A work on Christian ethics reviewed in this Journal is highly unusual, but this book is unique. Christopher Cook was previously Professor of the Psychiatry of Alcohol Misuse and is now Professorial Research Fellow in Theology at Durham University. He continues to work as consultant psychiatrist in addiction. His expertise with both theology and addiction psychiatry is reflected in this well-argued work, combining up-to-date psychiatry and public health with theology built on Biblical and patristic foundations.

Addiction is defined here as ‘behaviour over which an individual has impaired control with harmful consequences’. Cook explores five past and current models of alcohol addiction: moral, disease, scientific, attributional and excessive appetite. He describes the features of the alcohol dependence syndrome, emphasising the phenomenological and subjective aspects.

After describing the scientific, medical, psychiatric and public health approaches to alcohol misuse, he comments on Biblical references to drunkenness and gives a detailed analysis of St Paul's teachings on the divided self and St Augustine's teachings on the divided will. He compares these experiences of internal conflict with subjective awareness of compulsion to drink. There is usually, in the successful combating of addiction, a first-order desire: ‘I want a glass of wine,’ and a second-order volition: ‘I want not to want to drink’. Therefore, the self and the will are divided between ‘delight in God's law’ with refraining from drinking, and craving, ‘waging war against the law of [one's] mind’.

Alcohol misuse is compared with the tendency to sin, in which all are tempted but some manage to resist. St Paul indicated the power of sin to enslave and the freedom that comes in Christ; the conflict between will and action.

This theological model of addiction, which Cook applies to believers and non-believers alike, is developed both for individual and public health treatment. The internal conflict is serious; to be freed from addiction, a second-order volition is necessary – to want to want not to drink. However, the addict needs more than their own will power, as recognised by Alcoholics Anonymous, and the grace of God can come to all. Cook reckons that theology can be an important corrective to the tendency towards reductionism and determinism in contemporary discourse, with their consequence of nihilism in treatment. It is, therefore, an active and optimistic model.

This book is both explanatory and hopeful. Cook rejects the outmoded ‘moral’ model of alcoholism but proposes a theological model to explain how the battle for the will can be won by the grace of God. Although the book has addiction and its treatment as its central theme, there are also useful insights on the much-neglected area of the psychopathology of volition, which are relevant for other areas of psychiatry.