This excerpt from chapter 5 of “Powerless No Longer” covers the next two stages of change, the Preparation and Action phases. Both will be discussed more fully in subsequent chapters.
Preparation – making plans to change and deciding upon the method
Entering this stage, you have done your CBA and decided that the benefits of making a change outweigh those of continuing the way you were headed. You have taken care of the “why,” and are now considering the “how.” The good news is, there are many choices available, and, if you are really convinced that you want to change, many, if not most of them will work just fine for you. The bad news is that if you are still wrestling with the decision to quit, and many still are at this stage, some of the available choices may do you more harm than good. As I mentioned earlier, these stages are not cast in concrete, and people often drift back-and-forth between them, they are only a framework we use as a starting point so we can have a discussion about a difficult and complex subject. At this point, you are experimenting with taking control of your own life, and for some of you, this is a new and frightening experience.Continue reading
In the last chapter, we learned that 75% of all addicts quit using on their own without benefit of formal treatment or 12-step groups. In this chapter, we are going to explore exactly how they manage to overcome alcohol and drug dependence, which the prevailing wisdom tells us that one cannot do without help. What is there that appears to be different about those who recover on their own that separates them from the other 25% who show-up in treatment centers and 12-step groups, some of them over and over, and many of whom never recover from their condition.
There are many paths to recovery, perhaps as many as there are people who successfully recover. Those who achieve stable recovery tend to find their own way, some with the help of friends and family, some without; some with the help of formal religion, others making use of philosophical disciplines like Zen, or nothing at all; others find recovery in the rooms of self-help groups such as AA, NA or SMART Recovery®; still others utilize some sort of professional treatment facility, usually 12-step-based, but not always, as there are other therapies available. Many who recover choose more than one path, or a combination of paths, depending upon what works best in our own particular circumstances.
Whatever path is chosen, we all go through pretty much the same “stages” of change, and that’s what this chapter will focus upon: What these stages of change are, exactly, what triggers them, how do you tell what “stage” you’re in, and, most importantly, how do you begin? 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.