein College of Medicine, and Director of the Addiction Consultation Service at Montefiore Medical Center, Bronx, New York. He is the Book Review Editor for Psychiatric Times. Mr Lichtenberg is a fourth-year medical student at New York Medical College and is currently applying for residency in psychiatry.

In recent years, hardly a day has passed without some news outlet mentioning the latest opioid epidemic. Indeed, there is a lot to cover: the origins of the epidemic in the promotion of opioid analgesics, the way opioids have torn apart families and communities across the country, and how lawmakers have attempted to respond. Doctors, patients, politicians, and journalists have all weighed in with different perspectives. As psychiatrists we see the destruction in our hospitals and clinics and many have grown weary of reading more and more tales of woe and chicanery masquerading as treatment.

Since so much has already been written, it is reasonable to wonder whether we need another book about this phenomenon? Dr Adam Bisaga, an addiction psychiatrist at Columbia University, makes the case for why we need more information-and urgently-in 

Overcoming Opioid Addiction: The Authoritative Medical Guide for Patients, Families, Doctors, and Therapists

. Despite the multitude of articles and books on the subject, there is little in the way of guidance for addressing opioid use disorder (OUD) that specifically addresses patients, their families, and non-expert medical professionals. Worse, there is even less accessible literature that is grounded in sound scientific evidence. Dr Bisaga, along with his coauthor, health writer Karen Chernyaev, seeks to fill that gap with this practical, intelligently constructed book.

The book is divided into four parts. Each can be read independent of the others since they cover similar material but address separate audiences. The first part describes the nature of OUD and its role in fueling the latest iteration of an opioid epidemic. The next part delves into the details of treating OUD with medication-assisted treatment (MAT), the only evidence-based means of managing OUD. The project of explaining and promoting MAT lies at the heart of the book and distinguishes it from other approaches to OUD that ignore, or may be hostile to, using any medications to treat OUD. The third section addresses the needs and concerns of family members of OUD sufferers, and the fourth part addresses patients.

What struck us most was the plain and direct language used in each part. The authors successfully distill their expertise in OUD into a text that can be understood by readers who have little or no scientific background. Free of medical jargon and pretentiousness, this volume will be especially useful for patients and their families looking for sensible advice in navigating the perils of OUD.

Dr Bisaga does not present MAT as a cure-all. To the contrary, he emphasizes the challenges of treating OUD with MAT and notes that OUD has no definitive cure. A key part of his argument is that more people should think of OUD as they would diabetes or any chronic medical condition. MAT, he writes, is a necessary but insufficient component of recovering from OUD.

He is remarkably conciliatory towards engaging with nonmedical modes of treatment-as long as those other methods do not interfere with MAT. For example, he encourages patients to try attending support groups such as Narcotics Anonymous, a 12-step program modeled after the popular Alcoholics Anonymous. However, he warns that some people in Narcotics Anonymous may not be accepting of individuals recovering with the use of MAT. The goal is to have MAT serve as a bedrock for patients to lead meaningful lives in a way that makes sense for each patient.

Whether for a patient, family member, or a professional working with OUD patients, 

 will serve as an invaluable resource for those who want to treat OUD with an evidence-based and compassionate approach. While trying to stop an epidemic can seem like an insurmountable task, Dr Bisaga has shown how progress can be made using medicine, one patient at a time.

This article was originally posted on 10/5/18 and has since been updated.

Articles

Since so much has already been written about the opioid epidemic, it is reasonable to wonder whether we need another book about this phenomenon? Experts make the case for why we need more information-and urgently.