The number one reason for the self-changers I referenced in the last chapter quitting or modifying their substance use was, overwhelmingly, that it was no longer “worth it.” Using was too much hassle, too much trouble, and was causing too much discomfort and pain in their lives, relative to the benefit they were receiving from the drug. As it was their number one reason, it was also their number one motivation for self-change. With motivation, almost any program will work, or, in the case of 75% of former addicts, no program at all, as long as the addict has reached the point when he or she realizes that the costs outweigh the benefits.Continue reading
In this post, we will be talking about the first stage of the model of change, the Precontemplative, those who have not, as yet, made the connection between the substance they are abusing and the problems in their lives. Unfortunately, there is no clear program, procedure, or method guaranteed to help such people make the connection, other than trying not to stand between them and the consequences of their own behavior.
Most of us go on with our destructive habits for years until someone or something wakes us up, and unfortunately it’s impossible to predict what it will take to make a individual aware of his or her particular condition. Fairly early in my own recovery, I went along with some AA friends who were invited to tell their stories to a group of men who were confined in a minimum-security facility for alcohol-related offenses in Connecticut. These inmates were in Camp Hartell for a variety of offenses, mostly related to repeated arrests for driving under the influence (DUI), and there were even a few who were in there for what was then called “involuntary vehicular homicide while under the influence,” meaning they were responsible for the death of at least one innocent human being because they chose to continue to drink.
I talked with some of these fellows, and to a man they just couldn’t wait to get back out and “have a beer.” Here they were, locked-up, separated from friends and family, in deep legal trouble, and they couldn’t make the connection between the obvious problems in their lives and the alcohol they were drinking! I’ve worked with many substance abusers in various prison facilities, and in their minds, the problem wasn’t the substance at all, it was always something “else,” something totally out of their control that was responsible for their current situation.Continue reading
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.