There were no studies of self-remitters in either the drug or alcohol field prior to the 1960’s and 70’s, for several reasons, chief among them was that by the early 1960’s, the popular “disease model” had become the foundation of alcohol and drug research as well as policy in the United States. According to that model, addiction is irreversible and progressive, and, once addicted, the addict is powerless over his disease and cannot recover without help. It was believed that narcotic drugs (opium and derivatives) had properties that enslaved even casual users, instantly and for life.
Instead of studies, resources went into treatment centers for alcoholics, mostly based upon the 12-step model, and the prevention of any use of narcotic drugs. The suggestion that alcohol dependence, or heroin use might be temporary conditions that the afflicted might address on their own, struck at the heart of widespread and firmly rooted beliefs, and challenged strong and powerful vested interests in the prevention and treatment fields.
Another major reason there were no studies in those years was that the phenomenon of self-remission from alcohol and drugs was largely unknown, because of the population the researchers were seeing. The only addicts the researchers saw were those whose problems were severe enough to come to the attention of society, those who wound up behind bars or in treatment centers. The vast majority of drug and alcohol abusers who were addressing their problems on their own without help were simply invisible.
A researcher named Charles Winick noticed in 1962, that approximately two-thirds of the over sixteen-thousand addicts who were reported as regular users to the Federal Bureau of Narcotics between 1953 and 1954 were not reported again at the end of 1959. Believing that only a slight minority of regular users could be missed during a 2-year period, he concluded that, allowing for a number who probably died, the rest had ceased their drug use. He also found that three-quarters of the over seven-thousand addicts who had quit during the period 1955-60 had stopped their drug use prior to age 38. In addition, more then 80% stopped using prior to the tenth year of their addiction.
The conclusion Winick drew was that there might be some sort of natural life cycle of heroin addiction, and that after learning to cope with the stresses that drove them to drugs in the first place, addicts were able to “mature out” of their addictions.[i]
In 1968, an Australian psychiatrist, Les Drew noticed that a large number of clinical studies showed the number of alcoholics in relation to the population, tended to peak before the age of 50, then markedly decline. Although he felt some of the decline was due to the increased mortality rate among alcoholics, he didn’t believe that factor alone was enough to account for the differences he saw, nor were the effects of treatment programs. He began to believe that some sort of self-change process might account for a significant number of the alcoholics who disappear from alcohol statistics as they get older. He believed that the factors that might accompany aging, and account for the statistics were things like increasing maturity, responsibility, and family and social pressures.
What made his paper (along with Winick’s) something of a ground breaker was that, together, they made a strong and hard-to-ignore case that substance dependence was not always a progressive and irreversible condition, the widely-accepted belief at the time, even though there was little or no evidence for it.[ii] It would be years before researchers and treatment professionals realized that there was a tremendous difference in the appearance of alcohol and drug abuse between the general population and those who ended up in treatment.
Have you ever known someone who has quit smoking without the benefit of formal programs, self-help groups, or nicotine replacement therapy (NRT) (patches, pills, gum, etc.)? According to the American Heart Association, nicotine is one of the most addictive of all substances, weaving itself into virtually every facet of a smoker’s life. From an article by The National Institute on Drug Abuse:
“Research has shown how nicotine acts on the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways — the brain circuitry that regulates feelings of pleasure…nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse… For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction.” [i]
So, nicotine works the same way, and to the same extent as other drugs of abuse. We will look further into the addiction mechanism in the next chapter, but I’m sure that anyone who has ever tried to quit smoking understands how addictive it can be.
In 1986, the American Cancer Society reported that: “Over 90% of the estimated 37 million people who have stopped smoking in this country since the Surgeon General’s first report linking smoking to cancer have done so unaided.” [ii]
An article in the August 2007 edition of the American Journal of Public Health indicated that over 75% of those who successfully quit for 7 to 24 months did so without any help, as opposed to 12.5% who used NRT (patch or gum).[iii] A study in the February 2008 issue of the American Journal of Preventive Medicine indicated that almost 65% of quitters used no help, while around 30% used medication, and 9% used behavioral treatment.[iv]
The following appeared in PLoS Medicine, an open access, peer-reviewed medical journal in February of 2010:
“As with problem drinking, gambling, and narcotics use, population studies show consistently that a large majority of smokers who permanently stop smoking do so without any form of assistance…[T]he most common method used by most people who have successfully stopped smoking remains unassisted cessation…Up to three-quarters of ex-smokers have quit without assistance (’cold turkey’ or cut down then quit) and unaided cessation is by far the most common method used by most successful ex-smokers.” [v]
The evidence reveals that unassisted quit attempts have a much greater chance of success than those using the help of NRT’s, hypnosis, or any other method. In spite of that, the pharmaceutical industry continues to fund advertising campaigns aimed at convincing the general public, and physicians, that quitting “cold turkey,” without help, is a waste of time, and doomed to failure.
Because most assisted cessation attempts end in relapse, such “failure” risks could be interpreted by smokers as ‘I tried and failed using a method that my doctor said had the best success rate. Trying to quit unaided — which I never hear recommended — would be a waste of time.’ One review stated: “Such reasoning might well disempower smokers and inhibit quit attempts through anticipatory, self-defeating fatalism.” [vi] In other words, if the pills and patches don’t work for them, they will probably just give up.
The evidence clearly shows that empowering people with the belief they can quit smoking on their own is much more effective than feeding them the nonsense that they’re powerless.
[ii] Chapman S, MacKenzie R (2010) The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences. PLoS Med 7(2): e1000216. doi:10.1371/journal.pmed.1000216
[v] Chapman S, MacKenzie R (2010) The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences. PLoS Med 7(2): e1000216. doi:10.1371/journal.pmed.1000216
[vi] Gillies V, Willig C (1997) You get the nicotine and that in your blood: constructions of addiction and control in women’s accounts of cigarette smoking. J Community Appl Soc Psychol 7:285-301
This chapter has two main objectives. The first is to establish that three-quarters of all addicts recover on their own, or with minimal help. The second is to assure you that you are not powerless over your addiction. The men and women represented below weren’t powerless, and neither are you.
The evidence comes from published, peer-reviewed, scientific studies, and many of them are available to anyone with a computer. It would be impossible to present all of the studies supporting this contention in a book this size, so I’m providing some representative studies in this chapter, and many more in the appendix. These are multiple, repeatable, detailed studies, over several decades, documenting successful recoveries of men and women diagnosed with substance abuse or dependence, according to the guidelines of the American Psychiatric Association, (APA).
If we’re exploring “natural recovery,” it makes sense for us to begin by defining what it is that people are naturally recovering from. The APA publishes a reference volume called the Diagnostic and Statistical Manual of Mental Disorders, or DSM. They release a new one every few years, and the current one is the DSM-IV. It is by no means a perfect document, but it represents a consensus view of the criteria for diagnosing the various disorders it covers.
We need a benchmark, a ruler, a set of criteria, so we’re all speaking the same language throughout the rest of the book. The DSM, as imperfect as it is, will at least provide that set of criteria. It separates people into three distinct, mutually exclusive categories’: no substance abuse disorder, substance abuse only, or substance dependence. The DSM treats substance abuse disorders as a continuum, (like a volume control), varying from no abuse to severe dependence, based upon the number and relative severity of the criteria that are present. The following is quoted from the DSM-IV:
|DSM-IV Substance Abuse Criteria:Substance abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following, occurring within a 12-month period:
|DSM-IV Substance Dependence Criteria:Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:
Not all addicts display all of the criteria, not even the most severely addicted. For instance, although I exhibited almost all of the other criteria for substance dependence and abuse, I never had any legal problems related to my drinking, nor did I ever try to cut down or quit.
My subtitle, “75% of all addicts recover without 12-step, and you can too,” may seem controversial to you, if not, you would be in the minority, as surveys consistently show the majority of Americans believe addiction is a disease, addicts are powerless over it, cannot recover without help, and 12-step is the only method that works. One of my purposes in writing this is to conclusively demonstrate to you that these contentions are undeniably false; there is not a shred of evidence supporting them and the contrary evidence is overwhelming. Multitudes of repeatable studies, over several decades, prove beyond any doubt that three-quarters of the people meeting the criteria for substance abuse or dependence recover absolutely on their own, without treatment, 12-step groups, or formal help of any kind, indicating that you already possess all the power you need if you have a genuine desire to effect self-change in any area of your life, including your addiction.Continue reading