To cease smoking is the easiest thing I ever did. I ought to know because Ive done it a thousand times.Mark Twain
SAMUEL CLEMENS (Twain was his nom de plume) humorously mocked his inability to end his nicotine-fueled habit. But he might have gone for Quitting Round 1,001 had he had the benefit of recent research.
In 1982 Stanley Schachter, an eminent social psychologist then at Columbia University, unleashed a storm of controversy in the addictions field by publishing an article showing that most former smokers and overweight people he interviewed had changed successfully without treatment. He also cited a study that reported even higher rates of recovery among heroin users without treatment.
A particularly controversial finding was that the success rates of his so-called self-changers were actually greater than those of patients who underwent professional treatment. Schachter discussed two possible explanations. First, treatment seekers may be more severely addicted than self-changers. Second, studies typically examine only one change endeavor, whereas his interviews covered a lifetime of efforts. Perhaps it takes many tries before a person gets it right, he suggested.
Schachters findings were met with intense skepticism, even outright disbelief, particularly by those who believed in a disease model of addiction. In this view, addictions are diseases caused by physiological and psychological factors that are triggered by using the substance (drugs or alcohol); once the disease is triggered, the addict cannot control his or her substance use, and complete abstinence is the only way to manage the disease. Proponents of this model did not believe that so many people could change their addictions at all, let alone without treatment. Other criticisms came from researchers who questioned the scientific value of Schachters work because it was based on a small and selective sample and relied on self-reports of past behavior, which often are not accurate pictures of what really happened. Nevertheless, his findings served as a catalyst, encouraging many researchers to study self-change in addictive behaviors. Let us examine what the research tells us about how widespread successful self-change is for problem drinking and drug addiction.
Rates of Success
Psychologist Reginald Smart of the Center for Addiction and Mental Health in Toronto recently reviewed the findings on the prevalence of self-change efforts among problem drinkers. We draw the following conclusions from his review and from our reading of the literature:
- Most of those who change their problem drinking do so without treatment of any kind, including self-help groups.
- A significant percentage of self-changers maintain their recovery with follow-up periods of more than eight years, some studies show.
- Many problem drinkers can maintain a pattern of nonproblematic moderate use of alcohol without becoming readdicted.
- Those who do seek treatment have more severe alcohol and related problems than those who do not.
Although fewer studies of self-change in drug addiction exist, the results generally mirror those for problem drinking. In summary: self-change in drug addiction is a much more common choice for solving the problem than treatment is; a substantial percentage of self-changers are successful; a significant percentage of those who were formerly addicted continue to use drugs occasionally without returning to addiction-level use, and they maintain these changes fairly well over time; and those who seek treatment usually have more severe problems than those who do not.
The experiences of Vietnam veterans are especially instructive. Sociologist Lee N. Robins, then at the Washington University School of Medicine in St. Louis, and her associates published a widely cited series of studies beginning in 1974 on drug use and recovery in these veterans. While overseas, about 20 percent of the soldiers became addicted to narcotics. After discharge to the U.S., however, only 12 percent of those who had been addicted in Vietnam were found to be in that state at any time during the three-year follow-up. Fewer than 5 percent had overcome their addiction through therapy. Additional findings from Robinss studies suggested that abstinence is not necessary for recovery. Although nearly half the men who were addicted in Vietnam tried narcotics again after their return, only 6 percent became readdicted.
The results of Robinss studies suggest the power of self-change in drug addiction, but they also have been the target of many criticisms. For example, most men who became addicted in Vietnam had not had that problem before their tour of duty, suggesting that they may be unrepresentative of the general population of drug addicts. Moreover, their drug use may have been triggered by the stress of serving in Vietnam, making it easier for them to stop when they returned home. This last criticism is weakened, however, by the finding that most men who continued using some narcotics after discharge did not become addicted and by the fact that the return home was also very difficult because of the popular sentiment against that war in the U.S.
We need more and better research on the potential for self-change to conquer problem drinking and other addictions. Studies suffer from differences in the definitions of important terms such as addiction, treatment and recovery. The use of reports of past behavior and relatively short follow-up periods are problematic as well. We also do not know of any studies on self-change with prescription drug addiction. Finally, we need to know if recovery from drug addiction leads to substitution with another addiction. At least one study revealed that many former drug addicts became problem drinkers. Because of these caveats and others, the percentages we have reported should be taken only as rough estimates.
Although we have reviewed some encouraging initial results from the literature, it is our impression that many addictions professionals do not view self-change as very effective. Their conclusion may be largely correct for those problem drinkers and drug addicts to whom they are typically exposedtreatment seekers.
Generalizations from those who seek treatment to the population of problem drinkers and drug addicts as a whole may be incorrect for two reasons, however. First, those who seek treatment have more severe problems than those who do not; second, they may overrepresent those who have failed repeatedly in their attempts at self-change.
We may learn a great deal from people who successfully change addictive behaviors on their own. Whatever they are doing, they are doing something right. In addition to the work with problem drinkers and drug addicts, we are beginning to make headway in the study of self-change in other problem areas, such as problem drinking, smoking, obesity and problem gambling. Greater knowledge about self-change and how it comes about might be used to help people who are not in treatment find ways of shedding their addictions as well as to enhance the effectiveness of our treatment programs.
Note: This story was originally printed with the title, "D.I.Y. Addiction Cures?".