Up to now, nowhere on this web site have I spelled-out exactly what my book is designed to do, or how it’s designed to do it. The purpose of this post, which will also become a permanent “page” on the site, is to accomplish that. What follows is a chapter-by chapter breakdown of the book, so far as I currently envision it, (after all, it is a work in progress). You will see that the purpose of the book is to help you decide, out of the myriad possibilities, what program would or would not be right for you.
Chapter One: “Fifty Ways to Leave Your Lover;” is an overview of “Powerless No Longer” (PNL), detailing why I’m writing the book, who it’s for, offering an “intro to addiction,” and suggesting how to use the book, depending upon what your goals are. PNL can be read in order, or used as a toolbox. Some of those reading the book will have only begun thinking of making a change, while others will be deeply committed to change and looking for a viable pathway. Still others will already be far along their own pathway, and merely looking for a few tools and suggestions. This chapter will hopefully sort things out.
Chapter Two: “Complex Causes for a Complex Problem;” will primarily address the biological and physical aspects of addiction, the actual mechanism that makes us addicts. Addiction is a Bio-Psycho-Social malady, and this chapter addresses the first, and part of the second of these three components. The study of addictive behavior crosses several disciplines, including behavioral neuroscience, epidemiology, genetics, molecular biology, pharmacology, psychology, psychiatry and sociology. We are addicts due to very complex mechanisms, and some understanding of these mechanisms makes our actions, and our personalities, a little easier to understand.Continue reading
The first large-scale study of natural recovery was carried out by two researchers, Hasin and Grant, in 1995, using data from the National Health Interview Study, conducted in 1988. This large study used a sample of almost forty-four thousand people, eighteen and over, in all fifty states and the District of Columbia. They identified former drinkers, about 19% of the total sample, or over eight-thousand people. Of these, 21% were alcohol dependent and 42% were alcohol abusers according to DSM-IV criteria. Only 33% of the dependent people and 17% who were alcohol abusers had attended AA, or sought any other kind of treatment.
Breaking the numbers down, out of over eight-thousand former drinkers, thirty-five hundred were alcohol abusers, and seventeen-hundred met the criteria for alcohol dependence. 83% of the abusers quit on their own, along with 67% of those dependent upon alcohol. Overall, in this important study, 77% of those diagnosed with alcohol abuse or dependence quit on their own, without treatment, AA, or help of any kind.[i]
Several large surveys of recovery without treatment have been conducted in Canada. Using data from a national survey of nearly twelve-thousand, and an Ontario survey of over a thousand, one study of those who self-remitted found recovery rates about the same as the American study mentioned above: 77.6% of those who quit did so on their own without help of any kind.[ii]
A very large American study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in 2005, involved a sample size of over forty-three thousand adults in the United States. Data were collected through personal interviews, and out of the entire sample, almost four-thousand-five-hundred people were classified with DSM-IV substance dependence. Only 25.6% of the sample had ever sought help for their dependence. It can be calculated from this study that of those who were fully remitted in the last year, 72.4% did so without formal help.[iii]
Another natural recovery study involved several groups of dependent drinkers. One group had serious alcohol problems over many years and resolved them through abstinence or treatment, while another group experienced fewer problems but “matured out” of them as they aged. Yet another group recovered, and was able to drink with fewer problems than the abstinent groups. In this study, self-recoveries varied between 53.7% and 87.5% depending upon the number of DSM-IV problems the drinker had experienced. The greater number of symptoms, the lower the percentage of self-remitters. Even among those who had six or more problems, however, 53.7% recovered without formal treatment. As with all the other studies, recoveries with and without treatment were lower as the number of DSM-IV problems increased.[iv]
A study of older, untreated alcoholics involved almost two-thousand individuals recruited from a larger community sample. Using data from 4 and 10-year follow-ups, it was found that 73% of these 51-to 65-year-olds remitted without any formal help.[v]
These are just a very few of the several hundred studies that have looked at untreated remission of drug and alcohol abuse and dependence over the past forty years. Taken overall, the studies indicate that self-change accounts for just about three-quarters of all successful recoveries from substance abuse and dependency problems. That statistic is amazing enough, given that it’s kept so quiet by the treatment industry, but what follows is an even more severe blow to the disease model, and the myth of powerlessness.
Successful Non-abstinent outcomes and natural recovery
Many of the studies and reviews undertaken in the last several years have shown low-risk alcohol use among former abusers and dependents as a widespread and frequent occurrence. In a review of 28 natural recovery studies undertaken in 2000, 22 of the 28 studies (78%) showed significant levels of low-risk drinking on the part of the participants. As many as one-third, in some studies were able to return to moderate drinking, to the point where they no longer met DSM-IV criteria.[i] In the same review of 15 additional studies, 13 of the 15 (86.6%) showed the same results. A similar pattern emerged among drug users, where nearly half the studies reported limited drug use recoveries.[ii]
These results are about the same as those from several alcohol treatment outcome studies, which capture degree of abstinence over time, and together these data suggest that viewing abstinence as the only possible outcome for all drug and alcohol abusers is neither practical nor realistic.[iii] [iv]
The disease model of addiction, that has dominated the treatment field for decades, implies that you are powerless over your addiction, and therefore cannot find any meaningful recovery on your own. I hope that the examples and studies I have presented in this chapter have at least begun to convince you otherwise. If nothing else, you now know what researchers in the field have known for many years: that most addicts recover without formal help, and so can you.
[i] Sobell, L.C., Ellingstad, T.P., & Sobell, M.B. (2000) Natural recovery from alcohol and drug problems: Methodological review of the research with suggestions for future directions. Addiction, 95, 749-764
[ii] Sobell, L.C., Ellingstad, T.P., & Sobell, M.B. (2000) Natural recovery from alcohol and drug problems: Methodological review of the research with suggestions for future directions. Addiction, 95, 749-764
[iii] Breslin, F.C., et al. (1997). Alcohol treatment outcome methodology: State of the art 1989-1993. Addictive Behaviors, 22(2), 145-155
[iv] Rosenberg, H. (1993) Prediction of controlled drinking by alcoholics and problem drinkers. Psychological Bulletin, 113, 129-139Bulletin, 113, 129-139
[i] Hasin, D.S., & Grant, B.F. (1995). AA and other help seeking for alcohol problems: Former drinkers in the US general population. Journal of Substance Abuse, 7, 281-292
[ii] Sobell, L.C. Cunningham, J.A., & Sobell, M.B. (1996) Recovery from alcohol problems with and without treatment: Prevalence in two population surveys. American Journal of Public Health,7 966-972
[iii] Dawson D.A. et al (2005) Recovery from DSM-IV alcohol dependence: United States 2001-2002 Addiction, 100 281-292
[iv] Cunningham J.A., Lin, E., Ross, H.E., & Walsh, G.W. (2000). Factors associated with untreated remission from alcohol abuse or dependence. Addictive Behaviors, 25 317-321
[v] Schutte, K.K., Moos, R.H., & Brennan, P.L. (2006). Predictors of untreated remission from late-life drinking problems. Journal of Studies on Alcohol, 67 354-362.
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