There is a wealth of information available in the literature about the intersection of addiction and stress, but it is widely scattered through the neuroanatomical and behavioral fields. The textbook Stress and Addiction: Biological and Psychological Mechanisms, edited by Mustafa al'Absi, brings together this body of literature nicely and concisely in a single volume. An international group of researchers was brought together as writers for this book. The neurobiological and psychological research on stress and addiction is summarized, and al'Absi presents future directions for consideration.

This book was designed as a reference text for researchers, trainees, and practitioners across multiple specialties. However, it works best as a review for researchers and higher-level trainees due to the emphasis on basic neurobiological research and language that tends to be technical. It is less ideal for practitioners with a casual interest in research, since the focus is not on in-depth clinical evaluation or application. It works best as a resource for information about particular aspects of stress and addiction. It moves along with a progressive ideology and is cohesive enough (especially the summary in the last chapter by al'Absi) to be read start-to-finish, but most readers would probably use it as a reference on the shelf to be accessed as needed. The chapters tend to be somewhat repetitive, especially in the first section on neurobiology. Each chapter is fairly succinct (around 12 pages), but provides a relatively comprehensive review of the scope of the research area. The individual chapters are designed to give motivated readers an overview to find additional readings and research, and include extensive references.

The introduction for each chapter provides an overview of its contents and the logical progression of ideas reviewed. Some of the chapters feel repetitive due to the overlap of basic material, especially about the neuroanatomy of stress and/or addiction processes. Many of the chapters do not shy away from controversy and discuss studies that have conflicting results. The authors describe studies in the literature with findings contradictory to the theories proposed, which provides balance throughout this text. Some authors disclose and attempt to explain conflicting results of different experiments, to help readers understand their rationale. This speaks to the complex interactions involved in the stress response and addiction. Another good feature of this book is that it discusses the limitations of different research study designs and assessment instruments, again providing a sense of balance for readers.

The text reviews the neurobiological circuitry underlying the effects of stress on addiction, how stress in early life and/or ongoing stress alters regulation of the stress response, how the genetic risk for addiction may relate to different stress response patterns, and evaluates tools to assess stress and addiction. It is divided in to three sections: the first reviews neurobiology of stress and addiction, the second reviews psychosocial processes related to addiction and stress, and the third discusses clinical implications for assessment and treatment of patients. The first section consists of seven chapters and is primarily a review of the basic biology and neuroanatomy of the stress response, as well as stress mechanisms relevant to initiation, maintenance, and relapse to addiction. Data is summarized from studies in rodents and some primates relating to hypothalamic, opioid, and genetic aspects of both stress and addiction. Each chapter author(s) is quite knowledgeable about research in the area reviewed, often describing his or her own work in the field. The second section consists of five chapters that discuss psychosocial processes in humans that affect stress and addiction. These chapters present research data from epidemiological studies and human laboratory studies. However, chapter 9 discusses impulsive behaviors and provides several case vignettes on gambling, trichotillomania, and intermittent explosive disorder, and is the only chapter to provide vignettes. The third section on clinical implications does not exactly build on the previous two sections, although the preceding information is useful in understanding the underpinnings of some of the interventions discussed. The six chapters in the third section cover clinical and research assessment instruments for addiction and stress, as well as clinical interventions that have been studied and a chapter on investigational pharmacotherapy with glucocorticoid antagonists. Chapter 13 provides a nice summary of which items (checklist, structured interview, biomarkers) to use in research on stress, and chapter 14 reviews instruments that can be used to study addiction. The final chapter contains speculation about future behavioral and pharmacological treatments, as well as recommending directions for research.

In summary, Stress and Addiction: Biological and Psychological Mechanisms is a useful book that provides an overview of the research on stress and addiction in a concise format that motivated readers can use as a starting point to track down more in-depth information in diverse areas. It works best as a reference resource. The writers of the individual chapters are knowledgeable and present research findings clearly. The text is slightly repetitive in that some of the neurobiological material overlaps between chapters, but this negative is outweighed by several positives. The book provides a balanced view in terms of presenting conflicting research findings, and it discusses limitations of instruments and study designs. This book achieves its goal of bringing together biological and psychological findings on the overlap of stress and addiction.

About the Author: Michael Weaver is an Associate Professor of Medicine at Virginia Commonwealth University with certification in Addiction Medicine. Dr. Weaver is the Medical Director for the VCU Substance Abuse Consult Service and Director for the Addiction Medicine rotation for residents, medical students, and pharmacy students at VCU. He is involved in several research projects, including a study of gender differences in smoking cessation treatment, and studies of medications for alcohol and heroin dependence in criminal justice supervisees.