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by Stephen Ray Flora
State University of New York Press, 2007
Review by Leo Uzych, J.D., M.P.H. on Mar 7th 2009

Taking America Off Drugs

Taking America Off Drugs propounds the view that behavioral therapy is more effective than drug therapy for the treatment of behavioral problems.  In consonance with this thematic emphasis, the textual discourse is replete with harsh, unrelenting criticism of drug companies, and also psychiatrists, for their respective roles in the drugging of patients having behavioral problems.  The author, Stephen Ray Flora, is a Professor of Psychology at Youngstown State University.

It may be opined critically that Flora writes more in the manner of a zealot, advocating (with considerable bias) a particular view, rather than a dispassionate scientific investigator bent keenly on uncovering scientific truth.  But richly edifying nuggets of substantive gold may be embedded in the stylistically lay reader friendly textual terrain.  And the impassioned discourse of Flora may helpfully, at the least, engender intellectually fruitful debate germane to an evaluation of Flora's core thesis that behavioral therapy is more effective than drugs for treating behavioral problems.

In the text, there is a quite substantial amount of referenced material.  Revealing considerable erudition, Flora, over the course of the book, critically reviews and evaluates a multitude of research studies pertinent to behavioral problems, behavioral therapy, and drugs.  Citations (to the referenced information) are given in a list of alphabetized references, attached to the text's far end.  The multitudinous references are a conduit, effectually leading (for interested readers) to further study of the issue laden realm of behavioral therapy, drugs, and behavioral problems.

In the ten chapters comprising the substance of the text, Flora covers an expansive array of health concerns.  These concerns envelop: eating disorders (encompassing anorexia, bulimia, and binge eating disorder); phobias (including vaginal penetration, dental, and social phobias as well as generalized anxiety disorder, agoraphobia, and panic disorder); obsessive-compulsive disorder; attention deficit disorder; depression; schizophrenia; sleep difficulties; erectile dysfunction; premature ejaculation; irritable bowel syndrome; urinary incontinence; and premenstrual syndrome.

Regarding all of the foregoing problems, Flora proffers an interestingly distinct, if contentious, perspective, which he advocates quite stridently in a manner characteristically exuding considerable zeal.  Particularly, according to Flora, the problems discussed in the book are behavioral in nature (rather than brain based, or neurochemical).  And, with regard to the treatment of behavioral problems, behavioral therapy is more effective than drugs.  Drug companies are denigrated harshly by Flora as being tantamount to marketing machines bent rapaciously on peddling dangerous drugs (associated often with highly deleterious side effects), and fueled most importantly by an unrepentantly burning desire to maximize profits (instead of helping people).  Psychiatrists prescribing drugs to treat behavioral problems likewise are thrashed soundly, and repeatedly, by Flora's fearsome writing cudgel.

Critics may chide Flora for injecting his commentary with an unnecessarily high dose of vitriol.  There may, in this vein, be critical concern that Flora has written the book with a poisoned pen, which has resulted in the creation of a caricature of drug companies.  In a different vein, scientifically curious readers may question skeptically whether the analysis of Flora, with regard to the relative clinical efficacy of behavioral therapy compared to drugs to treat multifarious behavioral problems, demonstrates sufficient scientific rigor.  The caution may be added that the extant field of scientific investigation, impinging on behavioral problems, behavioral therapy, and drugs, is still in a fallow state.

Perhaps the greatest contribution made by this book is that, for the discerning reader, interesting questions can be identified.  For instance, Is a particular health problem "behavioral" in nature?  What drugs, if any, may potentially be used to treat that problem in a clinically efficacious manner?  What are the known, and suspected, side effects of any such drugs?  Are there behavioral therapies available to treat the problem effectively?  Are any such behavioral therapies likely to be relatively more clinically effective than drugs?  And, not least, how good is the available scientific data relevant to answering such questions?

Psychologists, psychiatrists, psychiatric nurses, psychotherapists, pharmacists, pharmacologists, drug counselors, behavioral therapists, drug industry professionals, school nurses, pediatricians, family medicine doctors, and health policy makers are among those likely to be enhanced professionally by an open minded, critical reading of the information, insights, and particular views advanced forthrightly by Flora.

© 2009 Leo Uzych

Leo Uzych (based in Wallingford, PA) earned a law degree, from Temple University; and a master of public health degree, from Columbia University.  His area of special professional interest is healthcare.