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Grillo's book draws a portrait of the Mexican drug cartels and how they have radically transformed in the past couple of decades. For the author, the criminal organizations in Mexico are not gangs; they are a "movement and an industry drawing in hundreds of thousands from bullet-ridden barrios to marijuana-growing mountains". The book explains how the cartels have created paramilitary death squads with tens of thousands of armed men from the country of Guatemala to the Texan border. It contains testimonies from members inside of the cartels; and while El Narco shows that the "devastation" of the Mexican Drug War may be south of the U.S. border, Grillo pinpoints that the United States "is knee-deep in this conflict".
In the British edition, published in September 2011, the book bore the subtitle, "The Bloody Rise of Mexican Drug Cartels". The US edition came out two months later, bearing a different subtitle. A Spanish-language version of the book titled "El narco: En el corazón de la insurgencia criminal mexicana" has also been released.