Peer review: thinking the unthinkable

T he contrived subtitle, "drugs, demons, and delinquents," might lead one to suspect that this book is a superficial and clichéd analysis of the subject and best avoided.Most books that set out to cover treatment of drug dependence, even those without melodramatic titles, are probably best avoided-other than by those preparing for examinations.This book, however, is a careful analysis of the subject that reveals the remarkable similarities in the dilemmas recognised, and alleged solutions offered, by different countries.A "global" review such as this offers the opportunity to analyse what really constitutes treatment of drug depend-ence, but the opportunity has not been taken here.The question of what dependence treatment is tends to be ignored-probably out of fear that the lack of an answer might become evident.Success of treatment of drug dependence is generally seen as analogous to that of any physical disease.That successful "treatment" for this condition, unlike that for any other, leaves patients more (socially) impaired than when they had the "disease" is not acknowledged.The "recovered" alcoholic, for example, stands out as different in social situations where most or all others drink: he or she is expected to join in the drinking and feels obliged to give an excuse when refusing, even if none is overtly demanded.Success of "treatment" therefore is much more a function of the extent of covert or overt social pressure to drink than is recognised.The same is true for the "recovered" drug user in a drug using milieu.A global view should provide unusual opportunities to examine cultural and social factors influencing the success of treatment.In this book, 47 authors from 20 countries provide "information on the development of drug treatment from a global perspective," but the opportunity for synthesis and shedding light on unseen premises is missed.Of the 20 countries chosen to provide the global perspective, 14 are European; the others are Canada, China, Colombia, Japan, Peru, and the United States.