by David Nutt
Goodreads rating: 1/5
Summary: The worst part about this book is that I came out feeling only marginally more informed about what we can do to minimize the harms going forward, about what policies I should support and what practices I should adopt. I would have even accepted a book that taught me a lot about the history, or that gave me a lot of anecdotal accounts that weaved stories both from the regulatory and user side of things. But instead I got none of this. Perhaps I'm not the target audience, maybe it's for people who haven't though much about the issue before. But there are still major issues (see Chapter 12) and insufficient summaries (see Chapter 13) to contend with, leading me to think I probably wouldn't recommend this book to anyone. Overall, I'd say about 5% of the book was new, useful material for me, another 5% a worthwhile read, and the rest either introductory or poor quality material that didn't help me grow at all. I'll proceed with a chapter by chapter breakdown (grouping similar ones together) to shine some further light.
Chapters 1 & 2 felt like a long ego trip. Don't get me wrong, the events are worth writing about, but Nutt doesn't give much substance here, he just gives you a sort of tabloid overview of the situation that felt like it was about 95% filler and 5% content. I would have loved to have learned more about the traditional relationship between the ACMD and the government, he gives something like a paragraph on this topic that I think had to be far richer and would either paint a picture of a relationship that has grown fraught recently or one that has been flawed from the start, each suggesting different ways to remedy the problem.
Chapters 3, 4, 5 & 16 all felt incredibly introductory, so if you have even a basic familiarity I recommend to skip them entirely. Note: the chronicling of how perception of cannibas changed from medicine to drug in chapter 5 was a notable exception that was something new and interesting.
Chapters 6 and 7 were almost enough to give this book two stars. Six presented the problems associated with alcohol better than any other place I've seen, and did a really good job to succinctly make the case for why we should think about it differently than we do. Seven did a good job at looking at the specific evolution of British policy on Mephedrone, and did a much better job to analyze something specific that actually shed some light on the issue and how to do better in the future.
Chapters 8 and 9 were a sloppy attempt at trying to say something meaningful about addiction, that didn't have the investigative journalism strength of Dopesick or the argumentative rigor of Addiction is a Choice.
Chapters 10 & 17 presented good questions, and gave some useful ways to think about them, but also took way too long to develop the ideas and could have been conveyed in half the pages (or probably in a set of bullet points for 17).
Chapters 11 & 15 were the places I expected to find policy Dos and Donts, and sure, there were some shallow recommendations (i.e. the generally push to remove triggers for people's addictions seems good and worth following). But again on the whole they were just way to abstract and felt like a cursory glance rather than a thoughtful engagement with potential policies.
Chapter 12 was by far the worst part of this book, transitioning from filler material to actively misleading and bad material. He started with a literary drive-by on prescription drugs that aren't psychotropic, like opiates, butchering the state of affairs and processing it in a matter of pages. He says at one point "Although physical dependence can happen when these drugs are taken therapeutically, the psychological cravings of addiction seem to occur only when these drugs are taken in non-prescribed ways" (216). He cites no sources for this, and seems to be saying something like "look, it's only when people misuse the drugs that harm comes up, so prescribing them for these medical cases isn't the issue" which would seem to imply he has done very little to consider how the opioid epidemic in the US started and what actors fanned the flame. The rest of the chapter is about psychotropic medication (mostly anti-depressants) and he generally seems unable to see with clear eyes here. Despite how he extorts alcohol going uncontested for its normalcy of use in everyday life, he doesn't happen to consider the negative side to antidepressants for even a sentence in this chapter. He claims that "the most powerful effect of SSRIs is preventing the recurrence of these disorders so long as patients continue to take their treatment" (223) but has no data to support how good these medications are at preventing recurrence (hint, not very). He makes arguments without drawing out his reasoning and support for the connections between various different pieces, using a figure on p.291 to show how benzos work for those with "abnormally low GABA function" but then failing to provide any support for those with anxiety, the target audience for the drug, often having abnormally low GABA function. He dismisses the troubles of withdraws from these medications in a sentence, saying "once the period of withdrawal has passed, they will probably feel better than they did before treatment" (hint, they often don't). He talks about the issue of anti-depressants and increased suicidal ideation, noting that there does seem to be a remarkable increase for those under 18, but then dismisses this in the span of a sentence because antidepressants aren't "recommended" for this age group (hint, not only are they recommended, they often are prescribed). He even does on to make the psychotropic drug-insulin comparison in the next chapter, saying "a child who needs Ritalin to function normally is not addicted. If they had diabetes they would need insulin every day and would suffer physical problems without it, but we wouldn't consider them 'addicted'" (241). We know diabetics need insulin, do we know that children who can't focus need Ritalin? This chapter went beyond sloppy to be borderline harmful, giving people a false sense of safety and confidence in a book that otherwise tries to uncover the "truth" despite what current opinion is. (And perhaps we shouldn't be surprised, Nutt is a psychiatrist after all).
Chapter 13 was partially a continuation of 12 on a new subject (performance enhancing) that just didn't seem to say much with backing and stuck to more general conjecture on the issue.
Chapter 14 again really suffered from a lack of engagement with some of the other literature out there. He briefly mentions the studies on psychedelics and addiction (255), but fails to bring home how the results from the Canadian study indicate psychedelic treatment for alcohol addiction is far more effective than any of the alternatives he mentioned before. I'd read How to Change your mind any day for a more nuanced and historical account of this specific class, one that might actual have something meaningful to say on their potential for treatment beyond the basics.