Annals of Clinical Psychiatry

AACP.com Annals of Clinical Psychiatry | Vol. 25 No. 2 | May 2013 153 Cocaine abuse epidemics come and go. Some of us remember the cocaine epidemic of the 1980s that peaked in 1985 and produced an estimated 2.5 million lifetime stimulant abusers (p 3). Some may assume cocaine abuse was a big problem but hopefully isn’t big anymore. Unfortunately, it still is, and we are facing yet another epidemic. There are approximately 1.4 million cocaine abusers and 350,000 methamphetamine abusers in the United States (p 3). The cocaine abusers are not just those remaining from the 1980s epidemic; there also has been a steady stream of new users (p 3). This edited volume brings us information that can help us face and fight this new, and in a way, larger and more dangerous epidemic. Why larger and more dangerous? Partially because methamphetamine was not a part of this equation during the previous epidemics. However, nowadays it is atypical to find a patient who abuses only cocaine or only methamphetamines (p 155). “Most stimulant users use these drugs in combination, often with the intent either to increase the effects produced by the primary stimulant or to ‘take the edge off’ a high when they want to control the cardiovascular and subjective effects” (p 155). In addition, the epidemiology and geography of stimulant abuse is different in the present epidemic, as the distribution of cocaine and methamphetamine is different. Cocaine is being supplied from South America, while amphetamines and methamphetamines are coming from more “home-grown” resources (illegal labs; methamphetamine imported from Mexico is replacing the locally produced methamphetamine) (p 1). Cocaine remains primarily an urban problem. Methamphetamine distribution was predominating in the rural, western, and southern regions of the United States and has moved to rural Midwestern states. Cocaine and methamphetamine abuse is not a problem limited to North America. Cocaine abuse has recently spread to Europe, starting in Spain. Methamphetamine abuse also is an international problem, “with two-thirds of the world’s 33 million methamphetamine abusers living in Asia” (p 4). The Philippines have the world’s highest rates of methamphetamine abusers: 2.9% of its population (p 4). These are staggering numbers, underscoring the fact that stimulant abuse has become a serious worldwide problem. This small volume consists of a Foreword (a useful summary of the book) by Herbert Kleber and 8 chapters written by 11 contributors. The first chapter, “Epidemiology and psychiatric comorbidity,” provides a wealth of information (some of it previously mentioned). The epidemiology part also points out some changes in patterns—a shift from inhaled to smoked methamphetamine, or increase of stimulant abuse in the form of pharmaceutical abuse (increasing number of prescriptions led to greater availability, easy access to stimulants through family and friends makes it cheap and attractive) (p 7). The authors also point out that “drug use is more common among patients with mental illnesses than among the general population” (p 9) and that methamphetamine users appear to be at higher risk for developing psychotic symptoms (p 8). The second chapter, “History, use, and basic pharmacology of stimulants,” includes a great and detailed, yet a bit boring, explanation of stimulants’ pharmacology. The history part includes many interesting pieces of information—Coca-Cola and Red Bull companies use “de-cocainized” extracts from coca leaves in their drinks; BOOK REVIEWS