This is a new edition of a book first published in 1991. If that means the original sold well enough to persuade the publishers that it was worth updating, one can see why. Dr Cooney's style is very readable and he seems to be aiming as much at the numerous long-suffering members of alcoholics' families as at the treatment industry or at alcoholics themselves, though both groups would also benefit from his broad church approach.
The 12 chapters, with titles such as signs, symptoms and cross addiction, physical and psychiatric complications, a family illness and mental mechanisms and medication are a mixture of debate, didactic information and answers to frequently asked questions. Unusually, but for me gratifyingly, the section on medication gives pride of place to Antabuse, rather than to acamprosate or naltrexone, and he stresses the need for third-party supervision, often involving family members as with Marc Galanter's network therapy. He also believes, as I do, that patients who refuse Antabuse but continue drinking, usually refuse it because they are not serious about engaging with treatment. Accordingly, I can forgive the repeated misspelling of acetaldehyde as acid aldehyde. Alcohol, he says, is a devious and powerful enemy and all legitimate means should be employed to combat it.
His broad church approach doesn't quite run to controlled drinking as a treatment option and though he recognizes the importance of the debate, it isn't mentioned in the comprehensive index. However, he does agree that recovery, rather than mere abstinence is the important thing. The updating includes Project Match whose results like most of us he regards as disappointing. He also makes an important point which should be made more often and which the drinks industry is also inclined to deny: Ethyl alcohol is an addictive drug a fact not generally accepted even by those drinkers who will vociferously denounce drug abuse.
The complications and manifestations of alcoholism, from liver palms, through fits and gastritis to Korsakov's syndrome and hallucinosis, are described in terms understandable to the non-medical reader. At times, the style is a bit too populist or simplistic. Detoxification is not really about ridding the body of the poisons which have accumulated because of abnormal drinking. It's about neuroadaptation following withdrawal of alcohol but he is correct in noting that on average...this process takes three to four days and that it can often be done on an out-patient basis.
Finally and this is not a criticism this is an Irish book and intending purchasers should be prepared for a few Irishisms. They include the idiom he had drink taken and the advice that certification of an alcoholic is a serious step and ... should be employed ... only as a last resort. No UK doctor has had this option since the 1959 Mental Health Act yielded to its 1983 successor. Even so, I would confidently recommend the book to my patients, their families and to some of their GPs.