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Alcohol Problems in Adolescents and Young Adults: Epidemiology, Neurobiology, Prevention, and Treatment
http://www.100md.com 《新英格兰医药杂志》
     Women under the Influence is a scholarly analysis of substance abuse among American women. This lucidly written book provides a perceptive and compassionate discussion of the factors that contribute to the abuse of a wide spectrum of substances and of the associated social and health consequences for women.

    In the foreword, Joseph A. Califano, Jr., notes that "Some 6 million girls and women abuse or are addicted to alcohol, 15 million use illicit drugs and misuse prescription drugs, and nearly 32 million smoke cigarettes." Accurate estimates of morbidity and mortality associated with alcohol abuse have been more difficult to obtain than estimates for cigarette smoking, and these approximations are complicated by the fact that heavy drinking and smoking often occur together. However, this book's estimates of the morbidity and mortality associated with cigarette smoking are astounding: "Each year, approximately 178,000 women die from a smoking-related disease. More women die each year in the United States from lung cancer than from breast, uterine, and ovarian cancers combined. While the rate of lung cancer deaths has been declining among men, the rate has soared by 600 percent among women." Also, "on average, a smoking woman loses 15 years of her life, while a smoking man loses 13 years."

    It is estimated that more than 7.5 million girls and women misuse or abuse prescription drugs each year, and women are more likely than men to become addicted to sedatives, antianxiety drugs, or hypnotic agents. Prescription-drug abuse and illicit-drug abuse, alone or in combination, may result in death from overdose, suicide, risky sex, and involvement in violence and criminal activities. During pregnancy, the continued use of alcohol, cigarettes, or prescription or illicit drugs (or both) can have catastrophic consequences for the neonate as well as for the mother. The estimated lifetime cost of caring for a child exposed to tobacco, alcohol, or drugs before birth is between $750,000 and $1.4 million. The eventual social costs associated with drug-exposure–related impairment of cognitive skills — and with the development of conduct disorders — are inestimable.

    This book thoughtfully examines the myriad factors that enhance vulnerability to substance-abuse problems across the life span and the unique challenges of life-stage transitions in women. The first chapter, which is entitled "Pathways to Substance Abuse among Girls and Women," offers a compelling analysis of the effects of direct advertising of alcohol and cigarettes and the multimedia glamorization of illicit drug use in fashion images, movies, and even the marketing of perfume. Young people are thought to be especially vulnerable to media presentations that associate drug use with pleasure, sex, freedom, liberation, and the ever-elusive but desirable image of being "cool."

    A chapter entitled "Getting over the Influence" summarizes barriers to treatment and the limitations of the available types of treatment programs. A substantial reduction in the problems associated with substance abuse will require improved access to treatment and research to develop more effective treatments. It is important for patients and physicians alike to recognize that substance abuse is a chronic disorder, and like many other chronic medical disorders such as cardiovascular disease, diabetes, and asthma, it may recur unpredictably and require additional treatment. Relapse does not negate prospects for eventual recovery, but it may be part of the complex process of recovery.

    The final chapter of the book, "Prevention and Policy Opportunities across the Life Span," describes many social, educational, and regulatory approaches. The authors argue that "effective prevention efforts should be tailored to the specific risks women face at different life stages as well as to factors universal to women of all ages." They conclude, "Only through effective prevention that is implemented early and consistently from childhood through adulthood, targeting the unique vulnerabilities of women and capitalizing on key opportunities for intervention, can we hope to reduce the problem of substance abuse and the corresponding need for accessible and affordable treatment services."

    Each chapter is well documented with extensive citations and background notes. Women under the Influence fills an important gap in the literature, and it is an outstanding contribution to knowledge about the causes, consequences, and prevention of substance abuse among American women across the life span.

    The preface to Alcohol Problems in Adolescents and Young Adults states, "Adolescence is already challenging. The addition of alcohol has only made it more so." What follows is an excellent review of alcohol abuse and dependence problems in young men and women. Recent findings concerning the epidemiology of alcohol abuse and dependence are presented in the first five chapters of this book. These chapters discuss factors that may contribute to the induction of alcohol abuse and dependence among adolescents and college-age young adults.

    The next four chapters describe some neurobiologic factors that may be important to consider in developing strategies to prevent and treat alcohol use and abuse among adolescents. These chapters include excellent reviews of the long-range consequences of drinking during adolescence, the effects of differences in alcohol sensitivity and tolerance during adolescence, the effects of alcohol on memory and memory-related brain function in adolescents and adults, and the effects of alcohol-use disorders on the human brain.

    Chapters 10 through 14 focus on the prevention of alcohol problems among adolescents, adolescents in special populations, college students, and children of alcoholics and other high-risk groups. These chapters also include a thoughtful examination of policies to reduce underage drinking. The final five chapters of the book discuss treatment of coexisting alcohol, drug, and psychiatric disorders as well as assessment-related issues in research on the treatment of adolescent drug abuse.

    Lawrence S. Brown, Jr., president of the American Society on Addiction Medicine, comments in the book's preface, "It makes sense that effective remedies to this major public health and societal challenge would be multifaceted, comprehensive, and guided by scientific evidence. The scientific information in this edition provides ample contributions to this effort." The book provides a comprehensive assessment of alcohol problems among adolescents and young adults, and it enhances our fund of information concerning the diagnosis, treatment, and ultimately prevention of alcohol problems in this vulnerable population. Together with Women under the Influence, it will inform policymakers as well as all readers who are concerned with the care of patients with substance abuse.

    Jack H. Mendelson, M.D.

    McLean Hospital

    Belmont, MA 02478

    jmendel@mclean.harvard.edu(Edited by Marc Galanter. )