Tag Archives for " DSM-IV "

The Major Studies, the End of the Powerless Myth

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]

Conclusion

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.

Nicotine, the Most Common Natural Recovery

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

Abuse and Dependence – Where Do You Fit?

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:

 

  • Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; or neglect of children or household).
  • Recurrent substance use in situations in which it is physically hazardous (such as driving an automobile or operating a machine when impaired by substance use).
  • Recurrent substance-related legal problems (such as arrests for substance related disorderly conduct).
  • Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (for example, arguments with spouse about consequences of intoxication and physical fights).
  • Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of substance.
  • Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
  • The substance is often taken in larger amounts or over a longer period then intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  • A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  • Important social, occupational, or recreational activities are given up or reduced because of substance use.
  • The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance

[i]

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.


[i] American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183).

 


[i] American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington D.C.: American Psychiatric Association. (pp. 181-183).